Browsing by Author "Fernandes, M"
Now showing 1 - 10 of 14
Results Per Page
Sort Options
- Abdominoplasty and Thoraco-Epigastric Flaps for Large Anterior Trunk Defects after Dermatofibrosarcoma Protuberans Wide Resection: Two Illustrative CasesPublication . Casal, D; Fradinho, N; Ramos, L; Ferreira, J; Varanda, A; Diogo, C; Baltazar, J; Fernandes, M; Correia, C; Almeida, MAINTRODUCTION: Excision of large dermatofibrosarcoma protuberans in the anterior aspect of the trunk often results in large surgical defects that frequently dictate the need for microsurgical reconstruction. However, this option is not always available. PRESENTATION OF CASE: The authors describe two patients with very large anterior trunk dermatofibrosarcoma protuberans: one in the epigastric region and the other in the hypogastric region. In the patient with the hypogastric tumor, a classical abdominoplasty flap associated with umbilical transposition was used to cover the skin defect after muscle and fascial plication, and placement of a polypropylene mesh. In the patient with the epigastric tumor, a synthetic mesh was also placed, and the skin and subcutaneous defect was reconstructed with a reverse abdominoplasty flap and two thoraco-epigastric flaps. In both cases, complete closure was possible without immediate or late complications. DISCUSSION: The local options described in this paper present several potential advantages compared to microsurgical reconstruction, namely they are easier and faster to perform and teach; they provide a good skin color and texture match; they are not associated with distant donor site morbidity; follow-up is usually less cumbersome; the post-operative hospital stay tends to be shorter; they are less costly; they are less prone to complete failure. CONCLUSION: The authors believe that these two patients clearly show that local flaps, although frequently neglected, continue to be valid options for reconstructing large anterior trunk defects, even in the current era of microsurgery enthusiasm.
- Adenocarcinoma do Ângulo de TreitzPublication . Quaresma, L; Pupo, A; Cabrita, F; Silva, G; Fernandes, M; Fradique, AC
- Um Caso de Sucesso no Tratamento Concomitante de Rotura de Aneurisma Intracraniano e Aneurisma VisceralPublication . Diogo, C; Baltazar, J; Fernandes, MA associação entre aneurismas intracranianos e viscerais é extremamente rara, com mau prognóstico. A situação de rotura surge habitualmente no contexto de urgência e implica um tratamento imediato. Relata-se o caso de uma doente com rotura de aneurisma da artéria comunicante anterior e da artéria pancreaticoduodenal anterior. A actuação concertada das várias especialidades permitiu a abordagem cirúrgica dirigida ao aneurisma visceral, sem o agravamento da hemorragia cerebral que a eventual clampagem da Artéria Aorta poderia provocar. A manutenção da estabilidade hemodinâmica foi essencial para a posterior realização de embolização do aneurisma intracraniano.
- 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.
- Disease Activity Assessment of Rheumatic Diseases During Pregnancy: a Comprehensive Review of Indices Used in Clinical StudiesPublication . Andreoli, L; Gerardi, MC; Fernandes, M; Bortoluzzi, A; Bellando-Randone, S; Brucato, A; Caporali, R; Chighizola, C; Chimenti, MS; Conigliaro, P; Cutolo, M; Cutro, MS; D'Angelo, S; Doria, A; Elefante, E; Fredi, M; Galeazzi, M; Gerosa, M; Govoni, M; Iuliano, A; Larosa, M; Lazzaroni, MG; Matucci-Cerinic, M; Meroni, M; Meroni, P; Mosca, M; Patanè, M; Pazzola, G; Pendolino, M; Perricone, R; Ramoni, V; Salvarani, C; Sebastiani, G; Selmi, C; Spinelli, F; Valesini, G; Scirè, CA; Tincani, APregnancy requires a special management in women with inflammatory rheumatic diseases (RDs), with the aim of controlling maternal disease activity and avoiding fetal complications. Despite the heterogeneous course of RDs during pregnancy, their impact on pregnancy largely relates to the extent of active inflammation at the time of conception. Therefore, accurate evaluation of disease activity is crucial for the best management of pregnant patients. Nevertheless, there are limitations in using conventional measures of disease activity in pregnancy, as some items included in these instruments can be biased by symptoms or by physiological changes related to pregnancy and the pregnancy itself may influence laboratory parameters used to assess disease activity. This article aims to summarize the current literature about the available instruments to measure disease activity during pregnancy in RDs. Systemic lupus erythematosus is the only disease with instruments that have been modified to account for several adaptations which might interfere with the attribution of signs or symptoms to disease activity during pregnancy. No modified-pregnancy indices exist for women affected by other RDs, but standard indices have been applied to pregnant patients. The current body of knowledge shows that the physiologic changes that occur during pregnancy need to be either adapted from existing instruments or developed to improve the management of pregnant women with RDs. Standardized instruments to assess disease activity during pregnancy would be helpful not only for clinical practice but also for research purposes.
- Hepatitis E Virus Genotype 1 Cases Imported to Portugal from India, 2016Publication . Mesquita, JR; Almeida-Santos, M; Fernandes, M; Maltez, F; Lino, S; Alves, L; Abreu-Silva, J; Oliveira, R; Curran, M; Nascimento, MHepatitis E in industrialized countries is mainly associated with genotype 3 hepatitis E virus (HEV) and normally causes a sporadic self-limiting disease in immunocompetent individuals. Unlike genotype 3, genotypes 1 and 2 circulate in developing countries, produce severe disease and occur in the epidemic form. Hepatitis E occurring in travellers returning from endemic areas in developing countries is not a novel epidemiological occurrence, however the vast majority of cases remain to be genetically studied. The present study describes two cases of severe acute hepatitis E that required hospitalization for 6 and 9 days in two individuals of Indian nationality that had recently migrated to Portugal to work. The retrieved HEV sequences both belonged to genotype 1 and had a high degree of nucleotide sequence identity, clustering with strains isolated in India and Nepal, in 2013 and 2014. Confirmed HEV genotypes of increased pathogenicity like genotype 1 are being introduced into otherwise naïve populations of industrialized countries such as European countries with consequences difficult to predict. As far as we know the present study is the first in Portugal to describe and genetically characterize imported cases of hepatitis E infection caused by HEV genotype 1.
- Heterogeneous lupus-specific lesions and treatment outcome, in a single patient, over a period of timePublication . Fernandes, M; Taulaigo, AV; Vidal, C; Agostini, P; Riso, N; Moraes-Fontes, MFThe report highlights the importance of strict clinico-histological correlations when skin biopsies are performed in diagnostic doubt in systemic lupus erythematosus. Furthermore, PUVA is never indicated in autoimmune conditions involving photosensitivity, due to high potential for internal and cutaneous aggravation of the disease, as the authors observed in this case.
- Primary Anti-Phospholipid Antibody Syndrome: Real-World Defining Features of Rethrombosis in the Course of DiseasePublication . Moraes-Fontes, MF; Pedro, F; Campos, MM; Fernandes, M; Yavuz, S; Oliveira, F; Panarra, AObjective: We aimed to identify features that allow differentiation of primary antiphospholipid syndrome (PAPS) patients that suffer recurrent thrombotic events (RTE) despite anticoagulation, from the other diagnosed PAPS patients. Methods: This was an exploratory study of anticoagulated PAPS patients attending an Autoimmune Diseases Unit (1998-2018). From 2016, anti-phospholipid antibodies and lupus anticoagulant were determined for each patient at consecutive visits, collected together with retrospective clinical characteristics, laboratory, and therapeutic markers and compared according to the occurrence of thrombotic events during follow-up. Results: Overall, two thirds of the patients were female, 93% were Caucasian, with a median age of 40 years at diagnosis, for a median time of 11.5 years in follow-up. Out of 54 patients, 10 were identified with RTE. There were no significant differences among the RTE and non-RTE patients as far as classical risk factors for clotting disorders. The RTE group was characterized by a higher proportion of younger patients, male sex and positivity for all laboratory markers, and initially and over follow-up as well as a sustained high-risk profile based on APS laboratory markers. Anticardiolipin IgG at onset was the only statistically significant marker of the RTE group. At the end of follow-up, consistent reversion to negative status was a rare event, observed in 20% of RTE vs. 25% of non-RTE patients. Conclusions: Despite therapy, we were able to identify features associated to thrombotic events in patients with PAPS. Prospectively regular clinical and laboratory monitoring might be warranted in order to treat APS more assertively.
- Protecting Older Patients with Cardiovascular Diseases from COVID-19 Complications Using Current MedicationsPublication . Alves, M; Fernandes, M; Bahat, G; Benetos, A; Clemente, H; Grodzicki, T; Martínez-Sellés, M; Mattace-Raso, F; Rajkumar, C; Ungar, A; Werner, N; Strandberg, T; EuGMS Special Interest Group in Cardiovascular MedicinePurpose: In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods: We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results: Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions: Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.
- Readmissions in Elderly Patients with Heart Failure. A Retrospective StudyPublication . Vieira Alves, R; Fernandes, M; Figueiredo, I; Drummond Borges, D; Lourenço, FHeart failure is a major cause of morbidity and mortality worldwide. The prevalence increases with age and usually progresses, leading to repeated hospital admissions and significant symptom burden for patients. The correct management of these patients may decrease readmissions and increase quality of life. Our aim is to compare elderly patients with and without 1-year readmissions in an internal medicine ward, particularly in terms of mortality. Retrospective study, consulting patient’s clinical records, with a diagnosis of heart failure. The patients were characterized and divided in groups: with (wR) and without readmission (woR) within 1 year. Mortality was the primary outcome. Eighty-nine patients were included; 60 woR and 29 wR. There was no gender dif ference between groups, the wR group had older patients. The most frequent comor bidities included atrial fibrillation, hyper tension and chronic renal failure stage 3 or higher. The most frequent cause of hospitalization was heart failure due to insufficient therapy or natural progression of the dis ease. The etiology of heart failure was mainly hypertensive and ischemic. The wR group had more patients classified as NYHA >III . In relation to the primary outcome; mortality at 12 months was higher in the group with repeated admissions . The characterization of this population allows us to highlight the causes of decompensation and to review medication in order to increase the quality of life.