Browsing by Author "Fernandes, MA"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
- Current Evidence on the Impact of Medication Optimization or Pharmacological Interventions on Frailty or Aspects of Frailty: a Systematic Review of Randomized Controlled TrialsPublication . Pazan, F; Petrovic, M; Cherubini, A; Onder, G; Cruz-Jentoft, A; Denkinger, M; van der Cammen, T; Stevenson, J; Ibrahim, K; Rajkumar, C; Bakken, M; Baeyens, JP; Crome, P; Frühwald, T; Gallaghar, P; Guðmundsson, A; Knol, W; O’Mahony, D; Pilotto, A; Rönnemaa, E; Serra-Rexach, JA; Soulis, G; van Marum, R; Ziere, G; Mair, A; Burkhardt, H; Neumann-Podczaska, A; Wieczorowska-Tobis, K; Fernandes, MA; Gruner, H; Dallmeier, D; Beuscart, J; van der Velde, N; Wehling, MBackground: Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. Methods: A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019. Results: Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty. Conclusion: So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.
- Mielinólise Centropôntica e Extrapôntica: Experiência de um Centro de Transplante HepáticoPublication . Fernandes, MA; Miranda, S; Marcelino, P; Mega, I; Machado, J; Perdigoto, R; Barroso, EIntrodução: A mielinólise centropôntica e extrapôntica (MCPEP) é uma síndrome desmielinizante rara. A MCPEP é mais prevalente em receptores de transplante hepático tendo um prognóstico desfavorável associado. A correção rápida de hiponatremia e agentes imunossupressores, como os inibidores da calcineurina, foram identificados como causas possíveis para o desenvolvimento desta patologia. Métodos: Os autores descrevem uma revisão casuística com cinco casos apresentados em tabela simples de doentes que no decorrer do internamento na unidade de cuidados intensivos após transplantação hepática, desenvolveram sinais e sintomas neurológicos concomitantemente com alterações imagiológicas identificadas através de ressonância magnética crânio encefálica compatível com MCPEP. Resultados: O consumo de etanol em excesso, síndrome de encefalopatia hepática e hiponatremia foram os 3 pontos mais comummente identificados no período pré-cirúrgico. Quatro dos cinco doentes apresentaram, durante o período intraoperatório, variação dos níveis séricos de sódio superior aos valores de referência. Conclusão: De forma de avaliar a prevalência, as manifestações clinicas e os resultados da patologia, os autores reviram os casos documentados de MCPEP num centro de referência de transplantação hepática.
- Pericarditis Due to Campylobacter Fetus Subsp. Fetus: a Case Report of an Uncommon InfectionPublication . Fernandes, MA; Gonçalves, F; Gonçalves, LPericarditis is a common condition with numerous aetiologies. Bacteria other than the Mycobacterium tuberculosis complex are an exceptional cause. We present a case of subacute pericarditis highly probable due to Campylobacter fetus subsp. fetus in an immunosuppressed patient undergoing biologic therapy in relation to systemic lupus erythematosus (SLE). On admission, the patient presented with chest pain, dyspnea, and diaphoresis and has lately developed fever and a large pericardial effusion (PE) with a concomitant increase in the inflammatory parameters. The clinical presentation, along with the exclusion of a flare of the autoimmune disease and the isolation of Campylobacter fetus subsp. fetus on blood samples permitted the diagnosis. After therapy with antibiotics and colchicine, the patient showed full recovery.