ULS_10.1-MED-Artigos
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- Multidisciplinary cardiorenal program for heart failure patients: Improving outcomes through comprehensive carePublication . Calça, Rita; Malho, Anabela; Domingos, Ana Teresa; Fernandes, Raquel Menezes; Silva, Francisca Gomes da; Aguiar, Carlos; Tralhão, António; Ferreira, Jorge; Rodrigues, Anabela; Fonseca, Cândida; Branco, PatríciaThe cardiorenal program (CRP), implemented within a specialized heart failure and kidney disease clinic, encompasses a multidisciplinary approach to the management of patients with heart failure and kidney disease. It focuses on optimizing therapy and improving patient outcomes. The CRP includes a range of services, including clinical evaluation, diagnostic testing, medical treatment, and patient education. The program provides comprehensive care for patients with cardiorenal syndrome, and includes a variety of healthcare professionals, such as cardiologists, nephrologists, pharmacists, and nurses, working together to provide the best possible care. The program also incorporates specific performance indicators to continuously evaluate and improve patient outcomes. The CRP's integrated multidisciplinary care and patient-centered approach is promising for the management of patients with cardiorenal syndrome. (c) 2025 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
- Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUSPublication . Barroso1, Andreia; Lin, Flávia; Carrondo, Maria Cristina; Palomino, Addy; Demarzo, Sergio Eduardo; Figueiredo, Viviane Rossi; Jacomelli, MarciaTo assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). Methods: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. Results: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.081-9.770; p = 0.036). Conclusions: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.
- Orientações de consenso para a abordagem dos resultados alterados nos testes de rastreio do cancro do colo do útero pela SPCPTGIPublication . Pedro, Amélia; Pacheco, Amália; Sousa, Rita; Mendinhos, Gustavo; Miranda, Mariana; Urzal, Cecília; Monteiro, Virgínia; Fraga, Teresa; Silva, Daniel Pereira da; Paula, Tereza; Oliveira, Isabel; Cabral, José; Moutinho, José FonsecaO cancro do colo do útero (CCU) é globalmente um dos tipos de cancro mais comum em mulheres. O rastreio do CCU é indispensável para a deteção e tratamento de lesões neoplásicas cervicais que possam evoluir para neoplasia, com o objectivo de reduzir a incidência deste cancro. Nos últimos anos, têm ocorrido alterações que visam o aumento da eficácia do rastreio. Nomeadamente, o uso de teste de deteção do vírus do papiloma humano como método de rastreio primário do CCU e a valorização da importância de adaptar a prática clínica em função do risco de desenvolvimento do CCU. Desta forma, são necessárias novas normas de atuação clínica, que contemplem esta mudança de paradigma. Assim, um grupo de especialistas analisou e discutiu a literatura mais recente, definindo recomendações e propondo normas de prática clínica que se focam na estratificação de risco, avaliação diagnóstica, e na conduta terapêutica e de seguimento de mulheres com resultados dos testes de rastreio alterados. Este trabalho tem como objetivo facilitar a prática clínica em resposta a resultados alterados nos testes e, consequentemente, melhorar a prevenção secundária do CCU.
- Treatment of greater trochanteric pain syndrome with ultrasound-guided bipolar pulsed radiofrequency of the trochanteric branches of the femoral nerve: a case series of nine patientsPublication . Vieira, André; Coroa, Mariana C.; Carrillo-Alfonso, Noélia; Correia, Francisco D.Background: Greater trochanteric pain syndrome (GTPS) is a prevalent cause of lateral hip pain that often leads to significant functional limitations. Conservative treatment options include physical therapy, pharmacological treatment, and more invasive techniques such as corticosteroid injections. However, despite the high success rates reported with corticosteroid injections, a significant number of patients have their symptoms persist or recur. Objectives: In this case series, we present the outcomes of nine patients with GTPS who underwent ultrasound-guided bipolar pulsed radiofrequency targeting the trochanteric branches of the femoral nerve. We aim to discuss the effectiveness and safety of this approach.Material and methods: Eligible patients referred to our centre underwent ultrasound-guided bipolar pulsed radiofrequency aimed at the trochanteric branches of the femoral nerve. The procedure consisted of one cycle at 42 degrees C for six minutes, followed by the injection of ropivacaine (0.2%, 3 mL) and dexamethasone (12 mg). The Brief Pain Inventory -Short Form (BPI-sf) and Lequesne Algofunctional Index (LAI) were used before the procedure and at the third and sixth months post-procedure. We monitored immediate and late complications, as well as adverse effects.Results and discussion: Our results indicate a favourable outcome for most patients, with an average pain reduction of 76.51% according to their report of the BPI-sf. Additionally, eight out of nine patients experienced at least 50% relief. These findings align with a previous case series, which reported a similar average pain reduction. Before the procedure, most patients were classified as "extremely severe" in the LAI, with an average score of 18.17. Although there was only a slight reduction of 16.84% at the six-month follow-up, this suggests a potential improvement in their functional status. We did not observe any immediate complications or adverse effects after the procedure, nor were any reported at the subsequent follow-ups, which is consistent with existing literature.Conclusions: Our study suggests that ultrasound-guided bipolar pulsed radiofrequency treatment is a promising minimally invasive technique for GPTS, especially for patients who do not respond to conservative treatments. Although our case series provides some evidence of effectiveness and safety, further controlled studies on a larger scale are necessary, particularly to compare this intervention with the use of corticosteroid injections alone.
- Anthracyclines versus no anthracyclines in the neoadjuvant strategy for HER2+ breast cancer: real-world evidencePublication . Pinho, Inês Soares de; Luz, Paulo; Alves, Lucy; Brás, Raquel Lopes; Patel, Vanessa; Martins, Miguel Esperança; Gonçalves, Lisa; Freitas, Ritas; Simão, Diana; Roldán Galnares, Maria; Fernandes, Isabel; Criado, Silvia Artacho; Gamez Casado, Salvador; Baena Cañada, Jose; Vega, Isabel M. Saffie; Costa, João G.; Fernandes, Ana S.; Sousa, Rita Teixeira de; Costa, LuísDeescalation strategies omitting anthracyclines (AC) have been explored in early human epidermal growth factor receptor 2-positive breast cancer (HER2+ EBC), showing similar efcacy regarding pathological complete response (pCR) and long-term outcomes as AC-containing regimens. The standard treatment for this tumor subtype is based on chemotherapy and dual HER2 blockade with trastuzumab and pertuzumab, with AC-containing regimens remaining a frequent option for these patients, even in non-high-risk cases. The primary aim of this study was to assess and compare the efectiveness of neoadjuvant regimens with and without AC used in the treatment of HER2+ EBC in the clinical practice according to the pCR achieved with each.
- Gastric metastasis from lung adenocarcinoma: an uncommon presentationPublication . Neves, Ana; Mendonça, Inês; Marques, José Alberto da Cunha; Costa, José; Almeida, Jorge S.Gastric metastasis is an infrequent occurrence, especially when derived from lung adenocarcinomas. They can grossly resemble advanced gastric cancer and require comprehensive evaluations of the patients and their symptoms.Here, we present the case of a 71-year-old patient admitted to our hospital due to intense, cramping abdominal pain. He had been previously diagnosed with a right lower lobe adenocarcinoma of the lung, which was treated in the previous year with chemotherapy and radiotherapy with good clinical response. The abdominal CT scan and the esophagogastroduodenoscopy showed a gastric infiltrating lesion resembling advanced gastric cancer. However, the biopsy showed malignant epithelial neoplasia with features of adenocarcinoma of pulmonary origin. Even though they are an uncommon finding, gastrointestinal metastases may be life-threatening and should be diagnosed as soon as possible, as the advent of molecular studies and new therapies may result in better survival rates.
- Dermatomyositis and Crohn's disease – Case reportPublication . Neves, Ana; Mendonça, Inês; Marques, José; Costa, José; Almeida, JorgeImmune‐mediated diseases tend to overlap in ways that are not completely understood. When a presentation is not entirely explained by a former condition, other hypotheses should arise. Additionally, the activity of 2 overlapping immune‐mediated conditions is not always associated. We present an unusual association between Crohn's disease and dermatomyositis in a 28‐year‐old man. The patient presented with a 2‐month history of proximal muscle weakness and a skin rash with heliotrope periorbital edema. Since the patient had already been diagnosed with Crohn's disease, he was under immunosuppressive therapy, and he had a family history of psoriasis, the diagnosis was not immediate and required an integrative approach. Laboratory analysis revealed elevated creatine kinase, aldolase, lactic dehydrogenase and transaminase levels. He had no symptoms of Crohn's disease exacerbation. Magnetic resonance imaging, electromyography, and muscle biopsy findings were consistent with inflammatory myopathy, although non‐specific. Corticosteroids were initiated with clinical and laboratory improvement within 1 month.
- Prophylactic negative pressure wound therapy in patients with closed surgical wound: an integrative reviewPublication . Tendeiro, Daniela; Mestre, Teresa; Martins, Helga; Carmo, AndréSurgical site infection is the leading healthcare-associated infection and a major contributor to rising healthcare costs. Implementation of measures to reduce this problem, particularly the prophylactic use of negative pressure wound therapy, may be an effective and promising method to reduce the risk of surgical site infection in patients with closed surgical wounds. The aim of the study was to identify the effectiveness of negative pressure wound therapy as a prophylactic measure in reducing the risk of surgical site infection in patients with a closed surgical wound. Whittemore and Knafl's five-step integrative review framework was carried out using three electronic databases. MEDLINE with Full-text, CINAHL with Full-text and Academic Search Complete were searched through the EBSCOhost Web platform. Articles search publication date was between 2018 and 2022. Nine studies were identified that addressed the effectiveness of prophylactic negative pressure wound therapy in reducing the risk of surgical site infection in the patient with a closed surgical wound. There was also evidence of effectiveness in reducing surgical wound dehiscence, drainage output and drainage time, as well as reducing the incidence of hospital readmissions and the need for wound debridement. Prophylactic negative pressure wound therapy can be an effective treatment option, among others, in reducing the risk of surgical site infection in patients with a closed surgical wound. This evidence promotes improved clinical practice regarding the management of the closed surgical wound, promoting health gains for patients.
- Gastric mixed neuroendocrine/non-neuroendocrine neoplasia: a rare entityPublication . Costa, José Damasceno e; Costa, Rita Seara; Moreira, Hélder Deveza; Ferreira, AníbalGastric neoplasms have different histological subtypes. Mixed neuroendocrine/non neuroendocrine neoplasms (MiNEN), as defined by the World Health Organization (WHO) 2019 Classification of Tumours of the Digestive System, are rare composite tumours bearing morphological characteristics of more than one histological type. Historically, the diagnosis requires that each component accounts for at least 30% of the total tumour burden. We present the case of a 70-year-old male, who was referred to our endoscopy unit for resection of a depressed lesion (Paris classification type 0 IIc) of 40mm in largest diameter, located on the lesser curvature of the gastric body. The lesion was submitted to en bloc resection by endoscopic submucosal dissection. Histological examination revealed a poorly differentiated intramucosal adenocarcinoma and a grade G3 well differentiated neuroendocrine tumour (NET), on a background of chronic atrophic gastritis. Unfortunately, examination of the NET component revealed intercepted margins. The patient is currently undergoing tumour staging and will be discussed by a multidisciplinary team to determine subsequent management.
- Frontline health workers: training needs assessment on immunisation programme. An EU/EEA-based surveyPublication . Gianfredi, Vincenza; Oradini-Alacreu, Aurea; Sá, Regina; Blandi, Lorenzo; Cadeddu, Chiara; Ricciardi, Walter; Signorelli, Carlo; Odone, AnnaBackground As part of continuing medical education, frontline healthcare workers (FHWs) have to maintain high standards of competence and knowledge. It is particularly true in the field of vaccination and vaccine acceptance, where knowledge and technologies evolve rapidly. MethodsFor this reason, we developed an anonymous 47-item web-based survey aimed to collect data about recent existing courses and FHWs' knowledge, learning needs and preferences for future courses, both in vaccinology and vaccine acceptance at the European level. The survey was conducted from October to November 2021, and disseminated through the Association of Schools of Public Health in the European Region (ASPHER) and European Centre for Disease Control (ECDC) networks by email.ResultsA total of 160 FHWs (63% females, 61% physicians) completed the questionnaire. Approximately half of the sample considered themselves skilled in almost all the explored areas considering vaccinology and vaccine acceptance. However, respondents were interested in attending courses regarding research and science and how to deal with misinformation and disinformation for the future. Moreover, an online version of the course, or at least a mixed format (in person and online), is considered the preferred format. Lastly, the most supportive materials in dealing with vaccinology and vaccine acceptance were short courses on specific topics.ConclusionsOur results are relevant to inform professional development staff in order to plan and implement more targeted courses in terms of educational training programmes and teaching formats that better match the interests and needs of FHWs.