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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]
  • Lessons from London: The BMJ Editorial Process

    • Pages: 291 - 292
      Abstract: n/a
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Magnetic Resonance Imaging Diagnosis of Hepatocellular Carcinoma in
           Cirrhotic Patients: Where Are We Now'

    • Pages: 293 - 296
      Abstract: n/a
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Analysis of the Cochrane Review: Pedicle Screw Fixation for Traumatic
           Fractures of the Thoracic and Lumbar Spine. Cochrane Database Syst Rev.

    • Pages: 297 - 300
      Abstract: Traumatic fractures of the thoracic and lumbar spine are common causes of spine surgery. Pedicle screw fixation is usually chosen, using monosegmentar, short or long segment instrumentations, with or without bone graft. This review aims to evaluate the effect of transpedicular fixation in traumatic fractures of the thoracic and lumbar spine. A systematic search on controlled, randomized or quasi-randomized trials comparing different methods of surgical treatment of this fractures was performed, followed by a process of article selection, data extraction and bias assessment by 3 independent authors. Eight articles were included in a total of 5 comparisons, between different transpedicular fixation techniques. No significant differences on function or quality of life, neurologic status or limitation of motion were found. Only instrumentation with fracture level screw incorporation showed significant decrease of pain when compared with instrumentation alone. Several techniques resulted in significant improvements of different radiological parameters. Significantly, surgeries with smaller duration were associated with lesser blood loss. Bone graft use caused a significant raise in post-operative complications, namely donor site pain. So, this paper showed that significative improvements in radiological parameters do not associate with correspondent clinical benefits, and only instrumentation with level screw incorporation is associated with a clear benefit on pain. Moreover, the need for bone graft is questioned, since it leads to no clinic-radiological improvement with a raise of complications. However, a small number of controlled studies is available on this topic.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Study on Portuguese Medical Schools’ Learning Conditions: A National
           Analysis on Student Satisfaction, Student-Tutor Ratios and Number of

    • Pages: 301 - 309
      Abstract: Introduction: Experiences of clinical and nonclinical learning environments, as well as assessment and study environments influence student satisfaction with their medical schools. Student-tutor ratios may impact on their perception of clinical learning environments. The aim of this study was to analyze medical students’ satisfaction and student-tutor ratios in relation to medical schools’ number of admissions.
      Materials and Methods: A questionnaire was created, regarding learning, assessment and study environments in eight medical schools. 2037 students participated in this cross-sectional study. Cronbach’s alpha (internal consistency) was calculated and principal component analysis was conducted. Pearson correlations and multiple comparisons were analyzed.
      Results: Assessment environments showed the highest satisfaction scores and clinical learning environments the lowest scores. The national student-tutor ratio in clinical rotations is 7.53; there are significant differences among schools. Institutions with higher number of admissions showed the lowest scores of overall student satisfaction (r = -0.756; p < 0.05), which decreased with progression in the medical course. High student-tutor ratios are strongly correlated with low levels of satisfaction regarding clinical learning environments (r = -0.826; p < 0.05).
      Discussion: Clinical learning environments show the lowest satisfaction scores, which may expose the effect of high ratios in clinical rotations. Depending on the number of admissions, significant differences between medical schools were found. Quality of teaching-learning strategies and articulation with hospitals might also be important variables.
      Conclusion: Medical schools with more admissions might be more susceptible to lower scores of student satisfaction. High student-tutor ratios in clinical rotations may reduce the quality of learning experiences and inhibit the acquisition of competences.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Endovascular Treatment of Aortic Aneurysms and Blood Transfusion. What do
           We Need'

    • Pages: 310 - 314
      Abstract: Introduction: Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but there’s no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule.
      Material and Methods: We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients’ age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis’ type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge.
      Results: We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p < 0.001) and between ASA classification and red blood cells units transfused after 24 hours (p < 0.01).
      Discussion: Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012.
      Conclusion: These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Hospital Mortality in Parkinson’s Disease: Retrospective Analysis in
           a Portuguese Tertiary Centre

    • Pages: 315 - 318
      Abstract: Introduction: Parkinson’s disease is associated with high hospital mortality. Male gender, late age at onset, higher disability and the coexistence of cognitive impairment or depression have been suggested to be risk factors of death. Pneumonia and cardiovascular diseases are the leading causes of death.
      Objective: To characterize the mortality (causes of hospital admission and death) of Parkinson’s disease patients in a tertiary hospital, as well as demographic and clinical characteristics.
      Material and Methods: Identification of hospital admissions of Parkinson’s disease patients that resulted in inpatient death between 2008 and 2014. Retrospective review of medical files and inclusion of patients with disease clinically confirmed by a neurologist. Assessment of causes of death and demographic and clinical characteristics of patients.
      Results: 1525 hospital admissions of Parkinson’s disease patients were identified, of which 150 resulted in death. Of these, 52 patients met the inclusion criteria. Mean age at onset of Parkinson’s disease symptoms was 66.8 years (± 8.7) and mean duration of disease was 12.5 years (± 7.9). Sixty-five percent of patients were in stages 4-5 of the Hoehn and Yahr scale. Thirty-three patients (63%) had dementia and eleven (21%) had depression. Infections were the leading cause of death (respiratory in 63% of cases).
      Discussion: Similarly to literature, pneumonia was the leading cause of hospital death and most patients presented advanced disease stage and dementia. Contrarily to other studies, life expectancy was not reduced and cardiovascular diseases and trauma were not causes of death in our population.
      Conclusions: This is the first Portuguese mortality study in Parkinson’s disease. Pneumonia is the leading cause of death. Advanced disease stage and dementia were common features in these patients.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Surgical Treated Spondylodiscitis Epidemiological Study

    • Pages: 319 - 325
      Abstract: Introduction: The term spondylodiscitis aims to describe any spinal infection. Medical treatment is the gold standard; nevertheless, surgical treatment can be indicated. The aim of this work was to study the epidemiological profile in a group of patients with spondylodiscitis surgically treated in the same medical institution between 1997 and 2013.
      Material and Methods: Eighty five patients with spondylodiscitis were surgically treated in this period. The authors analysed clinical data and image studies for each patient.
      Results: We treated 51 male and 34 female patients with an average age of 48 years old (min: 6 - max: 80). The lumbar spine was more often affected and Mycobacterium tuberculosis the most frequent pathogen. The number of cases through the years has been grossly stable, with a slight increase of dyscitis due to Staphylococcus aureus and decrease of the dyscitis without pathogen identification. Paravertebral abscess was identified in 39 patients and 17 had also neurological impairment, mostly located in the thoracic spine and with tuberculous aetheology. Immunosuppression was documented in 10 patients.
      Discussion: In this epidemiologic study we found a tuberculous infection, male gender and young age predominance. Despite a relative constant number of patients operated over the years, pyogenic infections due to Staphylococcus aureus seems to be uprising. Paravertebral abscess and neurological impairment are important dyscitis complications, especially in tuberculous cases.
      Conclusion: Spinal infections requiring surgical treatment are still an important clinical condition. Mycobacterium tuberculosis and Staphylococcus aureus represent the main pathogens with a growing incidence for the latest.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Epidemiology of Vertigo on Hospital Emergency

    • Authors: Luis Roque Reis, Rita Lameiras, Pedro Cavilhas, Pedro Escada
      Pages: 326 - 331
      Abstract: Introduction: Vertigo is one of the most frequent motives in seeking specialized medical care in an emergency. The aim of this study was to evaluate the relevance of balance disorders in the Otorhinolaryngology urgency, the epidemiological characteristics and the possible seasonality. It was used a sample of patients who were assisted in a health care emergency department of this specialty, of a universitary hospital and during a period of four years.
      Material and Methods: The project was conceived as a descriptive epidemiological study of population type, retrospective, during the period from 2010 to 2013. A total population of 40.173 attendances of patients during this period used the emergency eepartment of Otolaryngology. The parameters studied included age, gender, annual number of cases (total and percentage), date of crisis of vertigo, seasonal distribution by seasons and annual proportion of hospitalized cases.
      Results: A total of 4.347 patients (10.8%) sought medical attention due to dizziness/balance disorders over the four years of the study. There has been an annual increase in the number of cases between 7.6% (in 2010) and 17% (in 2013). Women were more often affected (68.3%) and crises occurred more often in individuals between 60 and 79 years of age (40%). The cases were distributed heterogeneous between the seasons, having more episodes of dizziness in summer and autumn and with an increasing trend between 2010 and 2013. The number of hospitalizations has increased annually over this period.
      Discussion: The epidemiology of vertigo and vestibular disorders is still a specific field to study, because it may be useful for clinical decision-making and health care planning.
      Conclusion: The study revealed that cases of vertigo in urgency increased annually and are more frequent in women, in elderly population and in Summer and Autumn.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Attachment Strategies and Neuroendocrine Biomarkers in Obese Children

    • Pages: 332 - 339
      Abstract: Introduction: Quality of the parent-infant relationship influences the mechanisms of development of the child’s physiological stress regulation. This study explored associations between attachment strategies and both cortisol and thyroid stimulating hormone, hypothesized to be respectively a potential mediator and a potential intervening variable of the mother-child relationship in obese children.
      Material and Methods: A sample of 83 obese children (46 boys), aged 10.9 (1.8) years was recruited from a child obesity clinic. Obesity was defined by body mass index percentile adjusted for age and sex. Metabolic biomarkers were measured by routine methods. Attachment strategies were assessed with self and parent-report questionnaires. Family functioning was assessed with parent-reported questionnaires (FACES-III). Multivariate linear regression analyses were performed.
      Results: Type A, avoidant attachment strategies, had significant positive association with thyroid stimulating hormone levels and negative association with cortisol levels (R2 = 0.352). Type B, secure attachment strategies, had significant positive associations with both hypothyroidism and body mass index percentile (R2 = 0.541). “Insecure attachment” (types A and C combined) strategies showed some evidence of positive association with thyroid stimulating hormone (R2 = 0.250).
      Discussion: These findings suggest that there may be commonalities in the regulation of hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes. Processes involved in development of the type A attachment strategy appear to be associated with effects on the regulatory mechanisms of the hypothalamic-pituitary-adrenal axis.
      Conclusions: In obese children, different attachment strategies are associated with diverse metabolic profiles. How this may contribute to developing differentiated treatment approaches remains to be explored.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Foreign Body Aspiration in the Elderly

    • Pages: 340 - 343
      Abstract: Foreign body aspiration is common in children and in the elderly, who may present with subtle symptoms. Clinical suspicion is crucial and bronchoscopy is the main diagnostic and therapeutic procedure available. This is the case of a man, 78 years old, with a history of chronic obstructive pulmonary disease, who presented with respiratory distress following oral intake of tablets. History taking and physical examination raised suspicion. The diagnosis was confirmed with flexible bronchoscopy and rigid bronchoscopy was carried out for treatment. The patient’s condition is stable and he is under investigations for dysphagia.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Oxygen Leukocyte Larceny

    • Authors: Miguel Pinto da Costa, Henrique Pimenta Coelho
      Pages: 343 - 347
      Abstract: The authors present a case of a 60-year-old male patient, previously diagnosed with B-cell chronic lymphocytic leukemia, who was admitted to the Emergency Room with dyspnea. The initial evaluation revealed severe anemia (Hgb = 5.0 g/dL) with hyperleukocytosis (800.000/µL), nearly all of the cells being mature lymphocytes, a normal chest X-ray and a low arterial oxygen saturation (89%; pulse oximetry). After red blood cell transfusion, Hgb values rose (9.0 g/dL) and there was a complete reversion of the dyspnea. Yet, subsequent arterial blood gas analysis, without the administration of supplemental oxygen, systematically revealed very low oxygen saturation values (~ 46%), which was inconsistent with the patient’s clinical state and his pulse oximetry values (~ 87%), and these values were not corrected by the administration of oxygen via non-rebreather mask. The investigation performed allowed to establish the diagnosis of oxygen leukocyte larceny, a phenomenon which conceals the true oxygen saturation due to peripheral consumption by leukocytes.
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Eosinophilic Esophagitis

    • Pages: 348 - 348
      Abstract: n/a
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Massive Vena Cava Thrombus Associated With a Renal Tumor

    • Pages: 349 - 349
      Abstract: n/a
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Letter to the Editor regarding the article: “Secondary Alveolar Bone
           Grafting in Orofacial Cleft: A Survey of a Portuguese Tertiary
           Hospital“ by Ana Isabel Costa, Hélder Morgado, Carlos Mariz,
           José Manuel Estevão-Costa. Acta Med Port 2016;29:210-6.

    • Authors: Marcos Roberto Tovani-Palone
      Pages: 350 - 350
      Abstract: n/a
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
  • Reply to the Letters to the Editor Concerning the Article: Ana Isabel
           Costa, Hélder Morgado, Carlos Mariz, José Manuel
           Estevão-Costa. Secondary Alveolar Grafting and Cleft Lip and Palate.
           Acta Med Port 2016;29:210-6.

    • Pages: 350 - 351
      Abstract: n/a
      PubDate: 2016-05-31
      Issue No: Vol. 29, No. 5 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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