Percorrer por tipo de recurso "clinical study"
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- Anterior Cruciate Ligament Reconstruction Using a Tibial-Pedicled Quadrupled Semitendinosus Autograft With Dual Adjustable-Loop Cortical SuspensionPublication . Rodeia, J; Alçada, R; Baptista, F; Goes, RAnterior cruciate ligament reconstruction is one of the most commonly performed procedures in knee surgery. Despite its frequency, numerous technical variations exist, and several aspects remain controversial. Hamstring tendons are among the most frequently used autografts, and there is growing interest in techniques that preserve the gracilis tendon. Additionally, preservation of the tibial insertion of the hamstrings has recognized biological and mechanical advantages. In this technical note, we describe a technique that aims to combine the advantages of both approaches: the benefits of using a short single semitendinosus graft, preserving the gracilis tendon, which is associated with lower donor-site morbidity and improved flexion strength compared with traditional 2-tendon harvests, and the advantages of maintaining the tibial attachment of the semitendinosus, which include improved graft vascularization and a secondary point of tibial fixation. This method uses a tibial-pedicled, quadrupled semitendinosus graft combined with a dual adjustable-loop cortical suspension device. The technique is reproducible, is cost-effective, and may offer both biological and mechanical benefits over conventional approaches.
- The effects of hyperbaric oxygen therapy on insulin resistance-an approach to physiologyPublication . Sampaio-Alves, M; Alpuim Costa, D; Gomes-Alves, I; Neves, JSBackground: Diabetes mellitus (DM) is a severe, chronic and complex metabolic disease that leads to multiple dysfunctions, including micro and macrovascular complications, which are a major cause of morbidity and mortality. Type 2 DM (T2D) is highly preventable, and the stages that precede it are the ideal target for therapeutic intervention. Hyperbaric oxygen therapy (HBOT) is an established medical treatment for several clinical conditions. Because DM is one of the most prevalent comorbidities in patients under HBOT, it has allowed the observation and inference of some of its effects on DM, suggesting clinical benefit in different spectrums of the disease. Our main aim was to gather the existing evidence on the impact of HBOT on insulin resistance, as this is the best predictor for the development of T2D. Materials and methods: The scoping review was the methodology chosen to include all available data. Exclusion criteria consisted of articles that did not mention the effects of HBOT on insulin resistance, described only the use of normobaric oxygen, or had no available translation to English, Spanish, or Portuguese. In addition, all data discussing any effects on insulin, insulin resistance, or insulin sensitivity were included. Results: Two hundred and thirty studies were found, and 17 were eligible. The HBOT appears to improve fasting glycaemia and decrease insulin resistance in patients with DM, with effects appearing after 1 treatment session. Additionally, it reduces levels of proinflammatory cytokines that contribute to insulin resistance. The duration of this sensitisation effect remains unknown, as do the contributing molecular factors. Conclusion: HBOT seems to improve glycaemic levels and insulin sensitivity, thus presenting a potential treatment approach to treat insulin resistance and its consequences. However, translation into clinical practice remains contingent on robust, yet unavailable, randomized clinical trials.
- Extensive Myocardial Calcification Following Fulminant Neonatal Enteroviral MyocarditisPublication . Noites, I; Guedes, S; Ferreira, M; Camilo, C; Abecasis, FMyocardial calcification is a rare but important complication of fulminant neonatal myocarditis, a potentially life-threatening condition. Only a handful of neonatal cases have been reported in the literature. We present the case of a previously healthy seven-day-old term male neonate who developed cardiogenic shock secondary to enteroviral myocarditis with confirmed central nervous system involvement. Despite prompt initiation of inotropic therapy, he required venoarterial extracorporeal membrane oxygenation (VA-ECMO) within 48 hours of admission. While on mechanical circulatory support, serial imaging showed progressively increased myocardial echogenicity on echocardiography and later curvilinear myocardial calcification on chest radiograph. The clinical course was characterised by persistent cardiac dysfunction and progression to irreversible multiorgan failure. Heart transplantation was deemed unfeasible, and life-sustaining therapies were withdrawn, following multidisciplinary discussion and family consultation. An autopsy was not performed. This case highlights myocardial calcification as a potential imaging marker of irreversible myocardial injury in fulminant neonatal myocarditis. Early recognition of progressive myocardial echogenicity and subsequent calcification may provide valuable prognostic information, helping clinicians assess disease severity and support informed decision-making in cases of fulminant neonatal myocarditis.
- O fenómeno da língua vilosa nigraPublication . Limbert, M; Amaral, F; Maio, P; Rebelo, D
- Giant Cell Arteritis With Central Nervous System Vasculitis Presenting As Binocular Diplopia and Ptosis due to Third Cranial Nerve PalsyPublication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, CWe report the case of a woman in her 60s with no notable comorbidities presented with a four-week history of bilateral temporal headache, scalp tenderness, jaw claudication, and sporadic fever. She also reported binocular diplopia for the previous 24 hours. Examination revealed tender superficial temporal arteries (TA) and right-sided third cranial nerve palsy with ptosis. Laboratory tests showed elevated inflammation markers. Cranial and cervical computed tomography (CT) and CT angiography (CTA) were unremarkable. She was treated with a single dose of intravenous methylprednisolone, followed by oral prednisolone. Subsequent TA duplex ultrasound demonstrated artery wall thickness, and TA biopsy confirmed chronic inflammation with disruption of the internal elastic lamina, both consistent with giant cell arteritis. Cranial magnetic resonance imaging (MRI) revealed scattered punctate areas on T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences, consistent with small-vessel vasculitis. Under corticosteroid treatment, the patient achieved full clinical remission at the four-month follow-up. This case illustrates an uncommon neurological presentation of giant cell arteritis with oculomotor nerve involvement, associated with findings suggestive of central nervous system vasculitis, and highlights the importance of early recognition and prompt corticosteroid treatment to prevent irreversible complications.
- Information Technology in Nursing Practice: A Scoping Review of Assessment Tools for Evaluating Nurses' CompetenciesPublication . Cachata, D; Costa, M; Magalhães, T; Lucas, P; Gaspar, FIntroduction: The ongoing evolution of Health Information Technology has provided professionals with major challenges in maintaining the safety and quality of care provided to patients, especially when it comes to hyper-technological environments in hospital. This has driven the need to develop specific competencies and maintain a balance between ethical aspects, social and legal challenges related to privacy and data security, as well as the challenge of ensuring person-centered care practice. Then it will be important to understand what competences nurses are developing, based on what models and what instruments exist to assess them. Purpose: Identify and map information technologies and measurement instruments used to assess nurses' competencies in technological environments in hospital. Methods: A scoping review was carried out using the methodology presented by The Joanna Briggs Institute. Results: Of the 101 articles extracted, 4 articles were selected where 5 instruments were identified that evaluate: (1) Informatics Competency in Nursing Leaders; (2) Technological Competence as Nursing Care - Perception and Practice dimension; (3) Self-Assessment of Nursing Informatics Skills; (4) Clinical Decision Making in Nursing, and (5) Self-Assessment Questionnaire that Assesses Nurses' Informatics Skills, for nursing informatics. Conclusion: The development and enhancement of technological skills in nursing care provide an innovative and crucial perspective for managing and organizing healthcare delivery. This perspective is of great importance, reinforced by the reality in which nurses find themselves, with highly technological nursing practice environments that are increasingly developed. Knowledge and use of IT equipment, areas of basic IT knowledge, information literacy, wireless device skills, the role of clinical IT, and applied IT skills are some of the skills identified by this study. The use of various support tools as instruments for clinical decision-making in nursing is also fundamental to the quality of nursing care.
- Long-term cardiovascular events in individuals hospitalised with COVID-19: a retrospective cohortPublication . Soares, P; Ruivinho, C; Silva, J; Lobão, MJ; Santos, L; Paixão, J; Ramalho, AR; Henriques, A; Simões, I; Guimarães, LE; Moça, R; Costa, A; Atanásio, G; Nóbrega, S; da Luz Brazão, M; Goes, AR; Leite, ABackground: Post-COVID condition encompasses a spectrum of persistent or emerging symptoms affecting multiple organ systems, including a heightened risk of cardiovascular complications. Despite growing recognition of this phenomenon, there remains a lack of comprehensive data regarding the incidence and risk factors associated with cardiovascular events during the post-acute phase in patients previously hospitalised for COVID-19. Thus, we aimed to estimate the incidence of cardiovascular events among patients hospitalised for COVID-19 in Portugal and assess the association between patient and infection characteristics and cardiovascular events in the COVID-19 post-acute phase. Methods: We conducted a registry-based retrospective cohort study from seven hospitals across Portugal. Data was retrospectively collected from the electronic medical record of each patient. We included individuals hospitalised due to COVID-19 between March 2020 and March 2021. Our outcome of interest was cardiovascular events in the post-acute phase of COVID-19, occurring at least 30 days after a positive SARS-CoV-2 test. The variables of interest considered were the severity of the episode, existing cardiovascular risk and vaccination status before the SARS-CoV-2 test. Person-years was estimated for each individual, and incidence rates were estimated. A Cox proportional hazard regression model was employed to assess risk factors. Results: We included 1,803 patients in the analysis, of which 143 (7.9%) experienced at least one cardiovascular event following COVID-19 hospitalisation. The overall incidence rate of having at least one cardiovascular event was 34.65 per 1,000 person-years (95% confidence interval (CI): 29.20; 40.82). We found higher risk of cardiovascular events for individuals with pre-existing cardiovascular risk (adjusted hazard ratio (aHR): 3.76, 95% CI: 1.53; 9.24) and lower risk for individuals with at least one vaccine dose before the SARS-CoV-2 test (partial vaccination - aHR: 0.44, 95%CI: 0.30; 0.64, complete vaccination - aHR: 0.46, 95%CI: 0.2; 0.80). We did not find a significant difference between the severity of the COVID-19 episode and the risk of having cardiovascular events post-COVID-19. Conclusion: Our findings suggest a substantial burden of cardiovascular complications post-COVID-19, underscoring the need for health services to be prepared and commence screening and preventive measures for individuals at higher risk.
- Lupus Enteritis: An Unusual Flare of Systemic Lupus ErythematosusPublication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, CA woman in her 20s with previously diagnosed systemic lupus erythematosus (SLE) presented with a year-long history of chronic watery diarrhea, significant weight loss, and additive symmetrical inflammatory polyarthritis. She had been receiving hydroxychloroquine, azathioprine, and low-dose prednisolone but had discontinued treatment shortly before admission due to persistent vomiting. Laboratory evaluation showed new-onset proteinuria, hypokalemia, hypomagnesemia, microcytic anemia, lymphopenia, low complement levels, and markedly elevated antinuclear and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) antibodies. Imaging demonstrated diffuse mural thickening and submucosal edema of the small bowel, a large left pleural effusion, and peritoneal fluid. The patient was treated with intravenous methylprednisolone pulses, followed by high-dose oral prednisolone and hydroxychloroquine. Renal biopsy revealed class III lupus nephritis, leading to the initiation of mycophenolate mofetil (MMF). Under this immunosuppressive regimen, gastrointestinal symptoms resolved, pleural effusion regressed, and renal parameters progressively improved. This case illustrates lupus enteritis as a rare but clinically significant manifestation of SLE, presenting with chronic diarrhea in association with other systemic features, including inflammatory polyarthritis, hematological involvement, and lupus nephritis. This report emphasizes the importance of considering lupus enteritis in patients with SLE who present with persistent gastrointestinal symptoms and of early recognition and prompt initiation of appropriate immunosuppressive therapy to prevent severe complications such as ischemia and perforation.
- Practical Guidance on the Detection of NTRK Fusions in Sarcomas: Current Status and Diagnostic ChallengesPublication . Fernandes, I; Macedo, D; Gouveia, E; Ferreira, A; Lima, J; Lopez, D; Melo-Alvim, C; Carvalho, A; Tavares, P; Rodrigues-Santos, P; Cardoso, P; Magalhães, M; Vieira, P; Brito, J; Mendes, C; Rodrigues, J; Netto, E; Oliveira, V; Sousa, C; Henriques Abreu, M; Pina, F; Vasques, HSarcomas are a rare and heterogeneous group of mesenchymal malignant tumors and account for approximately 1% of all adult cancers and around 20% of all pediatric solid tumors in Europe. Technology advances have enabled a more accurate and efficient characterization of the molecular mechanisms underlying the pathogenesis of sarcoma subtypes and revealed novel and unexpected therapeutic targets with prognostic/predictive biomarkers, namely the neurotrophic tyrosine receptor kinase (NTRK) gene fusion. The NTRK fusion assessment has recently become a standard part of management for patients with unresectable locally advanced or metastatic cancers and has been identified in various tumor types. In the more prevalent adult and pediatric sarcomas, NTRK fusions are present in 1% and 20%, respectively, and in more than 90% of very rare subsets of tumors. The inhibition of TRK activity with first-generation TRK inhibitors has been found to be effective and well tolerated in adult and pediatric patients, independently of the tumor type. Overall, the therapeutic benefit to those patients compensates for the difficulties of identifying NTRK gene fusions. However, the rarity and diagnostic complexity of NTRK gene fusions raise several questions and challenges for clinicians. To address these issues, an expert panel of medical and pediatric oncologists, radiologists, surgeons, orthopedists, and pathologists reviewed the recent literature and discussed the current status and challenges, proposing a diagnostic algorithm for identifying NTRK fusion sarcomas. The aim of this article is to review the updated information on this issue and to provide the experts' recommendations and practical guidance on the optimal management of patients with soft tissue sarcomas, infantile fibrosarcoma, gastrointestinal stromal tumors, and osteosarcoma.
- Primary Antiphospholipid Syndrome Presenting With Life-Threatening Diffuse Alveolar HemorrhagePublication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, CAntiphospholipid syndrome (APS)-associated diffuse alveolar hemorrhage (DAH) results from antiphospholipid-induced endothelial dysfunction, microvascular thrombosis, and complement activation. Management requires balancing thrombosis prevention and hemorrhage control. High-dose corticosteroids are the first-line therapy. We report a case of a 33-year-old male presenting with progressive dyspnea, hemoptysis, and hypoxemia. Initial evaluation revealed thrombocytopenia, anemia, elevated inflammatory markers, and diffuse bilateral ground-glass opacities on a thoracic computed tomography, consistent with DAH. Autoimmune serology confirmed persistent positivity for lupus anticoagulant, anti-cardiolipin IgM, and anti-β2-glycoprotein-I IgM, fulfilling APS classification criteria. The patient developed respiratory failure, requiring mechanical ventilation and venovenous extracorporeal membrane oxygenation (VV-ECMO). High-dose corticosteroids were initiated, leading to gradual improvement. He was successfully extubated and discharged on long-term anticoagulation with warfarin. At four years of follow-up, he remains free of APS-related complications. This case highlights the importance of recognizing APS as a cause of DAH, particularly in patients with unexplained pulmonary hemorrhage. Early diagnosis and aggressive therapy can improve outcomes.