Octreotide - Additional Conservative Therapy for Postoperative Chylothorax in Congenital Heart Disease

INTRODUCTION: Chylothorax is a rare but serious postoperative condition in children with congenital heart disease. Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative chylothorax. METHODS: The objective of this work was to analyze the efficacy and safety of this treatment for chylothorax after congenital heart surgery. We reviewed the records of sixteen patients with chylothorax after surgery for congenital heart disease between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of chylothorax and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects. RESULTS: The incidence of chylothorax in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of chylothorax and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention. DISCUSSION AND CONCLUSIONS: Octreotide is safe and effective in the treatment of postoperative chylothorax in children with congenital heart disease. It is a useful adjunctive therapy to the conventional treatment of this complication

Intracardiac Mass Due to Fibrosing Mediastinitis: The First Reported Case

We report a case of a woman, aged 53 years, presenting with a right atrial mass due to idiopathic fibrosing mediastinitis with periaortic involvement. This challenging diagnosis was confirmed by different imaging modalities and histopathologic analysis. The diagnosis of cardiac tumours is often difficult. To our knowledge, this is the first reported case of an intracavitary cardiac mass due to fibrosing mediastinitis. This rare disorder, which is characterized by invasive proliferation of fibrous tissue within the mediastinum, should be included in the differential diagnosis of intracardiac tumours

Isolated Aortic Coarctation: Experience in 100 Consecutive Patients

INTRODUCTION: Coarctation of the aorta (CoA) is a stenosis usually located in the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and presents excellent immediate results but significant residual problems often persist. OBJECTIVES: To describe the presentation, treatment and long-term evolution of a population of 100 unselected consecutive patients with isolated CoA in a single pediatric cardiology center. METHODS: This was a retrospective study of all patients with isolated CoA treated during4 the last 21 years (1987-2008). RESULTS: The patients (n=100, 68.3% male) were diagnosed at a median age of 94 days (1 day to 16 years). The clinical presentation differed between patients aged less or more than one year, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (88 and 63%, respectively; p < 0.01). Treatment, a median of 8 days after diagnosis, was surgical in 79 cases (20 end-to-end anastomosis, 31 subclavian flap, 28 patch) and percutaneous in the remaining 21 (15 balloon angioplasty, 6 with stenting). The mean age of surgical patients was younger than in those treated percutaneously (3.4 vs. 7.5 years; p < 0.01). Immediate mortality was 2% and occurred in the surgical group. There was no late mortality, in a mean follow-up of 7.2 +/- 5.4 years. Recoarctation occurred in 8 patients (6 surgical, 2 percutaneous). There are 46 patients who currently have hypertension (19 at rest, 27 with effort), their median age at diagnosis being older than the others (23 vs. 995 days; p < 0.01). CONCLUSIONS: Isolated CoA has an excellent short-term prognosis but a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment. Its potentially insidious presentation requires a high level of clinical suspicion, femoral pulse palpation during physical examination of newborns and older children being particularly important. Delay in treatment has an impact on late morbidity and mortality. Taking into account the data currently available on late and immediate results, the final choice of therapeutic technique depends on the patient's age, associated lesions and the experience of the medical-surgical team. Hypertension should be closely monitored in the follow-up of these patients, as well as its risk factors and complications

Hipertemia não pirogênica. Relato de casos

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Pênfigo foliáceo em canino jovem. Relato de caso

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Scaling-Up Digital Follow-Up Care Services: Collaborative Development and Implementation of Remote Patient Monitoring Pilot Initiatives to Increase Access to Follow-Up Care

Background: COVID-19 increased the demand for Remote Patient Monitoring (RPM) services as a rapid solution for safe patient follow-up in a lockdown context. Time and resource constraints resulted in unplanned scaled-up RPM pilot initiatives posing risks to the access and quality of care. Scalability and rapid implementation of RPM services require social change and active collaboration between stakeholders. Therefore, a participatory action research (PAR) approach is needed to support the collaborative development of the technological component while simultaneously implementing and evaluating the RPM service through critical action-reflection cycles. Objective: This study aims to demonstrate how PAR can be used to guide the scalability design of RPM pilot initiatives and the implementation of RPM-based follow-up services. Methods: Using a case study strategy, we described the PAR team's (nurses, physicians, developers, and researchers) activities within and across the four phases of the research process (problem definition, planning, action, and reflection). Team meetings were analyzed through content analysis and descriptive statistics. The PAR team selected ex-ante pilot initiatives to reflect upon features feedback and participatory level assessment. Pilot initiatives were investigated using semi-structured interviews transcribed and coded into themes following the principles of grounded theory and pilot meetings minutes and reports through content analysis. The PAR team used the MoSCoW prioritization method to define the set of features and descriptive statistics to reflect on the performance of the PAR approach. Results: The approach involved two action-reflection cycles. From the 15 features identified, the team classified 11 as must-haves in the scaled-up version. The participation was similar among researchers (52.9%), developers (47.5%), and physicians (46.7%), who focused on suggesting and planning actions. Nurses with the lowest participation (5.8%) focused on knowledge sharing and generation. The top three meeting outcomes were: improved research and development system (35.0%), socio-technical-economic constraints characterization (25.2%), and understanding of end-user technology utilization (22.0%). Conclusion: The scalability and implementation of RPM services must consider contextual factors, such as individuals' and organizations' interests and needs. The PAR approach supports simultaneously designing, developing, testing, and evaluating the RPM technological features, in a real-world context, with the participation of healthcare professionals, developers, and researchers.info:eu-repo/semantics/publishedVersio

Prolapso de uretra em cão da raça maltês. Relato de caso

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Developing and Validating High-Value Patient Digital Follow-Up Services: a Pilot Study in Cardiac Surgery

Background: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. Methods: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. Results: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. Conclusions: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.info:eu-repo/semantics/publishedVersio

Evaluation of the antioxidant activity of extracts obtained form cherry seeds.

Annual cherry production in Portugal is around 19,000 tonnes, in an area of about 6,450 ha and covering about 11,100 farms, concentrated in some northern and central interior territories. It is also in these regions that in recent decades there has been a significant increase in farms specialized in the production of cherry, using new cultivars and new technologies in a business production model. Apart from being consumed in fresh form, cherries are used for many food preparations, like sweets, jellies or confectionary. In the plants that transform cherries, a significant amount of cherry seeds (also called cherry pits) is generated as residue or waste. The possible usage of these residues as raw material for extraction of compounds with antioxidant properties is beneficial in term of economic value as well as environmental impact. Hence, the objective of this work was to obtain extract rich in compounds with antioxidant activity from cherry seeds. The cherry seeds were obtained from a local waste management company, Nutrofertil, located in Tondela, in the district of Viseu (Portugal). They were grinded and then submitted to extraction procedures testing different operating conditions: magnetic stirrer versus ultrasound, different solvents (methanol, ethanol, water) and temperatures (from 35 ºC to 80 ºC). For the obtained extracts antioxidant activity was evaluated through spectrophotometric methods, using the DPPH (2,2-diphenyl-1-picrylhydrazyl) and ABTS (2,2′-azino-di-(3-ethylbenzthiazoline sulfonic acid)) radicals, and also the Ferric Reducing Antioxidant Power Assay (FRAP). All measurements were replicated at least trice, and were expressed as mg Trolox equivalents per gram (mg TE/g). The results obtained for the different experimental conditions indicated that least efficient extractions at ambient temperature were obtained with methanol using magnetic stirrer and with water using ultrasounds, for which the antioxidant activities measured by the DPPH method were 0.26 and 0.33 mg TE/g and by the ABTS method were 0.82 and 0.86 mg TE/g, respectively. Most efficient methods were water:ethanol (at 50% concentration) and water (100%), using magnetic stirrer in both cases. Highest antioxidant activity was obtained for water:ethanol by the DPPH method (0.72 mg TE/g) and for water (100%) by the ABTS method (1.25 mg TE/g). Tests with different concentrations for the aqueous solutions of ethanol and at different temperatures revealed that with increasing concentration of water the antioxidant diminished, from 0.62 to 0.27 mg TE/g at 35 ºC using the DPPH method. Additionally, the variation in temperature allowed reaching a maximum extraction of compounds with antioxidant activity at 70 ºC and decreasing thereafter. The maximum values obtained were registered at 70 ºC for all cases and were 0.74 mg TE/g for the water:ethanol 50:50 (v/v) by the DPPH method, 2.16 mg TE/g for the water:ethanol 60:40 (v/v) by the ABTS method and 3.43 mg TE/g for the water:ethanol 60:40 (v/v) by the FRAP method. The results obtained by the different methods were concordant in terms of the observed trends but giving different values of the measured antioxidant activity, which is a common characteristic observed in these types of evaluation techniques. This research allowed establishing some operational conditions that should be selected in order to maximize the extraction of compounds with antioxidant activity from cherry seeds. The use of ultrasounds was not found beneficial and the magnetic stirrer technique revealed to be more useful. Also the use of methanol was not found suitable, which is a good point given that this solvent is more pollutant and has more problems of toxicity. With respect to temperature, it was found that temperatures higher than 70 ºC are not beneficial because they induce the degradation of some bioactive compounds thus reducing the antioxidant activity of thee extracts.info:eu-repo/semantics/publishedVersio