Hospital In Portugal Research Articles

Relationship among compassion satisfaction, burnout and traumatic stress with the patient safety / Relação entre satisfação por compaixão, burnout e estresse traumático com a segurança do paciente

Objective: to analyze the relationship among compassion satisfaction, burnout, and secondary traumatic stress with the patient safety culture. Method: cross-sectional study with nurses (n = 201) from hospitals in Portugal. The Professional quality scale and the three sections of Hospital survey on patient safety culture were used to data collection. Correlation and regressions tests were implemented. Results: compassion satisfaction was positively related to four of the five patient safety culture dimensions and with the patient safety grade, while burnout had a negative relationship with all the dimensions and with the patient safety grade and secondary traumatic stress had a negative relationship with three patient safety culture dimensions. Conclusions: measures aimed at increasing compassion satisfaction and decreasing burnout and secondary traumatic stress should be implemented to improve the quality of professional life and patient safety.
 Descriptors: Compassion fatigue; Stress disorders, traumatic; Burnout, professional; Patient safety; Nurses

Drivers of Energy Consumption in Portuguese Hospitals - a panel analysis

Abstract Background Buildings represent about 40% of global energy consumed, playing an important role in sustainable transformation. Health institutions account for 10% of the energy consumed by the commercial sector, however public policies do not cover energy management in this setting. Energy poverty in hospitals, such as poor heating, affect patients’ and workers’ health and wellbeing. As such, this study aims to analyse drivers of electricity and natural gas consumption of Portuguese hospitals. Methods Data regarding 25 hospitals in Portugal’s National Health Service from 2015-2020 were analysed as logarithms in a panel of 18 trimesters, using Panel-corrected Standard Errors estimators. The PSAR model considers the presence of an autocorrelation within the panel, and the Hetonly modeling deals with heteroscedasticity and autocorrelation. Results There is an elastic elasticity and a statistical significance of electricity and natural gas consumption in relation to the number of beds occupied, with a greater variation of natural gas than electricity consumption. In turn, there is a predominance of an inelastic elasticity of electricity and natural gas consumption in relation to the number of workers and number of emergency episodes. Conclusions Energy consumption is highly influenced by the number of beds occupied, highlighting the need for a strategic management of energy and planning of hospital capacity. Overall, the positive absolute effects of the elasticities for energy consumption reveal that hospitals do not use effective measures aimed at rational and cleaner energy consumption, requiring a paradigm shift in the energy matrix. Increasing energy efficiency policies and environmental practices, such as autonomous energy production and renewable energies, might effectively contribute in reducing conventional energy consumption and associated energy poverty, which in turn improve patients’ and workers’ conditions within the hospital and their health and wellbeing. Key messages • Strategic energy management and capacity planning can contribute to lower energy poverty and a paradigm shift in the energy matrix. • Hospital sustainability policies must include energy management, including autonomous energy production and investment in renewable energies.

Clinical experience of a cardio-oncology consultation at a tertiary university hospital in Portugal: An observational study

IntroductionHeart disease and cancer are the two leading causes of morbidity and mortality worldwide. Advances in cancer screening and management have led to longer survival and better quality of life. Despite this progress, many cancer patients experience cardiovascular complications during and after cancer treatment. This study describes the experience of a cardio-oncology program at tertiary academic hospital. MethodsIn this retrospective observational study, cancer patients referred to the CHULN cardio-oncology consultation (COC) between January 2016 and December of 2019 were included. Data collected included: patient demographics, cancer type, reason for referral, cardiovascular risk factors, cardiac and oncologic treatments and clinical outcomes. ResultsA total of 520 patients (mean age: 65 ± 14 years; 65% women) were referred to the COC. The main reasons for referral were suspected heart failure (26%), pre-high risk chemotherapy assessment (20%) and decreased LVEF (15%). Pre-existing cardiovascular risk factors were common (79%) and 309 (59%) were taking cardiac medications. The most common type of malignancy was breast cancer (216, 41%) followed by gastrointestinal (139, 27%). More than half received anthracycline-based regimens (303, 58%). Most patients (401; 77%) successfully completed cancer therapy. At the time of last data collection, the majority of patients were alive (430, 83%). Cardiac-related mortality was observed in 16%. ConclusionsThe close collaboration between cardiology and oncology teams and timely cardiac monitoring was the key to the majority of patients to completing their prescribed cancer therapy.

Predictors of problems reported on the EQ-5D-3L dimensions among people with impaired vision in northern Portugal

BackgroundThe EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss. Investigating predictors of individual EQ-5D health dimensions might reveal the underlying reasons. The aim of this study was to investigate predictors of health dimension ratings obtained with the EQ-5D-3L from participants with impaired vision representing a spectrum of eye diseases.MethodsObservational cross-sectional study with participants recruited at four public hospitals in Portugal. Outpatients with visual acuity of 0.30 logMAR(6/12) or worse in the better-seeing eye were invited to participate. Participants completed two instruments: the EQ-5D-3L (measures participants’ perceived health-related quality-of-life) and the Massof Activity Inventory (measures visual ability–ability to perform vision-related activities). This study used logistic regression models to identify factors associated with responses to the EQ-5D-3L.ResultsThe study included 492 participants, mean age 63.4 years (range = 18–93), 50% females. The most common diagnosis was diabetic retinopathy (37%). The mean visual acuity in the better seeing eye was 0.65 logMAR (SD = 0.48) and the mean visual ability was 0.62 logits (SD = 2.04), the correlation between the two was r = − 0.511 (p < 0.001). Mobility and self-care were the health dimensions with the fewest problems (1% reported extreme problems), anxiety and depression the dimension with the most problems (24% reported extreme problems). ROC curve analysis showed that the EQ-5D index was a poor predictor of cases of vision impairment whilst visual ability given was a good predictor of cases of vision impairment. Visual ability was an independent predictor of the response for all dimensions, higher ability was always associated with a reduced odds of reporting problems. The odds of reporting problems were increased for females in 3 out of 5 dimensions. Comorbidities, visual acuity and age-category were predictors of the odds of reporting problems for one dimension each.ConclusionsThe odds of reporting problems for the five health dimensions of the EQ-5D-3L were strongly influenced by the ability to perform vision-related activities (visual ability). The EQ-5D index showed poor performance at detecting vision impairment. These findings are informative and relevant for the clinic and for research evaluating the impact of eye diseases and disease treatments in ophthalmology.

Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study

BackgroundSarcopenia is prevalent in heart failure (HF) patients, contributing to its poor prognosis. Statin use is postulated as a probable risk for developing sarcopenia, but little is known regarding this association in HF patients. This work aims at classifying and characterising sarcopenia and at describing the association of statin use with sarcopenia in a sample of Portuguese HF outpatients.MethodsIn this cross-sectional study, a sample of 136 HF patients (median age: 59 years, 33.8% women) was recruited from an HF outpatients’ clinic of a University Hospital in Portugal. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2. Clinical, nutritional, and dietary data were collected.ResultsA total of 25 (18.4%) individuals were categorised as sarcopenic, ranging from 12.2% in younger (< 65 years) participants vs. 30.4% in older ones and from 3.3% in men vs. 47.8% in women. Severe sarcopenia accounted for 7.4% of the sample and sarcopenic obesity was identified in 5.1% of the individuals. A total of 65.4% of the participants were statin users. In multivariable analysis (n = 132, 25 sarcopenic), the use of statins was inversely associated with sarcopenia (OR = 0.03; 95% CI = 0.01, 0.30). Each additional age year was associated with a 9% increase in the likelihood of being sarcopenic (OR = 1.09; 95% CI = 1.01, 1.17), and each Kg.m−2 increment in body mass index was associated with a 21% decrease in the likelihood of sarcopenia (OR = 0.79; 95% CI = 0.65, 0.96). The daily use of five or more medicines was also directly associated with sarcopenia (OR = 26.87; 95% CI = 2.01, 359.26). On the other hand, being a man and being physically active were inversely associated with sarcopenia (OR = 0.01; 95% CI = 0.00, 0.07 and OR = 0.09; 95% CI = 0.01, 0.65, respectively).ConclusionsContrary to what was expected, patients medicated with statins were less likely to be sarcopenic. Although this finding deserves further research, we hypothesise that this might be related to the pleiotropic effects of statins on endothelial function, contributing to better neuromuscular fitness.

Nursing Care in Peripheral Intravenous Catheter (PIVC): Protocol of a Best Practice Implementation Project.

Background: The use of a peripheral intravenous catheters (PIVC) is a common invasive practice in healthcare settings. It is estimated that about 70% of people with PIVCs will develop associated complications, such as infections. It is the consensus that best practices could reduce the appearance of such complications and reduce the length of stay in hospital. Methods: A project will be applied to implement the best approach in peripheral venous catheterization, provided by clinical nurses from an inland hospital in Portugal. The Joanna Briggs Institute methodology will be used on evidence implementation projects, which will be developed in three phases. First, a baseline audit will be performed. The second phase implements corrective measures, and the third phase is a follow-up audit. Conclusions: This project will improve the practice of the nursing team on peripheral venous catheterization nursing cares, positively influencing the quality of nursing care and patient safety. The implementation and dissemination of this project could boost its replication in other centres.

Urticaria in a Pediatric Population: A Portuguese Single-Center Cohort Report.

BackgroundUrticaria typically involves the skin and mucosa and is characterized by the development of wheals, angioedema, or both. According to the temporal evolution of the lesions, urticaria is classified as acute (AU) or chronic (CU), depending on whether the episodes last for fewer or more than six weeks, respectively. This study aimed to characterize a group of children and adolescents with urticaria and describe its subtypes, associated comorbidities, treatment, and evolution.MethodologyThis retrospective, observational study included patients aged <18 years who were diagnosed with urticaria in a tertiary teaching hospital in Portugal, and followed up in a Pediatric Allergy Unit, between January 2019 and December 2021.ResultsA total of 43 patients, aged nine months to 16 years were included. Of these, 22 (51%) were males. AU was identified in 12 (28%) cases, chronic spontaneous urticaria in 21 (63%), and physical urticaria (to cold) in four (9%). Autoantibodies were detected in four patients with spontaneous urticaria. In 6% of patients with CU, the episodes were associated with angioedema. Most CU episodes were successfully managed with the recommended or double the recommended dose (48%) of H1 antihistamines. Three patients requiring fourfold higher than the recommended dose of H1 antihistamines remained unresponsive and were started on omalizumab. Associated autoimmune thyroiditis was diagnosed in four patients.ConclusionsIn this cohort of patients, urticaria was equally distributed between the genders and the first-line therapy was second-generation antihistamines, consistent with current guidelines. Universal screening for autoimmune diseases in patients with chronic spontaneous urticaria revealed four cases of thyroiditis, which supports the relevance of this approach when managing CU.

HYPERTENSIVE CRISIS AT THE EMERGENCY DEPARTMENT OF A CENTRAL HOSPITAL

Objective: Hypertension is a well-established cardiovascular risk factor. Its low control can progress to a hypertensive crisis (HC) and the emergency department (ED) is the first point of contact of these patients. This study’s aim was analyzing the profile and management of the patients presenting with HC at the ED of a central hospital in Portugal. Design and method: This study is descriptive and retrospective in nature, encompassing three months of adult patients admittances to the ED with symptomatic or asymptomatic hypertension (337 in total). We defined hypertension as blood pressure (BP) greater than or equal to 140/90mmHg and HC as BP greater than or equal to 180/110mmHg. Results: Patients presenting to the ED with elevated blood pressure were predominantly women (65%) aged over 60 years. BP values compatible with HC were found in 40,4% of cases. Hypertension was unknown to 13,3% of patients. Despite having previously diagnosed hypertension, 8,5% were not receiving any medication. At admission, headache (45,1%), nausea and dizziness (19,3%), and chest pain (17,2%) were the most frequent symptoms. About 18% were asymptomatic. 71% of patients with elevated BP were receiving treatment with antihypertensive drugs. All off those presenting with HC received pharmacological treatment. Angiotensin-converting enzyme inhibitor was the most used class (75%), followed by benzodiazepines (~52%). Regarding the evolution of the blood pressure in the ED, the majority of patients had controlled or lower blood pressure at the time of discharge. The outpatient antihypertensive medication was adjusted in 25,8% of cases. Adding another drug was the most common strategy (23%), followed by initiating a fixed drug combination (18,4%) or starting therapy with a single drug (15%). At a one-year follow-up, most of patients (90,5%) were not readmitted to the ED due to hypertension. Conclusions: Hypertension is still a common cause of admission to the ED, despite only 40% of cases representing real HC. The lack of uniform management at the ED, or after discharge, further demonstrates a missed opportunity to prevent future cardiovascular morbidity/mortality.

Call the Psychiatrist! - Study about Delirium in the context of liaison psychiatry

IntroductionDelirium is characterized as a short-term consciousness and cognition disturbance which tends to fluctuate during the course of the day. It is a common and serious problem, mainly in hospitalized older adults, potentially avoidable and often poorly recognized.ObjectivesWe propose an analysis on the theme through a work that evaluates the requests for psychiatric consultation made in a district hospital in Portugal during the course of 12 months.MethodsWe identified all patients on the requests for psychiatric consultation and obtained a demographic, clinical and consultation requests by medical specialties data and conducted statistical analysis using Excel.ResultsWe identified 106 consultation requests, in which 41 cases were eventually diagnosed as delirium. Most (83%) were hyperactive delirium, 12% were hypoactive delirium and 5% were mixed delirium. Incidence was higher in males (59%) and in those aged between 66 and 80 years old (56.1%). Most consultation requests were made by Internal Medicine (46.3%), followed by General Surgery (26.8%), Pulmonology (14.6%), Orthopedics (9.8%) and Neurology (2.5%). Finally, we analyzed which symptoms mentioned in the request made physicians consider requesting a psychiatric evaluation. Approximately half of the cases (48.8%) reported psychomotor agitation, followed by temporal/spatial disorientation (41.5%) and aggressive behaviour (17.1%).ConclusionsWe highlight a still notorious lack of proper identification of delirium, resulting in symptoms being incorrectly interpreted as a psychiatric disorder. This may cause a delay in the adequate diagnosis and management of the condition, increasing the morbidity and mortality of patients.DisclosureNo significant relationships.

P-262 Response to perioperative chemotherapy in locally advanced gastric cancer

Gastric cancer was the 6th most frequent tumor worldwide in 2020. The prognosis of patients with gastric and gastrooesophageal junction (GEJ) adenocarcinoma is poor. Many efforts had been made to improve these patients’ prognosis, as adjuvant chemotherapy, chemoradiation and perioperative chemotherapy. The benefit in overall survival (OS) and disease free survival (DFS) of perioperative chemotherapy was first demonstrated in MAGIC trial. FLOT trial established a superior regimen over ECF, despite that the prognosis is still poor with high recurrence rate. The authors’ aim was to characterize patients with locally advanced gastric cancer who underwent perioperative chemotherapy, their outcomes and the related factors with these outcomes, namely response to chemotherapy, resume post-operative regimen and pathological stage. Retrospective analysis of patients with locally advanced gastric cancer that underwent perioperative chemotherapy between January 1st 2016 and December 31st 2020 in a single hospital in Portugal. Clinic-pathological characteristics were accessed by reviewing medical records. A descriptive analysis was performed. Kaplan-Meier curves and Log-rank test were performed for survival analysis, SPSS®20. A total of 68 patients were included. The median age was 64-years-old (35-78), 69% (n=47) were male, 19% (n=13) had an ECOG-PS 0. As for clinical stage, 10% (n=7) were at stage Ib, 24% (n=16) stage II and 38% (n=26) stage III. 16% (n=11) were tumors of the GEJ. Regarding to histology 57% (n=39) presented intestinal type. 54% of the patients (n=37) received perioperative chemotherapy regimen with FLOT; 22% (n=15) EOX, 16% (n=11) FOLFOX and 7% (n=5) ECF. Surgery was performed in all patients, 59% (n=40) with total gastrectomy. 4% (n=3) had a complete response to preoperative chemotherapy, 22% (n=15) had a minimal response to chemotherapy, and in 43% it was not reported. 85% of the patients resume and 74% completed the initial chemotherapy regimen. With a median follow-up of 29 months (3-75), 35% (n=24) patients had an event (recurrence or death). The estimated 48 months DFS was 62%, and OS was 67%. In our study the resume of perioperative chemotherapy was associated with an improve DFS (56.5 months vs 10.4 months, p < 0.001) and OS (59 vs 13.5 months, p < .001). Patients who completed chemotherapy regimen presented a better OS (61.2 vs 40.8 months) however this increase was not statistical significant. Pathological response to chemotherapy was not associated with a better outcome. Despite that pathologic lymph node staging had impact in DFS (ypN0 51.8 months vs ypN3 14.9 months, p < .001) and OS (ypN0 53months vs ypN3 25 months, p=.001) Perioperative chemotherapy regimen was not associated with the outcome. 18% of the patients experienced adverse events grade ≥3, with neutropenia as the most common, without difference between regimens. No grade 5 adverse events occurred. Our results emphasize the importance of completing perioperative chemotherapy regimen. The retrospective nature of this study, the small sample size, and, most important, the low report in pathology, limits the assessment of the value of response to preoperative chemotherapy.

The Importance of Design in the Development of a Portable and Modular Iot-Based Detection Device for Clinical Applications

The integration of human factors engineering methods within the medical device design and development process has been highlighted by international standards organizations. Such methods are contributing to the development of safer medical devices, more suitable to users’ needs. Errors during device operation might hamper effective patient diagnosis and treatment, or eventually lead to injury or death. Thus, the designing process of a medical device is indeed crucial to user experience and safety operation. This paper presents a human-centred design analysis of a novel IoT-based screening prototype (iLoF) based on Artificial Intelligence algorithms built-in in a patented-photonics system developed by a deep tech startup. The influence of the design process during the development of the prototype was addressed, based on a human-centred design methodology and considering the device’s application environment. iLoF’s prototype on-field applicability was evaluated considering a single case-study carried out at one of the main hospitals in Portugal through interviews to ten healthcare professionals with high experience in laboratorial testing. A benchmark assessment and a comparison matrix along with the market products are also presented to fully understand the technology state and to find new solutions that can influence iLoF’s product development.

OCD symptom dimensions and treatment: a new dimension?

IntroductionBackground: Obsessive-compulsive disorder (OCD) is a condition that includes distressing obsessions and repetitive compulsions. Usually presents with a wide range of symptons normally grouped into different clusters or dimensions. clinical impression and some empirical data suggest that certain groups of symptoms or clusters are more responsive to treatment than others, thus it can help clinicians to better guide initial treatment choices and management of individual patientsObjectivesObjetictive: to describe the symptom dimensions in a clinical database that includes patients accompannied in an obssessive conpulsive disorder consultation in a tertiary hospital in Portugal and to point out some differences in treatment outcomes.MethodsWe searched Pubmed and Cochrane Library database for english language articles.ResultsTo date it appears that pharmacotherapy and CBT are an effective treatment for the various OCD dimensions, although not all dimensions have been adequately studied or respond well to treatment. Knowing a specific symptom profile may have implications in treatment components that clinicians should be aware of.ConclusionsMore research will be needed to determine the best tailor treatments to each patient’s profile and Modifications to treatment may be needed. Clinical implications and directions for future research are discussed.DisclosureNo significant relationships.

Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in a Tertiary Level Hospital in Portugal.

Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe manifestation of coronavirus disease 2019 (COVID-19). The aim of this study was to describe the characteristics of children with MIS-C admitted to a pediatric tertiary hospital in Portugal. Observational descriptive study of MIS-C patients admitted between April 2020 and April 2021. Demographic and clinical characteristics, diagnostic tests, and treatment data were collected. The diagnosis of MIS-C was based on the World Health Organization and Centers for Disease Control and Prevention criteria. We reported 45 children with MIS-C. The median age was seven years (IQR 4 - 10 years) and 60.0% were previously healthy. SARS-CoV-2 infection was confirmed in 77.8% by RT-PCR or antibody testing for SARS-CoV-2, and in 73.3%, an epidemiological link was confirmed. All the patients had a fever and organ system involvement: hematologic (100%), cardiovascular (97.8%), gastrointestinal (97.8%), mucocutaneous (86.7%), respiratory (26.7%), neurologic (15.6%), and renal (13.3%) system. Neurological (p = 0.035) and respiratory (p = 0.035) involvement were observed in patients with a more severe presentation. There was a significant difference of medians when comparing disease severity groups, namely in the values of hemoglobin (p = 0.015), lymphocytes (p = 0.030), D-dimer (p = 0.019), albumin (p < 0.001), NT-proBNP (p = 0.005), ferritin (p = 0.048), CRP (p = 0.006), procalcitonin (p = 0.005) and IL-6 (p = 0.002). From the total number of children, 93.3% received intravenous immunoglobulin, 91.1% methylprednisolone, and one patient (2.2%) received anakinra. Thirteen patients (28.8%) required intensive care and there were no deaths. Of the 21 patients evaluated, 90.4% had reduction of exercise capacity and of the 15 patients who underwent cardiac magnetic resonance, 53.3% had sequelae of cardiac injury. We observed a large spectrum of disease presentation in a group of patients where most were previously healthy. A small percentage of patients (28.9%) had a severe presentation of the disease. MIS-C is a challenge in current clinical practice and its diagnosis requires a high level of clinical suspicion as the timely initiation of therapy is essential to prevent complications. However, there is no scientific consensus on the treatment and follow-up of these patients.

Dental Pain in Cats: A Prospective 6-Month Study.

Dental pathology is among the most ubiquitous diseases in cats of all ages. Dental pain is yet to be fully understood in cats and therefore its presence is often missed. To better understand feline dental disease as a pain trigger during routine examination and whether disease severity correlates to the degree of pain, a 6-month prospective study in a cats' only veterinary hospital in Portugal was conducted. Sixty-four cats that randomly presented for different clinical procedures were evaluated. Dental and periodontal abnormalities (primary dental parameters, PDP), as well as clinical signs related to dental pain (secondary dental parameters, SDP), were assessed. All cats underwent an oral cavity examination, upon which, the Feline Acute Pain Scale from Colorado State University Veterinary Teaching Hospital (CPS), was used in order to assess pain. Six PDP (periodontal disease, gingival index, calculus index, tooth resorption, tooth fracture and missing teeth) and five SDP (mouth discomfort, halitosis, hypersalivation, difficulty in holding food and several attempts at prehension of food), were compared with CPS pain scores. All SDP were significantly associated to higher CPS pain scores (p < 0.05). The number of missing teeth was significantly associated to higher CPS pain scores (p < 0.0001). A trend was observed between higher CPS pain scores and tooth resorption (p = 0.08). This study concluded that cats with dental disease feel pain during clinical examination and the pain increases as the severity of the disease progresses.

Public Views About Involvement in Decision-Making on Health Data Sharing, Access, Use and Reuse: The Importance of Trust in Science and Other Institutions.

BackgroundData-intensive and needs-driven research can deliver substantial health benefits. However, concerns with privacy loss, undisclosed surveillance, and discrimination are on the rise due to mounting data breaches. This can undermine the trustworthiness of data processing institutions and reduce people's willingness to share their data. Involving the public in health data governance can help to address this problem by imbuing data processing frameworks with societal values. This study assesses public views about involvement in individual-level decisions concerned with health data and their association with trust in science and other institutions.MethodsCross-sectional study with 162 patients and 489 informal carers followed at two reference centers for rare diseases in an academic hospital in Portugal (June 2019–March 2020). Participants rated the importance of involvement in decision-making concerning health data sharing, access, use, and reuse from “not important” to “very important”. Its association with sociodemographic characteristics, interpersonal trust, trust in national and international institutions, and the importance of trust in research teams and host institutions was tested.ResultsMost participants perceived involvement in decision-making about data sharing (85.1%), access (87.1%), use (85%) and reuse (79.9%) to be important or very important. Participants who ascribed a high degree of importance to trust in research host institutions were significantly more likely to value involvement in such decisions. A similar position was expressed by participants who valued trust in research teams for data sharing, access, and use. Participants with low levels of trust in national and international institutions and with lower levels of education attributed less importance to being involved in decisions about data use.ConclusionThe high value attributed by participants to involvement in individual-level data governance stresses the need to broaden opportunities for public participation in health data decision-making, namely by introducing a meta consent approach. The important role played by trust in science and in other institutions in shaping participants' views about involvement highlights the relevance of pairing such a meta consent approach with the provision of transparent information about the implications of data sharing, the resources needed to make informed choices and the development of harm mitigation tools and redress.

Clinical presentation of non-functioning pituitary tumors: the experience at a tertiary care hospital in Portugal

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

MO847: C-Reactive Protein to Albumin Ratio and 6-Month Mortality in Incident Haemodialysis Patients

Abstract BACKGROUND AND AIMS The prevalence of chronic kidney disease (CKD) is growing worldwide and ranges from 8% to 16%. Mortality rates are higher in the first few months of haemodialysis (HD). Protein-energy malnutrition has been demonstrated to be a major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has been associated with increased mortality risk. We aimed to evaluate if CAR could be used to predict 6-month mortality in incident HD patients. METHOD Retrospective analysis of CKD patients who initiated chronic HD between January of 2014 and December of 2019 in a tertiary-care hospital in Portugal. CAR was calculated at HD start. We analyzed 6-month mortality. Variables were submitted to univariate and multivariate analysis to determine factors predictive of 6-month mortality after HD start. We assessed the logistic regression method of the CAR to predict 6-month mortality and the discriminatory ability was determined using the receiver operating characteristic (ROC) curve. RESULTS A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older [76.50 ± 11.39 versus 67.29 ± 15.52 years; P &amp;lt; 0.001, OR: 1.055 (1.035–1.074); P &amp;lt; 0.001, aOR: 1.058 (1.030–1.086); P &amp;lt; 0.001], had more frequently cardiovascular disease [65.1% versus 46.1%; P &amp;lt; 0.001, OR: 2.192 (1.437–3.342); P &amp;lt; 0.001, aOR: 2.210 (1.210–4.037); P = 0.010], central venous catheter at HD start [83.5% versus 58.3%; P &amp;lt; 0.001, OR: 3.622 (2.136–6.142); P &amp;lt; 0.001, aOR: 3.090 (1.584–6.026); P &amp;lt; 0.001], lower PTH [229.44 ± 170.50 versus 365.95 ± 415.80; P = 0.006, OR: 0.998 (0.996–0.999); P &amp;lt; 0.001, aOR: 0.998 (0.997–1.000); P = 0.014] and higher CAR [2.85 ± 3.85 versus 1.36 ± 2.44; P &amp;lt; 0.001, OR: 1.159 (1.086–1.236); P &amp;lt; 0.001, aOR: 1.126 (1.023–1.239); P = 0.015]. The AUC for mortality prediction was of 0.706 [95% confidence interval (0.65–0.76); P &amp;lt; 0.001]. The optimal CAR cut-off was &amp;gt;0.5, with an odds ratio of 5.362 (95% CI 3.208–8.963; P &amp;lt; 0.001). CONCLUSION In our study, we demonstrated that higher CAR was independently associated with a higher mortality rate in the first 6 months of starting HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.

Necrotizing fasciitis of the vulva due to carbapenem-resistant Enterobacteriaceae as a complication of acute myeloid leukemia treatment: a case report

BackgroundCarbapenem-resistant Enterobacteriaceae strains have been reported in healthcare facilities with a rising incidence and are a major concern owing to infections that are often severe and can be potentially fatal, with limited therapeutic options. Klebsiella pneumonia represents the most frequently isolated microorganism.Case presentationWe report the case of a Caucasian 52-year old Caucasian woman with acute myeloid leukemia was admitted to the inpatient hematology unit at a university referral hospital in Portugal. This hospital has endemic colonization of Carbapenem-resistant Enterobacteriaceae and contention measures are being implemented to reduce spreading of these multidrug resistant bacteria. After receiving first line chemotherapy according to the intermediate-dose cytarabine regimen, in context of deep medullary aplasia, the patient developed a localized infection of the vulva, which progressed to a necrotizing fasciitis. This is a rare, life-threatening, and fulminant infection. Carbapenem-resistant Klebsiella was isolated in both vulvar exudate and blood cultures. The patient underwent multiple schemes of antimicrobials, but progressed with multiorgan compromise and was admitted to the intensive care unit for a short period for stabilization. Surgical debridement was performed twice with clinical improvement and, after 6 weeks, a skin graft was executed with good response. Reevaluation of the hematologic disease showed a complete response to first cycle of induction therapy. Despite success in resolving this complex infection, decisions regarding antibiotic treatment represented a tremendous challenge for the whole team. The importance of multidisciplinary collaboration was key for the patient’s recovery and survival, and therefore, needs to be acknowledged.ConclusionsThis clinical case raises awareness on a clinical entity that can be life threatening and, therefore, requires a high level of suspicion to assure an early integrated approach to avoid complications. Endemic spreading of carbapenem-resistant Enterobacteriaceae is becoming a reality, and health policies need to be urgently undertaken at the national level to decrease morbidity and mortality because of health facilities-related infections.

Evaluation of Methicillin-Resistant Staphylococcus aureus Carriage in the Elderly in Portugal Using Selective Enrichment Followed by Quantitative Real-Time PCR.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in Portugal is worrisome and among the highest in Europe. Surprisingly, MRSA prevalence in the community was described as very low (<2%) based on studies that used classical culture-based methods (CCBM). We investigated whether the apparent limited spread of MRSA in the community in Portugal might result from low sensitivity of CCBM. Nasopharyngeal- and oropharyngeal-paired samples obtained from senior adults living in nursing (n = 299) or family homes (n = 300) previously characterized by CCBM were reanalyzed. Samples were inoculated in a semi-selective enrichment medium, and those showing visible growth were evaluated by qPCR targeting nuc, mecA, and mecC genes (SSE+qPCR). By SSE+qPCR, 34 of the 1,198 (2.8%) samples were MRSA positive compared with 21 (1.8%) by CCBM. SSE+qPCR improved non-significantly detection of MRSA carriers from 5.4% to 8.0% (p = 0.12) in the nursing home collection, and from 0.3% to 1.7% (p = 0.13) in the family home collection. MRSA isolates belonged to three HA-MRSA clones widely disseminated in Portuguese hospitals. In conclusion, use of semi-selective medium combined with qPCR did not change the overall scenario previously described. In Portugal, MRSA circulation in the community among senior adults is low.

Pediatric Abusive Head Trauma: A Case Series in a Tertiary Hospital

Characterise cases of Abusive Head Trauma (AHT) over an 8-year period in a tertiary hospital in Portugal, including the main demographic and clinical characteristics, as well as long-term follow-up and sequelae.