Successful Application of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in a Case of Subglottic Stenosis.

We widely employ microlaryngeal surgery to treat diverse oropharyngeal and laryngeal conditions, but it presents challenges to shared airway management. This case report addresses the limitations of conventional techniques, such as tracheal intubation and jet ventilation, and explores the emerging interest in transnasal humidified rapid insufflation ventilatory exchange (THRIVE). While THRIVE offers advantages such as enhanced visualization and reduced airway trauma, its application is limited by the duration of apnea, with the literature referring to a maximum of 30 minutes of apnea. We present the successful application of THRIVE as the primary airway management technique in a patient undergoing a 55-minute dilation procedure for subglottic stenosis. Successful oxygenation was achieved, creating a tubeless field and improving visibility. The patient maintained oxygen saturation above 98%, demonstrating the effectiveness of THRIVE in managing prolonged apnea. Remarkably, intentional ventilation via a face mask at specific moments allowed extended apneic oxygenation without harmful carbon dioxide levels. This report complies with the growing evidence supporting the efficacy of THRIVE in providing extended apnea for tubeless surgery. The success demonstrated in our case highlights the feasibility and effectiveness of THRIVE in situations demanding prolonged apnea and complex airway management.

Neuropsychiatric Symptoms Assessment: Cross-cultural Adaptation and Validation of the Portuguese Abe's BPSD Score (ABS).

OBJECTIVES: This study aims to report on the development and psychometric properties of the Portuguese-language Abe's BPSD score (ABS) to screen for neuropsychiatric symptoms (NPS). METHODS: ISPOR and COSMIN recommendations were followed to translate and culturally adapt the ABS. A validation study was conducted to assess the psychometric properties of the newly-translated instrument. Outpatients attending a psychogeriatric consultation were included by consecutive referrals and were assessed with the ABS, the Neuropsychiatric Inventory (NPI) and NPI Caregiver Distress scale (NPI-D), and the Mini-Mental State Examination (MMSE). The ABS reliability (internal consistency, item-total correlations, inter-rater and test-retest reliability), validity (concurrent and convergent), feasibility and diagnostic accuracy were examined. RESULTS: Overall, 107 participants were included. The ABS Cronbach alpha was 0.672, and item-total correlations ranged from -0.056 to 0.546. Strong inter-rater (ICC 0.997; 95%CI: 0.995-0.999) and test-retest reliability (ICC 0.976; 95%CI: 0.958-0.986) were found. Concurrent validity with NPI was high (rs = 0.847, p < .001), and correlations with MMSE and NPI-D were also significant. An exploratory threshold score ≥2 is proposed to identify clinically relevant NPS. CONCLUSIONS: Data provide satisfactory proof of ABS psychometric characteristics. Nevertheless, some items exhibited less optimal properties. CLINICAL IMPLICATIONS: The newly-translated instrument proved to be relevant, valid and easy to use in a real geriatric clinical setting.

Urgent/emergency surgery during COVID-19 state of emergency in Portugal: a retrospective and observational study.

Background: SARS-CoV-2 virus changed society's behaviour. Population was advised to reduce unnecessary heath care use to accommodate urgent cases and daily increase of COVID-19 patients. Health care facilities faced huge challenges, having to readjust their response to preserve good quality of care. In Portugal, a significant reduction in the number of admissions to the Emergency Department (ED) was reported all over the country, however the impact on the dynamics of undeferrable surgery remains to be reported. This study compares the volume and characteristics of urgent/emergency surgery during the 2020 COVID-19 pandemic with the homologous period in 2019, chronologically illustrating the national evolution of new COVID-19 cases and the social and hospital containment response. Methods: A retrospective observational study was conducted in a tertiary hospital center located in the most affected region by COVID-19 in Portugal. Medical records of patients who underwent urgent/emergency surgery between March 1st and May 2nd of both 2020 and 2019 were examined and the volume of surgeries were compared. Also, daily national updates from Portuguese Directorate-General for Health were analysed. Results: During the COVID-19 pandemic approximately 30% less patients underwent urgent/emergency surgery (99%CI = 0.18-0.61, p < 0.001). Waiting time for surgery showed no difference between both years (p = 0.068), but patients who did surgery during the 2020 pandemic had higher mortality rates than the ones who did it in 2019 (11.4% in 2020 and 5.9% in 2019, p = 0.001). Reduction in surgery volume was correlated with the increasing number of infected cases nationally. Conclusion: This study demonstrates decreasing numbers of urgent/emergency procedures during the COVID-19 pandemic that may be justified by the national growth number of infected cases. Preoperative mass screening strategy was implemented without compromising the efficiency of surgical service, but patients' mortality was higher. The importance of visiting the ED during COVID-19 pandemic for serious cases that cannot be managed in other settings should be highlighted.

BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation.

Objective This study aims to present the Selective Reminding Test(SRT) and Word List Generation (WLG) adaptation to the Portuguese population, within the validation of the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T)for multiple sclerosis (MS) patients.Method 66 healthy participants (54.5% female) recruited from the community volunteered to participate in this study.Results A combination of procedures from Classical Test Theory (CTT) and Item Response Theory (ITR) were applied to item analysis and selection. For each SRT list, 12 words were selected and 3 letters were chosen for WLG to constitute the final versions of these tests for the Portuguese population.Conclusion The combination of CTT and ITR maximized the decision making process in the adaptation of the SRT and WLG to a different culture and language (Portuguese). The relevance of this study lies on the production of reliable standardized neuropsychological tests, so that they can be used to facilitate a more rigorous monitoring of the evolution of MS, as well as any therapeutic effects and cognitive rehabilitation.

BRBN-T validation: adaptation of the Selective Reminding Test and Word List Generation / Validação da BRBN-T: adaptação do Selective Reminding Teste do Word List Generation

Objective This study aims to present the Selective Reminding Test(SRT) and Word List Generation (WLG) adaptation to the Portuguese population, within the validation of the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T)for multiple sclerosis (MS) patients.Method 66 healthy participants (54.5% female) recruited from the community volunteered to participate in this study.Results A combination of procedures from Classical Test Theory (CTT) and Item Response Theory (ITR) were applied to item analysis and selection. For each SRT list, 12 words were selected and 3 letters were chosen for WLG to constitute the final versions of these tests for the Portuguese population.Conclusion The combination of CTT and ITR maximized the decision making process in the adaptation of the SRT and WLG to a different culture and language (Portuguese). The relevance of this study lies on the production of reliable standardized neuropsychological tests, so that they can be used to facilitate a more rigorous monitoring of the evolution of MS, as well as any therapeutic effects and cognitive rehabilitation.

Objectivo Este estudo tem como objectivo a adaptação do Selective Reminding Test (SRT) e do Word List Generation (WLG)para a população portuguesa, no decurso da validação da Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) para doentes com esclerose múltipla (EM).Método 66 sujeitos saudáveis (54.5% sexo feminino), foram recrutados da comunidade e voluntariaram-se para, participar neste estudo.Resultados Uma combinação de procedimentos da Teoria Clássica dos Testes (TCT) e da Teoria de Resposta ao Item (TRI) foi aplicada à análise e seleção dos itens. Para cada lista do SRT foram selecionadas 12 palavras e para o WLG foram escolhidas 3 letras, que constituem a versão final destes testes para a população Portuguesa.Conclusões A combinação da TCT e da TRI maximizou a tomada de decisão na seleção de itens na adaptação do SRT e do WLG para uma língua e cultura diferentes (o Português). A relevância deste estudo prende-se com a produção de testes de avaliação neuropsicológica fidedignos, que podem ser utilizados na monitorização rigorosa da evolução da EM, efeitos da terapêutica e reabilitação cognitiva.