ULS2-Artigos (em revistas ou actas indexadas)
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- Admission severity of atrial-fibrillation-related acute ischemic stroke in patients under anticoagulation treatment: a systematic review and meta-analysisPublication . Garcia, Catarina; Silva, Marcelo; Araújo, Mariana; Henriques, Mariana; Margarido, Marta; Vicente, Patrícia; Nzwalo, Hipólito; Macedo, AnaIn non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS). We sought to analyze the literature to assess the association between pre-admission anticoagulation (VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001 and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC.
- Internuclear ophthalmoplegia, skew deviation and nystagmus from facial colliculus infarction: small lesion big troublePublication . Valente, Diana Vilares; de Almeida, Tomás Duarte; Gil, Inês; Nzwalo, Hipólito; Félix, Ana CatarinaIsolated internuclear ophthalmoplegia (INO) is an extremely rare presentation of stroke [1–3]. INO is defned by the presence of ipsilateral adduction paresis with contralateral dissociated nystagmus on horizontal gaze and is caused by strategic brainstem lesions involving the medial longitudinal fasciculus (MLF) [2, 3].
- Long‐term association between disease activity and disability in early axial Spondyloarthritis: Results from a prospective observational study of inflammatory back painPublication . PD, Carvalho; Ruyssen‐Witrand, Adeline; Marreiros, Ana; Machado, Pedro M.Objective Our primary objective was to study the long-term association between disease activity and disability in axial spondyloarthritis (SpA). Our secondary objective was to define patient profiles according to their level of disability. Methods We analyzed data collected during the first 5 years of follow-up of a large early axial SpA cohort, the Devenir des Spondylarthropathies Indifferenciees Recentes (DESIR) cohort. Multivariable models were built to study the association between the Health Assessment Questionnaire for Ankylosing Spondylitis (HAQ-AS) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), adjusting for potential confounders. Hierarchical multivariable analysis was conducted using the chi-square automatic interaction detector (CHAID) method, to help determine how variables best cluster to explain HAQ-AS. Results Data from 644 patients and 5,152 visits were analyzed. HAQ-AS was longitudinally, independently, and positively associated with ASDAS-CRP (adjusted B [adjB] 0.205 [95% confidence interval (95% CI) 0.187, 0.222]), the enthesitis score (adjB 0.011 [95% CI 0.008, 0.015]), the Bath Ankylosing Spondylitis Metrology Index (adjB 0.087 [95% CI 0.069, 0.105]), and female sex (adjB 0.172 [95% CI 0.120, 0.225]). The CHAID decision tree revealed ASDAS-CRP as the first variable with discriminative power on HAQ-AS. The cutoffs that separated different patient disability profiles were obtained. Conclusion Disease activity contributes longitudinally to disability and is hierarchically superior to any other variable in explaining this health domain. Enthesitis and spinal mobility are also key drivers of disability in early axial SpA. ASDAS-CRP cutoffs that separated different patient disability profiles largely mimicked the cutoffs previously defined for ASDAS-CRP disease activity states.
- Stroke due to Percheron artery occlusion: description of a consecutive case series from Southern PortugalPublication . Reis, Diana; Cerullo, Giovanni; Florêncio, André; Frias, Catarina; Aleluia, Leonor; Drago, José; Nzwalo, Hipólito; Fidalgo, Ana P.The artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. Stroke caused by AOP occlusion is seldom reported. AOP leads to bilateral thalamic and rostral midbrain infarct presenting with unspecific manifestations. There are few descriptions of case series of stroke caused by AOP. We sought to review the clinicoradiological characteristics of AOP infarction from Algarve, Southern Portugal. Eight consecutive cases were retrospectively identified by searching the electronic clinical charts, as well as the stroke Unit database (2015–2020). Sociodemographic (age and gender) and clinicoradiological characteristics (etiological classification, admission severity, manifestations, and short- and long-term prognoses) were retrieved. The corresponding frequency of AOP infarction was 0.17% (95% confidence interval: 0.05–0.28). The mean age was 67.1 (range: 60–80) years. The range of stroke severity evaluated assessed by the National Institute of Health Stroke Scale ranged from 5 to 23 (median ¼ 7.5). None of the patients receive acute ischemic stroke reperfusion treatment. AOP patterns were isolated bilateral paramedian thalamic (n ¼ 2), bilateral paramedian and anterior thalamic (n ¼ 2), and bilateral paramedian thalamic with rostral midbrain (n ¼ 4). Two patients (20%) died on the short term (30 days). At hospital discharge, six patients had functional disability of 2 on the modified Rankin scale. In the follow-up at 6 months, half (n ¼ 3) of the survivors had persistent hypersomnia and two had vascular dementia. Stroke from AOP presents with variable clinical and radiological presentations and patients do not receive alteplase. The shortterm survivor and the long-term functional independency can be compromised after AOS infarct.
- Occurrence of Guillain-Barre syndrome during the initial symptomatic phase of COVID-19 disease: coincidence or consequence?Publication . Seixas, Rui; Campoamor, David; Lopes, João; Bernardo, Teresa; Nzwalo, Hipólito; Pascoalinho, DulceViral infections are frequently present before the clinical manifestation of Guillain-Barre syndrome (GBS). Multiple studies on coronaviruses have shown that these viruses have neurotropic characteristics, and their molecular mimicry can induce inflammatory demyelinating neuropathy. Herein, we describe a case of a GBS in an 85-year-old patient infected with SARS-CoV-2, manifested with acute progressive symmetric ascending quadriparesis, urinary dysautonomia, and dysphagia, who responded well to treatment with intravenous human immunoglobulin.
- Use of alfentanil in palliative carePublication . Ferraz, José António; Sousa, Filipa; Alves, Lucy; Liu, Patricia; Coelho, SaraAlfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1–20), and the median final 24-h dose of alfentanil was 5 mg (1–60), (p < 0.001). The initial 24-h median number of rescue doses was 2 (0–8), and the final median number of rescue doses was 1 (0 to 8), (p = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil.
- Stroke-associated cortical deafness: a systematic review of clinical and radiological characteristicsPublication . Silva, Gracinda; Gonçalves, Rita; Taveira, Isabel; Mouzinho, Maria; Osório, Rui; Nzwalo, HipólitoBackground: Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. Methods: PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: “deafness” and “stroke”, or “hearing loss” and “stroke” or “auditory agnosia” and “stroke”. Results: We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschl’s gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions. Conclusions: Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.
- Reabilitação de paralisia facial periférica unilateral em Guillain-Barré: estudo de casoPublication . Gonçalves, Rita; Veríssimo, Gonçalo; Afonso, Maria Alexandra; Malaia, LuísAs paralisias faciais podem ter uma multiplicidade de etiologias, contudo têm em comum o impacto negativo não só para as funções do sistema estomatognático, como também na autoimagem e expressão emocional. O presente artigo tem como objetivo a descrição de um estudo de caso relativo a uma paralisia facial periférica unilateral na sequência de Síndrome de Guillain-Barré. Pretende-se deste modo a partilha de experiência em termos de avaliação e intervenção neste tipo de alterações e a apresentação do respetivo resultado funcional. Ressalta-se, também, o importante papel da equipa interdisciplinar (composta por médico fisiatra, fisioterapeuta, fonoaudiólogo, terapeuta ocupacional e equipa de enfermagem) enquanto catalisador para a evolução e na gestão de eventuais intercorrências. Salienta-se, ainda, a importância da integração do paciente enquanto membro da equipa de reabilitação, empoderando-o e responsabilizando-o pelo sucesso da intervenção.
- Estudo de algumas variáveis potenciadoras do comprometimento organizacional dos profissionais nas organizações de saúde: uma revisão integrativaPublication . Gonçalves, Carina; Gonçalves Correia, David Manuel; Correia, Tânia; José, Helena; Henriques, Fernanda; Gouveia, Maria JoséO comprometimento organizacional surge como parte integrante de uma gestão eficaz dos recursos humanos, podendo-se traduzir num efeito significativo na satisfação do cliente, isto porque, profissionais de saúde mais comprometidos prestam melhores cuidados, o que se reflete em melhores resultados. Para além dessas vantagens, o comprometimento organizacional permite reduzir o absentismo e diminuir a rotatividade de profissionais, o que contribui para organizações mais coesas. Em organizações com elevado grau de complexidade, como é o caso das organizações de saúde, a preocupação com o comprometimento organizacional deve adquirir especial atenção, pois a profissionalização e a retenção dos seus profissionais, que são altamente qualificados, é imprescindível na maximização da eficiência e produtividade e, consequente, obtenção de ganhos em saúde. A realização desta revisão integrativa da literatura teve como base orientadora da investigação a questão: Quais as variáveis potenciadoras do comprometimento organizacional dos profissionais nas organizações de saúde? O objetivo foi identificar algumas variáveis que potenciam o comprometimento organizacional nas organizações de saúde e demonstrar como influenciam o comportamento organizacional dos seus profissionais. Os resultados obtidos permitiram identificar cinco variáveis potenciadoras do comprometimento organizacional: identificação com o plano estratégico da organização, confiança na liderança, tomada de decisão, condições laborais e satisfação pessoal. Concluiu-se que as variáveis identificadas evidenciam resultados positivos nas organizações de saúde. Contudo, importa, não só identificar em novos estudos outras variáveis, mas também, clarificar e aprofundar conhecimentos acerca das variáveis já identificadas, de forma a compreender como estas podem ser aplicadas, com o intuito de, cada vez mais, se promover o comprometimento organizacional nas organizações de saúde e, essencialmente, nas equipas de Enfermagem.
- Liderança e satisfação na equipa de enfermagem: revisão narrativaPublication . Fernandes, Vania; Contente, Catarina; Aljustrel Guerreiro, Inês; José, Helena; Gouveia, Maria José; Henriques, FernandaObjetivo: De forma a compreender a influência e relação no binómio liderança e satisfação em enfermagem, o objetivo deste estudo foi apresentar uma revisão bibliográfica narrativa acerca do tema e analisar o conhecimento produzido entre a relação liderança e a satisfação na equipa de enfermagem. Método: Trata-se de uma revisão narrativa da literatura. As bases de dados utilizadas foram a EBSCO (CINAHL Complete, MedLine Complete) para responder à pergunta de partida: “Qual o conhecimento relativamente à influência da liderança na satisfação da equipa de enfermagem no período de 2016-2021?". Para obtenção dos artigos, foram utilizados como critérios de inclusão: fontes primárias e revisões da literatura, integrativas, disponíveis na integra, em idioma português, espanhol e inglês, nos últimos cinco anos (2016-2021) e como critérios de exclusão: teses e dissertações, revisões narrativas, artigos duplicados ou noutros idiomas, considerando os seguintes descritores: liderança, satisfação no trabalho e enfermagem, aceites pela DeCS. As pesquisas desenvolveram-se durante o mês de maio de 2021 e selecionaram-se 26 artigos. Após análise dos artigos foram realizadas leituras exploratórias para maior compressão dos assuntos definidos e exploração do material recolhido, foram selecionados 7 artigos.