Repositório da Unidade Local de Saúde São José
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HBV and VZV Seroprotection Loss in MS Patients Under DMT.
Publication . Ladeira, Filipa; Oliveira, Tiago; Soares, Mafalda; Araujo, Cristina; Sousa, Ana; Brum, Marisa; Sequeira, João; Capela, Carlos
Background: Strategies recommended to decrease the risk of infection associated with the use of multiple sclerosis disease-modifying treatments include screening and immunization against common viral infections such as varicella-zoster (VZV) and hepatitis B (HBV). However, the data concerning the durability of those vaccine responses and the need for re-test is scarce.
Objectives: We aimed to evaluate HBV and VZV seroprotection loss in MS patients under DMT.
Methods: We conducted a cohort study including patients with basal seroprotective titers against HBV/VZV viruses and a subsequent serology performed at least 3 months apart. We evaluated predictors of seroprotection loss through a binary regression.
Results: HBV seroprotection loss occurred in one-fifth of patients in a median interval of 21.3 months. Anti-CD20 treatment (OR 8.559 95%CI 3.467- 21.130, p < 000.1), age at last serology higher or equal to 55 years (OR 7.506, 95% CI 2.473-22.786, p < 0.001) and basal HBsAb titer (OR 0.992, 95%CI 0.987 -0.996, p=0.001) increase the risk of seroprotection loss. VZV seroprotection loss occurred rarely in a median interval of 21.3 months. We could not identify any factor associated with an increased risk of VZV seroprotection loss.
Conclusions: Anti-CD20 drugs are associated with a loss of seroprotection against HBV in a short-interval follow-up.
Strongyloides Stercoralis After Renal Transplantation - A Global Threat.
Publication . Abrantes, Rita; Barata, Rui; Caeiro, Fernando; Ferreira, Aníbal; Nolasco, Fernando
Idiopathic Scoliosis Trends One Year After COVID-19: A Retrospective Study.
Publication . Pereira, Ana; Lima, Diana; Martins, Mariana; Plancha-Silva, Teresa; Amaral-Silva, Marta; Marques, Elsa
Introduction The reorganization of healthcare services during the COVID-19 pandemic was associated with compromised management of conditions not related to the pandemic. Methods A retrospective descriptive case series study was carried out that included patients followed up at the Spine Deformities (SD) consultation at Centro Hospitalar e Universitário Lisboa Central from January 2019 through December 2021 regarding diagnosis, treatment, referral, and the number of consultations performed. Results Referrals significantly dropped in 2020 (p<0.001). The average number of consultations per patient was found to not vary significantly in 2020 despite the reorganization of our healthcare unit due to the pandemic. 22% of the consultations were performed online. Idiopathic scoliosis (IS) was the primary diagnosis in 50% of the patients observed for the first time during the three-year time period. An increase of 18% was found in the number of IS patients that required bracing in 2021. However, late referrals, defined as the patient meeting surgical criteria at the time of initial presentation, did not increase. Conclusion Despite the significant decrease in primary care referrals during 2020, an overcompensation increase in referrals was not observed in 2021. However, the increase in the percentage of patients needing bracing might reflect a delayed initial presentation to the SD consultation.
Predictors and Prognostic Significance of Postoperative Complications for Patients with Intrahepatic Cholangiocarcinoma.
Publication . Endo, Yutaka; Moazzam, Zorays; Woldesenbet, Selamawit; Araujo Lima, Henrique; Alaimo, Laura; Munir, Muhammad Musaab; Shaikh, Chanza F; Guglielmi, Alfredo; Aldrighetti, Luca; Weiss, Matthew; Bauer, Todd W; Alexandrescu, Sorin; Poultsides, George A; Kitago, Minoru; Maithel, Shishir K; Pinto Marques, Hugo; Martel, Guillaume; Pulitano, Carlo; Shen, Feng; Cauchy, François; Koerkamp, Bas Groot; Endo, Itaru; Pawlik, Timothy M
Background: The prognostic impact of major postoperative complications (POCs) for intrahepatic cholangiocarcinoma (ICC) remains ill-defined. We sought to analyze the relationship between POCs and outcomes relative to lymph node metastases (LNM) and tumor burden score (TBS).
Methods: Patients who underwent resection of ICC between 1990-2020 were included from an international database. POCs were defined according to Clavien-Dindo classification ≥ 3. The prognostic impact of POCs was estimated relative to TBS categories (i.e., high and low) and lymph node status (i.e., N0 or N1).
Results: Among 553 patients who underwent curative-intent resection for ICC, 128 (23.1%) individuals experienced POCs. Low TBS/N0 patients who experienced POCs presented with a higher risk of recurrence and death (3-year cumulative recurrence rate; POCs: 74.8% vs. no POCs: 43.5%, p = 0.006; 5-year overall survival [OS], POCs 37.8% vs. no POCs 65.8%, p = 0.003), while POCs were not associated with worse outcomes among high TBS and/or N1 patients. The Cox regression analysis confirmed that POCs were significant predictors of poor outcomes in low TBS/N0 patients (OS, hazard ratio [HR] 2.91, 95%CI 1.45-5.82, p = 0.003; recurrence free survival [RFS], HR 2.42, 95%CI 1.28-4.56, p = 0.007). Among low TBS/N0 patients, POCs were associated with early recurrence (within 2 years) (Odds ratio [OR] 2.79 95%CI 1.13-6.93, p = 0.03) and extrahepatic recurrence (OR 3.13, 95%CI 1.14-8.54, p = 0.03), in contrast to patients with high TBS and/or nodal disease.
Conclusions: POCs were independent, negative prognostic determinants for both OS and RFS among low TBS/N0 patients. Perioperative strategies that minimize the risk of POCs are critical to improving prognosis, especially among patients harboring favorable clinicopathologic features.
Management of Type B Aortic Dissection: Assessing Paradigm Shifts and the Impact of Endovascular Technology.
Publication . Bastos Gonçalves, Frederico