Browsing by Author "Costa, M"
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- Angioplastia Primária na Mulher: Realidade NacionalPublication . Calé, R; Sousa, L; Pereira, H; Costa, M; Sousa Almeida, MObjetivos: A mortalidade na mulher após angioplastia primária (ICP-P) é superior à do homem. Contudo, permanece contraditório o papel do sexo poder ser fator de risco independente para mortalidade no contexto de enfarte agudo do miocárdio com supradesnivelamento de ST (EAMST). Com base no Registo Nacional de Cardiologia de Intervenção (RNCI),pretendemos avaliar como é que o género feminino influencia o prognóstico a curto prazo nos doentes com EAMST submetidos a ICP-P a nível nacional. Métodos: De 60 158 doentes incluídos prospetivamente no RNCI de 2002-2012, incluímos na análise 7544 doentes com EAMST tratados por ICP-P, dos quais 25% foram mulheres. Utilizámos modelos de regressão logística e ajustamento por propensity score para avaliar o impacto do sexo na mortalidade hospitalar. Resultados: As mulheres foram mais idosas (68 ± 14 versus 61 ± 13, p < 0,001), mais diabéticas(30 versus 21%, p < 0,001) e hipertensas (69 versus 55%, p < 0,001). Os homens foram revascularizados mais cedo (71 versus 63% nas primeiras 6 horas, p < 0,001). Choque cardiogénico foi mais frequente nas mulheres (7,1 versus 5,7%, p = 0,032). Estas apresentaram um pior prognóstico a curto prazo, com 1,7 x maior risco de morte intra-hospitalar (4,3 versus 2,5%; IC 95% 1,30-2,27; p < 0,001). Utilizando um modelo de regressão ajustado através de um propensity score, o sexo deixa de ser preditor de mortalidade hospitalar (OR 1,00; IC 95% 0,68-1,48; p = 1,00). Conclusões: No RNCI as mulheres com EAMST tratadas com ICP-P apresentaram maior risco cardiovascular, um acesso menos atempado a ICP-P e um pior prognóstico. Contudo, após ajustamento do risco, o género feminino deixa de ser preditor independente de mortalidade hospitalar.
- Autoimmune Progesterone Dermatitis: Treatment with OophorectomyPublication . Medeiros, S; Rodrigues-Alves, R; Costa, M; Afonso, A; Rodrigues, A; Cardoso, J
- Coronary Optical Coherence Tomography: A Practical Overview of Current Clinical ApplicationsPublication . Cruz Ferreira, R; Pereira-da-Silva, T; Patrício, L; Bezerra, H; Costa, MCoronary optical coherence tomography has emerged as the most powerful in-vivo imaging modality to evaluate vessel structure in detail. It is a useful research tool that provides insights into the pathogenesis of coronary artery disease. This technology has an important clinical role that is still being developed. We review the evidence on the wide spectrum of potential clinical applications for coronary optical coherence tomography, which encompass the successive stages in coronary artery disease management: accurate lesion characterization and quantification of stenosis, guidance for the decision to perform percutaneous coronary intervention and subsequent planning, and evaluation of immediate and long-term results following intervention.
- Dermatose Autoimune à Progesterona. Revisão da Literatura a Propósito de um Caso ClínicoPublication . Medeiros, S; Rodrigues Alves, R; Costa, M; Afonso, A; Rodrigues, A; Cardoso, JAs dermatoses com agravamento pré-menstrual cíclico constituem um problema comum, reflexo da sensibilidade da pele aos efeitos hormonais. Muitas dermatites crónicas agravam transitoriamente no período pré-menstrual, enquanto que outras são apenas clinicamente aparentes após este período. O termo dermatose auto-imune à progesterona (DAIP) é reservado aos poucos casos em que é demonstrada alergia à progesterona, estando associado a um espectro variável de manifestações cutâneas como a urticária, angioedema, eczema, foliculite, entre outras. Nas mulheres afectadas, ocorre 3 a 10 dias previamente ao início do fluxo menstrual, melhorando cerca de 2 dias após o seu início. Os autores descrevem o caso de uma doente com DAIP com início durante a gravidez, submetida a terapêutica cirúrgica de ooforectomia bilateral. Efectuamos uma revisão da literatura médica no que concerne aos aspectos clínicos, patogénese, diagnóstico e opções terapêuticas desta doença.
- Endoscopic Treatment of Early Gastric Obstruction After Sleeve Gastrectomy: Report of Two CasesPublication . Costa, M; Capela, T; Seves, I; Ribeiro, R; Rio-Tinto, RMorbid obesity is an epidemic and complex disease which imposes a multidisciplinary approach. Laparoscopic sleeve gastrectomy has become a frequent procedure given its effi- cacy and safety compared to other surgical options. However, it isn’t free from complications. Lax gastric fixation or incorrect positioning of the stomach during surgery can result in early gastric outlet obstruction caused by a volvulus-like mechanism by rotation of the stomach around its anatomic axes. This report refers to two cases of post sleeve gastric torsion resulting in persisting vomiting after initiating oral intake. The diagnosis was confirmed by upper gastrointestinal-contrast study and gastroscopy. In both cases, a fully covered self-expandable metallic stentwas insertedwhich prompted the gastric lumen to become permeable resulting in symptomatic resolution. The stents were removed endoscopically aftertwo and three months. Beyond more than three years offollow-up,the patients remain asymptomatic and no recurring ‘‘stenosis’’ was noticed.In these cases the use offully covered self-expandable metallic stents demonstrated to be effective and safe in the treatment of post sleeve gastric torsion.
- Fistulization of J-PEG Jejunal Tube into the Colon in a Patient Treated with Duodopa® Infusion: A Case ReportPublication . Russo, P; Costa, M; Silva, M; de Sousa, A; Carvalho, D; Saiote, J; Mendes, MThe continuous delivery of a levodopa/carbidopa gel suspension (Duodopa®) into the small bowel through a jejunal tube inserted via percutaneous endoscopic gastrostomy represents a new treatment method in advanced Parkinson disease. Some severe device-related complications have been described in the last few years. Some of them are associated with phytobezoar formation at the pigtail of the catheter. We present the case of a Parkinson disease patient treated with the Duodopa infusion system complicated by jejunal tube fistulization into the colon. We suggest a possible treatment strategy for this complication, which has not been described in the literature to date.
- Fistulizing Gastric GISTPublication . Costa, M; Russo, P; Ramos, G
- Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes: PRIME-FFR (Insights From the POST-IT [Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease] and R3F [French FFR Registry] Integrated Multicenter Registries - Implementation of FFR [Fractional Flow Reserve] in Routine Practice)Publication . Van Belle, E; Bravo Baptista, S; Raposo, L; Henderson, J; Rioufol, G; Santos, L; Pouillot, C; Ramos, R; Cuisset, T; Calé, R; Teiger, E; Jorge, E; Belle, L; Machado, C; Barreau, D; Costa, M; Hanssen, M; Oliveira, E; Besnard, C; Costa, J; Dallongeville, J; Pipa, J; Sideris, G; Fonseca, N; Bretelle, C; Guardado, J; Lhoest, N; Silva, B; Barnay, P; Sousa, MJ; Leborgne, L; Silva, JC; Vincent, F; Rodrigues, A; Seca, L; Fernandes, R; Dupouy, PBackground: Fractional flow reserve (FFR) is not firmly established as a guide to treatment in patients with acute coronary syndromes (ACS). Primary goals were to evaluate the impact of integrating FFR on management decisions and on clinical outcome of patients with ACS undergoing coronary angiography, as compared with patients with stable coronary artery disease. Methods and results: R3F (French FFR Registry) and POST-IT (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease), sharing a common design, were pooled as PRIME-FFR (Insights From the POST-IT and R3F Integrated Multicenter Registries - Implementation of FFR in Routine Practice). Investigators prospectively defined management strategy based on angiography before performing FFR. Final decision after FFR and 1-year clinical outcome were recorded. From 1983 patients, in whom FFR was prospectively used to guide treatment, 533 sustained ACS (excluding acute ST-segment-elevation myocardial infarction). In ACS, FFR was performed in 1.4 lesions per patient, mostly in left anterior descending (58%), with a mean percent stenosis of 58±12% and a mean FFR of 0.82±0.09. In patients with ACS, reclassification by FFR was high and similar to those with non-ACS (38% versus 39%; P=NS). The pattern of reclassification was different, however, with less patients with ACS reclassified from revascularization to medical treatment compared with those with non-ACS (P=0.01). In ACS, 1-year outcome of patients reclassified based on FFR (FFR against angiography) was as good as that of nonreclassified patients (FFR concordant with angiography), with no difference in major cardiovascular event (8.0% versus 11.6%; P=0.20) or symptoms (92.3% versus 94.8% angina free; P=0.25). Moreover, FFR-based deferral to medical treatment was as safe in patients with ACS as in patients with non-ACS (major cardiovascular event, 8.0% versus 8.5%; P=0.83; revascularization, 3.8% versus 5.9%; P=0.24; and freedom from angina, 93.6% versus 90.2%; P=0.35). These findings were confirmed in ACS explored at the culprit lesion. In patients (6%) in whom the information derived from FFR was disregarded, a dire outcome was observed. Conclusions: Routine integration of FFR into the decision-making process of ACS patients with obstructive coronary artery disease is associated with a high reclassification rate of treatment (38%). A management strategy guided by FFR, divergent from that suggested by angiography, including revascularization deferral, is safe in ACS.
- As Implicações/Impacto dos Registos de Enfermagem em Linguagem CIPEPublication . Abreu, C; Almeida, MC; Costa, M; Santos, R; Jácome, PA implementação dos registos electrónicos na prática de enfermagem permitirá um vasto suporte na informação, possibilitando o desenvolvimento de formação/investigação, continuidade e monitorização da qualidade dos cuidados. Irá igualmente contribuir para dar maior visibilidade ao impacto dos cuidados de enfermagem nos ganhos em saúde das populações.
- Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective ReviewPublication . Costa, M; Canena, J; Mascarenhas-Lemos, L; Loureiro, R; Silva, M; Carvalho, D; Capela, T; Russo, P; Ramos, G; Mateus-Dias, A; Ferraz-Oliveira, M; Mota Veiga, P; Coimbra, JBrush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently used strategy for obtaining a tissue sample from an indeterminate biliary stricture. A recent study reported that age is a factor associated with positive yields, but further analysis of how age influences the results was lacking. We aimed to evaluate clinical effectiveness of biliary cytology and prognostic factors for a positive outcome, especially age. Methods: This study was a single-center, retrospective, clinical study of 77 consecutive patients who underwent brush cytology during ERCP to obtain a diagnosis of an indeterminate biliary stricture. We compared 2 routine cytology techniques: A (smear); B (centrifugation of the cytological material collected and the cut-off brush + cell block when sufficient amount of material was available). The data were collected aiming to compare the accuracy of the different techniques used and the prognostic factors affecting the outcome, with a particular focus on age. The yield for brush cytology was compared with the gold standard defined as either definitive histology or the long-term clinical course. Results: The overall accuracy of the 2 used methods was 75.3%. Sensitivity was 52.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 66.1%. Although not statistically significant, there was a trend toward accuracy for method B compared with method A (80.4 vs. 65.4%; p = 0.153). Multiple logistic regression analysis showed that younger age was the only independent prognostic factor associated with a positive diagnosis (OR 0.95; 95% CI 0.90-0.99; p = 0.039). Receiver operating characteristic curves for age yielded an area under the curve value of 68.2%. On the basis of the Youden index, 69 years was found to be the optimal cutoff for age. Conclusions: In this series, the accuracy of routine biliary brush cytology was not equal for all methods and ages; in particular, younger patients (below 69 years) tended to have a higher probability of a correct diagnosis.