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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- Advancing Access to Intestinal Microbiota Transplant: Bridging the Gap Between National Practices and the European StrategyPublication . Dinis, L; Pinheiro, H; Póvoa, P; Calhau, C; Pestana, D; Marques, CClostridioides difficile is an opportunistic pathogen that can cause a range of conditions, from asymptomatic carriage to severe illness, posing a significant public health threat due to its high mortality rates and substantial healthcare costs. Traditional treatment options, including antibiotics, often fail to eradicate the infection, leading to recurrent cases that severely impact patients' lives. Intestinal microbiota transplant (IMT) has emerged as an effective strategy for decolonizing pathogenic agents, demonstrating safety and efficacy, particularly in treating recurrent Clostridioides difficile infection (rCDI). Despite its potential, access to IMT is limited due to safety concerns, logistical challenges, and a lack of proper guidance, underscoring the urgent need for structured intestinal microbiota banks (IMBs). These organized facilities are crucial for the collection, screening, processing, and distribution of intestinal microbiota preparations, thereby facilitating the clinical application of IMT. In this narrative review, we discuss the relevance of applying IMT for the treatment of rCDI in Europe, with a focus on Portugal. We highlight the existence and distribution of IMBs across Europe and their importance in improving access to IMT. This review also addresses the challenges in creating an IMB and the development of such a structure in Portugal as a centralized repository for high-quality, standardized microbiota preparations, making IMT accessible for national hospitals. Additionally, it emphasizes the need to raise awareness among healthcare providers and the public to support the broader adoption of IMT.
- 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.
- 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.
- 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.
- Blood-borne virus testing in European emergency departments: current evidence and service considerationsPublication . Smout, E; Ruf, M; Buti, M; Pinto, IV; Nebbia, G; Hunter, L; Aldersley, MA; Esteves, C; Medina, D; Llaneras, J; Douthwaite, S; Page, EEInnovative testing approaches are needed to meet global targets for the blood-borne viruses (BBVs) HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). We conducted a systematic review of BBV testing in emergency departments (EDs) in Europe to evaluate prevalence, effectiveness of ED testing and linkage to care (LTC). We searched PubMed, Embase and Cochrane Library for articles on ED BBV testing published between January 2012 and July 2022. Studies conducted outside Europe or prior to 2012 were excluded owing to epidemiological and healthcare service variation, together with studies that did not report core parameters. Reference lists from included articles were manually searched. Seventeen original articles met the inclusion criteria. Seven studies reported on HIV testing only. ED prevalence: HIV Ab, 0.0%-1.1%; HBsAg, 0.2%-0.9%; and HCV RNA, 0.2%-3.9%. BBV testing uptake varied by policy and offer methodology: opt-out, provider-initiated: 9.7%-44.2%; electronic health record (EHR) modification: 52.1%-88.9%; and opt-in, provider-initiated: 3.9%-37.7%. LTC rates were 8.1%-100% and varied by BBV, generally highest for HIV and lowest for HCV. There was variable detail in outcome reporting and description of clinical LTC pathways. ED BBV testing in Europe is feasible and identifies high numbers of infections (including, where reported, new diagnoses and disengaged patients), often among marginalized populations who use open-access EDs for healthcare. Factors associated with higher levels of sustained testing uptake included opt-out testing (vs opt-in), EHR (vs provider-initiated) and integration of community services. We propose a toolkit of components necessary for a high-performing ED BBV testing programme.