HC - Hospital de Cascais
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Inaugurado em 2010, o Hospital de Cascais Dr. José de Almeida é um projeto inovador na área da saúde. Gerido em parceria público-privada, pelo Grupo Ribera, serve uma população de quase 300 000 habitantes maioritariamente do concelho de Cascais. Está certificado pelas mais importantes entidades em termos de Acreditação de Saúde (JCI), Certificações de Qualidade e Ambientais (ISO 9001, 14001 e 45001) e é um Hospital HIMSS estágio 7, sendo um dos Hospitais mais tecnológicos da Europa.
Tem como missão, trabalhar para melhorar a saúde e o bem-estar das pessoas. Assente em valores como a Transformação, Ética, Trabalho e Compromisso, a sua vocação é transformar a forma como se trabalha e inova na gestão de projetos de saúde para acrescentar valor à sociedade atual e futura.
O Innovation Health Center (IHC), visa promover toda a área da inovação do Hospital, tendo como base três pilares estratégicos: A Investigação e Conhecimento, a Transformação Digital e a Eficiência e Sustentabilidade.
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- Um Afrodisíaco Potencialmente Fatal: Intoxicação por CantaridinaPublication . Diaz, P; Carneiro, A; Montes, V; Alves, SCantharidin is a toxin extracted from coleoptera beetles, commonly known as 'Spanish fly'. Traditionally it was used as an aphrodisiac, a vesicant or as an abortifacient. Intoxication by this substance has been widely reported, generally associated with gastrointestinal complications, such as digestive hemorrhage, and genitourinary disorders, such as hematuria and acute kidney injury. The authors describe the case of a 51-year old male patient who developed severe cantharidin poisoning after ingesting a preparation ('tea formulation') containing the substance. The patient reported a burning sensation in his oral cavity, diarrhea and hematuria, having sustained acute kidney injury and atypical neurological symptoms. Due to the lack of an antidote, the available treatment options are reduced to supportive measures. This case strengthens the need for a thorough medical history to ascertain the use of 'natural' products and medicinal herbs (i.e. of unregulated origin), and the importance of educating the community to their potential toxicity.
- An Analysis From a Tertiary Pediatric Hospital: Does Physical Activity Play a Role in the Management of Children and Young Adults With Osteogenesis Imperfecta?Publication . Galhardo Saraiva, F; Jonet, J; Roquette, M; Ovídio, J; Pires, MS; Lameiras Campagnolo, JIntroduction: Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by reduced bone density and increased proneness to fractures. It manifests across a varied clinical spectrum of expressions in children and young adults. It is crucial for children with OI to have a multidisciplinary follow-up, including orthopedics, pediatrics, and physical medicine and rehabilitation. Although exercise may have no effect on the disease itself, it might improve the autonomy, self-esteem, and fitness of these children. Methods: Retrospective cohort analysis of children and young adults aged three or more years old followed-up in a Level III Pediatric Hospital between 1995 and 2020. Demographic and clinical data were obtained from the hospital records and from the caregivers via phone calls. To our knowledge, this is the first national case series published assessing exercise habits in children with this condition. Results: Among the 21 patients studied, the median age was 14 years, with no gender predominance. Eighteen (86%) practiced regular physical activity, while the remaining three (14%), all of whom were type III OI, were totally dependent. Of the aforementioned 18 children, 12 (67%) considered practicing the same level of physical activity compared to their healthy peers, although most of them needed adaptations. The most reported extracurricular activity was swimming, in 50% of the cases. About 39% engaged in physical activity two times or less per week, and 89% practiced for one hour or less per session. Discussion: Over the years, it has become clear that physical activity is an important part of OI management. While awareness of the importance of exercise already exists, proper planning, follow-up, and monitoring are essential.
- An unusual manifestation of severe edema in nephrotic syndromePublication . Garrotes, M; Mota, M; Deuchande, S; Theias-Manso, R; Costa-Reis, P; Rita-Sandes, AKeypoints What is known – Ascites is a common finding in nephrotic syndrome. – Adherence to treatment is important to prevent nephrotic syndrome complications. What is added – Transudation of ascitic fluid through the abdominal wall is a rare complication of nephrotic syndrome. – The treatment of transudation of ascitic fluid and skin lesions is challenging and improvement may take several weeks.
- Anchorless Onlay Dynamic Anterior Stabilization of the Shoulder Using a Guided Posterior Double Endobutton FixationPublication . Maia Dias, C; Alçada, R; Ribeiro da Silva, MThe treatment of shoulder instability in the presence of a subcritical glenoid defect poses challenges, as simple Bankart seems insufficient, and the Latarjet procedure may be excessive. Recently, a dynamic anterior stabilization technique involving anterior transposition of the long head of the biceps (LHB) through a subscapularis split was described for that purpose. Previously published results demonstrated good short-term results, but several technical pitfalls have also been mentioned. We describe an onlay, anchorless, and intra-articular knotless method of fixing the LHB into the anterior glenoid that provides the important stabilizing "sling effect" of the dynamic anterior stabilization while avoiding some of the pitfalls described by other techniques.
- Avaliação do Conhecimento das Mulheres com Epilepsia em Idade Fértil sobre o Impacto da sua Doença na Contraceção, Gravidez e Amamentação: Um Estudo Transversal MulticêntricoPublication . Lopes das Neves, P; Ventura, R; Sobral-Pinho, A; Silva, E; Morgadinho, A; Vitor, J; Miranda, M; Madureira, B; Moniz Dionísio, J; Pinheiro, R; Delgado, S; Carapinha, D; Rego, A; S´á, F; Pelejão, MR; Antunes, F; Marques, I; Brito da Silva, V; Castro Sousa, S; Peres, J; Martins, A; Tojal, RIntroduction: The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy. Material and methods: The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature. Results: One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants' knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones. Conclusion: The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.
- Beware of the air when diabetes is therePublication . Fernandes, B; Taborda, F; Lobão, MJ
- Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping ReviewPublication . Branco, MG; Mateus, C; Capelas, ML; Pimenta, N; Santos, T; Mäkitie, A; Ganhão-Arranhado, S; Trabulo, C; Ravasco, PBioelectrical Impedance Analysis (BIA) is a reliable, non-invasive, objective, and cost-effective body composition assessment method, with high reproducibility. This scoping review aims to evaluate the current scientific and clinical evidence on BIA for body composition assessment in oncology patients, under active treatment. Literature search was conducted through MEDLINE, CINAHL, Scopus and Web of Science databases, following PRISMA-ScR Guidelines. Inclusion criteria comprised studies reporting the use of BIA for body composition evaluation in adults with cancer diagnosis. Studies including non-cancer pathology or only assessing nutritional status were excluded. This scoping review comprised a total of 36 studies: 25 were original studies including 18 prospective studies, six cross-sectional studies and one retrospective study and 11 were systematic reviews. Population size for the included original articles ranged from 18 to 1217 participants, comprising a total of 3015 patients with cancer with a mean baseline Body Mass Index (BMI) ranging from 20.3 to 30.0 kg/m2 and mean age ranging between 47 and 70 years. Review articles included a total of 273 studies, with a total of 78,350 participants. The current review considered studies reporting patients with head and neck cancer (HNC) (n = 8), breast cancer (BC) (n = 4), esophageal cancer (EC) (n = 2), liver cancer (n = 2), pancreatic cancer (PC) (n = 3), gastric cancer (GC) (n = 3), colorectal cancer (CRC) (n = 8), lung cancer (LC) (n = 1), skin cancer (SK) (n = 1) and multiple cancer types (n = 6). BIA is a suitable and valid method for the assessment of body composition in oncology. BIA-derived measures have shown good potential and relevant clinical value in preoperative risk evaluation, in the reduction of postoperative complications and hospital stay and as an important prognostic indicator in persons with cancer. Future research on the diagnostic value and clinical applications of BIA and BIA-derived phase angle (PhA) should be conducted in order to predict its impact on patient survival and other clinical outcomes.
- Bronchopulmonary Dysplasia: A Five-Year Retrospective Cohort Study on Differences in Clinical Characteristics and Morbidities According to Severity GradingPublication . Kakoo Brioso, E; Moscoso, J; Malveiro, D; Aguiar, M; Tuna, MIntroduction: Bronchopulmonary dysplasia (BPD) is the most common complication associated with extreme prematurity. Although several criteria defining severity were developed over time, there are a few studies describing the differences in BPD phenotype and neonatal morbidities and complications between severity groups. We aimed to describe these differences in BPD patients of a neonatal intensive care unit (NICU). Methods: We conducted an observational retrospective cohort study through a medical record review over a five-year period. Participants were newborns admitted to an NICU who were diagnosed with BPD. We performed a descriptive statistical analysis of gestational complications and the use of antenatal corticosteroid therapy, birth-related data, and complications throughout the NICU stay, as well as the respiratory support used. We also compared different severity groups across these variables. The patients were divided into severe and non-severe BPD using the severity criteria of the 2001 NICHD/NHLBI/ORD consensus workshop. Results: A total of 101 newborns with BPD participated in the study and 73 had data on BPD severity. The median gestational age was 27 weeks, ranging from 23 to 32 weeks. Of these 73 newborns, 36 had mild BPD (49.3%), 10 had moderate BPD (13.7%), and 27 had severe BPD (37.0%). When comparing severe and non-severe BPD, we found that extreme prematurity, extremely low birth weight, and small size for gestational age were more frequent in the severe BPD group (p-value=0.012, p-value<0.001, and p-value=0.012, respectively). Infants with severe BPD had a longer duration of invasive ventilation than those with mild or moderate BPD (p-value<0.001). Late sepsis, necrotizing enterocolitis, severe brain injury, and retinopathy of prematurity were more frequent in severe BPD (p-value=0.017, p-value=0.045, p-value=0.033, p-value=0.003, respectively). Discussion: Previously published evidence describing causal links between BPD development and comorbidities exists but data on their impact on BPD severity are scarce. In our study, severe BPD seemed to be associated with a higher frequency of comorbidities and complications. Further studies are needed to ascertain the impact of each morbidity on the severity of BPD and if measures to prevent them could lead to potentially milder BPD disease.
- Carbapenemase-producing Enterobacteriaceae in a Portuguese hospital – a five-year retrospective studyPublication . Gorgulho, A; Grilo, AM; Figueiredo, M; Selada, JBackground: Our hospital experienced an outbreak of OXA-48-producing Enterobacteriaceae, triggering this study. We aimed to describe the population with carbapenemase-producing Enterobacteriaceae (CPE) in our hospital from 2014 to 2018, the phenotypic and genotypic characteristics of isolates, and strategies to stop the outbreak. Methods: We performed a retrospective study, including every patient with CPE species in a clinical sample. Epidemiology, risk factors, treatment and outcomes were gathered from medical records. Results: A total 113 patients were included, ranging from 5 in 2015 to 83 in 2018. In 2018 the number of CPE went from 4 in May to 20 in July. With the implemented measures, propagation stopped. Implantable devices were present in 36% of patients and open wounds in 34%. Antibiotics had been prescribed to 71% of patients in the prior 30 days and most of the patients had been hospitalized for more than 5 days prior to sample collection or had a hospital stay in the previous year.Klebsiella pneumoniae was the most common species (87%). OXA-48 (62%) and Klebsiella pneumoniae-carbapenemase (KPC) (15%) were the most common carbapenemases, with OXA-48 being implicated in the 2018 outbreak. The case fatality rate at 30 days was 32%. Combination therapy resulted in less mortality. Conclusions: While KPC is the most common carbapenemase in Europe and Portugal, we experienced an important OXA-48 outbreak. Surveillance should be in place as these isolates are probably spreading. Effective communication, multidisciplinary team work and proper infection control measures are some of the best strategies during outbreaks.
- Carotid Sinus Syndrome in a Patient with Head and Neck Cancer: A Case ReportPublication . Toscano, M; Cristina, S; Alves, ARSyncope is a common complaint among patients presenting to the emergency department. Its differential diagnosis is broad and its management varies significantly depending on the underlying etiology. This is especially complex in patients with head and neck cancer since it may appear as an initial manifestation of the disease, as a side effect of surgery or radiotherapy, or as an indicator of local recurrence. Carotid sinus syndrome is a rare disease, whose pathophysiology is not yet fully understood. Here, we present the rare case of a 79-year-old male patient with a left cervical lymph node metastasis from an occult primary malignancy, who was admitted due to recurrent syncope. Paroxysms of extreme bradycardia were detected and a definitive dual chamber pacemaker was placed; however, the patient remained symptomatic. Cervical CT-scan revealed incarceration and compression of the left carotid sinus. The patient underwent radiotherapy, with favourable response, and remains asymptomatic to date.