Acta Médica Portuguesa最新文献

{"title":"Experience of the MALA bag in the open abdomen management in an obstetrical intensive care unit.","authors":"M. Vasquez, Luis Mendoza, R. Reyes, H. Zerón","doi":"10.20344/AMP.2019","DOIUrl":"https://doi.org/10.20344/AMP.2019","url":null,"abstract":"Introduction: Current indications for open abdomen management are damage control surgery, severe intra-abdominal sepsis, abdominal compartment syndrome, abdominal wall closure under tension and mass loss of the abdominal wall. Objective: To describe the experience in open abdomen management using the MALA (mayor absorcion de liquido abdominal [greater absorption of abdominal liquid]) bag at the Maternal-Perinatal Hospital Monica Pretelini Saenz, Health Institute of the State of Mexico. Material and Methods: This was a bidirectional, descriptive and observational study. All patients with the diagnosis of open abdomen managed with the MALA bag admitted to the Obstetric Intensive Care Unit from February 2009 to June 2012 were included. Results: From 25 cases identified in the period of the study, seven were eliminated for incomplete files, remaining 18 cases for the analysis. The mean age was 31.5 years. 78% of the patients were multigravidas, 50% of them with a history of 2 or more deliveries, 83% had a previous cesarean section and 78% were hysterectomized. Evisceration was present in one patient. The main indication for surgical management was damage control. One patient died and a second was transferred to another institution, the rest were discharged by clinical improvement. 12 patients (67%) spent less than 14 days in the Obstetric Intensive Care Unit, only one patient required more than 30 days in the unit. Discussion: Halve the women who required this surgical alternative, were above 30 years of age. Stressing is the fact that from the 18 admitted patients, 14 (78%) had undergone obstetric hysterectomy, with the etiology of uterine atony in most cases. Damage control surgery seems to be the most elective surgical option to use MALA bag followed by ACS and abdominal sepsis. Conclusion: The MALA bag can offer an economic and effective surgical option for the open abdomen management as well as a drainage technique.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114467544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Propósito do Artigo “Indicações para Cesarianas num Hospital Terciário Durante 7 Anos”","authors":"C. Guerreiro","doi":"10.20344/amp.5051","DOIUrl":"https://doi.org/10.20344/amp.5051","url":null,"abstract":"<jats:p />","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114697134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Que Fatores Determinam os Níveis de Atividade Física após Programa de Reabilitação Cardíaca?","authors":"Diogo Soares, Sofia Viamonte, S. Magalhães, Maria Miguel Ribeiro, Ana Barreira, P. Fernandes, Severo Torres","doi":"10.20344/amp.1742","DOIUrl":"https://doi.org/10.20344/amp.1742","url":null,"abstract":"Introduction: The Cardiac Rehabilitation Programs have gained tremendous importance in the prevention of cardiovascular disease and it’s a challenge to ensure the practice of regular exercise during and after the supervised program. The aim of this study was to determine the factors that influence the physical activity habits at 12 months after the Cardiac Rehabilitation Program.Material and Methods: Prospective study, including 580 patients with ischemic heart disease who were consecutively oriented for Cardiac Rehabilitation Program at Cardiovascular Prevention and Rehabilitation Unit of Centro Hospitalar do Porto, between January 2008 and June 2011. Physical activity levels were measured with International Physical Activity Questionnaire which was calculated at the beginning of the program, 3 and 12 months later. The following variables were chosen and tested as potential determinants of physical activity habits of 12 months after program: age; sex; modifiable risk factors; functional capacity (achieved in treadmill stress test); laboratory analysis (HbA1c, lipid profile, C-Reactive Protein and Brain Natriuretic Peptide). A linear regression analysis was carried to identify the significant determinants and to find the best model adjustment.Results: Advanced age, female gender, functional capacity and low levels of physical activity prior to the Cardiac Rehabilitation Program, as well as a weak evolution of the International Physical Activity Questionnaire during the program were the best univariable predictors of a less favourable evolution of the International Physical Activity Questionnaire during 12 months of follow-up. A multivariable linear regression analysis showed that the best explanatory model included age, gender and evolution of the International Physical Activity Questionnaire during the supervised program (R2 Adj. = 0.318; f = 60.62, p < 0.001).Conclusion: The identification of certain subgroups of patients with lower tendency toward physical activity is beneficial to enable timely and individualized strategies to maximize the therapeutic and preventive potential of the Cardiac Rehabilitation Programs.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116105626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Função Gonadal na Síndrome de Turner","authors":"M. Alves, Margarida Bastos, T. A. Santos, F. Carrilho","doi":"10.20344/amp.1316","DOIUrl":"https://doi.org/10.20344/amp.1316","url":null,"abstract":"Introduction: Turner syndrome is characterized by the absence, total or partial, of one X chromosome in females, being one of the most frequent chromosomal abnormalities. Diagnosis is made by karyotype. Turner syndrome manifestations include primary hypogonadism, before or after puberty (gonadal dysgenesis). The degree and extent of gonadal disfunction are variable.Objectives: We intended to assess clinical, karyotype, gonadal function and pelvic ultrasound characteristics in women with Turner syndrome.Material and Methods: Retrospective study of patients with Turner syndrome followed in Endocrinology and Human Reproduction Departments of Hospitais da Universidade de Coimbra - Centro Hospitalar e Universitário de Coimbra, E.P.E. We evaluated the entire sample and considered group 1 (with spontaneous puberty and menarche) and group 2 (without spontaneous puberty). Parameters assessed: age at initial study, puberty (Tanner stages), karyotype, FSH, pelvic ultrasound (initial and after puberty), diagnostic laparoscopy and pubertal induction. Statistical Program: SPSS (20.0).Results: Global sample: 79 patients, 14.7 ± 6.6 years. No pubertal signs in 57.1%; 67.1% with primary amenorrhea and 6.6% with secondary amenorrhea. Karyotype: X monosomy-37.2%, mosaicism-37.2%, X structural changes-25.6%. Median FSH of 59.5 mIU/ mL. Initial ultrasound: normal uterus 34.2%, atrophic uterus 65.8%; normal ovaries 21.6%, atrophic ovaries 78.4%, ovarian follicles in 5.1%. Post-puberty ultrasound: normal uterus 67.9%, atrophic uterus 32.1%; normal ovaries 36.4%, atrophic ovaries 63.6%. Laparoscopy was performed in 16 (20.3%) patients, confirming the sonographic findings. Only two women with induced puberty became pregnant: one spontaneously, interrupted; another by donated oocytes, normal outcome. Group 1 (with spontaneous puberty and menarche):20 (25.3%) patients, 16.1 ± 8.9 years. Tanner at baseline: M1-22.2%, M2-33.3%, M3-16.7%, M4-16.7%, M5-11.1%. Karyotype: mosaicism-65%, X structural changes-20%, X monosomy-15%. Median FSH of 7 mUI/mL. Initial ultrasound: normal uterus-72.2%,atrophic uterus 27.8%; normal ovaries 63.2%, atrophic ovaries 36.8%. Post-puberty ultrasound: normal uterus 100%; normal ovaries 72.7%, atrophic ovaries 27.3%. Group 2 (without spontaneous puberty): 59 (74.7%) patients, 14.0 ± 5.5 years. Tanner at baseline: M1-69.2%, M2-13.5%, M3-5.8%, M4-3.8%, M5-7.7%. Karyotype: X monosomy-43.9%, X structural changes-28.1% mosaicism-28.1%. Median FSH of 74 mUI/mL. Initial ultrasound: normal uterus 20.4%, atrophic uterus 79.6%; normal ovaries 7.4%, atrophic ovaries92.6%. Post-puberty ultrasound: normal uterus 60.0%, atrophic uterus 40.0%; normal ovaries 27.3%, atrophic ovaries 72.7%. Pubertal induction at 16.1 ± 4.1 years, with bone age of 12.7 ± 1.6 years. Groups 1 and 2 differ significantly in karyotype (p = 0.010), median FSH (p < 0.001), and uterine and ovarian dimensions (p < 0.001).Conclusions: Most patients had gonadal dysfunction and needed pubertal ","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"70 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113957321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lesão Visceral em Trauma Abdominal: Um Estudo Retrospetivo","authors":"Sara Leite, António Taveira-Gomes, H. Sousa","doi":"10.20344/amp.2104","DOIUrl":"https://doi.org/10.20344/amp.2104","url":null,"abstract":"Background: Abdominal trauma is a major cause of morbi-mortality all over the world which makes it essential an approach focused on rapid diagnosis and treatment. The main goals of this study are to identify global epidemiologic data of abdominal trauma in our tertiary trauma center and to study traumatic lesions, treatment and outcome.Material and Methods: Retrospective analysis of the clinical file of all patients admitted with abdominal trauma, over a period of 5 years, in a tertiary trauma center.Results: the total mean of ages was 42.6 years and the male gender was the most affected (74.2%). At admission, most patients had a Revised Trauma Score > 4. The mainly causes of trauma were blunt from motor-vehicle collisions (39.9% as motor-vehicle occupant and 10.7% from pedestrian collisions) and falls (25.5%). Penetrating trauma, by abdominal stab wounds and gunshot wounds, occurred only in 12.3% of the cases. Hollow visceral injuries were more frequent in that context. In 19.5% of the cases multiple abdominal organinjury occurred. Conservative treatment was performed in 65.3% of the cases. Global mortality was 12%, being null after penetrating lesions.Conclusions: Abdominal trauma, more frequently, is the result of motor-vehicle crashes and falls, being blunt in the majority of the cases. The most affected organs are solid and the approach is conservative. Hollow visceral lesions continue to be of difficult diagnose.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121811670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O Respeito pela Autonomia da Criança na Regulação das Responsabilidades Parentais","authors":"Bárbara Santa Rosa, Francisco Corte-Real, Duarte Nuno Vieira","doi":"10.20344/amp.4050","DOIUrl":"https://doi.org/10.20344/amp.4050","url":null,"abstract":"Child custody decisions are among the most difficult is one of the most difficult for judges to make. The possibility of child abuse allegations or parents’ deviant/psychopathologic behaviours within this context, make the decision further complicated. Based on jurisprudence the listening of children opinion is a way to protect their best interest. In fact children have the right to express an opinion in all matters affecting their life. It should be given proper consideration to children opinion according with his/her age and maturity. Nonetheless custody disputes are emotionally draining issues. Asking the child to express an opinion during a public hearing, most likely in the presence of both parents, its not recommended because this is a potential stressful experience. Child interviews should take place in a proper environment and be set to their age. Medicine and Psychology have an important role in assessing children cognitive, emotional and volitional abilities, which is essential to properly account their opinions according to autonomy degree. This essay analyses the contribution of medico-legal and/or psychological exams to respect the autonomy of the child in cases of regulation of parental responsibilities. The conclusion is the need to establish a symbiotic relationship between the medical and legal perspectives of the (open) concept of child’s best interests.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123928093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rede Nacional de Cuidados Continuados e Tempo de Internamento dos Doentes com Acidente Vascular Cerebral 2010-2011","authors":"Catarina Canha, Ana Massano, Hélder Esperto, Joana Rato, T. Ferreira, Argemiro Geraldo","doi":"10.20344/amp.1741","DOIUrl":"https://doi.org/10.20344/amp.1741","url":null,"abstract":"Introduction: The National Post Hospital Care Project was created to provide a continuity of care after hospitalization or to functionally dependent people. Currently there is a great difficulty in the integration of patients. The objective of this paper is to compare the impact of the referral to the Project versus being discharged home, in the length of stay of stroke patients between 2010 and 2011.Material and Methods: Retrospective study of patients admitted to the Neurology Infirmary A and Stroke Unit of Coimbra’s University Hospital, in 2010 and 2011. The cases analyzed were 1 209, featuring demographic data, length of stay, Rankin Score (mRS) and destination after discharge. The data was analyzed comparing the two years concerning the length of stay of stroke patients referred to the Project and those discharged home, given the their Rankin Score.Results: In 2011, the number patients referred to the National Post Hospital Care Project was higher, 23.5% compared to 21.4%. The length of stay for the same Rankin Score of the patients referred to National Post Hospital Care Project, remained higher than those discharged home: for a Rankin Score of 1: 11, versus 26 days for the Project; Rankin Score 2: 13, versus 29 days for the project; Rankin Score 3: 13, versus 23 days for the Project; Rankin Score 4: 17, to 33 days for the Project, Rankin Score 5: 27, versus 39 days to the Project. After comparison between the length of stay of patient discharged of and those referred to the National Post Hospital Care Project, it was estimated that the referral represented an hospitalization excess of 1 718 days in 2010 and 1 198 days in 2011.Conclusion: The National Post Hospital Care Project is unable to meet the actual needs although the waiting time has reduced, possibly due to the increased number of beds and the possibility of patients waiting at home.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124247059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contributos para a Validação da Versão Portuguesa do EQ-5D","authors":"P. Ferreira, L. N. Ferreira, L. Pereira","doi":"10.20344/amp.1317","DOIUrl":"https://doi.org/10.20344/amp.1317","url":null,"abstract":"Introduction: The EQ-5D allows the achievement of two essential components of any measure of health-related quality of life to be used in cost-utility economic evaluations: (i) a profile describing the health status in terms of domains or dimensions; and (ii) a numeric value associated with the health status described.Aim: The Portuguese version of the EQ-5D questionnaire was completed in 1998, based on guidelines set by the EuroQol Group, including translation and back translation procedures. Despite its wide use in Portugal, until now it had not yet been published studies that initially led to the Portuguese version and the guarantee of acceptability, reliability and validity. The purpose of this article is to document these first values relating to the Portuguese version of the EQ-5D.Material and Methods: We used three different samples: a first one with 1,500 individuals representative of the Portuguese population; a second with 140 individuals just intended for the reliability test; and a third sample with 643 individual patients with cataracts, asthma, chronic obstructive pulmonary disease, or rheumatoid arthritis.Results: The acceptability was assessed by the number of missing responses. It was also found a marked ceiling effect, with a large part of the sample not reporting any problems in the dimensions of the EQ-5D.Discussion: The construct validity was tested by examining the degree to which low values of EQ-5D were positively associated with increasing age, being female, and the sick, as well as the values of dimensions of the SF-36v2 scale. Convergent validity was based on correlations between EQ-5D values and other specific measures. The EQ-5D showed moderate to high correlations with other diseasespecific measures of health status and health related quality of life.Conclusion: We can state that the Portuguese version of the EQ-5D has a good accessibility, reliability and validity in measuringhealth.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"323 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115841936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto dos Biossimilares no Tratamento da Psoríase","authors":"Tiago Torres, P. Filipe, Manuela Selores","doi":"10.20344/amp.5001","DOIUrl":"https://doi.org/10.20344/amp.5001","url":null,"abstract":"<jats:p />","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115471278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Populações Celulares Periféricas (CD4+, CD8+ e CD19+) em Indivíduos Dislipidémicos","authors":"Jose Pereira de Moura, Manuel Santos Rosa, V. Alves, Anabela Mota Pinto, Victor Rodrigues, J. M. Silva, J. J. Alves de Moura","doi":"10.20344/amp.1989","DOIUrl":"https://doi.org/10.20344/amp.1989","url":null,"abstract":"Introduction: The past decade has witnessed an increasing recognition that inflammatory mechanisms play a central role in the pathogenesis of atherosclerosis and its complications. Recently, attention was focused on the potential role of plasma markers of inflammation as risk predictors among those at risk for cardiovascular events. Of these potential markers, C-reactive protein (CRP), IL6, metalloproteinases, ICAM, VCAM and other molecules, have been extensively studied. On the other hand, to our knowledge, there are only a few studies on the role of inflammatory cells, like T and B lymphocytes in the atherosclerosis.Material and Methods: By Flow Cytrometry analysis we have determined on dyslipidemic people and on a control group, the percentage of some peripheral inflammatory cells, like CD3+, CD4+, CD8+, CD19+, CD56+, CD56CD8+, DN, CD25+, CD26+, CD25CD3+, CD26CD3+, CD25CD26CD3+, CCR5+, CCR5CD3+, CCR5CD4+, HLADR+, HLADRCD4+, HLADRCD8h+, HLADRCD8low+, HLADRCD8+, CD95+, CD95CD95L+, CD3CD95+, CD3CD95L+, CD62L+, CD3CD62L+, CD69+, CD69CD3+ e CD69CD4+.Results: In the present study we have particularly studied the percentage of CD4+, CD8+ and CD19+ cells. The CD4+ cells have been significantly reduced in the people with dyslipidemia.Discussion: We do not know the peripheral numbers of the subtype Th1 and Th2, neither the percentage of CD4+CD25+ cells (regulatory T cells). We have not find any differences on the percentage from the CD8+ and CD19+ cells.Conclusions: In spite of the identified limitations resulting from the small-sized samples, it was possible to show a reduction of some molecules after application of acetylsalicylic acid.","PeriodicalId":104695,"journal":{"name":"Acta Médica Portuguesa","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129692993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}