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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]
  • Auditory Neuropathy: Clinical Evaluation and Diagnostic Approach

    • Pages: 353 - 359
      Abstract: Introduction: Auditory neuropathy is a condition in which there is a change in the neuronal transmission of the auditory stimuli. Our objective was to describe the patients’ series within the clinical spectrum of auditory neuropathy.
      Material and Methods: We designed a transversal, retrospective study, with a description of a consecutive case series. Auditory neuropathy was defined by the presence of acoustic otoemissions plus absent/abnormal auditory brainstem responses with cochlear microphonism.
      Results: 34 patients with bilateral hearing loss, 23 males and 11 females, were included in the study. Eighty percent of the cases had congenital onset of hearing loss. Acoustic otoemissions were absent in 67% of them. Cochlear microfonism was present in 79% of all cases. Prenatal, perinatal or ambiental factors were present in 35.2% of the cases.
      Discussion: Medical literature shows great variability in findings related to auditory neuropathy, both in its etiology and epidemiological data.
      Conclusion: Auditory neuropathy presents a broad spectrum of changes that may result from mild to severe changes in the functioning of the auditory pathway, and in our sample we observed that 80% of Auditory neuropathy have congenital onset of hearing loss and/or with cochlear microphonism identified. 91% of patients experience significant hearing impairment and 53% suffer from severe or profound deafness.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Study of the Sociodemographic Factors and Risky Behaviours Associated with
           the Acquisition of Sexual Transmitted Infections by Foreign Exchange
           Students in Portugal

    • Pages: 360 - 366
      Abstract: Background: Sexual transmitted infections are a main cause of morbidity, being a public health problem due to its reproductive complications, mostly observed in teenagers and young adults. The purpose of this study was to evaluate sociodemographic factors and risky behaviours associated with sexual transmitted infections acquisition and to assess personal awareness of risky behaviour and the knowledge about Chlamydia trachomatis infection between foreign exchange students in Portugal.
      Material and Methods: The main instrument for data collection was a questionnaire, applied to foreign students in university exchange in Portugal, during the years 2012/2013, 2013/2014 e 2014/2015
      Results: Three hundred and thirty eight (338) questionnaires were evaluated, being 58.3% female students, aged between 17 and 30 years old. Mean age for the beginning of the sexual activity was 17.5 years old and the mean number of lifetime sexual partners was 6.9. Concerning the answers given: 11.8% mentioned a sexual relationship with the same gender, 9.5% mentioned that they have never done oral sex and 29% assumed they had practiced anal sex; 82.1% mentioned alcohol/drugs consumption; 21% did not know that Sexual transmitted infections can be transmitted through oral sex and 42.3% did not recognize Chlamydia trachomatis as an Sexual transmitted infections agent.
      Discussion: Although sexual transmitted infections can affect individuals of all ages, races and sexual orientation, various demographic, social and behavioral factors have revealed influence in their prevalence rates.
      Conclusion: Despite knowing about sexual transmitted infections, these students maintain sexual risky behaviours, mainly early age for starting sexual activity, multiple sexual partners and the absence of protection during sexual activities.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Establishing the Role of Unlinked Total Elbow Arthroplasty in Low Demand
           Patients: A Long-Term Follow-up Study

    • Authors: Sara Machado, Isabel Almeida Pinto, Rui Pinto, Paulo Ribeiro de Oliveira
      Pages: 367 - 372
      Abstract: Introduction: Experience with total elbow arthroplasty is scarce in most centers. It seems to have a significant rate of associated complications. Most studies are based on non-validated outcome measures and short-term results.
      Material and Methods: We selected patients undergoing unlinked total elbow arthroplasty, with a resultant sample of thirteen cases, with a mean postoperative follow-up of 72 months. We applied the Mayo Elbow Score and all patients underwent an X-ray study, prior to surgery and during the follow-up period.
      Results: All patients have a systemic inflammatory condition. The mean Mayo score increased from 43 points preoperatively to 70 and 80 points at the intermediate follow-up period (with a mean of 15 months after the operation) and at the time of the latest follow-up evaluation (with a mean of 72 months after the operation). There was an increase in range of motion in all cases. There was one case of mechanical failure and two cases of transient ulnar neuropathy.
      Discussion: Elbow dysfunction causes great loss in patient´s quality of life, incapacitating them for the simplest activities. Small improvements in range of motion and pain relief result in significant changes in the patient’s functional ability. There is a demand to clarify the performance of total elbow arthroplasty in selected patient groups in order to throw more light on the relative roles of the available implants.
      Conclusions: The results obtained in this study seem to confirm the long-term benefit of the unlinked arthroplasty in severe joint dysfunction in patients with low physical demand, particularly in rheumatoid arthritis, a common and limiting condition in our population.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Multidimensional Strategy Regarding the Reduction of Central-line
           Associated Infection in Pediatric Intensive Care

    • Pages: 373 - 380
      Abstract: Introduction: To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate.
      Material and Methods: A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2).
      Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter.
      Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection
      Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Percutaneous Endovascular Aortic Repair with Local Anesthesia – One
           Day Surgery

    • Pages: 381 - 388
      Abstract: Introduction: To evaluate the results of the abdominal aortic aneurism endovascular treatment (EVAR), percutaneously and with local anesthesia, according to the concept of one day surgery.
      Material and Methods: Unicentric, retrospective analysis of patients with aorto-iliac aneurysmal disease, consecutively treated by EVAR with percutaneous access trough the Preclose technique (pEVAR), according to the outpatient criteria, with one overnight stay in the hospital. The technical success, exclusion of the aneurysmal sac, endoleak, re-intervention and mortality were evaluated.
      Results: Twenty consecutive patients (all male; mean age 74.65 years) were treated by EVAR with percutaneous access and local anesthesia, from which 95% (19) presented with abdominal aortic aneurysm and 5% (1) common iliac aneurysm. All implants were sucessfully performed, with an initial endoleak rate of 10% (2), determined by one type 1a endoleak successfully corrected intra-operatively and one type 2a endoleak diagnosed in the first imaging control, which sealed spontaneously on the second control. Initial technical success for percutaneous closure was 97.5%, with one case reported of femoral pseudo-aneurism, posteriorly treated by percutaneous thrombin injection. Median length of stay was one day [1-10], with a mean follow-up of 11.4 months [1-36]. Both the re-intervention and mortality rate are 0% for the selected period.
      Conclusion: Our one day surgery model for the outpatient treatment of abdominal aortic aneurysm by the pEVAR technique is innovative, safe and effective, as long as the selection criteria are respected.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • HIV/AIDS Indicators for Clinical Care Quality Assessment: Relevance and
           Utility Assessed by Health Professionals

    • Pages: 389 - 400
      Abstract: Introduction: After conducting a systematic review of quality indicators for assessing HIV/AIDS clinical care, we aimed to assess the clinical relevance and practice utility of those indicators from the point of view of HIV/AIDS physician experts.
      Material and Methods: This is an observational, cross-sectional study, in which we selected, by convenience, physicians who work in an Infectious Disease Department of a central hospital to complete two questionnaires with a core set of indicators to establish the most relevant and useful indicators for assessment of the clinical HIV/AIDS care. A Likert scale was used to rank the indicators.
      Results: Eleven of thirteen physicians filled two questionnaires. From the initial list of 53 quality indicators, 21 were identified as the most relevant and useful in HIV/AIDS clinical care. The internal consistency for clinical relevance in each indicators domain was for clinical signs and symptoms (p = 0.971), for therapy (p = 0.900), for prognosis (p = 0.820) and diagnosis (p = 0.733) and for practice utility were diagnosis (p = 0.934), clinical signs (p = 0.964), laboratory examinations (p = 0.947), therapy (p = 0.583) and prognosis (p = 0.368).
      Discussion: In the process of assessing the clinical relevance and practice utility of HIV/AIDS quality care indicators, it was found that the majority of physicians agreed that diagnosis and clinical symptoms and signs indicators domains are the most important for assessing the quality of care for HIV/AIDS patients.
      Conclusion: This instrument should be considered as a diagnostic tool, allowing hospital administrators to identify if HIV/AIDS care is properly delivered or needs improvement.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Efficacy of the Vaccines Against Human Papillomavirus in Women Older than
           24 Years in the Cervix Cancer Prevention

    • Authors: Jaime Pimenta Ribeiro, Isabel Borges
      Pages: 401 - 408
      Abstract: Introduction: Cervix cancer is the fourth most common female cancer and the second most frequent in women aged 15 to 44 years. The infection by the human papillomavirus is a necessary condition in almost all of cervix cancer cases; it is a sexually transmitted disease and all women sexually active are at risk of being infected. There are currently three vaccines against human papillomavirus, and despite of the efficacy being well proven in woman aged up to 25 years, it is not well established in older ages.
      Material and Methods: It was performed a literature review of the current evidence about the efficacy of the vaccines against human papillomavirus in women older than 24 years in the cervix cancer prevention, and was assessed the evidence quality by the GRADE system.
      Results: Two randomized controlled trials were identified with a total of 9,571 participants – 4,792 vaccinated and 4,779 at the control group and reported data of 48 months period follow-up. The relative risk reduction was 41% (95% CI: 29 a 50%) – for the vaccinated group. There were no differences in safety and tolerability between the two groups – vaccine and control.
      Conclusion: The actual evidence shows that the vaccines against human papillomavirus 16 and/or 18 in women older than 24 until 45 years have an important efficacy at reducing the risk of having persistent infection and/or to acquire cervix cancer precursor lesions.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Massive Upper Airway Bleeding: A Rare Case of Aortobronchial Fistula

    • Pages: 409 - 412
      Abstract: Clinical presentation of haemoptysis and haematemesis often generates confusion, becoming a difficult task to determine the source of upper airway bleeding. Aortobronchial fistula is a rare entity, but has been a reported complication in patients that have undergone aortic vascular surgery. A high clinical suspicion is fundamental to making this diagnosis. A 69 year old male, with a previous diagnosis of chronic gastritis, is admitted to the emergency room for vomiting blood. In the first 24 hours after admission, the patient develops respiratory insufficiency after an episode of massive bleeding from his mouth. A computed tomography is performed, which shows a descending thoracic aortic aneurism and signs of aortobronchial fistula. Urgent thoracic endovascular repair was performed. Early symptoms of aortobronchial fistulae are nonspecific which complicates the diagnosis and can lead to treatment delay. The use of bronchoscopy in these cases is controversial.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Endometrial Tuberculosis Simulating an Ovarian Cancer: a case report

    • Authors: Silvia Eleonora Di Giovanni, Teresa Margarida Cunha, Ana Luisa Duarte, Ines Alves
      Pages: 412 - 415
      Abstract: Female genital tuberculosis remains a major health problem in developing countries and is an important cause of infertility. As symptoms, laboratory data and physical findings are non-specific, its diagnosis can be difficult. We describe a case of a 39-year-old woman suffering from peri-umbilical pain and increased abdominal size for one year, anorexia, asthenia, weight loss, occasionally dysuria and dyspareunia, and four months amenorrhea. Laboratory data revealed cancer antigen 125 (CA-125) level of 132.3 U/mL, erythrocyte sedimentation rate of 42 mm/h, and gamma-globulins of 2.66 g/dL. Computed Tomography scan showed loculated ascites. It was initially suspected a carcinomatous origin, but ascites evaluation was negative for malignant cells. Magnetic Resonance Imaging from another hospital showed endometrial heterogeneity. Therefore, an endometrial biopsy was performed demonstrating an inflammatory infiltrate with giant cells of type Langhans and bacteriological culture identified Mycobacterium tuberculosis.
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Pyogenic Granuloma in a Patient on Gefitinib

    • Pages: 416 - 416
      Abstract: N/A
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
  • Penile Squamous Cell Carcinoma

    • Authors: Ermelindo Tavares, Margarida Rato, Helena Gomes
      Pages: 417 - 417
      Abstract: N/A
      PubDate: 2016-06-30
      Issue No: Vol. 29, No. 6 (2016)
       
 
 
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