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- A Standardized Classification for Subdural Hematomas- IPublication . Alves, JL; Santiago, JG; Costa, G; Mota-Pinto, ASubdural hematomas are a frequent and highly heterogeneous traumatic disorder, with significant clinical and socioeconomic consequences. In clinical and medicolegal practice, subdural hematomas are classified according to its apparent age, which significantly influences its intrinsic pathogenic behavior, forensic implications, clinical management, and outcome. Although practical, this empirical classification is somewhat arbitrary and scarcely informative, considering the remarkable heterogeneity of this entity. The current research project aims at implementing a comprehensive multifactorial classification of subdural hematomas, allowing a more standardized and coherent assessment and management of this condition. This new method of classification of subdural hematomas takes into account its intrinsic and extrinsic features, using imaging data and histopathological elements, to provide an easily apprehensible and intuitive nomenclature. The proposed classification unifies and organizes all relevant details concerning subdural hematomas, hopefully improving surgical care and forensic systematization.
- Opiniões sobre a visita de enfermagem em unidades de cirurgia: tradução, adaptação e validação de questionáriosPublication . Morgado, T; Nunes, LREnquadramento: Apesar da visita de enfermagem ou passagem de turno junto dos doentes garantir a continuidade dos cuidados de enfermagem, origina diversas questões éticas. Objetivos: Traduzir, adaptar e validar 2 questionários de colheita de dados sobre a visita de enfermagem em unidades cirúrgicas para a cultura portuguesa; identificar a opinião dos doentes e dos enfermeiros sobre a visita de enfermagem. Metodologia: Tradução, retroversão e adaptação dos questionários aplicados em 7 unidades cirúrgicas de um hospital central em Portugal de 22/08/2008 a 28/06/2009. A amostragem não probabilística acidental foi constituída por 137 enfermeiros e 96 doentes. Resultados: A visita de enfermagem promove a relação empática e de ajuda; a observação do doente e o planeamento de cuidados, no entanto é necessário clarificar o seu objetivo; incentivar à participação e ao envolvimento dos doentes; utilizar um discurso compreensível e garantir a privacidade da informação. Conclusão: Os questionários revelaram-se fidedignos e válidos na identificação das opiniões dos doentes e dos enfermeiros sobre a visita de enfermagem nas unidades de cirurgia em estudo.Background: Although bedside nursing handover ensures the continuity of nursing care, it raises several ethical issues. Objectives: To translate, adapt and validate 2 data collection questionnaires about bedside nursing handover in surgical units into Portuguese, and identify the patients and nurses’ opinions about bedside nursing handover. Methodology: Translation, back-translation and adaptation of the questionnaires in 7 surgical units of a central hospital in Portugal between 22/08/2008 and 28/06/2009. The non- -probability sampling consisted of 137 nurses and 96 patients. Results: Bedside nursing handover promotes an empathic and helping relationship, patient observation and care planning; however, it is necessary to clarify its purpose, encourage patient participation and engagement, use clear information, and ensure information privacy. Conclusion: The questionnaires proved to be reliable and valid to identify the patients and nurses’ opinions about bedside nursing handover in the surgical units under analysis.
- Adaptação cultural e propriedades psicométricas da versão portuguesa da escala Pain Assessment in Advanced DementiaPublication . Batalha, LM; Antunes-Duarte, CI; Rosário, RA; Pereira da Costa, MF; Pereira, VJ; Morgado, T
- Intervenções promotoras da literacia em saúde mental dos adolescentes: Uma revisão sistemática da literaturaPublication . Morgado, T; Botelho, MCONTEXTO: O conceito de literacia em saúde mental foi definido como o conhecimento e as crenças sobre distúrbios mentais que ajudam no seu reconhecimento, gestão ou prevenção. Quer internacionalmente, quer nacionalmente os estudos evidenciam reduzida literacia em saúde mental dos adolescentes e a necessidade de serem desenvolvidas intervenções em contexto escolar para aumentar o seu nível de literacia em saúde mental. OBJETIVO: Foi realizada uma revisão sistemática da literatura com o objetivo de identificar a evidência científica atual e disponível sobre as intervenções promotoras da literacia em saúde mental dos adolescentes. METODOLOGIA: Foi formulada a questão de investigação segundo a mnemónica PICO: Que intervenções (I) promovem a literacia em saúde mental (O) dos adolescentes (P)? e definidos os critérios de selecção dos estudos. Seguidamente foram selecionadas as palavras-chave que permitiram realizar a pesquisa. Foram efetuadas as pesquisas em bases de dados electrónicas durante os meses de Abril e Maio de 2013, para resultados de 2008 a 2013. RESULTADOS: Resultaram 15 artigos em texto completo, dos quais 12 artigos foram excluídos. Foram incluídos 3 artigos submetidos posteriormente à avaliação da sua qualidade metodológica. CONCLUSÕES: Os estudos indicam a necessidade de serem desenvolvidas, validadas e avaliadas intervenções que promovam a literacia em saúde mental dos adolescentes. No entanto, a complexidade das intervenções de promoção da literacia em saúde mental dos adolescentes exige que essas sejam investigadas através de um processo de desenvolvimento, viabilidade/pilotagem, avaliação e implementação.
- Cerebral venous thrombosis: an unexpected complication from spinal surgeryPublication . Lourenço-Costa, B; Shamasna, M; Nunes, J; Magalhães, F; Peliz, AJPURPOSE: To provide new insights into the pathophysiology, prevention and diagnosis of cerebral venous thrombosis (CVT) associated with iatrogenic cerebrospinal fluid (CSF) leaks and/or external CSF drainage. METHODS: Case report and literature review. RESULTS: We describe the case of a 30-year-old woman who developed a CSF fistula after lumbar spinal surgery. The treatment included rest, hydration, caffeine, and continuous lumbar CSF drainage. After closure of the fistula, the patient complained of severe orthostatic headache. Thrombosis involving the superior sagittal sinus, the right transverse sinus, the right sigmoid sinus, and the right jugular vein was diagnosed after neurological deterioration. CONCLUSION: A few reports have associated CVT with various forms of spinal meningeal injury. However, it has been rarely documented following spinal surgery complicated by accidental durotomy and/or external lumbar CSF drainage. CSF hypovolemia may precipitate CVT in patients having prothrombotic risk factors. Patients who have or had CSF leaks and/or lumbar CSF drains who present with symptoms of intracranial CSF hypotension should remain in the horizontal position to prevent CVT. In that context, the diagnosis of CVT depends on a high degree of suspicion.
- Traumatic middle cerebral artery aneurysm secondary to a gunshot wound.Publication . Santos, G; Lima, T; Pereira, S; Macahdo, ETraumatic intracranial aneurysms are rare lesions, accounting for less than 1% of all intracranial aneurysms. Formation of these lesions after a penetrating missile wound is very unusual, and diagnosis can be difficult due to the presence of associated lesions. In this article, we report a case of a woman who developed a middle cerebral artery aneurysm after a gunshot wound, and discuss potential pitfalls found during diagnostic work-up.
- Cerebral venous thrombosis: an unexpected complication from spinal surgeryPublication . Costa, BL; Shamasna, M; Nunes, J; Magalhães, F; Peliz, AJPURPOSE: To provide new insights into the pathophysiology, prevention and diagnosis of cerebral venous thrombosis (CVT) associated with iatrogenic cerebrospinal fluid (CSF) leaks and/or external CSF drainage. METHODS: Case report and literature review. RESULTS: We describe the case of a 30-year-old woman who developed a CSF fistula after lumbar spinal surgery. The treatment included rest, hydration, caffeine, and continuous lumbar CSF drainage. After closure of the fistula, the patient complained of severe orthostatic headache. Thrombosis involving the superior sagittal sinus, the right transverse sinus, the right sigmoid sinus, and the right jugular vein was diagnosed after neurological deterioration. CONCLUSION: A few reports have associated CVT with various forms of spinal meningeal injury. However, it has been rarely documented following spinal surgery complicated by accidental durotomy and/or external lumbar CSF drainage. CSF hypovolemia may precipitate CVT in patients having prothrombotic risk factors. Patients who have or had CSF leaks and/or lumbar CSF drains who present with symptoms of intracranial CSF hypotension should remain in the horizontal position to prevent CVT. In that context, the diagnosis of CVT depends on a high degree of suspicion.
- Complex sacral fracturePublication . Alves, JL; Duarte, N; Rocha, A; Frade, MJWe reported a case of a patient with suspected cauda equina syndrome secondary to sacral fracture, after sustaining a fall. The difficulty in early diagnosis of complex sacral fractures and the lack of clearly defined guidelines for treatment are highlighted. Thorough clinical examination is mandatory, in order to make an adequate initial assessment and follow symptoms progression and response to treatment. The threshold for performing CT imaging (or MRI, if advised), when suspecting sacral fracture and neurological compromise, should be low. A multidisciplinary approach, with contributions from orthopaedic and/or neurosurgical surgery and physiatry, should be the gold standard of treatment. In this particular case, conservative management and close follow-up led to a significant improvement of problems and a good final outcome, showing that surgical decompression is not the only valid option and that further prospective studies are needed, regarding patient selection and timing of intervention.
- Amplified and Homozygously Deleted Genes in Glioblastoma: Impact on Gene Expression LevelsPublication . Crespo, I; Tão, H; Nieto, AB; Rebelo, O; Domingos, P; Vital, AL; Patino, MC; Barbosa, MD; Lopes, MC; Resende de Oliveira, C; Orfão, A; Tabernero, MDBACKGROUND: Glioblastoma multiforme (GBM) displays multiple amplicons and homozygous deletions that involve relevant pathogenic genes and other genes whose role remains unknown. METHODOLOGY: Single-nucleotide polymorphism (SNP)-arrays were used to determine the frequency of recurrent amplicons and homozygous deletions in GBM (n = 46), and to evaluate the impact of copy number alterations (CNA) on mRNA levels of the genes involved. PRINCIPAL FINDINGS: Recurrent amplicons were detected for chromosomes 7 (50%), 12 (22%), 1 (11%), 4 (9%), 11 (4%), and 17 (4%), whereas homozygous deletions involved chromosomes 9p21 (52%) and 10q (22%). Most genes that displayed a high correlation between DNA CNA and mRNA levels were coded in the amplified chromosomes. For some amplicons the impact of DNA CNA on mRNA expression was restricted to a single gene (e.g., EGFR at 7p11.2), while for others it involved multiple genes (e.g., 11 and 5 genes at 12q14.1-q15 and 4q12, respectively). Despite homozygous del(9p21) and del(10q23.31) included multiple genes, association between these DNA CNA and RNA expression was restricted to the MTAP gene. CONCLUSIONS: Overall, our results showed a high frequency of amplicons and homozygous deletions in GBM with variable impact on the expression of the genes involved, and they contributed to the identification of other potentially relevant genes.
- Craniectomia descompressiva na enfarte cerebral malignoPublication . Cabrita, F; Pereira, R; Carvalho, M; Cordeiro, G; Barbosa, MD
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