Browsing by Author "Barbosa, R"
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- An Unexpected Infection in a Venous Leg Ulcer: a Case ReportPublication . Veríssimo, M; Guimarães, D; Casal, D; Carvalho, S; Matias, M; Barbosa, R; Bexiga, JProvidencia rettgeri is a Gram-negative bacillus that is most usually seen in urinary tract infections. Skin and soft tissue infections with P rettgeri are rare and there few case reports described in the literature. A 43-yearold woman presented to the emergency department with a leg ulcer of 3 months duration. Microbiological results isolated P rettgeri and Pseudomonas aeruginosa. She underwent surgical debridement and split-thickness skin grafting alongside IV antibiotic therapy and dressing care, with complete resolution of the wound 3 months after admission. The differential diagnosis of leg ulcers is wide and must include infection and venous insufficiency. Although venous ulcers are common, typically they are not responsible for rapid evolving ulcers that destroy tissues below the muscular fascia. In this case report, the authors hypothesise that P rettgeri had a major role in the severity of the ulcer in an otherwise healthy woman. A greater understanding of how P rettgeri affects wound pathophysiology is needed in order to distinguish between colonisation versus infection and discriminate bacterial synergy, as well as having better treatment guidelines.
- Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction: Acellular Dermal Matrix versus Inferior Dermal FlapPublication . Mata Ribeiro, L; Meireles, R; Brito, I; Costa, P; Rebelo, M; Barbosa, R; Choupina, M; Pinho, C; Ribeiro, MBackground Implant-based breast reconstruction has evolved tremendously in the last decades, mainly due to the development of new products and techniques that make the procedure safer and more reliable. The purpose of this study was to compare the outcomes in immediate one-stage breast reconstruction between acellular dermal matrix (ADM) and inferior dermal flap (IDF). Methods We conducted a retrospective comparative study of patients submitted to immediate breast reconstructions with an anatomical implant and ADM or IDF in a single center between 2016 and 2018. Outcomes evaluated included major complications, early complications, reinterventions, readmissions, and reconstruction failure. Simple descriptive statistics and univariate analysis were performed. Results A total of 118 breast reconstructions (85 patients) were included in the analysis. Patients in the IDF group had a higher body mass index (median = 27.0) than patients in the ADM group (median = 24). There were no statistically significant differences among both groups regarding immediate major complication, early complications, readmissions, and reinterventions. Conclusion There are no significant differences in complications between the ADM and IDF approach to immediate implant breast reconstruction. In patients with higher body mass index and large, ptotic breasts, we recommend an immediate implant reconstruction with IDF.
- Impact of Body Mass Index, Age and Tobacco Use on the Outcomes of Immediate Breast Reconstruction with Implants and Acellular Dermal MatrixPublication . Mata Ribeiro, L; Meireles, R; Brito, I; Costa, P; Rebelo, M; Barbosa, R; Choupina, M; Pinho, C; Ribeiro, MBackground This study aimed to analyze the effect of body mass index (BMI), age, and tobacco use on alloplastic breast reconstruction. Methods We conducted a retrospective study of patients who submitted to immediate breast reconstructions with an anatomical implant and acellular dermal matrix in a single center between 2016 and 2018. Outcomes evaluated included immediate complications, early complications, reinterventions, readmissions, and reconstruction failure. Patients were divided into two groups concerning each potential risk factor (BMI < or ≥25; age < or ≥ 50 years; and smokers vs nonsmokers). Simple descriptive statistics and univariate analysis were performed. Results A total of 101 breast reconstructions (73 patients) were included in the analysis. The mean BMI was 24, and the mean age was 44.5 years old. Smokers accounted for 14 breast reconstructions (13.9%). The rate of early infections, mastectomy flap necrosis, and implant removal was significantly higher in overweight patients. The total volume of breast drainage was higher in the age ≥ 50 years group. Smoking did not alter the outcomes. Conclusions A BMI ≥ 25 is a risk factor for early infections and reconstructive failure. Age ≥ 50 years is associated with a higher volume of breast drainage but does not seem to impact the success of the reconstruction. Smoking does not appear to affect the outcomes significantly in this type of reconstruction. Surgeons should consider delaying the reconstruction or using autologous tissue when patients are overweight.
- In Vitro Design of a Novel Lytic Bacteriophage Cocktail with Therapeutic Potential Against Organisms Causing Diabetic Foot InfectionsPublication . Mendes, JJ; Leandro, C; Mottola, C; Barbosa, R; Silva, F; Oliveira, M; Vilela, C; Melo-Cristino, J; Górski, A; Pimentel, M; São-José, C; Cavaco-Silva, P; Garcia, MIn patients with diabetes mellitus, foot infections pose a significant risk. These are complex infections commonly caused by Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii, all of which are potentially susceptible to bacteriophages. Here, we characterized five bacteriophages that we had determined previously to have antimicrobial and wound-healing potential in chronic S. aureus, P. aeruginosa and A. baumannii infections. Morphological and genetic features indicated that the bacteriophages were lytic members of the family Myoviridae or Podoviridae and did not harbour any known bacterial virulence genes. Combinations of the bacteriophages had broad host ranges for the different target bacterial species. The activity of the bacteriophages against planktonic cells revealed effective, early killing at 4 h, followed by bacterial regrowth to pre-treatment levels by 24 h. Using metabolic activity as a measure of cell viability within established biofilms, we found significant cell impairment following bacteriophage exposure. Repeated treatment every 4 h caused a further decrease in cell activity. The greatest effects on both planktonic and biofilm cells occurred at a bacteriophage : bacterium input multiplicity of 10. These studies on both planktonic cells and established biofilms allowed us to better evaluate the effects of a high input multiplicity and a multiple-dose treatment protocol, and the findings support further clinical development of bacteriophage therapy.
- Orbital Exenteration for Eyelid Skin CarcinomaPublication . Guerra, AS; Barbosa, R; Choupina, M; Pinho, C; Ribeiro, M; Pontes, LExenteration of the orbit is a disfiguring and destructive procedure; it is generally performed for orbital malignancies and often provides a significant reconstructive challenge. Our purpose was to evaluate the clinical indications for orbital exenteration in a tertiary referral center and to assess the reconstructive options employed. A retrospective nonrandomized analysis was performed, selecting all patients undergoing orbital exenteration over a 5-year period, between January 2005 and January 2010. Patient demographics, tumor characteristics, and reconstructive techniques used were evaluated. Twenty patients with a mean age of 76.5 years underwent total orbital exenteration. Basal cell carcinoma was the main operative indication (45%), followed by squamous cell carcinoma (15%). Reconstructive techniques included cover of the raw orbital cavity with a temporal muscular flap in all cases followed with split skin grafting (25%), bilaterally pedicle V-Y advancement flap (10%) and a fasciocutaneous island flap of the retroauricular region (65%). Twenty percent of patients had local complications and all were treated in a satisfactory fashion. Eyelid skin tumors remain an important cause of orbital exenteration. Temporal muscle flap is a reliable and stable reconstructive solution after orbital exenteration and additional aid is supplied with skin grafts or local flaps. This technique ensures a good aesthetic outcome and better situation for later complementary treatments and minimal associated donor site morbidity.