Browsing by Author "Borges, A"
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- Abcesso Renal na GravidezPublication . Santos, L; Borges, A; Serrano, F; Alves, MJ; Campos, AApesar das infecções urinárias serem relativamente frequentes durante a gravidez, a ocorrência de um abcesso renal é muito raro. A patogénese do abcesso renal tem mudado ao longo dos anos. Actualmente, mais de 75% dos casos têm origem numa infecção do aparelho urinário. Os autores apresentam o caso clínico de uma grávida de 35 anos, internada às 38 semanas e cinco dias de gestação por febre, náuseas, vómitos e dor lombar à direita. Os dados clínicos e os exames complementares realizados levaram ao diagnóstico de abcesso renal. É feita uma revisão da literatura acerca do tema.
- Acute Sheehan's Syndrome Presenting as Central Diabetes InsipidusPublication . Robalo, R; Pedroso, C; Agapito, A; Borges, ASheehan's syndrome occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. Improvements in obstetrical care have significantly reduced its incidence in developed countries, but postpartum pituitary infarction remains a common cause of hypopituitarism in developing countries. We report a case of severe postpartum haemorrhage followed by headache, central diabetes insipidus and failure to lactate, which prompted us to investigate and identify both anterior and posterior pituitary deficiency compatible with Sheehan's syndrome. A timely diagnosis allowed us to implement an adequate treatment and follow-up plan, which are known to improve clinical status and patient outcome.
- Anticoagulação e Cirurgia GinecológicaPublication . Furtado Lima, A; Fatela, A; Borges, AOs acidentes tromboembólicos são uma das causas de maior morbilidade pós-cirúrgica. Com esta revisão os autores pretendem recordar alguns conceitos sobre hemóstase, são ainda abordadas as indicações e o perfil dos fármacos mais utilizados para profilaxia de tromboembolismo venoso em doentes submetidas a cirurgia ginecológica. As doentes cirúrgicas que fazem anticoagulação com Varfarina levantam algumas questões aquando do momento da cirurgia pelo que, por fim, se propõe um protocolo de actuação em doentes cirúrgicas sob anticoagulação de longa duração.
- Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV CohortPublication . Borges, A; Hoy, J; Florence, E; Sedlacek, D; Stellbrink, HJ; Uzdaviniene, V; Tomazic, J; Gargalianos-Kakolyris, P; Schmid, P; Orkin, C; Pedersen, C; Leen, C; Pradier, C; Mulcahy, F; Ridolfo, A; Staub, T; Maltez, F; Weber, R; Flamholc, L; Kyselyova, G; Lungren, J; Mocroft, A; EuroSIDABackground: Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes. Methods: EuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed. Results: During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis. Conclusions: In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.
- Associação entre Pré-Eclâmpsia Grave e Anticorpos Anti-FosfolípidosPublication . Borges, A; Dias, EUm número clinicamente importante de mulheres com pré-eclâmpsia grave de início precoce tem níveis significativos de anticorpos (Ac) anti-fosfolípidos. A sua detecção precoce pode ajudar a definir o risco de complicações no peri-parto levando ao estabelecimento de medidas de prevenção de episódios trombóticos nestas doentes.
- Burkitt’s Lymphoma Related to Epstein–Barr Virus Infection During PregnancyPublication . Cordeiro, A; Machado, AI; Borges, A; Alves, MJ; Frade, MJSetting: Burkitt’s lymphoma is a rare form of cancer and is an extremely rare diagnosis during pregnancy. This form of lymphoma is a very fast growing B cell neoplasm and chemotherapy is the treatment of choice for the disease in all its stages. Case report: The authors describe the case of a Caucasian 40-year-old nulliparous woman, with previous known Epstein–Barr virus infection, that presents at 28 weeks gestation with supraclavicular adenopathy and multiple bilateral breast nodules, in which biopsy showed non-Hodgkin lymphoma, Burkitt’s type. Discussion: There are few described cases of Burkitt’s lymphoma during pregnancy and in general the outcomes have been poor. In most of the cases, the patients were not treated by current standards or instead had a late diagnosis. This neoplasia is the most rapidly progressive human tumor, and any delay in initiating therapy can adversely aVect patient’s prognosis. The authors discuss treatment options in pregnancy and its perinatal implications.
- Chronic Hypertension with Gestational Diabetes Mellitus: What About Complications?Publication . Campos, A; Massa, AC; Rangel, R; Cardoso, M; Borges, AThe aim of this study was to evaluate the impact of chronic hypertension and gestational diabetes on pregnancy outcomes. We conducted a historical cohort study of 334 women undergoing singleton births in a Portuguese tertiary care center in Lisbon during 2012. Women were categorized into gestational diabetes mellitus with or without chronic hypertension. Pregnancy outcomes were compared using nonparametric tests. Multivariable analysis was used to control for potential confounders. The rate of preeclampsia in women with both chronic hypertension and gestational diabetes was 26.8% versus 3.8% in women with only gestational diabetes (p<0.05). Preterm birth was significantly more frequent in women with diabetes and chronic hypertension, 22.9% versus 9.7%, compared with women who only had gestational diabetes (p<0.05). The rate of newborns small for gestational age in women with the two conditions was 19.1% versus 7.6% in women with only gestational diabetes (p<0.05), but the rate of large for gestational age newborns in women of chronic hypertension and gestational diabetes was 9.6% versus 3.8% in gestational diabetes (p<0.05). The impact of having both chronic hypertension and gestational diabetes in pregnancy leads to poor pregnancy and perinatal outcomes, represented by more maternal, obstetrical and neonatal morbidity.
- Congenital Complete Atrioventricular Block. Case Report and Review of the LiteraturePublication . Massa, AC; Freitas, I; Borges, A; Serrano, FIntroduction: Congenital complete atrioventricular block (AVB) without cardiac malformation is a rare and potentially fatal condition. In most cases it is associated with maternal systemic lupus erythematosus through transplacental passage of antibodies anti-SSA/Ro and/or anti-SSB/La. Antenatal fluorinated-steroids have been successful in reversing first and second degree congenital AVB but inconsistent in third degree block. Case Report:The authors report a case of fetal bradycardia diagnosed at 24 weeks of gestation. The fetal echocardiogram revealed a second/third degree AVB without structural heart disease. Maternal anti-SSA/Ro antibodies were detected. There was no blockage improvement with maternal oral fluorinated-steroids. An elective cesarean section was performed at term with the delivery of a healthy girl that required an epicardical pacemaker on the 8th day of life. Conclusion: In this case, treatment with maternal fluorinated corticosteroids was not effective in preventing progression of the heart block.
- Conservative Management of Asymptomatic Adnexal Masses Classified as Benign by the IOTA ADNEX Model: a Prospective Multicenter Portuguese StudyPublication . Brito, M; Borges, A; Rodrigues, S; Ambrósio, P; Condeço, R; Lacerda, A; Bernardo, MJ; Pinto, P; Djokovic, DThis prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.
- Consulta de Hipertensão e Gravidez. Avaliação Comparativa entre o Ano de 1999 e 2004-2005Publication . Campos, A; Dias, E; Borges, AA mulher com hipertensão crónica ou com hipertensão em gravidez anterior pode apresentar na gravidez actual, quadros clínicos de agravamento. A vigilância durante a gravidez, exige uma equipa multidisciplinar com experiência nestas situações. Neste artigo pretendemos fazer uma avaliação comparativa e resultados da gravidez na população que acorre à consulta em dois momentos com 5 anos de intervalo na Consulta de Hipertensão e Gravidez da MAC.