Este trabalho caracterizou as lesões dentárias e maxilofaciais nos tecidos moles e duros num estudo cohorte de doentes politraumatizados graves. Utilizou o registo prospectivo de doentes politraumatizados que usa a metodologia TRISS para a análise da severidade. O critério de inclusão foi a presença de lesão anatómica na face, utilizando o Abbreviated Injury Scale decorrente de acidente de viação e trabalho. O estudo foi complementado com a consulta do processo clínico e a consulta de follow-up aos 6 meses. Entre 2002 e 2005 admitiram-se na Sala de Emergência do Hospital Geral de Santo António, 868 doentes politraumatizados graves. 151 tiveram lesão na face por acidente de viação (92%) e acidente de trabalho (8%). 85% pertencia ao sexo masculino e à faixa etária 15–19 anos de idade (18%). 37% das lesões localizaramse nos tecidos moles e a região mais atingida foi a órbita direita (14%). A região dos tecidos duros mais atingida foi a nasal (28%). A observação dos processos clínicos dos doentes complementou a informação do registo prospectivo mas só a entrevista aos 6 meses permitiu compreender a importância destas lesões no seu todo. Os registos das lesões desde o processo clínico à base de dados prospectiva, passando pela observação dos doentes no follow-up revelam que o trauma maxilofacial e principalmente dentário é pouco valorizado na avaliação inicial do doente. This study characterized the dental and maxillofacial injuries in hard and soft tissues in a cohort of severe trauma patients. Used the prospective registry of trauma patients that uses TRISS methodology for severity analysis. Inclusion criterion was the presence of anatomical lesion in the face, using the Abbreviated Injury Scale due to road traffic accident and work-related accidents. The study was complemented with the patient's registries and 6 months follow-up. Between 2002 and 2005 were admitted to the Emergency Room of Santo Antonio General Hospital, 868 severe trauma patients. 151 had lesions on the face due to traffic accident (92%) and accidents at work (8%). A total of 85% was males, and the age group 15–19 years of age dominated (18%). 37% of lesions were located in the soft tissues and the region most affected was the right orbit (14%). The region most affected in the hard tissue was the nasal (28%). The records of injuries from the clinical prospective data through observation of patients in follow-up show that the main dental and maxillofacial trauma is of little importance in the initial evaluation of the patient.
Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease.To evaluate the predictive factors of small bowel patency in Crohn's disease patients.Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule) from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention), other patients were considered to have negative patency of the small bowel (patency capsule retention).Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention). In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001) and penetrating phenotypes (OR 11.73, p = 0.001), left-sided colonic lesions (OR 3.77, p = 0.038), ileal stricture (OR 9.76, p = 0.003); previous intestinal surgery was found to be protective (OR 0.16, p = 0.006).Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.
Abstract Background and Aims Interest in histology for ulcerative colitis [UC] has increased recently. This systematic review and meta-analysis aims to assess, for the first time, whether histological outcomes are more informative than endoscopic and clinical outcomes in distinguishing the impact of intervention over placebo in induction trials. Methods MEDLINE, ScienceDirect and Cochrane Central Register of Controlled Trials were searched to identify randomized placebo-controlled trials [RCTs] enrolling moderate-to-severe UC patients. Studies were assessed using the Quality Assessment Tool for Studies with Diverse Designs. We analysed the pooled proportion of patients achieving clinical, endoscopic and histological remission and response after a pharmacological intervention and compared the results with those of placebo-treated patients by using a random-effects model. Results From 889 identified records, 13 RCTs were included. The odds ratio [OR] for remission was higher in patients receiving intervention than in those under placebo for clinical (OR 2.13, 95% confidence interval [CI] 1.33–3.43), endoscopic [OR 1.46, 95% CI 0.19–11.18] and histological remission [OR 1.85, 95% CI 1.20–2.84]. Significant differences were observed for all response outcomes [clinical: OR 2.27, 95% CI 1.84–2.85; endoscopic: OR 2.16, 95% CI 1.51–3.10; histological: OR 3.63, 95% CI, 1.41–9.36]. No significant heterogeneity existed; no subgroup effects were found for duration of the induction or histological scale [p > 0.05]. Clinical and histological remission and endoscopic response were concordant in discriminating interventions from placebo. Conclusion Histological outcomes are informative in trials of moderate-to-severe UC. Further studies analysing histology at the end of induction are needed to confirm its relevance in distinguishing the efficacy of an intervention over placebo in comparison to clinical and endoscopic outcomes and to explore its prognostic value.
Abstract Purpose To develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns. Methods Participants were parents of inpatient newborns with the diagnosis of non‐syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Results Parents of eight newborns were allocated to the intervention group ( n = 15 parents) and eight to the control group ( n = 13 parents). It was performed as an intention‐to‐treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL‐Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups. Conclusions The PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.
Central blood pressure (CBP) is the pressure exerted by the blood column at any given moment on the aortic and carotid artery walls, which is a close proxy for the blood pressure inside the brain and the heart, and is thus a better marker of cardiovascular morbidity and mortality than peripheral blood pressure (PBP). To assess how the augmentation index (AI), peripheral pulse pressure (pPP), central pulse pressure (cPP) and subendocardial viability ratio (SEVR) vary in hypertensive patients according to level of control of CBP and PBP. We performed an observational, cross-sectional study in a convenience sample from a general practice in Central Portugal over a period of four days in May 2010. Measurements were taken after a four-minute resting period. The following values were considered to reflect controlled pressures: PBP <140/90 mmHg, CBP <130/80 mmHg, pPP <55 mmHg and cPP <45 mmHg. The sample included 93 patients, 38 male (41.3%), mean age 62.3±11.1 years, with no significant difference in gender distribution. PBP was controlled in 55 (59.8%), and CBP in 53 (57.6%). Both PBP and CBP were controlled in 50 patients (54.3%) and neither was controlled in 34 (37.9%). pPP and cPP were significantly lower in those with controlled PBP (p<0.001) and CBP (p<0.001). AI was non-significantly lower in those with controlled PBP (78±9 vs. 80.7) and those with controlled CBP (78±9 vs.81±7) (p=0.02). SEVR was within the desirable range in 93 patients (92.2%). In a convenience sample of 92 patients, PBP and CBP were controlled in 59.8% and 57.6%, respectively. Those with controlled PBP had significantly better peripheral systolic and diastolic blood pressure, CBP, pPP and cPP; the same was true of those with controlled CBP, who also had a significantly better AI. A pressão arterial central (PAC) é a pressão exercida pela coluna sanguínea, em cada momento, nas artérias aorta e carótidas sendo uma aproximação à pressão arterial no coração e cérebro e assim um marcador mais relacionado com a morbi-mortalidade cardiovascular do que a pressão arterial periférica (PAP). Verificar, segundo o controlo da PAC e da PAP, como se distribuem os valores de índice de aumento (IA), de pressão de pulso central (PPC), de pressão de pulso periférica (PPP) e razão de viabilidade sub-endocárdica (SEVR), em pacientes com o prévio diagnóstico de hipertensão arterial (HTA). Estudo observacional transversal em amostra de conveniência no ambiente de Medicina Geral e Familiar (MGF) em quatro dias do mês de maio de 2010. Os pacientes estiveram em repouso durante pelo menos quatro minutos antes do início das duas medições. Definiram-se: controlo de PAP valores inferiores a 140/90 mmHg, de PAC valores inferiores a 130/80, de PPP valores inferiores a 55 mmHg e de PPC valores inferiores a 45 mmHg. Amostra de n = 92, sendo 38 homens (41,3%). Idade média de 62,3 ± 11,1 anos, sem diferença por sexos. PAP controlada em n = 55 (59,8%) e PAC controlada em n = 53 (57,6%). Para n = 50 (54,3%) havia simultâneo controlo da PAP e da PAC e para n = 34 (37,0%) havia simultâneo não controlo. A PPP e a PPC é significativamente menor nos controlados de PAP (p < 0,001) e de PAC (p < 0,001) na comparação com os não controlados. O IA é menor sem significado nos controlados da PAP (78 ± 9) que nos não controlados da PAP (80 ± 7) e é também menor nos controlados da PAC (78 ± 9) do que nos não controlados (81 ± 7 (p = 0,02). Para n = 93 (92,2%) o SEVR tinha um valor desejável. Medicados com medicamentos atuando no sistema renina-angiotensina-aldosterona (SRAA) 78,4% dos estudados. Numa amostra de n = 92 indivíduos, 59,8% tinham PAP controlada e 57,6% tinham a PAC controlada. Há, para a PAP, valores melhores nos controlados e com significado, em Pressão Arterial Sistólica Periférica, Pressão Arterial Diastólica Periférica, Pressão Arterial Central, Pressão de Pulso Periférica e Pressão de Pulso Central. O mesmo se verifica para o Controlo da Pressão Arterial Central com associada diferença significativa para o Índice de Aumento (p = 0,02). A percentagem do ciclo cardíaco em diástole, tinha valores desejáveis para 92,2% dos estudados.
Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were recruited and had a successful RHI measurement by PAT. General demographic and clinical information including traditional cardiovascular risk factors were registered from all participants. Thereafter, patients were prospectively followed-up for a median time of 47 (IQR 19–66) months to determine associations of RHI with renal outcomes, MACCEs, hospitalizations or mortality. Results: In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m2 (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, p < 0.0001) and correlated negatively with age (r = −0.469, p < 0.0001), Charlson index (r = −0.399, p < 0.0001), systolic blood pressure (r = −0.256, p = 0.005), and proteinuria (r = 0.211, p = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, p = 0.493). In adjusted analysis, only age (β = −0.014, p = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, p = 0.584), hospitalizations (1.90 vs. 2.04, p = 0.334), and all-cause mortality (1.65 vs. 2.01, p = 0.208) or MACCEs (1.77 vs. 2.01, p = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, p = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, p = 0.035). Conclusion: Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.
Abstract Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women, but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status. IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped into low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma MS. Of the pregnant women, 54 % correctly recognised iodine as important to neurocognitive development, 32 % were unable to identify any iodine-rich food and 71 % presented lack of knowledge regarding iodised salt. Of the women, 61 % had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women who correctly recognised the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/l). In conclusion, knowledge on iodine importance is positively associated with iodine status. Despite this, recognising iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy-promoting actions are urgently needed to improve iodine status in pregnancy.
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