Hospital Central do Funchal

A infeção por vírus Monkeypox no homem caracteriza-se por um exantema cutâneo papulovesicular ou pseudopustular, com linfoadenopatias e febre. Apesar de apresentar frequentemente um curso benigno e autolimitado, estão descritas apresentações severas com hospitalização e morte, nomeadamente em doentes imunocomprometidos. Os autores descrevem um caso de Mpox disseminada e progressiva num doente com imunodeficiência secundária à infeção por vírus da imunodeficiência humana de tipo-1 (VIH-1) não controlada, complicada de sobreinfeção bacteriana das lesões por Pseudomonas aeruginosa, com subsequente quadro de choque séptico refratário e desfecho fatal. O presente caso pretende alertar para as apresentações mais severas de Mpox e complicações associadas que agravam o prognóstico de uma doença habitualmente autolimitada.

In recent years, healthcare is evolving to meet the needs of a growing and ageing population. To support better and more reliable care, a comprehensive and up-to-date Personal Health Record (PHR) is essential. Ideally, the PHR should contain all health-related information about an individual and be available for sharing with healthcare institutions. However, due to interoperability issues of the medical and fitness devices, most of the times, the PHR only contains the same information as the patient Electronic Health Record (EHR). This results in lack of health-related information (e.g., physical activity, working patterns) essential to address medical conditions, support prescriptions, and treatment follow-up. This paper introduces the B-Health IoT Box, a fog IoT computing framework for eHealth interoperability and data collection that enables seamless, secure integration of health and contextual data into interoperable health records. The system was deployed in real-world settings involving over 4500 users, successfully collecting and transmitting more than 1.5 million datasets. The validation shown that data was collected, harmonized, and properly stored in different eHealth platforms, enriching data from personal EHR with mobile and wearable sensors data. The solution supports real-time and near real-time data collection, fast prototyping, and secure cloud integration, offering a modular, standards-compliant gateway for digital health ecosystems. The health and health-related data is available in FHIR format enabling interoperable eHealth ecosystems, and better equality of access to health and care services.

Enquadramento: a complexidade do cuidado à pessoa crítica fundamenta a necessidade de áreas de especialização em Enfermagem que dotam o enfermeiro de competências acrescidas, permitindo a prestação de cuidados individualizados e especializados. Objetivo: mapear o conhecimento sobre o impacto da enfermagem especializada no cuidado à pessoa em situação crítica. Metodologia: realizada uma scoping review, proposta pelo The Joanna Briggs Institute, e construída seguindo as seguintes etapas: definição do objetivo, pergunta de pesquisa e critérios de inclusão; pesquisa, seleção e análise das publicações; síntese dos resultados. As bases de dados incluídas foram: EBSCOhost (MEDLINE, CINAHL Complete, eBook Collection), SciELO e Science Direct. A pesquisa contemplou publicações entre 2017 e 2021, ficando o corpus da revisão constituído por cinco artigos científicos. Resultados: os estudos descreveram os efeitos positivos dos cuidados de enfermagem especializados no âmbito do cuidar à pessoa em situação crítica e, consequentemente, dos serviços aos quais se encontram afetos. Conclusão: os cuidados de enfermagem especializados no âmbito do cuidar à pessoa em situação crítica aumentam os níveis de satisfação global da pessoa, permitem identificar atempadamente complicações, diminuem o tempo de internamento, diminuem os custos associados aos cuidados e o tempo do início do tratamento.

ABSTRACT Introduction Restorative Brain–Computer Interfaces (BCIs) provide an alternative non-muscular channel for stroke patients lacking volitional movement by enhancing sensorimotor rhythm modulation through motor imagery (MI). MI practice can be augmented with embodied feedback via virtual reality (VR). However, the clinical impact of embodied VR-BCI training remains under-explored. Methods This study examines the effects of embodied VR-BCI training on brain activity patterns (measured through EEG and fMRI) and clinical outcomes (assessed by the Fugl–Meyer Assessment, FMA) in four chronic stroke patients. Over a 3-week MI-BCI intervention, patients performed a bimanual rowing task (NeuRow) in VR. EEG data were used to extract Event-related desynchronization (ERD) and lateralization indices, while fMRI data focused on the primary motor (M1) and supplementary motor (SMA) regions of interest. Results Results indicated that all patients significantly induced ERD power, though the affected side exhibited reduced ERD compared to baseline during contralateral MI. Post-intervention, significant ERD differences from both hemispheres were observed, with decreased ERD correlating with no clinical improvement. Patients showing decreased ERD lateralization had no FMA score improvement. Activity within ipsilesional M1 and SMA correlated with FMA scores. Conclusions The findings suggest a relationship between brain activity and clinical outcomes, highlighting that increased ERD lateralization is associated with clinical improvement.

Background: Ménière’s disease (MD) lacks a universally accepted pathogenesis model. Recent research has revisited the vascular hypothesis. This study aims to compare the cerebrovascular burden in patients with MD and age-matched controls, investigating the potential role of cerebrovascular dysfunction in MD. Methods: A total of 145 patients (70 MD, 75 controls) underwent magnetic resonance imaging (MRI) assessment for small-vessel disease (SVD) markers (including Fazekas and EPVS scores), cortical strokes, and baseline comorbidities. Statistical analyses were performed to compare the cerebrovascular burden between the groups, adjusting for potential confounders. Results: The MD group exhibited significantly higher mean SVD scores across various measures compared to controls (p < 0.05). This association persisted even after adjusting for age, sex, and comorbidities (ORs ranging from 1.746 to 2.495, p < 0.05). Neither the presence of cortical strokes nor comorbidities significantly differed between groups. Conclusions: This study is the first to compare cerebrovascular burden between MD patients and controls. The findings suggest that cerebrovascular dysfunction may contribute to MD incidence. Further research is needed to elucidate the relationship between cerebrovascular disease and MD, potentially leading to novel therapeutic avenues.

Cardiac arrest is a common cause of death worldwide. Sodium bicarbonate (SB) has commonly been used during cardiopulmonary resuscitation (CPR) to correct metabolic acidosis (MA). However, the existence of evidence about its administration remains controversial. This systematic review aimed to summarize the effectiveness of SB in patients with in-hospital and out-of-hospital cardiac arrest. We searched Medline, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies that used SB in cardiac arrest, from November 1962 until December 2023. A totalof 372 records were identified and 12 studies were included. Despite few studies suggesting that SB may improve outcomes inprolonged CPR, the overall data revealed that SBwas associated with lower rates of ROSC andoutcomes.This review conceded that there is limited evidence to warrant the use of SB during CPR other than under specific conditions, which include hyperkalemic cardiac arrest, severe cardiotoxicity, or overdose due to tricyclic antidepressants. In conclusion, SB is not recommended for conventional use in patients with cardiac arrest. Further studies should be performed to determine whether ithasany benefit in these scenarios.

Background. Vespula spp. and Polistes spp. are relevant species in South Europe, with Vespa velutina nigrithorax (VVN) being considered a public health problem. We aimed to characterize a cohort of Portuguese patients referred for large local reaction (LLR) and/or systemic reaction (SR) to vespids. In patients treated with venom immunotherapy (VIT), induction protocol and frequency of adverse reactions were evaluated. Methods. Retrospective study including patients with LLR and SR to vespids referred to our Immunoallergology Department (2008-2022). Results. A total of 129 patients were evaluated, the majority were male adults (n = 77, 59.7%), from rural areas. From these, 51 patients had SR (Mueller classification: 7.8% grade I, 19.6% grade II, 37.3% grade III, 35.3% grade IV). We found no differences regarding the levels of total serum IgE, basal serum tryptase value, sIgE levels to the eliciting venom or their molecular components, regarding the severity of the SR that motivated the referral to our clinic. In the SR group, previous LLR Hymenoptera sting were reported in 15.7%. Thirty-eight patients (74.5%) initiated VIT: 22 with wasp venom, 14 with paper wasp venom and 2 with Vespa velutina venom. There was one mild systemic reaction, not requiring adrenaline and 4 LLR. Re-stings after VIT occurred in 16 patients, without any systemic or local reactions. Currently, eleven patients remain under VIT. Conclusions. Most vespid-venom allergic patients are male adults from rural areas. Sensitization to wasp venom was present in 52.9%, paper wasp in 33.3% and Vespa velutina in 13.7%. The frequency of adverse reactions during both induction and maintenance phases appears to be low. Despite a reduced sample size, our experience with VVN VIT, suggests its safety.

The leafhopper fauna of the Iberian Peninsula is the least studied in Europe. Recent surveys in agroecosystem areas of southern Spain, specifically in Andalusia, aimed to identify potential Auchenorrhyncha vectors of the bacterium Xylella fastidiosa. During these surveys, three previously unrecorded species of Cicadellidae belonging to the subfamily Deltocephalinae have been discovered. These newly recorded species are Balclutha incisa (Matsumura), Cicadulina (Cicadulina) bipunctata (Melichar), and Maiestas angustisecta (Linnavuori). Generally, these species were previously only known from American, African and eastern Palaearctic regions. This work is the first to record these species on the European mainland. Detailed descriptions of adult specimens have been provided, along with information on their current distribution and host plants. The potential role of these leafhoppers as potential vectors of plant pathogens is discussed, highlighting their importance in agroecosystems.