ULS2-Artigos (em revistas ou actas indexadas)
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- Assessing the medical waste management practices and associated risk perceptions in Algarve hospitals, PortugalPublication . Ferreira, Vera; Ribau Teixeira, MargaridaIn the past few years, there has been an increase in public concern about the medical wastes management on a global basis and a significant effort has been directed toward proper and safe management of hazardous medical wastes. However, if there is not a clear understanding of the risks, inadequate management practices are often implemented. The objective of this study was to analyse the medical waste management practice of hospitals in Algarve (Portugal), analyse the risk perception of medical staff (nurses, doctors and housekeepers) and assess the risk for medical staff. This study was carried out in the three hospitals, one public and two private. Field visits and questionnaires survey method was implemented to collect information regarding different medical waste management aspects and the perception of risk associated with medical wastes by the medical staff. The risk assessment was based in real injuries data associated with sharps and needles (estimate of infections) and in inadequate wastes separation, i.e. frequency of errors in separation. There are some problems in the medical waste management in all hospitals due to lack of training and resources. Nurse’s group show slightly higher knowledge about medical wastes separation, with 71.6% correct answers, and doctor’s group lower knowledge, with 64.8% correct answers. Only 26% of doctors participated in training programs and this medical staff group evidences a lower perception of risk associated of the infectious wastes (group IV wastes). The separation about pharmaceuticals, cytotoxic and pathological waste has more errors, which in reality can be reflected in a higher percentage of inadequate treatment and final disposal, and has impacts in medical workers and environment. Most injuries from needlestick/sharp occur during patient care, but there are medical wastes risk associated, mainly linked to the deposition in containers and separation errors of this material. However, only HVB is likely to occur in hospitals, in coming years if the prophylaxis is not 100%. Results indicate the waste management is affected by perception of risk and training programs.
- Gla-Rich Protein Is a Novel Vitamin K-Dependent Protein Present in Serum That Accumulates at Sites of Pathological CalcificationsPublication . Viegas, Carla; Cavaco, Sofia; Neves, Pedro L.; Ferreira, Ana; Joao, Alexandre; Williamson, Matthew K.; Price, Paul A.; Cancela, M. Leonor; Simes, DinaMineralization of soft tissues is an abnormal process that occurs in any body tissue and can greatly increase morbidity and mortality. Vitamin K-dependent (VKD) proteins play a crucial role in these processes; matrix Gla protein is considered one of the most relevant physiological inhibitors of soft tissue calcification know to date. Several studies have suggested that other, still unknown, VKD proteins might also be involved in soft tissue calcification pathologies. We have recently identified in sturgeon a new VKD protein, Gla-rich protein (GRP), which contains the highest ratio between number of Gla residues and size of the mature protein so far identified. Although mainly expressed in cartilaginous tissues of sturgeon, in rat GRP is present in both cartilage and bone. We now show that GRP is a circulating protein that is also expressed and accumulated in soft tissues of rats and humans, including the skin and vascular system in which, when affected by pathological calcifications, GRP accumulates at high levels at sites of mineral deposition, indicating an association with calcification processes. The high number of Gla residues and consequent mineral binding affinity properties strongly suggest that GRP may directly influence mineral formation, thereby playing a role in processes involving connective tissue mineralization. (Am J Pathol 2009, 175:2288-2298; DOI; 10.2353/ajpath.2009.090474)
- What is the role of apelin regarding cardiovascular risk and progression of renal disease in type 2 diabetic patients with diabetic nephropathy?Publication . Silva, Ana Paula; Fragoso, Andre; Silva, Claudia; Viegas, Carla; Tavares, Nelson; Guilherme, Patricia; Santos, Nelio; Rato, Fatima; Camacho, Ana; Cavaco, Cidalia; Pereira, Victor; Faisca, Marilia; Ataide, Joao; Jesus, Ilidio; Neves, Pedro LeãoAims. To evaluate the association of different apelin levels with cardiovascular mortality, hospitalization, renal function, and cardiovascular risk factors in type 2 diabetic patients with mild to moderate CKD. Methods. An observational, prospective study involving 150 patients divided into groups according to baseline apelin levels: 1 <= 98pg/mL, 2 = 98-328 pg/mL, and 3 >= 329 pg/mL. Baseline characteristics were analyzed and compared. Multivariate Cox regression was used to find out predictors of cardiovascular mortality, and multivariate logistic regression was used to find out predictors of hospitalization and disease progression. Simple linear regressions and Pearson correlations were used to investigate correlations between apelin and renal disease and cardiovascular risk factors. Results. Patients' survival at 83 months in groups 1, 2, and 3 was 39%, 40%, and 71.2%, respectively (P = 0.046). Apelin, age, and eGFR were independent predictors of mortality, and apelin, creatinine, eGFR, resistin, and visfatin were independent predictors of hospitalization. Apelin levels were negatively correlated with cardiovascular risk factors and positively correlated with eGFR. Patients with lower apelin levels were more likely to start a depurative technique. Conclusions. Apelin levels might have a significant clinical use as a marker/predictor of cardiovascular mortality and hospitalization or even as a therapeutic agent for CKD patients with cardiovascular disease.
- Prevenção de erros com medicamentos num hospitalPublication . Espírito Santo, Margarida; Campos, Paula; Neves, CristelOs erros de medicação são atualmente considerados um problema de saúde pública, pois mesmo considerando que grande parte não cause danos aos pacientes, demonstram fragilidade no processo de trabalho e indicam uma relação direta com riscos maiores de ocorrências de acidentes graves.(1,2) OBJECTIVOS: Identificar medicamentos que possam levar a situações de erro na dispensa ou administração, e em particular medicamentos que apresentem elevado risco de provocar um evento mortal aquando da sua troca, e sugerir medidas preventivas que possam minimizar a sua ocorrência. MÉTODOS: Procedeu-se à análise da lista dos medicamentos fornecida pelos serviços farmacêuticos, identificando os que apresentavam fonéticas semelhantes entre si, diversas dosagens para a mesma substância ativa, mais do que uma forma farmacêutica (FF), e ainda os medicamentos potencialmente perigosos (MPP).(3) RESULTADOS: Da lista de medicamentos analisados (n=530), verificou-se que 16,4% apresentavam fonéticas semelhantes entre si. Para evitar trocas nestes medicamentos, foi sugerido enfatizar as diferenças entre os nomes dos medicamentos, através da colocação destas sílabas em letra maiúscula. Cerca de 42,6% dos medicamentos apresentava mais do que uma dosagem disponível, e 19,8% apresentava mais do que uma FF. Sugeriu-se que cada dosagem fosse destacada com uma cor específica, verde (mais baixa), laranja (intermédia-alta), amarelo (intermédia-baixa) ou vermelho (mais alta). Para medicamentos com apenas uma dosagem a cor utilizada seria o azul. Dos medicamentos analisados, verificou-se ainda que 24,7% são MPP. Foi sugerido que estes MPP sejam armazenados em local diferenciado, e que sejam identificados com sinalética especifica de alerta. CONCLUSÕES: Para prevenir erros de medicação assim como garantir o uso racional e seguro dos medicamentos, é fundamental que exista uma interação entre o pessoal do serviço farmacêutico e dos enfermeiros. A maioria dos erros pode ser evitada se existir um sistema de distribuição que permita identificar o medicamento correto a dispensar e a administrar. BIBLIOGRAFIA: 1. JÚNIOR, D. Erro medicamentoso em cuidados de saúde primários e secundários: dimensão, causas e estratégias de prevenção. Rev Port Saúde Pública; Vol. 10 (2010), p. 40-46. 2. American Society of Hospital Pharmacists. ASHP Guidelines on Preventing Medication Errors in Hospitals. Am J Hosp Pharm. Vol. 50 (1993), p. 305-314. 3. ISMP's List of High-Alert Medications [homepage da internet]; Institute for Safe Medication Practices. (consult. a 18.09.2013). Disponível em: http://www.ismp.org.
- Clinicoepidemiological profile of cerebral venous thrombosis in Algarve, Portugal: a retrospective observational studyPublication . Nzwalo, Hipólito; Rodrigues, Fatima; Carneiro, Patricia; Macedo, Ana; Ferreira, Fatima; Basilio, CarlosBackground: Cerebral venous thrombosis (CVT) is a very uncommon disorder with a wide variety of clinical manifestations. There are few studies describing the clinical and epidemiological profile of CVT in peripheral or rural areas. Over the last decades, the frequency in which this disease is diagnosed has increased due to greater awareness and availability of noninvasive diagnostic techniques. Materials and Methods: A hospital-based retrospective case review of adult (>= 15 years) patients with CVT between 2001 and 2012 is described. 31 patients with confirmed imagiological diagnosis of CVT were included. Statistical Analysis Used: Statistical analysis was performed using R version 2.15.2. Incidence rate was computed as number of new cases by time. Confidence interval (CI) was set at 95% and P < 0.05 was considered significant. Results: The average annual incidence was 0.84 (CI: 0.58-1.18) to 0.73 (CI: 0.5-1.02) per 100 000 cases for adult population. There were 23 (74%) women and 8 (26%) men. Predominant initial manifestations were headache, followed by altered mental status and seizures. Median diagnostic delay from onset of illness was 8 days. All patients were treated with unfractionated heparin or low-molecular heparin followed by warfarin. Complete recovery occurred in the majority of cases 22 (78.6%) but two patients died during hospitalization. Conclusions: Albeit with some particularities, the epidemiology and clinical manifestations we found are comparable to what has been reported in western studies.
- Reply to: Neurological outcome after cardiac arrest: cold and dark issues [editorial].Publication . Granja, Cristina; Nassar Junior, Antonio PauloWe are thankful for the interest in our editorial.(1) We agree that the study population in Kim et al.(2) is different from that of Leão et al.(3), insofar as the first consisted of patients who had pre-hospital cardiorespiratory arrest, and the second consisted of patients with out-of-hospital and in-hospital cardiorespiratory arrest. However, neither study showed benefits to achieving the target hypothermia more quickly. In addition, the study by Leão et al. suggested a worse prognosis in patients who reached hypothermia more quickly.(3) As mentioned in the editorial, although the study had several limitations, there is a pathophysiological rationale for this finding.(4,5)
- Today, in the endoscopist handsPublication . Roseira, Joana; Sousa, Helena Tavares; Queirós, P.; Antunes, A. G.; Vaz, A. M.; Gago, T.; Contente, L.; Guerreiro, H.Endoscopic submucosal dissection (ESD) was first described as a non-surgical promise for early gastric epithelial lesions.
- Vanek tumor -endo-laparoscopic approachPublication . Cunha, Miguel; Roseira, Joana; Rachadell, J.; Amorim, E.; Americano, M.:Vanek’s tumor was first reported in 1949 as a benign gastrointestinal (GI) submucosal alteration, being more prevalent at the stomach (70%) and ileum (20%). This entity corresponds to 0.1% of all gastric polyps, and its diagnosis is mostly incidental when searching for an upper gastrointestinal bleeding cause. The authors present a case and iconography of a Vanek lesion.
- Mineral metabolism and inflammation: factors related to left ventricular hypertrophy in patients with diabetic nephropathyPublication . Jerónimo, Teresa; Fragoso, Andr?; Mendes, Filipa; Silva, Ana Paula; Pimentel, Ana; Tavares, Nelson; Camacho, Ana; Neves, Pedro LeãoLeft ventricular hypertrophy (LVH) is an important risk factor for cardiovascular disease in patients with diabetic nephropathy (DN) and is an independent predictor of mortality in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the association of LVH with mineral metabolism and inflammation in a population of patients with DN. In an observational study were included 119 type 2 diabetic patients with CKD stages 3 and 4. The population was divided into two groups, according to the presence of LVH: group 1 (G-1) with LVH (left ventricular mass index (LVMI) > 125 g/m2 in male patients and LVMI > 110 g/m2 in female patients) and group 2 (G-2) without LVH (LVMI ? 125 g/m2 in male patients and LVMI ? 110 g/m2 in female patients). The patient characteristics of each group were compared regarding several biological and laboratory parameters. Patients with LVH displayed lower values of estimated glomerular filtration rate (eGFR) (p = 0.0001) and albumin (p = 0.046), and higher levels of phosphorus (p = 0.0001), intact parathyroid hormone (iPTH) (p = 0.0001), insulin resistance (HOMA-IR) (p = 0.0001) and interleukin-6 (IL-6) (p = 0.0001), compared with patients without LVH. In a logistic regression model, phosphorus (odd ratio (OR) = 1.825 (1.075-4.414), p = 0.038), iPTH (OR = 1.991 (1.098-3.000), p = 0.004) and IL-6 (OR = 3.538 (1.863-6.719), p = 0.0001) were independently related to LVH. In a multiple linear regression model, phosphorus (r = 0.602, p = 0.038), iPTH (r = 1.009, p = 0.044) and IL-6 (r = 1.264, p = 0.0001) were positively related to LVMI. Phosphorus, PTH and IL-6 were related to LVH in our diabetic population with CKD stages 3 and 4
- Calcific uraemic arteriolopathy - A mini-reviewPublication . Mendes, Filipa; Rocha, Sofia Couto; Agapii, Rodica; Silva, Ana; Fragoso, Andr?; Jerónimo, Teresa; Pimentel, Ana; Neves, Pedro LCalcific Uraemic Arteriolopathy (CUA) or calciphylaxis, is a thrombotic disorder of skin and subcutaneous tissue which typically presents with painful purpuric nodules that may progress to necrotic ulcers, and is a severe, life-threatening condition. CUA is an uncommon clinical entity that affects mostly haemodialysis (HD) patients. Although the process of vascular calcification was initially thought to be the result of a passive deposition of calcium-phosphate crystals, current knowledge suggests a distinct mechanism, including cellular activity with differentiation of vascular smooth muscle cells (VSMCs) into chondrocyte as well as osteoblast-like cellular phenotypes and deficiencies in calcification inhibitors. Although multiple studies suggest a potential relationship between warfarin and CUA, larger prospective studies are needed in order to better evaluate this association, and randomised controlled trials are needed to assess the benefit of distinct interventions in this setting. In this article the topic of CUA is reviewed based on a clinical case of a 65-year-old man undergoing haemodialysis, who underwent an aortic valve replacement one year earlier, receiving a mechanical heart valve, and who has been under warfarin therapy since then