HVFX - Hospital de Vila Franca de Xira
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O Repositório tem como missão armazenar, divulgar, gerir, preservar e dar acesso à produção científica do Hospital de Vila Franca de Xira em formato digital, contribuindo deste modo para o aumento da sua visibilidade e impacto e garantindo a preservação da memória intelectual da instituição.
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Browsing HVFX - Hospital de Vila Franca de Xira by Field of Science and Technology (FOS) "Ciências Médicas"
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- Artificial Intelligence to Close the Gap between Pharmacokinetic/Pharmacodynamic Targets and Clinical Outcomes in Critically Ill Patients: A Narrative Review on Beta LactamsPublication . Gonçalves Pereira, João; Fernandes, Joana; Mendes, Tânia; Gonzalez, Filipe André; Fernandes, Susana M.Abstract: Antimicrobial dosing can be a complex challenge. Although a solid rationale exists for a link between antibiotic exposure and outcome, conflicting data suggest a poor correlation between pharmacokinetic/pharmacodynamic targets and infection control. Different reasons may lead to this discrepancy: poor tissue penetration by β-lactams due to inflammation and inadequate tissue perfusion; different bacterial response to antibiotics and biofilms; heterogeneity of the host’s immune response and drug metabolism; bacterial tolerance and acquisition of resistance during therapy. Consequently, either a fixed dose of antibiotics or a fixed target concentration may be doomed to fail. The role of biomarkers in understanding and monitoring host response to infection is also incompletely defined. Nowadays, with the ever-growing stream of data collected in hospitals, utilizing the most efficient analytical tools may lead to better personalization of therapy. The rise of artificial intelligence and machine learning has allowed large amounts of data to be rapidly accessed and analyzed. These unsupervised learning models can apprehend the data structure and identify homogeneous subgroups, facilitating the individualization of medical interventions. This review aims to discuss the challenges of β-lactam dosing, focusing on its pharmacodynamics and the new challenges and opportunities arising from integrating machine learning algorithms to personalize patient treatment.
- Atrial Fibrillation in critically ill patients: incidence and outcomesPublication . Paula, Sofia B.; Oliveira, André; Melo e Silva, João; Simões, André F.; Gonçalves Pereira, JoãoAbstract Background: Atrial fibrillation (AF), either chronic or new onset, is common in critically ill patients. Its epidemiology and relationship with clinical outcomes are poorly known. Objective: To understand the burden of AF in patients admitted to ICU and its impact on patients’ outcomes. Methods: Single-center retrospective, cohort study, evaluating all patients with AF admitted to a non cardiac intensive care unit over the course of 54 months. Clinical outcomes were evaluated in the short (hospital discharge) and long-term (2-year follow-up). The hazard ratio (HR) with 95% CI was computed for the whole population as well as for propensity score-matched patients, with or without AF. Results: A total of 1357 patients were screened (59.1% male), with a mean age of 75±15.2 years, length of intensive care unit stay of 4.7±5.1 days, and hospital mortality of 26%. A diagnosis of AF was found in 215 patients (15.8%), 142 of which had chronic AF. The hospital all-cause mortality was similar in patients with chronic or new-onset AF (31% vs. 28.8%, p=0.779). Patients with AF had higher in-hospital, 1-year, and 2-year mortality (30.2%, 47.9%, and 52.6% vs. 22.9%, 35.3%, and 38.4%, respectively). However, after propensity score matching (N=213), this difference was no longer significant, neither in-hospital mortality (Odds Ratio 1.10; 95% CI 0.72-1.66), 1-year mortality (OR 1.16; 95% CI 0.79-1.70) or 2-years mortality, (Odds Ratio 1.16; 95% CI 0.79-1.70). Conclusions: In ICU patients AF was common, either chronic or new-onset, being diagnosed in 15.8%. Patients with AF had higher mortality but no significant differences were found in the short- and long-term mortality after adjustment for severity on admission.
- C-reactive Protein Variation and Its Usefulness in the Prognostication and Monitoring of Patients With Pneumococcal PneumoniaPublication . Gomes, André; Ribeiro, Rui; Froes, Filipe; Mergulhão, Paulo; Gonçalves Pereira, JoãoCommunity-acquired pneumonia (CAP) is a prevalent and life-threatening infection that causes significant morbidity and mortality. Biomarkers, such as C-reactive protein (CRP), can help to diagnose, monitor, and prognose patients with this condition. This study aimed to analyze the disease course, the CRP peak concentration, its relationship with prognosis, and its variation in hospitalized patients with pneumococcal CAP.
- A Case Report of Hemophagocytic SyndromePublication . Mendes, Tânia F.; Oliveira, Ana Isabel; Gomes, Carolina; Sousa, Nuno A.; Gonçalves Pereira, JoãoAbstract Hemophagocytic syndrome (HPS) represents a critical and often overlooked hyperinflammatory condition that can lead to rapid multi-organ failure and high mortality rates, particularly in adults. This article presents a compelling case study of a 45-year-old male with a complex clinical presentation, highlighting the diagnostic challenges posed by HPS, including its nonspecific symptoms and the necessity for a high index of suspicion. We underscore the paramount importance of early recognition, thorough differential diagnosis, and prompt initiation of treatment to improve patient outcomes. This case not only illustrates the intricacies of diagnosing HPS but also advocates for increased awareness among healthcare providers to mitigate the risks associated with this life-threatening syndrome.
- Cerebral schistosomiasis in a patient travelling from São Tomé and PríncipePublication . Armindo, Rui Duarte; Costa, Sónia; Almeida, Vânia; Barroso, CândidaAiming to raise awareness for the possibility of schistosomal involvement of the central nervous system in travellers returning from endemic areas and/or immigrants to nonendemic areas, the authors report a case of neuroschistosomi asis in a Portuguese patient coming from the Republic of São Tomé and Príncipe with good clinical outcome following praziquantel therapy. This is the first case of neuroschistosomiasis associated with São Tomé and Príncipe reported in literature and further studies are needed to confirm which species of this parasite are endemic of that region. We conclude that early diagnosis is key to reduce clinical severity and therefore validation of new diagnostic techniques and establishment of consensual treatment guidelines would be important.
- Critically ill patients with high predicted mortality: Incidence and outcomePublication . Oliveira, André; Vieira, Tatiana; Rodrigues, Ana; Jorge, Núria; Tavares, Luís; Costa, Laura; Paiva, José Artur; Gonçalves Pereira, JoãoAbstract Objective: As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown. Design: Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA). Setting: Sixteen Portuguese multipurpose ICUs. Patients: Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mor tality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained. Interventions: None. Main Variables of Interest: Hospital, 30 days, 1 year mortality. Results: We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0 ± 5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34---3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04---1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P = .92). At one year of follow-up, 30% of patients in the high-risk group were alive. Conclusions: Roughly 12% of patients admitted to the ICU for more than 24 h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.
- Efeito da cafeína e testes cognitivos na avaliação hemodinâmica cerebral em jovens estudantes da Escola Superior de Saúde Dr. Lopes DiasPublication . Pires, Marizete; Nunes, Gil; Rodrigues, Francisco; Coelho, Patrícia; Pires, JoanaIntrodução – A cafeína induz alterações fisiológicas, como o aumento da pressão arterial, que se refletem na hemodinâmica cerebral. Objetivos – Avaliar o efeito da cafeína nas velocidades de fluxo das artérias cerebrais, bem como relacionar o seu efeito com testes cogni tivos. Método – Estudo observacional, prospetivo, em 35 estudantes, dos 18 aos 25 anos, da Escola Superior de Saúde Dr. Lopes Dias. Os voluntários foram distribuídos em dois grupos, sendo que o grupo 1 consumiu um café normal e o grupo 2 um descafeinado de marca branca, sem adição de açúcar. Os dados foram recolhidos através da realização do exame triplex scan transcraniano e do teste cognitivo MoCa, após realizado consentimento livre e esclarecido. O procedimento foi dividido em duas fases, pré e pós-estimulante. No decorrer do estudo foram assegurados os princípios da declaração de Helsínquia. Na correlação das variáveis foram utilizados os testes não paramétricos Wilcoxon, Spearman e Mann-Whitney. Resultados – Comparativamente ao basal, na condição de cafeína houve um aumento nas velocidades de fluxo das artérias cerebrais médias (p=0,0001), o mesmo sucedeu com a pontuação do MoCa Teste (p=0,0001). Discussão – Na análise das velocidades de fluxo das principais artérias cerebrais e aquando da realização de testes cognitivos constata-se um aumento significativo das velocidades de fluxo sob efeito da cafeína, apesar de esta ser mais notória na artéria cerebral média. Conclusão – A artéria cerebral média é a artéria mais suscetível a alterações; no entanto, estas não diferem entre o café normal e desca feinado; o mesmo acontece aquando da realização do MoCa Teste.
- Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study)Publication . Mergulhão, Paulo; Gonçalves Pereira, João; Fernandes, Antero Vale; Krystopchuk, Andriy; Ribeiro, João Miguel; Miranda, Daniel; Castro, Heloísa; Eira, Carla; Morais, Juvenal; Lameirão, Cristina; Gomes, Sara; Leal, Dina; Duarte, Joana; Pássaro, Leonor; Froes, Filipe; Martin-Loeches, IgnacioAbstract: Ventilator-associated pneumonia (VAP) is a prevailing nosocomial infection in critically ill patients requiring invasive mechanical ventilation (iMV). The impact of VAP is profound, adversely affecting patient outcomes and placing a significant burden on healthcare resources. This study assessed for the first time the contemporary VAP epidemiology in Portugal and its burden on the healthcare system and clinical outcomes. Additionally, resource consumption (duration of iMV, intensive care unit (ICU), hospital length of stay (LOS)) and empirical antimicrobial therapy were also evaluated. This multicenter, retrospective study included patients admitted to the hospital between July 2016 and December 2017 in a participating ICU, who underwent iMV for at least 48 h. Patients with a VAP diagnosis were segregated for further analysis (n = 197). Control patients, ventilated for >48 h but without a VAP diagnosis, were also included in a 1:1 ratio. Cumulative VAP incidence was computed. All-cause mortality was assessed at 28, 90, and 365 days after ICU admission. Cumulative VAP incidence was 9.2% (95% CI 8.0–10.5). The all-cause mortality rate in VAP patients was 24.9%, 34.0%, and 40.6%, respectively, and these values were similar to those observed in patients without VAP diagnosis. Further, patients with VAP had significantly longer ICU (27.5 vs. 11.0 days, p < 0.001) and hospital LOS (61 vs. 35.9 days, p < 0.001), more time under iMV (20.7 vs. 8.0 days, p < 0.001) and were more often subjected to tracheostomy (36.5 vs. 14.2%; p < 0.001). Patients with VAP who received inappropriate empirical antimicrobials had higher 28-day mortality, 34.3% vs. 19.5% (odds ratio 2.16, 95% CI 1.10–4.23), although the same was not independently associated with 1-year all-cause mortality (p = 0.107). This study described the VAP impact and burden on the Portuguese healthcare system, with approximately 9% of patients undergoing iMV for >48 h developing VAP, leading to increased resource consumption (longer ICU and hospital LOS). An unexpectedly high incidence of inappropriate, empirical antimicrobial therapy was also noted, being positively associated with a higher mortality risk of these patients. Knowledge of the Portuguese epidemiology characterization of VAP and its multidimensional impact is essential for efficient treatment and optimized long-term health outcomes of these patients.
- Frailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC studyPublication . Mestre, Ana; Afonso, Rodrigo; Simões, André Ferreira; Correia, Iuri; Gonçalves Pereira, JoãoObjective: Frailty is a multidimensional syndrome characterized by diminished physiological reserve, increasing the risk of adverse outcomes, particularly in intensive care unit patients. The Clinical Frailty Scale, ranging from 1 (nonfrail) to 9 (terminally ill), is widely used to quantify frailty. This post hoc analysis of the Palliative Multicenter Study in Intensive Care (PalMuSIC) assesses the impact of frailty and clinical severity on short- and long-term outcomes. Methods: This subanalysis involved 23 Portuguese intensive care units and 335 patients. Patients admitted between March 1 and May 15, 2019, aged ≥ 18 years, and hospitalized for > 24 hours in the intensive care unit were eligible. The severity of illness was assessed using SAPS II, and frailty was assessed using the clinical frailty scale, which was recorded by a nurse and a doctor in charge. Patients were classified as frail (clinical frailty scale score ≥ 5), prefrail (clinical frailty scale score = 4), or nonfrail (clinical frailty scale score < 4). The outcomes measured included intensive care unit and hospital LOS (length of stay), need for organ support, infections, mortality at hospital discharge and mortality at 6 months post discharge. We divided the population in half according to the length of their intensive care unit stay to evaluate a possible interaction between intensive care unit length of stay and frailty. Results: The mean age was 63.2 years, and 66% were male. The mean SAPS II score was 41.8. Frailty was observed in 23.0% of the patients. Frail patients had higher hospital mortality (39.0% frail patients versus 28.2% prefrail patients versus 11.8% nonfrail patients) and 6-month mortality (frail 49.4% frail patients versus 30.6% prefrail patients versus 15.6% nonfrail patients). Patients with longer intensive care unit stays had higher 6-month mortality rates than did those with shorter intensive care unit stays did, which resulted in more frail patients: odds ratio (95% confidence interval) 3.1 (1.2 - 7.8) versus odds ratio 1.8 (0.9 - 4.0) in nonfrail patients. Conclusion: Frailty may significantly impact hospital and 6-month mortality. In our cohort, a longer intensive care unit length of stay was associated with worse long-term outcomes, especially in frail patients.
- O GRAU DE LITERACIA EM AVC: IMPACTO NA ATIVAÇÃO DO SERVIÇO DE EMERGÊNCIAPublication . Costa, Rafaela Almeida da; Nunes, Gil; Coelho, Patrícia; Pires, JoanaO acidente vascular cerebral é uma das patologias que apresenta maior parcela de óbitos em Portugal, embora possa ser prevenível. É um evento neurológico súbito, originado pelo défice de aporte sanguíneo ao cérebro que tem como característicos 3 sinais de alerta: a falta de força num membro, a boca ao lado e a dificuldade em falar. Pode apresentar outras manifestações clínicas de acordo com o território afetado e estar associado a inúmeros fatores de risco vasculares. O conhecimento da população sobre esta doença cerebrovascular é essencial, pois culmina na ativação eficaz do serviço de emergência e consequente tratamento. Este artigo de revisão foi efetuado com o intuito de analisar a importância do grau de literacia em saúde no acionamento do serviço de emergência/via verde do acidente vascular cerebral, correlacionando com o grau de instrução da população sobre esta doença cerebrovascular. Foram analisados 14 artigos, sendo apresentados os seus principais resultados. Estes demonstraram que o grau de literacia da população acerca do acidente vascular cerebral é reduzido e que é um dos principais fatores que fomenta o baixo contacto do serviço de emergência, traduzindo-se em tempos pré e intra-hospitalares superiores às janelas de tempo terapêuticas recomendadas. É referido ainda o défice de organização e ineficiência dos diversos profissionais de saúde perante este tipo de doentes. Apesar disto, é visível que quando ocorrem campanhas de exposição a informação sobre esta patologia, existe um aumento do conhecimento geral. É fundamental apostar em estratégias de promoção educacionais sobre esta temática, de modo a existir uma população instruída e capaz de agir rapidamente perante um evento destes, sendo igualmente necessário formar constantemente os respetivos profissionais de saúde. E, desta forma, agilizar os processos e promover um maior sucesso na administração terapêutica.
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