Acta Medica Port
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The use of the transoesophageal echocardiography (TEE) in the critically ill patient admitted to the general intensive care unit begins to turn out to be very important but it is still little spread. The full implementation of the echocardiography in the general intensive cares is compromised by the acoustic window. However, TEE can flyover this difficulty adding to the advantages widely described of the transthoracic echocardiography (TTE) other high values 1. ⋯ The use of the echocardiography in the ventilated patient admitted to the general intensive care unit still lack for some definition. This clinical commentary was carried out by the intention of revising the most relevant literature that values the use and efficiency of the TEE in the ventilated critically ill patient in order to explain its use and consequently helping to implement the TEE in clinical practice. So, one managed to define the application of the TEE in the critically ill patient in several clinical scenarios, the haemodynamically unstable patient, the patient with global respiratory insufficiency, the patient with hipoxémia.
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Parkinson's disease (PD) is a common disorder that causes a marked decrease in the quality of life of patients and implies high costs at the social, familiar and economic levels. The diagnosis is essentially achieved on clinical grounds and there is an extensive list of possible differential diagnoses, thus being fundamental to recognize the typical clinical features of PD, and then proceed to effective treatment, thus improving disability and the quality of life of patients. This review article, built on evidence-based knowledge and clinical experience, approaches pathogenesis, clinical features, the diagnostic methodology and current concepts in the treatment of PD in a pragmatic and updated manner.
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Multicenter Study
[Conditions for neonatal resuscitation in Portuguese delivery rooms: a national survey (2009)].
In Portugal, since 1989, the rates of maternal, perinatal and neonatal mortality present a significant decrease, after the implemented perinatal network. The continuous assessment of the existing conditions at the different levels of perinatal care is essential to identify deviations from normality and may allow the optimization of quality of care. ⋯ The care of the newborn in the national delivery rooms can and should be improved. It is necessary to adapt the equipment and human resources to the needs of each centre. Protocols and practices such as oxygen and "prophylactic" surfactant must be updated, transport after birth must be reduced and the communication with the obstetric teams should be improved.
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Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS ≥ 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS ≥ 7 a laparotomy procedure may be indicated. ⋯ We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of ≥ 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients.
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Legionella pneumophila is responsible for approximately 6-14% of hospital admitted community acquired pneumonia (CAP) cases. It is associated with a significant severity. ⋯ Cerebellar dysfunction is a rare disorder (3.7% of cases), but is well documented and has been reported in the first cases of the disease. The authors warn for the relevance of the epidemiological context and emphasize the importance of reporting cases to identify outbreaks, tracing the source of contamination and preventing new cases.