LS - LHP - Lusíadas Hospital do Porto
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- Adipose-Derived Stem Cell Therapy Combined With Platelet-Rich Plasma for the Treatment of Avascular Necrosis of the TalusPublication . Sousa, R; Babulal, J; Amado, PAvascular necrosis (AVN) is characterized by compromised blood supply to bone tissue, often resulting in significant pain and functional impairment. Conservative treatment options for early-stage AVN of the talus are scarce, with non-weight-bearing protocols and hyperbaric oxygen therapy showing limited efficacy. This report presents a potential novel approach to managing non-traumatic AVN of the talus using a combination of adipose-derived stromal vascular fraction (SVF) and platelet-rich plasma (PRP). A 60-year-old male presented with progressive right ankle pain of a two-year evolution. Magnetic resonance imaging (MRI) revealed stage II AVN of the talus with extensive bone infarctions occupying almost all of its volume but with no collapse. A single injection of SVF and PRP was performed after diagnostic arthroscopy, followed by a tailored rehabilitation protocol. The patient experienced significant pain relief, with no further need for analgesics, and was able to return to non-impact sports. At the 18-month follow-up, functional scores showed significant improvement, and MRI showed stable AVN with no evidence of collapse. This report highlights SVF and PRP as a potential effective conservative option for non-traumatic talar AVN.
- Advancing patient‐centered care: Recent developments in UEG's patient relationsPublication . Burra, P; Amil Dias, J; Torres, J; Botos, A; Acedo, P; Bertelsen, B; Bretthauer, M; Carboni, A; Dugic, A; Fracasso, P; Koltai, T; Leone, S; Maravic, Z; Matysiak‐Budnik, T; McColaugh, L; Mishkovikj, M; Wickramasinghe, K; van Leerdam, M
- Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the VulvaPublication . Vieira-Baptista, P; Bornstein, J
- Comparative clinical and radiologic evaluation between patients undergoing standard reversed shoulder arthroplasty or bony increased offsetPublication . Amorim-Barbosa, T; Ribau, A; Fonte, H; Barros, LH; Claro, RBackground: Modifications of the medialized design of Grammont-type reverse shoulder arthroplasty (RSA) using a bony increased offset (BIO-RSA) has shown better clinical results and fewer complications. The aim of this study is to compare the clinical results, complications, and radiological outcomes between patients undergoing standard RSA and BIO-RSA. Methods: A retrospective review was performed of 42 RSA procedures (22 standard RSA and 20 BIO-RSA). With a minimum of 1 year of follow-up, range of motion (ROM), Constant shoulder score (CSS), visual analog scale (VAS), and subjective shoulder score (SSS) were compared. Radiographs and computed tomography (CT) scan were examined for scapular notching, glenoid and humeral fixation, and graft healing. Results: At a mean follow-up of 27.6 months (range, 12-48 months), a significant difference was found for active-internal rotation (P=0.038) and for passive-external rotation (P=0.013), with better results in BIO-RSA. No other differences were found in ROM, CSS (P=0.884), VAS score, and SSS. Graft healing and viability were verified in all patients with CT scan (n=34). The notching rate was 28% in the standard RSA group and 33% in the BIO-RSA group, but the standard RSA had more severe notching (grade 2) than BIO-RSA (P=0.039). No other significative differences were found in glenoid and humeral fixation. Conclusions: Bone-graft lateralization is associated with better internal and external rotation and with less severe scapular notching compared to the standard RSA. Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation.
- COVID-19 related acute genital ulcer: a case reportPublication . Jacyntho, CM; Lacerda, MI; Carvalho, MS; Ramos, MR; Vieira-Baptista, P; Bandeira, SHAcute vulvar ulcer (Lipschütz's ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations. This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. We report a case of a 35-year-old woman who was diagnosed with COVID-19 who did not have severe symptoms, but had high levels of D-dimer for 9 days. The COVID-19 diagnosis was followed by the appearance of an acute, necrotic, extremely painful vulvar ulcer, although symptoms caused by COVID-19 had improved. We emphasize the importance of the differential diagnosis to exclude diseases such as Behçet's syndrome, Sexually Transmitted Infections, as well as the presence of viruses that generally trigger Lipschütz's ulcer, such as Epstein-Barr virus and cytomegalovirus. No treatment is usually necessary, however, in the present report due to the pain experienced by the patient, we successfully used oral prednisone.
- Desensitization to carboplatin in low-grade glioma. A revision of 100 treatments in childrenPublication . Cernadas, J; Vasconcelos, MJ; Fernandes, AP; Carneiro-Leão, L; Gil-da-Costa, MJ
- Deviated Nose: Partial Lateral Osteotomies in a New Preservation Rhinoplasty ConceptPublication . Sousa Vieira, A; Milicic, D; Torrão Pinheiro, C; Carvalho, GBackground: A deviated nose continues to be a problem to solve in Rhinoplasty. Various techniques were presented as a possible solution of this aesthetic and functional nasal deformation. In the light of current trend of preservation of structures and function, a modification of osteotomies was presented. Goals: The goal of this paper is to present partial lateral osteotomies surgical technique performed with piezo-electric instruments. Methods and Results: Partial and incomplete osteotomies were introduced as method to avoid disinsertion of nasal pyramid of glabellar area and to avoid bony step in areas of osteotomy cut. Rhinosculpture in its extended mode was promoted for modulation of bony structure with obtaining immediate aesthetic and structural results, minoring a surgical trauma. Conclusion: An incomplete oblique transverse, lateral and intermediate osteotomies, facilitates the "slide-down" positioning of the bone edges, without the need of bone dessinsertion in glabellar region.
- Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study)Publication . Mergulhão, P; Pereira, JG; Fernandes, AV; Krystopchuk, A; Ribeiro, J; Miranda, D; Castro, H; Eira, C; Morais, J; Lameirão, C; Gomes, S; Leal, D; Duarte, J; Pássaro, L; Froes, F; Martin-Loeches, IVentilator-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.
- Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study)Publication . Mergulhão, P; Pereira, JG; Fernandes, AV; Krystopchuk, A; Ribeiro, JM; Miranda, D; Castro, H; Eira, C; Morais, J; Lameirão, C; Gomes, S; Leal, D; Duarte, J; Pássaro, L; Froes, F; Martin-Loeches, IVentilator-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
- Exploring Cannabidiol (CBD) and Cannabigerol (CBG) Safety Profile and Skincare PotentialPublication . Luz-Veiga, M; Mendes, A; Tavares-Valente, D; Amorim, M; Conde, A; Pintado, ME; Moreira, HR; Azevedo-Silva, J; Fernandes, JCannabinoids have long been known for their bioactive properties, with their topical application as anti-inflammatory compounds being at the forefront of research for the past decade. Concurrently, the cosmetic market is a fast-growing industry in constant need of new biomolecules. In this work, we studied the safety profile for topical applications of two cannabinoids: cannabidiol (CBD) and cannabigerol (CBG) and assessed their potential as skin care ingredients. The CBG used in this work resulted from bio-fermentation, and to the best of our knowledge, there are no extensive reports on its safety and usage as a cosmetic ingredient. Our results show that CBD and CBG do not exhibit cytotoxicity, mutagenicity, or skin sensitization. Moreover, we verified an absence of primary irritability, accumulated irritability, phototoxicity and photosensitization, supporting the claims of dermatologically tested, hypoallergenic and non-irritating. While these cannabinoids did not show significant anti-aging effects by altering the extracellular matrix components (both in vitro and ex vivo), they demonstrated promise as protective agents against inflammation caused by air pollution. Specifically, they reduced the levels of pro-inflammatory cytokines, making them valuable in combating environmental skin damage. Overall, our results validate the safety of topical use of cannabinoids, while paving the way for further research in the beauty and personal care market as soothing agents.