Search

Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.

Introduction: The hospital setting faces a rate of bed occupation by patients whose discharge is limited by other factors apart from clinical needs. This urges the need for an early identification of the patients at risk of delayed discharge due to social factors in order to reduce expenses and to add value that converts itself into the patient health. The aim of this study was to identify the demographic and clinical factors that may be associated with delayed discharge., Material and Methods: Demographic and clinical comorbidity data on 582 patients of an internal medicine ward from a tertiary hospital center during the years 2018 and 2019 was analyzed. A binomial logistic regression model was used, adjusted for sex, age, and length of clinical stay, in order to identify potential risk factors associated with delayed discharge., Results: A total of 473 patients admitted in the internal medicine ward throughout the two years of study were included. Ninety-four (19%) of these patients had their discharge delayed beyond their clinical needs; sixty-four (68%) of these were females. The most representative age was between 75 - 89 years old (45.7%). The characteristics that significantly differed between both non-delayed and delayed discharge were female sex (OR 2.84, 95% CI 1.65 - 4.90, p-value < 0.05), prolonged clinical stay (OR 2.64, 95% CI 1.60 - 4.937, p-value < 0.05) and diabetes mellitus (OR 1.87, 95% CI 1.08 - 3.23, p-value < 0.05). Besides these, the presence of heart failure (OR 0.52, 95% CI 0.27 - 0.99, p-value < 0.05) and chronic kidney disease (OR 0.34, 95% CI 0.14 - 0.86, p-value < 0.05) were associated with a lower risk of delayed discharge., Conclusion: Female sex, a prolonged clinical stay and diabetes mellitus were associated with a higher risk of delayed discharge, while heart failure and chronic kidney disease were associated with a reduced risk. These findings create a basis for a possible future multicentre study aimed at creating a clinical prediction rule to stratify the risk of delayed hospital discharge in the Portuguese population.

Describing a Mundus Novus was a very singular task in the sixteenth century. It was an effort shaped by a permanent inherent tension between novelty and normality, between the immense variety of new facts (some extraordinary) and the demand of credibility. How did these inner strains affect the narrative style of the first descriptions of the natural world of 'the Indies'? How were the first European observers of the nature of America able to simultaneously transmit the idea of immensity and regularity ( mundus), and that of novelty ( novus)? How did they attempt to describe new worlds knowing that there was a lot - perhaps too much - to tell? This paper focuses not on the much-discussed epistemological issues related to those questions, but on their narrative and stylistic consequences. We argue that the first Europeans meeting the new realities of the Americas or India had to meet new challenges, and these translated into texts with specific characteristics. Thus, their first descriptions are essentially different from the texts about the natural world that were written before or after the 'discovery'. We show that they adopted very specific discursive approaches, and were deeply influenced by the credibility strategies of the medical profession in which they had been trained.

Zilsel's thesis on the artisanal origins of modern science remains one of the most original proposals about the emergence of scientific modernity. We propose to inspect the scientific developments in Iberia in the early modern period using Zilsel's ideas as a guideline. Our purpose is to show that his ideas illuminate the situation in Iberia but also that the Iberian case is a remarkable illustration of Zilsel's thesis. Furthermore, we argue that Zilsel's thesis is essentially a sociological explanation that cannot be applied to isolated cases; its use implies global events that involve extended societies over large periods of time.

Purpose: To determine if diffusion-weighted (DW) magnetic resonance (MR) imaging with measurements of the apparent diffusion coefficient (ADC), pure diffusion coefficient, perfusion-related diffusion coefficient, and perfusion fraction can be used to differentiate between viable tumor and fibrous and necrotic regions within malignant liver tumors., Material and Methods: The prospective study was approved by the institutional review board, and informed consent was obtained from all patients. Forty-eight patients with 51 malignant tumors were assessed. MR images of the liver were obtained by using DW imaging with 11 b factors (0-500 sec/mm(2)) and gadolinium-enhanced three-dimensional gradient-echo T1-weighted imaging. Tumors were segmented into viable tumor and fibrous and necrotic regions according to the enhancement pattern after injection of a nonspecific gadolinium chelate and, in surgically removed lesions, results of histopathologic correlation. The ADC, pure diffusion coefficient, perfusion-related diffusion coefficient, and perfusion fraction were calculated, and values were compared between viable tumor and fibrous and necrotic regions with the Kruskal-Wallis test followed by the Dunn multiple comparison test., Results: The pure diffusion coefficient differed significantly between regions of viable tumor tissue and fibrosis (1.16 × 10(-3) mm(2)/sec ± 0.29 and 1.48 × 10(-3) mm(2)/sec ± 0.31, respectively; P = .016) and between regions of viable tumor tissue and necrosis (1.70 × 10(-3) mm(2)/sec ± 0.49, P = .002). There was a significantly lower perfusion fraction in necrotic regions (14% ± 6) than in viable tumor regions (21% ± 8, P = .005), but the perfusion fraction of the fibrous regions (21% ± 7) did not differ significantly from that of the other two regions. ADCs and perfusion-related diffusion coefficients did not differ significantly among the three regions., Conclusion: Results of this study show that viable tumor regions in malignant liver tumors can be differentiated from fibrous and necrotic regions with use of the pure diffusion coefficient but not with the other diffusion parameters.

Giant choriangiomas are rare placental tumours, associated with a high prevalence of pregnancy complications and a poor perinatal outcome. Neonatal consequences include severe microangiopathic haemolytic anaemia, thrombocytopaenia and hydrops. The associated high perinatal death rate (30-40%) has led to a number of prenatal therapeutic interventions with limited success in most cases. The authors present a case of non-immune fetal hydrops caused by a giant chorioangioma, diagnosed at 27 weeks of gestational age. Despite tocolytic therapy, the baby was born prematurely (28 weeks of gestational age) and required transfusion of blood derivatives, intensive phototherapy and exchange transfusion. She had an uncomplicated recovery and was discharged home in the second month of life. The authors emphasise the need to consider chorioangioma as a cause of non-immune fetal hydrops and microangiopathic haemolytic anaemia.

Idiopathic congenital chylothorax is defined as an abnormal accumulation of lymphatic fluid within the pleural space and is a relatively rare condition. It is a cause of progressive respiratory distress with nutritional and immunological consequences. Treatment of congenital chylothorax has been conservative management and cases unresponsive usually require surgery. We report a case of idiopathic congenital chylothorax treated with octreotide (a somatostatin analogue), avoiding surgery after failed conservative medical treatment. The patient promptly improved after initiation of endovenous octreotide treatment (10 µg/kg/h) with no observed side effects.

Cerebral hemiatrophy or Dyke-Davidoff-Masson syndrome is a condition characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis, and mental retardation. These findings are due to cerebral injury that may occur early in life or in utero. The radiological features are unilateral loss of cerebral volume and associated compensatory bone alterations in the calvarium, like thickening, hyperpneumatization of the paranasal sinuses and mastoid cells and elevation of the petrous ridge. The authors describe three cases. Classical findings of the syndrome are present in variable degrees according to the extent of the brain injury. Pathogenesis is commented.

The echocardiographic study of 480 patients over 60 years (medium age: 75.4) revealed 37 (33 women) of them having mitral calcification (MC). The analysis of clinical and metabolic data of these 37 patients plus their electro, phono and echocardiographic assessment revealed: 1) MC was observed in 7.7% of this elderly population and its incidence tended to increase with age; 2) MC was more frequent and more pronounced in women; 3) cardiocirculatory abnormalities responsible for a high systolic pressure in the left ventricle, such as hypertension (64.9%) and aortic stenosis (10.8%) were the most commonly associated cardiac pathologies; 4) no history of illnesses usually aggressive to the mitral valve was detected; 5) plasma lipids and calcium were normal; 6) in 27.0% of patients with MC there was some degree of mitral stenosis and/or insufficiency and surgical correction has been considered in some cases; 7) changes in production and/or conduction properties were frequent, causing bradyarrhythmias, tachyarrhythmias and intraventricular block. Taking these points into consideration, a careful follow-up of confirmed cases is suggested, in order to detect and treat any complications without delay.