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Journal Cover   Acta Médica Portuguesa
  [SJR: 0.155]   [H-I: 11]   [0 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0870-399X - ISSN (Online) 1646-0758
   Published by Ordem dos Médicos Homepage  [1 journal]
  • Analysis of the Cochrane Review: Interventions for Improving Upper Limb
           Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820.

    • Abstract: Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were: 1- Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions; 2- Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living; 3- Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality
      and repetitive task practice; 4- Unilateral arm training may be more effective than bilateral arm training; 5- Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs; 6- There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies. Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.
      PubDate: 2015-10-09
      Issue No: Vol. 28 (2015)
  • Hyperbaric Oxygen Therapy for the Treatment of Fournier’s Gangrene:
           A Review of 34 Cases

    • Authors: Isabel Rosa, Francisco Guerreiro
      Abstract: Introduction: Fournier’s gangrene is a serious necrotizing infection that can be fatal if not promptly attended. Treatment for this condition consists of a combination of surgical debridement, antibiotherapy and supportive care. Hyperbaric oxygen therapy is used as an adjuvant for the optimization of infected tissue oxygenation and for its bactericidal and bacteriostatic effects.
      Material and Methods: The data presented in this study encompass a period of 25 years of clinical records of patients with Fournier’s gangrene that had been treated at our center with hyperbaric oxygen therapy.
      Results: A total of 34 patients were treated. The vast majority of patients were males (94.1%) with a mean age of 53.7 years. Urinary tract was the most frequent source of infection and diabetes was most common comorbidity seen in patients. Mortality rate was 20.8%.
      Discussion: The most common observed comorbidity was diabetes, suggesting diabetes as one predisposing factor. The majority of deceased patients had diabetes, although no significant correlation between diabetes and death was found. The area of residence of patients may affect patients’ referral to these facilities.
      Conclusions: Although Fournier’s gangrene is a rare condition, it is nevertheless a fatal illness, namely in patients with comorbidities like diabetes. Hyperbaric oxygen therapy is recommended as an adjuvant to conventional therapy and should be considered whenever available. To further assess the role of hyperbaric oxygen therapy, in the treatment of this condition, additional studies should be carried out.
      PubDate: 2015-09-17
      Issue No: Vol. 28 (2015)
  • Mediterranean Spotted Fever: Retrospective Review of Hospitalized Cases
           and Predictive Factors of Severe Disease

    • Abstract: Introduction: Mediterranean spotted fever, an ancient zoonotic disease raising current issues. This study aims to reevaluate the disease clinical picture and to identify prognostic factors related to severe disease.
      Material and Methods: We evaluate cases admitted to a central hospital during 12-year period. The risk factors were determined by uni and multivariate analysis, comparing patients admitted in general infirmary versus intermediate/intensive care units or in case of death.
      Results: We reviewed 71 cases of Mediterranean spotted fever. The mean age was 63.3 ± 16.7 years and 52.1% were male. The eschar was observed in 62.0%. Fever and rash were the most common clinical findings. Forty five percent of patients developed complications and 22.5% were admitted to intermediate and/or intensive care units. Apyrexia, dyspnea, renal failure and elevated lactic dehydrogenase levels at admission were predictors of severe disease development (p < 0.034). Alcoholism was related with prolonged hospitalization (p = 0.020). Absence of fever (p = 0.019) and elevated serum creatinine levels (p = 0.028) were identified as independent factors associated with severe outcome. The mortality rate was 2.8%.
      Discussion: Although Mediterranean spotted fever is usually assumed to be benign, severe cases are emerging.
      Conclusion: Early identification of the infection and continuous patient surveillance are crucial, particularly in those with greater risk of developing severe or fatal disease.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology' A
           Case-Control Study

    • Abstract: Introduction: It is still unclear whether the etiology of ischemic stroke differs between cancer and non-cancer patients. Stroke and cancer share common modifiable risk factors but evidence suggests that cancer patients have specific conditions that increase the risk of stroke. Our goal was to compare the etiology of ischemic stroke in cancer and non-cancer patients.
      Material and Methods: Case-control study conducted in patients admitted to a stroke unit between January 2007 and December 2012. Cases had a concomitant diagnosis of cancer and acute ischemic stroke, controls of only stroke. Age, gender, vascular risk factors and etiology were compared between groups.
      Results: Fifty-six cases were identified; 64.3% were men with a mean age of 71 years; 21 patients had evidence of active cancer. Gastrointestinal cancer (25.9%) was the most common; 151 controls were included matched for gender and age. Common modifiable vascular risk factors, between groups (cases versus controls) were not significantly different, except for diabetes mellitus, more frequent in the control group (16.1% vs 33.8%, p = 0.02). Previous thrombotic events were more frequent in the cancer cohort (8.9% vs 0.7%, p = 0.007). Other determined etiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (13.0% vs 0.8%, p < 0.01), and a hypercoagulable state was significantly more prevalent in active cancer patients.
      Discussion: In our case-control study two subsets of cancer patients were delineated. In a subgroup, cancer and stroke co-exist, sharing traditional vascular risk factors. In another subset of patients, stroke appears to be directly related to the presence of a malignancy, where hypercoagulopathy turns out to be a decisive mechanism.
      Conclusion: In clinical grounds, hypercoagulopathy as stroke etiology should prompt the physician to screen the patient for occult cancer.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Suicidal Behavior among Portuguese Psychiatry Trainees: Comparison with
           the European Situation

    • Abstract: Introduction: The aim of this paper was to assess the prevalence of suicide ideation and attempts in Portuguese psychiatry trainees (adult and child and adolescence), and compare the data with the general population and other European countries.
      Material and Methods: A structured and anonymous questionnaire was sent by email to 159 portuguese trainees of adult psychiatry and child and adolescence psychiatry with questions about personal history of suicidal ideation and suicide attempts, as well as family history of suicide attempts and completed suicides. This is part of the BoSS Study (Burnout Syndrome Study) performed in 21 countries worldwide. Data was analysed in SPSS v.19.
      Results: From the inquired population, 62 trainees (40,3%) partially responded, and 46 (29%) were complete responders - these entered the final analysis. There was a ratio of 2:1 (female:male) and a mean age of 29 years. The suicidal ideation was present in passive form in 44% and in active form in 33%; also, 4.3% of respondents had previous suicide attempts. In first degree relatives, 22% had attempted suicide and 13% completed suicide.
      Discussion: The results are worriying and may be associated with some factors to which this population is exposed.
      Conclusion: It is necessary further research to better understand this phenomenon, its causes and potential modifiers.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Haemorrhagic Gingival Hypertrophy: A Striking Presentation of Acute
           Myelomonocytic Leukaemia

    • Abstract: Keywords: Gingival Hypertrophy; Leukemia, Myelomonocytic, Acute.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Alcohol and Youth in Portugal: An Intervention Through the Triangle

    • Authors: Sofia Ribeiro, Sara Silvestre
      Abstract: Keywords: Adolescent; Alcohol Drinking; Portugal.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Pantothenate Kinase Associated Neurodegeneration in Two Brothers

    • Abstract: Keywords: Neurodegenerative Diseases; Phosphotransferases (Alcohol Group Acceptor); Siblings.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Auto-Immune Pancreatitis: The Diagnostic Role of Imaging Studies

    • Abstract: Auto-immune pancreatitis is an uncommon and underdiagnosed pathology. Its clinical picture is not specific and the diagnosis is therefore difficult. Imaging studies have a crucial role in the diagnostic process and also in the follow-up of treatment. With the objective of emphasizing the importance of imaging in the correct diagnosis of this pathology, the authors report the case of a patient with longterm unspecific abdominal complaints that was diagnosed as auto-immune pancreatitis after laboratorial and imaging investigation. Assuming this diagnosis it was instituted treatment with oral methylprednisolone, which succeeded, with progressive resolution of the clinical, laboratorial and imaging findings.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Takotsubo Cardiomyopathy: Cause of a Cardiogenic Shock

    • Abstract: Takotsubo cardiomyopathy, of unknown etiology, is characterized by sudden and transient systolic dysfunction of the mid-apical segments of the left ventricle without significant coronary disease, and full normalization of segmental changes. More common in middle-aged women, it is cause of differential diagnosis with acute coronary syndrome. We present the case of a 59 year old woman admitted to the emergency room with sudden chest pain and dyspnea. At presentation: acute hypotensive pulmonary edema requiring aminergic support and invasive ventilation. Blood tests showed elevated necrosis myocardial enzymes. Serial electrocardiograms: sinus rhythm with progressive inversion of the T wave through the precordial leads (v2 - v6). Control echocardiograms: overall decreased
      systolic function with apical akinesia, and full reversal of the changes in 2 weeks. Cardiogenic shock of unknown etiology was admitted and a coronary computed tomography angiography was performed excluding coronary heart disease, supporting the diagnosis of Takotsubo cardiomyopathy.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Hypothyroidism Associated to TSH Hormone-Receptor Autoantibodies with
           Blocking Activity Assessed In Vitro

    • Abstract: Thyroid-stimulating hormone-receptor autoantibodies normally causes hyperthyroidism. However, they might have blocking activity causing hypothyroidism. A 11-year-old girl followed due to type 1 diabetes mellitus, celiac disease and euthyroid lymphocytic thyroiditis at diagnosis. Two years after the initial evaluation, thyroid-stimulating hormone was suppressed with normal free T4; nine months later, a biochemical evolution to hypothyroidism with thyroid-stimulating hormone-receptor autoantibodies elevation was seen; the patient remained always asymptomatic. Chinese hamster ovary cells were transfected with the recombinant human thyroid-stimulating hormone -receptor, and then exposed to the patient´s serum; it was estimated a ‘moderate’ blocking activity of these thyroid-stimulating hormone-receptor autoantibodies, and concomitantly excluded stimulating action. In this case, the acknowledgment of the blocking activity of the serum thyroid-stimulating hormone-receptor autoantibodies, supported the hypothesis of a multifactorial aetiology of the hypothyroidism, which in the absence of the in vitro tests, we would consider only as a consequence of the destructive process associated to lymphocytic thyroiditis.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Monoclonal Antibodies for Multiple Sclerosis Treatment

    • Authors: Filipe Palavra
      Abstract: Since their introduction in medical therapy, in the last quarter of the 20th century, monoclonal antibodies have gained an increasing importance in the treatment of various diseases. Neurology has been one of the medical specialties benefiting of the therapeutic potential of these monoclonal antibodies and certain neurological conditions may now contain such drugs in their therapeutic algorithms. Multiple sclerosis is one of these diseases and, in addition to the monoclonal antibodies already licensed for clinical use, several others are in development for future utilization in this specific area. The future will certainly pass through this kind of drugs and, in this article, a review of the most relevant data related to monoclonal antibodies already in use and also in clinical development for multiple sclerosis treatment will be performed.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Periarticular Corticosteroid Injection in the Therapeutic Approach of
           Musculoskeletal Disease in General Practice: A systematic Review

    • Authors: Irene Trindade
      Abstract: Introduction: Periarticular corticosteroid injection utilization by General Practitioners treating musculoskeletal disease in primary health care system is internationally acknowledged. This article aims at analyzing this evidence and contributing to the discussion of a potential development of the technique in Portugal.
      Material and Methods: Qualitative analysis of randomized control trials, cost-effectiveness studies, cross-sectional studies, retrospective cohort studies and observational studies, using PRISMA model. Data Sources: PubMed, Cochrane Library and Essential Evidence Plus. Eligibility criteria: corticosteroid injection mention in the treatment of musculoskeletal disease and an element that indicates primary health care context.
      Results: Nine randomized control trials, three cost-effectiveness studies, three cross-sectional studies, three descriptive studies and one retrospective cohort study were reviewed. Most success parameters of corticosteroid injections performed by general practitioners showed short term efficacy; at long term they did not outstand other therapeutic options. The balance between the economic burden ascribed to this technique utilization in primary health care context and gain in subject’s quality of life is favorable. The eleven studies assessing security registered only minor side effects and no serious ones.
      Discussion: The periarticular corticosteroid injection technique performance places it as a therapeutic option treating musculoskeletal disease in Portuguese primary health care. Nevertheless further evidence is required to support its efficacy and safety parameters, namely at national level.
      Conclusion: Corticosteroid injection utilization in primary health care constitutes an effective and safe option, with the potential to improve primary health care service rendering in an economically sustainable way.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • The Importance of Early Referral in Pediatric Acute Liver Failure

    • Abstract: Introduction: Acute liver failure is a rare disorder associated to high morbidity and mortality despite survival improvement through liver transplantation. The importance of a multidisciplinary approach and early referral to a pediatric liver transplantation center were important conclusions of a national meeting in 2008, from which resulted an actuation consensus.
      Objectives: To characterize acute liver failure admissions in a Pediatric Intensive Care Unit of the portuguese pediatric liver
      transplantation center. To compare results before (A) and after (B) 2008.
      Material and Methods: Observational, retrospective study during a 20 year period (1994-2014). Inclusion criteria: age < 18 years old and acute liver failure (INR ≥ 2 without vitamin K response and hepatocellular necrosis). Children with previous liver disease were excluded.
      Results: Fifty children were included, with median age of 24.5 months. The most common etiology under 2 years old was metabolic (34.6%) and above that age was infectious (29.2%). Forty six percent were submitted to liver transplantation and 78% of them survived. Overall mortality was 34%. Median referral time was 7 days in period A (n = 35) and 2 days in period B (n = 15; p = 0.006). Pediatric risk of mortality´s median was 14.7 in period A and 6.5 in B (p = 0.019). Mortality was 37% vs 26% in periods A and B, respectively (p = 0.474).
      Discussion and Conclusions: Overall mortality was similar to the observed in other European centers. Liver transplantation is in fact the most effective therapeutic option. After 2008, there was a reduction in referral time and cases severity on admission; however, mortality has not reduced so far.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Neonatal Morbidity in Term Newborns Born by Elective Cesarean Section

    • Authors: Maria Cristina Resende, Lea Santos, Isabel Santos Silva
      Abstract: Introduction: International guidelines suggest that non-urgent planned deliveries be scheduled at or after 39 weeks. Despite this recommendation elective cesarean often occurs before 39 weeks. Some research has demonstrated that elective cesarean before 39 weeks poses a greater risk to the infants than at or after 39 weeks.
      Objective: To evaluate neonatal morbidity in term newborns born by elective cesarean section.
      Material and Methods: Retrospective study of all term elective cesarean sections (scheduled and without labor) performed in level III maternity, in the last 11 years (2003 - 2013). High risk pregnancies were excluded: twins, premature rupture of membranes, preeclampsia, poorly controlled diabetes mellitus, Rh isoimmunization and congenital malformations. Two groups of newborns with gestational age less than 39 weeks and equal or greater than 39 weeks gestational age were compared.
      Results: In our sample, 45% of elective caesarean sections were performed before 39 weeks. Infants born before 39 weeks were more frequently admitted in neonatal intensive care, odds ratio 2.4 [1.4 – 4.1] p = 0.001, had more respiratory morbidity, odds ratio 2.4 [1.6 - 3.8] p < 0.001, more hyperbilirubinaemia odds ratio 2.3 [1.5 – 3.7] p < 0.001, more hypoglycaemia and/or feeding difficulties odds ratio 1.6 [1.2 – 2.4] p = 0.006, and longer admissions (more than five days), odds ratio 2.0 [1.4 - 3] p < 0.001.
      Discussion: As in other studies ‘early term’ had higher respiratory and metabolic morbidity and consequently had a longer hospital stay.
      Conclusion: These findings support recommendations to delay elective cesarean delay until 39 weeks of gestation.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Current Clinical Indications for Small Bowel Capsule Endoscopy

    • Abstract: Introduction: Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice.
      Material and Methods: Bibliographic review of relevant and recent papers indexed in PubMed.
      Results and Discussion: Small bowel capsule endoscopy enables a non-invasive full-assessment of the small bowel mucosa, with high diagnostic yield even for subtle lesions. In patients with obscure gastrointestinal bleeding, diagnostic yield is higher when performed early after the onset of bleeding. Endoscopic treatment of angioectasias using balloon-assisted enteroscopy may contribute to reduce rebleeding, while the risk of rebleeding in patients with “negative“ small bowel capsule endoscopy is debatable. Cross-sectional imaging
      may be more accurate than small bowel capsule endoscopy for the diagnosis of large small bowel tumors. The Smooth Protruding Index on Capsule Endoscopy (SPICE score) may help to differentiate submucosal tumors from innocent bulges. Small bowel capsule endoscopy is also a key diagnostic instrument in patients with suspected Crohn’s disease and non-diagnostic ileocolonoscopy; it may also influence prognosis and therapeutic management, by determining disease extent and activity in patients with known Crohn’s disease. The role of small bowel capsule endoscopy to investigate possible complications in patients with non-responsive coeliac
      disease is evolving.
      Conclusions: Small bowel capsule endoscopy is a valuable diagnostic instrument for patients with obscure gastrointestinal bleeding and/or suspected small bowel tumors; it may also be a key examination in patients with suspected Crohn’s disease, or patients with known Crohn’s disease to fully assess disease extension and activity; finally, it may contribute for the diagnosis of complications of non-responsive coeliac disease.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Translation, Cultural Adaptation and Validation of the Power of Food Scale
           for Use by Adult Populations in Portugal

    • Authors: Gabriela Ribeiro, Osvaldo Santos, Marta Camacho, Sandra Torres, Filipa Mucha-Vieira, Daniel Sampaio, Albino J. Oliveira-Maia
      Abstract: Introduction: The Power of Food Scale measures appetite for, rather than consumption of, palatable foods - a construct frequently designated as hedonic hunger. The purpose of this study was to examine the psychometric properties of a Portuguese version of the Power of Food Scale, namely reliability and construct validity.
      Material and Methods: Data was obtained from 1266 adult participants sampled from three different populations in Portugal: two nonclinical samples and one multi-center sample of severely obese candidates for weight-loss surgery.
      Results: We found that the factor structure of the Portuguese version of the Power of Food Scale is similar to that of the original scale and that the Portuguese version of the Power of Food Scale has good internal structure, test-retest reliability and construct validity. In addition, we provide the first contribution towards defining population norms for Power of Food Scale scores.
      Discussion: The Portuguese version of the Power of Food Scale proved to have good psychometric properties: it is a valid and reliable tool for measuring hedonic hunger, supporting its use both in clinical and non-clinical samples, as well as in prospective studies.
      Conclusion: Our results show that the Portuguese version of the Power of Food Scale is a useful measure for researchers and clinicians who are interested in exploring the construct of hedonic hunger in Portuguese-speaking populations, including those suffering from obesity.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Quality of Recovery after Anesthesia: Validation of the Portuguese Version
           of the “Quality of Recovery 15” Questionnaire

    • Abstract: Background: The “Quality of Recovery 15” questionnaire is used for the study of quality recovery after anesthesia. The aim of this study was to validate the Portuguese version of “Quality of Recovery 15” questionnaire.
      Material and Methods: After study approval by the institutional ethics committee, an observational and cohort prospective study was conducted on patients scheduled for elective surgery from June to August 2013. The “Quality of Recovery 15” questionnaire was translated in accordance with available guidelines. The “Quality of Recovery 15” Portuguese version was used before surgery (T0) and 24h postoperatively (T1) on 170 patients. Patients who were unable to give informed consent or had cognitive impairment were excluded. Poor quality of recovery was defined for “Quality of Recovery 15” score at T1 lower than the mean “Quality of Recovery 15”
      score minus 1 standard deviation. Reliability and observer disagreement was assessed using interclass correlation. Non-parametric tests were used for comparisons.
      Results: There was a negative correlation between “Quality of Recovery 15” score and time spent in the postanesthesia care
      (ρ = −0.264, p = 0.004) and length of hospital stay (ρ = −0.274, p = 0.004). Thirty-two patients (19%) had poor quality of recovery. Patients with poor quality of recovery had more frequently diabetes mellitus and hypertension and they were taking antidepressants drugs more frequently. Patients with poor quality of recovery were more frequently submitted to combined anesthesia and less frequently to general anesthesia and locoregional anesthesia (p = 0.008). The questionnaire had a good internal consistency and test–retest reliability was good.
      Discussion: The Portuguese version of the “Quality of Recovery 15” showed a good correlation with the original.
      Conclusion: This questionnaire appears to be an accurate and reliable assessment for quality of recovery.
      PubDate: 2015-09-11
      Issue No: Vol. 28 (2015)
  • Thirdhand Smoke: A Concept to Remember!

    • Abstract: Keywords: Tobacco Smoke Pollution; Smoking.
      PubDate: 2015-09-01
      Issue No: Vol. 28 (2015)
  • Characterization and Evolution of Avoidable Admissions in Portugal: The
           Impact of Two Methodologic Approaches

    • Abstract: Introduction: The aim of this study is to evaluate the health systems performance through the avoidable hospital admissions, once these have gained international relevance. We used two different methods to identify the admissions for Ambulatory Care Sensitive Conditions, describing the Portuguese reality and evolution.
      Material and Methods: Over 12 million hospitalizations were analyzed between 2000 and 2012 using the national hospital discharge databases. We used two different methodologies to identify the hospitalizations for Ambulatory Care Sensitive Conditions, determining their concordance. We also estimated potential improvement scenarios.
      Results: In 2012, 4.4% and 32.4% of the hospitalizations for medical causes were avoidable according to the Canadian and Spanish methodologies respectively. The hospitalizations are more frequent in children and the elderly. The most frequent causes vary according to the age group and methodology. During the analyzed period the rate of admissions has dropped 20% according to the Canadian methodology and increased 16% according to the Spanish methodology. There are regional clusters of performance under and above the national average. The concordance between methodologies is low. The improvement scenarios estimated possible reductions between 20.3% and 53.5% of the hospitalizations.
      Discussion: The avoidable admissions assume a relevant volume in Portugal. Although in theory they are avoidable their complete elimination is a practical impossibility. Their study, however, allows the evaluation and results motorization enabling to establish intervention priorities.
      Conclusion: To have a precise characterization of the avoidable admissions in Portugal it is necessary to achieve consensus on the identification methodology.
      PubDate: 2015-09-01
      Issue No: Vol. 28 (2015)
  • Prediction of Success in External Cephalic Version under Tocolysis: Still
           a Challenge

    • Abstract: Introduction: External cephalic version is a procedure of fetal rotation to a cephalic presentation through manoeuvres applied to the maternal abdomen. There are several prognostic factors described in literature for external cephalic version success and prediction scores have been proposed, but their true implication in clinical practice is controversial. We aim to identify possible factors that could contribute to the success of an external cephalic version attempt in our population.
      Material and Methods: We retrospectively examined 207 consecutive external cephalic version attempts under tocolysis conducted between January 1997 and July 2012. We consulted the department’s database for the following variables: race, age, parity, maternal body mass index, gestational age, estimated fetal weight, breech category, placental location and amniotic fluid index. We performed descriptive and analytical statistics for each variable and binary logistic regression.
      Results: External cephalic version was successful in 46.9% of cases (97/207). None of the included variables was associated with the outcome of external cephalic version attempts after adjustment for confounding factors.
      Discussion: We present a success rate similar to what has been previously described in literature. However, in contrast to previous authors, we could not associate any of the analysed variables with success of the external cephalic version attempt. We believe this discrepancy is partly related to the type of statistical analysis performed.
      Conclusions: Even though there are numerous prognostic factors identified for the success in external cephalic version, care must be taken when counselling and selecting patients for this procedure. The data obtained suggests that external cephalic version should continue being offered to all eligible patients regardless of prognostic factors for success.
      PubDate: 2015-08-21
      Issue No: Vol. 28 (2015)
  • Professional Medical Writing: A Tool for High Quality Publications

    • Abstract: Keywords:
      Authors hip; Interprofessional Relations; Periodicals as Topic.
      PubDate: 2015-08-21
      Issue No: Vol. 28 (2015)
  • Streptococcus pneumoniae Vaccination in Children and Adolescents at High
           Risk of Invasive Pneumococcal Disease

    • Abstract: Background: In Portugal, pneumococcal vaccination is free of charge and recommended by the Directorate-General of Health for the pediatric population at high risk of invasive pneumococcal disease. Our main aim was to describe the vaccination uptake in a pediatric population attending a hospital outpatient clinic.
      Material and Methods: Cross-sectional observational survey of a pediatric population attending a referral hospital outpatient clinic, from July to December 2014. Data was collected from clinical records, Individual Health Bulletin or the registry from Plataforma de Dados da Saúde®.
      Results: Of the 122 participants, 95.9% had, at least, one shot of pneumococcal vaccine, but only 64.8% of these completed the age recommended vaccination scheme. Uptake was higher in children < 5 years old. The proportion of complete vaccination schemes was 100% in hemoglobinopathies and human immunodeficiency virus infection groups, 66.7% in prematures, 62.5% in splenectomized and 54.7% in Down syndrome. Children had better complete vaccination schemes when they attended the Pediatric Infectious Disease (100%) and Pulmonology Clinics (88.2%). Children > 5 years old had a higher uptake of 23-valent polysaccharide vaccine than the 2 to 5-years old ones (74.5% vs 40.5%; p < 0.001).
      Discussion: Most of our pediatric population at high risk of IPD was vaccinated; nevertheless, only two-thirds had completed the scheme for their age. The main failure was on the 23-valent polysaccharide vaccine administration.
      Conclusions: Although these results are better than those reported in other European countries with similar recommendations, it is essential to explore the causes for the observed flaws in order to optimize vaccination rates.
      PubDate: 2015-08-13
      Issue No: Vol. 28 (2015)
  • Electronic Cigarette: Position of the Portuguese Society of Pneumology

    • Abstract: Keywords: Electronic Cigarettes/adverse effects; Nicotine; Portugal; Smoking Cessation/methods.

      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
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