Browsing by Author "Formiga, A"
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- Aneurisma Venoso Popliteu. Relato de 2 CasosPublication . Pereira, AM; Moniz, L; Formiga, A; Bilhim, T; Neves, JO aneurisma da veia popliteia (AVP) é uma entidada rara mas que comporta um risco importante de trombose venosa profunda (TVP) e consequente tromboembolismo pulmonar (TEP). Uma vez que a anticoagulação não é eficaz na prevenção dessas complicações, a cirurgia é o tratamento indicado pela quase totalidade dos autores. Apresentamos dois casos tratados no nosso serviço que ilustram o caráter pleomórfico desta doença – o primeiro manifestando-se como uma massa popliteia pouco sintomática e o segundo como um quadro semelhante a TVP numa doente cuja mãe falecera por TEP de causa não esclarecida. Ambos foram tratados pela técnica de aneurismectomia com venorrafia lateral, com bom resultado confirmado imagiologicamente ao fim de 6 meses. Fazemos ainda uma discussão com base na literatura. O AVP é uma entidade rara e de etiologia não esclarecida, cuja principal complicação é o TEP. O tratamento cirúrgico é a abordagem de eleição. A técnica cirúrgica utilizada de aneurismectomia com venorrafia lateral apresenta bons resultados e pode ser considerada curativa. Por esses motivos é uma doença a considerar no diagnóstico diferencial quer de massas popliteias quer de fenómenos tromboembólicos de repetição.
- Aneurismas Venosos Superficiais. Casuística, Casos Clínicos e Revisão da LiteraturaPublication . Neves, J; Sousa, V; Cavadas, D; Cabete, J; Formiga, AOs aneurismas venosos são uma entidade patológica pouco frequente, embora a sua deteção possa vir a aumentar como consequência da crescente utilização do ecodoppler como meio complementar de diagnóstico. Podem apresentar-se, clinicamente, como massas dos tecidos moles, ocasionalmente simulando hérnia ou adenopatia da região inguinal, particularmente os que surgem no sistema venoso superficial dos membros inferiores. Estão descritos na literatura casos de aneurismas venosos superficiais associados a tromboembolismo pulmonar. Considerando a potencial morbimortalidade, a abordagem terapêutica é cirúrgica na maioria dos casos. Os autores apresentam a sua casuística de aneurismas venosos superficiais num período de 20 anos, três casos clínicos mais exemplificativos e fazem uma revisão da literatura.
- Dakin's Solution in the Treatment of Severe Diabetic Foot InfectionsPublication . Duarte, B; Formiga, A; Neves, JAcute necrotising diabetic foot (DF) infections are common, costly, and do not infrequently result in debilitating major lower-extremity amputations. Dakin's solution is a long-standing topical antiseptic that has shown benefit in this clinical setting, but its use is undermined by a presumed risk of cytotoxicity. In this single-centre case series, we retrospectively evaluated 24 patients with severe necrotising DF infections treated with a cyclical instillation of Dakin's solution at a referral multidisciplinary DF unit. Most patients achieved favourable outcomes in infection control and limb salvage, with only one patient (4.2%) requiring a major (at or above-the-ankle) amputation. The mean time to complete or near-complete wound granulation was 5.4 weeks. Of the 12 patients who completed 12 or more months of longitudinal follow up, only 2 (12.2%) had a wound recurrence. In this severe DF infection patient cohort, Dakin's solution led to a clinically meaningful improvement. No remarkable impairment in the wound-healing process was observed.
- Dakin's Solution: Is There a Place for it in the 21st Century?Publication . Duarte, B; Cabete, J; Formiga, A; Neves, JDakin's solution (DS) is a time-honoured antiseptic that still remains part of the wound care armamentarium. In spite of its cytotoxicity, some question its use in the current era. We report the case of a 52-year-old diabetic woman who was admitted for sepsis because of a severely infected diabetic foot. Urgent surgical drainage and debridement left a 9 × 9-cm deep, complex, infected wound with both bone and tendon involvement. Treatment with local negative pressure was unsuccessful. DS was regularly instilled through a tube left in the wound dressing. A marked improvement was observed with this strategy as the wound bed was much cleaner and fully granulated after 6 weeks. No adverse effects were noted. This case debunks the myth that topical antiseptics necessarily impair wound healing. DS can still be considered an option for difficult-to-treat, complex and heavily infected wounds.
- Diabetic Foot Infection: Causative Pathogens and Empiric Antibiotherapy Considerations-The Experience of a Tertiary CenterPublication . Neves, JM; Duarte, B; Pinto, M; Formiga, A; Neves, JMost moderate-to-severe diabetic foot infections (DFIs) require hospitalization with urgent surgical approach and administration of empiric antibiotherapy. To ensure optimal antibiotic coverage, regular microbiological background updates are imperative. The purpose is to characterize the microbiological profile and the antibiotic sensitivity pattern of the DFI causative pathogens isolated within a specialized DFI unit of a tertiary hospital, in order to establish evidence-based policies regarding empirical antibiotic use. A cross-sectional study was conducted. Microbiological cultures and corresponding antibiotic sensitivity tests collected from moderate-to-severe DFIs as a first approach to the hospitalized patient were retrieved and analyzed during a 12-month period. Two groups were analyzed: inpatients that had been previously followed at the diabetic foot clinic of the hospital and inpatients without a previous contact with the hospital services. A total of 125 isolates obtained from 87 patients were deemed for analysis. Globally, a predominance of Gram-positive bacteria was observed (60%). Staphylococcus aureus was the most common pathogen. The global ratio of methicillin-sensitive S aureus to methicillin-resistant S aureus (MRSA) was 1.3:1, with similar findings in both groups. According to the antibiotic sensitivity test results, and within the recommended empiric antibiotic regimens for DFI, piperacillin/tazobactam seems to be the most suitable option. Gram-positive bacteria prevail as the main isolates in DFIs. Screening for MRSA-specific risk factors is mandatory. When going for a first empiric therapy, piperacillin/tazobactam is recommended in this institution, and an anti-MRSA agent should be added early, if necessary. We encourage continuous monitoring for the bacterial prevalence in Portuguese diabetic foot centers as it is paramount for the decision making regarding DFI protocols.
- Multidrug-Resistant Bacteria in Diabetic Foot Infections: Experience from a Portuguese Tertiary CentrePublication . Pessoa E Costa, T; Duarte, B; João, AL; Coelho, M; Formiga, A; Pinto, M; Neves, JIn recent years, the emergence of antibiotic resistant pathogens made increasingly difficult to establish appropriate empiric antimicrobial therapy protocols for acute diabetic foot infection (DFI) treatment. Early recognition of the population at-risk for multidrug-resistant (MDR) bacterial infection is of paramount importance in order to decrease large-spectrum antibiotic overuse. This study used retrospective cohort study in a multidisciplinary tertiary diabetic foot unit. Patients with severe DFI were included and divided according to their infection resistance profile (susceptible vs MDR bacteria). Data regarding their comorbidities and length of hospital stay were collected. The primary endpoint was to determine the risk factors for MDR infections and to evaluate if these were associated with an increased length of stay (LOS). A total of 112 microbial isolates were included. Predominance of Gram-positive bacteria was observed and 22.3% of isolated bacteria were MDR. Previous hospitalisation was associated with a higher likelihood of MDR infection. MDR bacterial infection was also associated with an increased LOS (P = .0296). Our study showed a high incidence of MDR bacteria in patients with a DFI, especially in those who had a recent hospitalisation. MDR infections were associated with a prolonged LOS and represent a global public health issue for which emergent measures are needed.
- O Pé Diabético com Infecção Aguda: Tratamento no Serviço de Urgência em PortugalPublication . Neves, J; Matias, R; Formiga, A; Cabete, J; Moniz, L; Figueiredo, J; Sampaio, CO pé diabético é uma complicação major comum da Diabetes mellitus sendo o cirurgião geral o responsável pelo seu diagnóstico e tratamento. A infecção aguda é uma urgência médico-cirúrgica. Este artigo tem como objectivos orientar o cirurgião no diagnóstico e tratamento do pé diabético infectado no serviço de urgência. Antibioterapia de largo espectro, drenagem/ desbridamento cirúrgico no serviço de urgência, internamento, repouso do membro e apósitos adequados são medidas essenciais para o correcto tratamento do pé diabético com infecção moderada-grave. Os desbridamentos devem, sempre que possível, preservar a estrutura e funcionalidade do pé. A intervenção atempada é essencial para reduzir o número de amputações major, a mortalidade e custo social associados.