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Journal Cover Acta Médica Portuguesa
  [SJR: 0.148]   [H-I: 15]   [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]
  • Fresh Wind at Acta Médica Portuguesa

    • Authors: Tiago Villanueva
      Pages: 667 - 668
      Abstract: N/A.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Atopic Dermatitis: The New Therapeutic Revolution in Dermatology

    • Authors: Tiago Torres
      Pages: 669 - 670
      Abstract: N/A.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Analysis of the Cochrane Review: Omega-3 Fatty Acids for the Treatment of
           Dementia. Cochrane Database Syst Rev. 2016;4:CD009002.

    • Authors: David Cordeiro Sousa, Guilherme Ferreira Dos SANTOS, João Costa, António Vaz-Carneiro
      Pages: 671 - 674
      Abstract: Dietary supplementation with omega-3 polyunsaturated fatty acids from fish and plant sources is commonly prescribed as a nonfarmacological alternative to improve brain functions and slow down the progression of dementia. This use is mostly based on findings of preclinical studies which established the role of omega-3 polyunsaturated fatty acids in the development and integrity of the brain, as well as epidemiological research that found evidence of malnutrition in patients with dementia. This Cochrane systematic review included three randomized, placebo-controlled trials at low risk of bias, in which omega-3 polyunsaturated fatty acids were administered to people with mild to moderate Alzheimer’s disease in the form of supplements. Of the main results of this systematic review we highlight the lack of convincing evidence for the efficacy of omega-3 polyunsaturated fatty acids supplementation in the treatment of patients with Alzheimer’s disease, as well as the low frequency of reported adverse events, with a comparable overall frequency between omega-3 polyunsaturated fatty acids and the placebo groups. The effects on other populations with dementia remain unclear. This paper aims to summarize and discuss the main results and conclusions of this systematic review, as well as its implications for the daily clinical practice.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • In the Child’s Best Interest: The Contribution of Child and
           Adolescent Psychiatry

    • Authors: Víitor Ferreira Leite, Carla Araújo, Teresa Cartaxo, Luísa Veiga, Mário Jorge Loureiro
      Pages: 675 - 682
      Abstract: Introduction: Child and Adolescent Forensic Psychiatry involves a multidisciplinary assessment at the courts’ requested to assist them in the process of justice delivery.
      Material and Methods: Retrospective study which included 233 forensic requests to two child and adolescent psychiatrists from Coimbra’s HP-CHUC Child and Adolescent Psychiatry Department between 1998 and 2012.
      Results: Biographic, psychopathology, social and family aspects were analyzed. The response time throughout the process, the origin and nature of the request’s and the type of process which originated the request were also assessed. The authors identified the involved professionals and whether they needed to go to court. When there were questions, they evaluated the capacity to answer them, the forensic difficulties and solutions found, and the presence of recommendations.
      Discussion: The obtained results met the clinical experience and literature regarding demography and psychopathology. As for the difficulties, there were a number of aspects which could be improved by both parts, aiming to ameliorate the articulation between Health and Justice.
      Conclusion: With this study it was possible to reflect on the authors forensic practice, in order to develop a closer partnership with the courts to promote the real ‘best interests’ of children/adolescents and their families.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Pain Management, Local Infection, Satisfaction, Adverse Effects and
           Residual Pain after Major Open Abdominal Surgery: Epidural versus
           Continuous Wound Infusion (PAMA Trial)

    • Authors: Rita Araújo, Céline Marques, David Fernandes, Emanuel Almeida, Joana Alves, Mariana Rodrigues, Miguel Ferreira, Ricardo Bernardo, Rita Santa-Bárbara, Sara Freitas, Célia Xavier, Isabel Neves
      Pages: 683 - 690
      Abstract: Introduction: The Management of postoperative pain after abdominal surgery is a major challenge to the anesthesiologist. The optimization of postoperative analgesia improves prognosis contributing also to patient satisfaction and reducing morbidity and mortality. The aim of this randomized control study is to perform the comparative analysis in terms of effectiveness of an unconventional and still poorly technique implemented, continuous wound infusion, and the currently most applied and gold standard technique, epidural analgesia, in the postoperative period after abdominal surgery.
      Material and Methods: Fifty patients, previously subjected to abdominal surgery by median laparotomy with xifo-pubic incision were randomized to receive postoperative analgesia via epidural (n = 25) or via continuous wound infusion (n = 25) during 48 hours. The primary outcome was analysis of pain at rest (< 4/10 numerical pain scale) after 24 hours postoperatively. Scores of pain at six, 12 and 48 hours and three months after surgery were also evaluated, as well as the incidence of adverse effects 48 hours postoperatively.
      Results: The proportion of patients with successful control of postoperative pain was 84% against 60% with epidural analgesia and continuous wound infusion, respectively. Within the continuous wound infusion group with uncontrolled pain, all patients rated the pain below 6/10 24 hours postoperatively. The incidence of nausea, vomiting, pruritus or íleus was lower in the continuous wound infusion group, with statistically significant results for recovery of intestinal function. There was one case of systemic local anesthetic toxicity with an episode of frequent ventricular extrasystoles without hemodynamic instability, which ceased after suspension of continuous epidural infusion of local anesthetic.
      Discussion: This study suggests that continuous wound infusion is the technique with most efficacy and safety, being even better than epidural analgesia in postoperative pain control after major abdominal surgery. This technique is associated with better analgesia, lower incidence of side effects, high level of satisfaction and no residual pain, contributing to enhanced recovery.
      Conclusion: Continuous wound infusion is an effective technique, which should be implemented for analgesia after major abdominal surgery, with advantages when compared with epidural analgesia, especially low incidence of adverse effects.
      Registration: Trial not registered.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Reliability, Stability and Validity of the Brazilian Adaptation of the
           Oliveira Questionnaire on Low Back Pain in Young People

    • Authors: Debora Soccal Schwertner, Raul Oliveira, Ana Paula Ramos Marinho, Magnus Benetti, Thais Silva Beltrame, Renata Capistrano
      Pages: 691 - 698
      Abstract: Introduction: The objective of this study was to adapt the Brazilian version, and verify the validity, reliability and internal consistency of the Oliveira questionnaire on low back pain in young people.
      Material and Methods: The questionnaire was translated from European Portuguese into Brazilian Portuguese by means of translation and re-translation. The validity of the contents was determined by experts who analyzed the clarity and pertinence of the questions. Fifteen young people aged 15 to 18 took part in the pre-test step (qualitative analysis), 40 in the test-retest (reliability) and 679 in the evaluation of internal consistency. The intra-class correlation coefficient and Spearman’s correlation coefficient were used in the reliability analysis (test-retest), and Cronbach’s alpha to determine the internal consistency (stability).
      Results: In the translation phase the questionnaire was modified and considered suitable, observing similarity and equivalence of the two versions. After being corrected by the experts in the validation of the contents, the instrument was considered suitable and valid, and in the pre-test, the young people suggested some modifications to make the questionnaire more succinct. With respect to reliability, the values for the intra-class correlation coefficient were between 0.512 – acceptable and 1 – excellent and Spearman’s correlation coefficient varied between 0.525 and 1, classifying the instrument as reproducible. The internal consistency was considered acceptable with a 0.757 Cronbach’s alpha.
      Discussion: The Oliveira questionnaire was choosen since it has been used in several Portuguese studies; moreover, it addresses the need to raise data regarding low back pain and associated risk factors.
      Conclusions: The Brazilian version of the Oliveira questionnaire on low back pain in young people showed valid and reliable cultural adaptation, with good reliability and stability.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Medical Training Experience and Expectations Regarding Future Medical
           Practice of Medical Students at the University of Cape Verde

    • Authors: Antonio Pedro Delgado, Antonieta Soares Martins, Paulo Ferrinho
      Pages: 699 - 703
      Abstract: Introduction: Cape Verde is a small insular developing state. Its first experience of undergraduate medical education began in October 2015. The purpose of this paper is to describe and analyze the professional expectations and profile of the first class of medical students at the University of Cape Verde.
      Material and Methods: A piloted, standardized questionnaire, with closed and open-ended questions, was distributed to registered medical students attending classes on the day of the survey. All data were analyzed using SPSS.
      Results: Students decided to study medicine in their mid-teens with relatives and friends having had significant influence over their decisions. Other major reasons for choosing medical training include “to take care of other people”, “fascination for the subject matters of medicine” and “I have always wanted to”. The degree of feminization of the student population is extremely high (20/25; 80.0%). Medical students are in general satisfied with the training program, and have expectations that the training received will allow them to be good professionals. Nevertheless, they consider the course too theoretical. Medical students know that this represents an opportunity for them to contribute to public welfare. Nonetheless, their expectations are to combine public sector practice with private work. Medical students come mostly from Santiago Island where the Capital of the Country is located. They still do not know about their future area of specialization. But all of those who want to specialize want to do so abroad. They mostly expect to follow hospital careers rather than health administration or family and community medicine.
      Discussion: This study contributes to the growing body of knowledge about medical students’ difficulties and expectations regarding medical schools or curriculums in lusophone countries. The decision to invest in the training of local physicians is justified by the need to be less dependent on foreigners. Local postgraduate medical training programs are already considered a priority for the immediate future.
      Conclusion: Cape Verde is pursuing a bold strategy to deal with a shortage of medical doctors. The problems experienced by medical students provide an important insight to help the new medical school to provide a better learning environment for students. The fact that students are not sure about their future area of specialization is an opportunity to guide them towards the areas of the health system with pressing needs. The current feminization of the medical workforce will be sustained with the profile of the present intake, hence the need to take this into account in workforce planning.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • The Experience of a Protocol for the Management of Pediatric Minor Head
           Injury: A Three Years Longitudinal Study

    • Authors: Joana Matias, Sofia Almeida, Sofia Ferrito, Ana Margarida Queiroz, Ana Dias Alves, Ana Tavares, Andreia Amorim, Paulo Calhau, Isabel Saraiva de Melo
      Pages: 704 - 712
      Abstract: Introduction: Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution’s practice protocol.
      Material and Methods: Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).
      Results: Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.
      Discussion: Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.
      Conclusion: The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Stapedo-Vestibular Ankylosis: Retrospective Study of Five Cases in São
           Tomé e Príncipe

    • Authors: Paula Campelo, Cristina Caroça, Catarina Tinoco, Diogo Oliveira e Carmo, João Paço
      Pages: 713 - 718
      Abstract: Introduction: Otosclerosis is a common form of conductive hearing loss characterized by abnormal bone remodeling exclusively in the otic capsule. The prevalence of otosclerosis varies in racial populations and is described as being rare in black African populations. In this paper we aim to report five cases of clinical, and surgically confirmed, otosclerosis in black individuals, in São Tomé and Príncipe.
      Material and Methods: Since February 2011, Ear, Nose and Throat consultations and surgeries specialty have been carried out at Dr. Ayres de Menezes Hospital in cooperation with the project ‘Health for all’. A retrospective analysis was undertaken of the records of all patients subjected either to stapedectomy or partial stapedectomy until February 2014. Information regarding clinical presentation, audiometric data and surgery reports was recorded.
      Results: Five adult patients underwent stapedectomy or partial stapedectomy. All of them presented with normal otoscopy, conductive or mixed hearing loss on audiogram and normal tympanometry with absent stapedial reflexes. None of the patients had signs of infection or history of head trauma. Three cases showed improvement in the air-bone gap after surgery. The other two were lost to follow-up.
      Discussion: We documented and surgically confirmed five cases of clinical otosclerosis in this population. A thematic review was carried out and concluded that, despite being described as a rare event in this race, available literature on this topic is not enough to state that there is lower prevalence of otosclerosis amongst the African population.
      Conclusion: Even if not common, otosclerosis cannot be disregarded as a possible cause for conductive hearing loss among the population of São Tomé and Principe.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Vitamin B12 Deficiency in Type 2 Diabetes Mellitus

    • Authors: Carlos Tavares Bello, Ricardo Miguel Capitão, João Sequeira Duarte, Jorge Azinheira, Carlos Vasconcelos
      Pages: 719 - 726
      Abstract: Introduction: Type 2 diabetes mellitus is a common disease, affecting up to 13.1% of the Portuguese population. In addition to the known micro and macrovascular complications, drug side effects constitute a major concern, leading to changes in the treatment guidelines, which favor safety over efficacy. Metformin is the first-line pharmacological treatment for most patients with type 2 diabetes mellitus; however, it has been associated with vitamin B12 deficiency in up to 30% of treated patients. The authors describe the prevalence of vitamin B12 deficiency in a diabetic population and explore the possible underlying factors.
      Material and Methods: Retrospective, observational study. Clinical and laboratory data of type 2 diabetes mellitus patients whose vitamin B12 status was evaluated in the last decade (2005 - 2016) were analyzed. Patients with known malabsorptive syndromes or having undergone bariatric surgery were excluded from the study. Statistical analysis of the data was done and the results were considered statistically significant at p values < 0.05.
      Results: The study included a total of 1007 patients (58% women) with a mean age of 66.4 ± 12.2 years and 11 ± 10.4 years of type 2 diabetes mellitus duration. These patients had a high prevalence of complications: diabetic renal disease 47.7%, neuropathy 9.2%, retinopathy 14.9%, coronary artery disease 8.4%, cerebrovascular disease 10.9%, and peripheral arterial disease 5.5%. Vitamin B12 deficiency (< 174 ng / dL) was present in 21.4% of the population and this subgroup was older (68.4 vs 65.8 years, p = 0.006), had a longer type 2 diabetes mellitus duration (13.35 vs 10.36 years; p = 0.001), higher prevalence of retinopathy (20.9% vs 13.3%; p = 0.005) and thyroid dysfunction (34% vs 23.7%; p = 0.002). Vitamin B12 deficiency was also more frequent in patients treated with metformin (24.7% vs 15.8%; p = 0.017), antiplatelet agents (25.4% vs 16.2%, p < 0.001), and calcium channel blockers (26.8% vs 18.2%; p = 0.001). After adjustment for possible confounders, the variables associated with B12 deficiency were: metformin, hypothyroidism, age and type 2 diabetes mellitus duration.
      Discussion: Despite the retrospective design, the results report a high prevalence of vitamin B12 deficiency in the type 2 diabetic population. This study also demonstrates that the B12 deficiency risk is higher in older people, with longer diabetes mellitus duration, hypothyroidism and treated with metformin.
      Conclusion: Further studies are needed to identify the risk factors for the B12 deficit. The recognition of these variables will contribute to optimize the screening and prevention of the B12 deficiency in type 2 diabetes mellitus.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Partial Red Blood Cell Exchange in Children and Young Patients with Sickle
           Cell Disease: Manual Versus Automated Procedure

    • Authors: Carlos Escobar, Marta Moniz, Pedro Nunes, Clara Abadesso, Teresa Ferreira, António Barra, Anabela Lichtner, Helena Loureiro, Alexandra Dias, Helena Almeida
      Pages: 727 - 733
      Abstract: Introduction: The benefits of manual versus automated red blood cell exchange have rarely been documented and studies in young sickle cell disease patients are scarce. We aim to describe and compare our experience in these two procedures.
      Material and Methods: Young patients (≤ 21 years old) who underwent manual- or automated-red blood cell exchange for prevention or treatment of sickle cell disease complications were included. Clinical, technical and hematological data were prospectively recorded and analyzed.
      Results: Ninety-four red blood cell exchange sessions were performed over a period of 68 months, including 57 manual and 37 automated, 63 for chronic complications prevention, 30 for acute complications and one in the pre-operative setting. Mean decrease in sickle hemoglobin levels was higher in automated-red blood cell exchange (p < 0.001) and permitted a higher sickle hemoglobin level decrease per volume removed (p < 0.001), while hemoglobin and hematocrit remained stable. Ferritin levels on chronic patients decreased 54%. Most frequent concern was catheter outflow obstruction on manual-red blood cell exchange and access alarm on automated-red blood cell exchange. No major complication or alloimunization was recorded.
      Discussion: Automated-red blood cell exchange decreased sickle hemoglobin levels more efficiently than manual procedure in the setting of acute and chronic complications of sickle cell disease, with minor technical concerns mainly due to vascular access. The threshold of sickle hemoglobin should be individualized for clinical and hematological goals. In our cohort of young patients, the need for an acceptable venous access was a limiting factor, but iron-overload was avoided.
      Conclusion: Automated red blood cell exchange is safe and well tolerated. It permits a higher sickle hemoglobin removal efficacy, better volume status control and iron-overload avoidance.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Building a Maternal and Newborn Care Training Programme for Health-Care
           Professionals in Guinea-Bissau

    • Authors: Ana Reynolds, Ahmed Zaky, Joana Moreira-Barros, João Bernardes
      Pages: 734 - 741
      Abstract: Introduction: The Integrated Programme of Maternal and Child Health aims to reduce maternal and child mortality in Guinea-Bissau. The purpose of this article is to share our experience in building a training programme on maternal and newborn care for health-care professionals in Guinea-Bissau.
      Material and Methods: Regional directors of the four target areas chose a group of staff who provide prenatal and childbirth care to attend the course (12 to 15 trainees per region). In each region, 15 highly interactive and practical sessions were scheduled over eight weeks. The trainees’ summative and reactive assessment was obtained using a multiple choice questionnaire (final test) and an anonymous survey, respectively.
      Results: Attendees included 25 nurses, 17 midwives and 14 doctors. About two thirds had five years’ practice or less. Test median scores were higher among trainees with two to nine years of practice (54.4% to 60.9%), as compared to those with a year or less (47.8%) or 10 or more years (45.7%). Pedagogical variables were rated as ‘good’ or ‘very good’ by 91% to 95% of the attendees.
      Discussion: Use of an interactive and practical pedagogical methodology produced positive results and was crucial to tailoring the training to local needs. However, adapting the syllabus according to professional categories and experiences should be considered.
      Conclusion: Our results warrant further development and evaluation of training programmes on maternal and neonatal care in Guinea-Bissau.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Premature Atherosclerosis in HIV-Infected Pediatric Patients: Literature
           Review and Clinical Approach

    • Authors: Paula Martins, Eduardo Castela, Graça Rocha, Cristina Sena, Raquel Seiça
      Pages: 742 - 749
      Abstract: Human immunodeficiency virus infected children and adolescents are a pediatric group with increased risk of premature cardiovascular disease. The virus itself, the antiretroviral therapy and the lifestyle establish a complex interplay of factors that promotes an accelerated atherosclerosis. This process is probably mediated by dyslipidaemia, dysregulation of glucose metabolism, lipodystrophy, inflammation, endothelial dysfunction and a prothrombotic state. The clinical approach to this population in terms of cardiovascular prevention is mainly based on efficient treatment of the infection, reduction of the modifiable risk factors and promotion of lifestyle changes.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging
           Differential Diagnosis

    • Authors: Ana Rita Garcia, João Ribeiro, Helena Gervásio, Francisco Castro e Sousa
      Pages: 750 - 753
      Abstract: Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Methemoglobinemia After Paracetamol Ingestion: A Case Report

    • Authors: Catarina Queirós, Pedro Salvador, Ana Ventura, Daniela Lopes
      Pages: 753 - 756
      Abstract: Methemoglobinemia is a potentially fatal condition, mainly acquired after intoxication by certain drugs. To this date, only three cases associated with paracetamol have been reported. This case report describes a patient with autosomal dominant polycystic kidney disease undergoing hemodialysis who was self-medicated with acetaminophen for seven days (at a daily dose of 3 g); the patient went to the hospital after noticing the appearance of a diffuse brownish skin tone, without other symptoms. Arterial blood analysis revealed an increase in methemoglobin levels, with biochemistry showing an increase in total bilirubin and alanine aminotransferase. Paracetamol was discontinued and on reassessment nine days after the onset of symptoms the patient had a clear improvement in her skin color, with normalization of methemoglobin levels.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
  • Vulvar Metastasis of Cervical Squamous Cell Carcinoma

    • Authors: Joana Moreira-Barros, Kuan-Gen Huang
      Pages: 757 - 757
      Abstract: N/A.
      PubDate: 2017-10-31
      Issue No: Vol. 30, No. 10 (2017)
       
 
 
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