Browsing by Author "Antunes, M"
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- Causas de Morte em Doentes com Hemofilia: Estudo Retrospectivo de 1979 a 2007, no Serviço de Imunohemoterapia do HSJPublication . Costa, C; Antunes, M; Diniz, MJ
- Cirurgia e Hemofilia com Inibidor: 4 Casos ClínicosPublication . Santos, A; Diniz, MJ; Antunes, M
- Clinical Adverse Events in Elderly Hospitalized Patients in a Medical Ward - a Prospective StudyPublication . Vieira Alves, R; Fernandes, M; Figueiredo, I; Drummond Borges, D; Antunes, MIntroduction: Studies to date describe between 3% to 50% of patients experiencing one or more clinical adverse event (CAE) during their hospital admission and many preventable. The aim of this prospective study was to determine the frequency of medical CAEs in a medical ward. Also the study aimed to compare data between patient age groups and determine the effect on length of hospital stay and mortality. Methods: This is a prospective study, consulting patients’ electronic clinical notes over 6 months . Every week, all patient electronic processes were reviewed, and CAEs noted. The episode was only noted if the episode was clearly labeled as a CAEs by the medical team in the patient´s notes. If confounding factors were present, this episode was excluded. Patients were grouped by age; compared in terms of demographics, comorbidities, diagnosis at admission and readmission rate. Primary outcomes included mean length of stay and mortality. Results: 62 episodes were studied, 14.8% of those admitted to hospital experienced a CAE. The most frequent adverse events included analytical alterations, anemia and blood loss, infection and altered state of consciousness. The most commonly implicated therapies were anticoagulants (23%) which lead to episodes of bleeding, anti-hypertensive and diuretics (17%) immunosuppressive therapy (16%) beta blockers (1%) and insulin (1%). Mean length of stay in hospital was 17 days in all groups, longer than the average length of stay of this medical ward which is 11 days. Mortality rate within one year of hospitalization was 30% in total, again significantly higher than the 10% mortality rate calculated for the same period on the ward. Conclusion: This study demonstrates that CAEs are still far too common, probably underestimated, cause serious harm to patients and strains healthcare services further.
- Cross-Sectional Epidemiological Study to Understand the Approach to Treatment in the Routine Care of Patients with Hemophilia B in Spain and PortugalPublication . Álvarez-Román, MT; Carvalho, M; Benítez-Hidalgo, O; Catarino, C; García-Frade, LJ; Rodríguez-López, M; Antunes, M; Fernández-Mosteirín, N; Kjöllerström, P; Morais, S; Galmes, B; López-Fernández, MF; Riera-Sans, L; Rodrigues, JF; Jiménez-Yuste, V; Salvado, RIntroduction: Treatment options for patients with hemophilia B (PWHB) have improved in the last decade, but epidemiological studies are required to optimize clinical management and define unmet needs. Objective: The objective of the study is to investigate current disease management and quality of life (QoL) in PWHB in Spain and Portugal. Methods: Epidemiological, cross-sectional, multicenter study with moderately severe and severe PWHB. Sociodemographic, epidemiological, clinical, treatment, and QoL data were collected retrospectively over a 24-month period. Results: Of the 75 patients included in the study, 78.7% received prophylactic treatment and 21.3% on demand; 65.3% were treated with SHL-FIX and 10.7% with rIX-FP. Bleeding occurred in 81.3%, mainly in the form of spontaneous bleeding. Prophylaxis resulted in a lower annualized bleeding rate, better joint health, and better QoL, compared to on-demand treatments. Patients treated with rIX-FP throughout the study had better disease control and QoL than those treated with SHL-FIX. Conclusion: With the largest sample to date of PWHB from Spain and Portugal, our understanding of the management and impact of hemophilia B is broadened and, in accordance with previous evidence, it shows the benefits of prophylaxis and the advantages that the FIX extended half life products life FIX can offer.
- Elective Laparoscopic Cholecistectomy in a Severe Hemophilia A Patient with Inhibitors to Factor VIIPublication . Santos, A; Antunes, M; Diniz, MJ; Pimentel, T
- Glanzmann's Thrombastenia Treatment: a Center's ExperiencePublication . Santos, A; Antunes, M; Diniz, MJ
- HCV Infection in Patients with Hereditary Bleeding DisordersPublication . Caiado, A; Antunes, M; Santos, AL; Esteves, J; Diniz, MJIntroduction: Hepatitis C virus (HCV) infection in patients with hereditary bleeding disorders (HBDs), as a consequence of treatment with transfusion of human bloodderived components between the late 1970s and 1980s, represents a major health concern. Objectives: Assessment and evaluation of the burden of HCV infection, its complications, and treatment in a population of patients with HBDs. Methods: Analysis of a series of 161 patients with HBDs treated in the Immunohemotherapy Service of the Centro Hospitalar de Lisboa Central (Lisboa, Portugal), consultation and systematic review of the patients clinical processes, elaboration of a database comprising the information gathered; and statistical study of its variables: age, gender, degree of severity of the bleeding disorder, treatment modality, and major and minor complications of HCV infection. Results: Sixty-five (40%) of the 161 patients have HCV infection. Among the patients with hemophilia A, 36% are severe and 62% of those have HCV infection; 9% moderate with 57%; 25% mild with 20%. In the hemophilia B group, 8% are severe with 23% infected and 6% moderate or mild with 10%. Concerning the patients with von Willebrand disease, 12% have type 2 with 16% infected and 4% have type 3 with 86%. Conclusions: HCV infection represents a very significant complication of the treatment employed in the past in the studied population. Considering that most of these patients were infected in the late 1970s and early 1980s, and the natural evolution of HCV infection in patients without bleeding disorders, it is expected that the prevalence of major complications will rise significantly in the coming years. Prophylactic measures should be implemented to enhance the follow-up protocols and prevent further development of liver damage in these patients.
- Hemorragia do Psoas-Ilíaco em Doentes com Hemofilia. Experiência do Serviço de Imuno-Hemoterapia do Centro Hospitalar de Lisboa - Hospital de S. JoséPublication . Santos, N; Caldas, J; Antunes, M; Diniz, MJ
- Infections After Liver Transplantation: A Retrospective, Single-Center StudyPublication . Antunes, M; Teixeira, A; Fortuna, P; Moya, B; Martins, A; Bagulho, L; Pereira, JP; Bento, L; Perdigoto, R; Barroso, E; Marcelino, PObjective. To access the incidence of infectious problems after liver transplantation (LT). Design. A retrospective, single-center study. Materials and Methods. Patients undergoing LT from January 2008 to December 2011 were considered. Exclusion criterion was death occurring in the first 48 hours after LT. We determined the site of infection and the bacterial isolates and collected and compared recipient’s variables, graft variables, surgical data, post-LT clinical data. Results. Of the 492 patients who underwent LT and the 463 considered for this study, 190 (Group 1, 41%) developed at least 1 infection, with 298 infections detected. Of these, 189 microorganisms were isolated, 81 (51%) gram-positive bacteria (most frequently Staphylococcus spp). Biliary infections were more frequent (mean time of 160.4 167.7 days after LT); from 3 months after LT, gram-negative bacteria were observed (57%). Patients with infections after LT presented lower aminotransferase levels, but higher requirements in blood transfusions, intraoperative vasopressors, hemodialysis, and hospital stay. Operative and cold ischemia times were similar. Conclusion. We found a 41% incidence of all infections in a 2-year follow-up after LT. Gram-positive bacteria were more frequent isolated; however, negative bacteria were commonly isolated later. Clinical data after LT were more relevant for the development of infections. Donors’ variables should be considered in future analyses.
- Prophylatic Treatment of Hemophilia A Patients with InhibitorsPublication . Antunes, M; Santos, A; Diniz, MJ