Browsing by Author "Gomes, F"
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- Brain Natriuretic Peptide Levels Predict Morbidity and Mortality in Haemodialysis PatientsPublication . Matias, P; Jorge, C; Aires, I; Lage, H; Gil, C; Gomes, F; Arranhado, E; Ferreira, ABackground: Brain natriuretic peptide is a predictor of mortality in multiple cardiovascular diseases but its value in patients with chronic kidney disease is still a matter of debate. Patients and methods: We studied 48 haemodialysis patients with mean age 70.0±13.9 years,62.5% female, 43.8% diabetics, with a mean haemodialysis time of 38.1±29.3 months. To evaluate the role of brain natriuretic peptide as a prognostic factor in this population we performed a two-session evaluation of pre- and postmid-week haemodialysis plasma brain natriuretic peptide concentrations and correlated them with hospitalisation and overall and cardiovascular mortality over a two-year period. Results: There were no significant variations in pre– and post-haemodialysis plasma brain natriuretic peptide concentrations. Pre- and post-haemodialysis brain natriuretic peptide concentrations were significantly greater in patients who died from all causes(p=0.034 and p=0.001, respectively) and from cardiovascular causes (p=0.043 and p=0.001, respectively). Patients who were hospitalised in the two-year study period also presented greater pre- and posthaemodialysis brain natriuretic peptide concentrations(p=0.03 and p=0.036, respectively). Patients with mean brain natriuretic peptide concentrations ≥ 390 pg/mL showed a significantly lower survival at the end of the two-year study period. Conclusion: Brain natriuretic peptide was a good predictor of morbidity and mortality (overall and cardiovascular) in our population.
- Caracterização dos Casos Observados numa Equipa de Psiquiatria da Infância e Adolescência. Um Estudo RetrospectivoPublication . Encarnação, R; Moura, M; Gomes, F; Caldeira da Silva, PAo longo das últimas décadas tem-se assistido a um crescente número de crianças que necessita de avaliação e acompanhamento em Psiquiatria da Infância e Adolescência. Actualmente estima-se que entre 10 a 20% das crianças tenham um ou mais problemas de Saúde Mental, sendo que apenas um quinto destas recebem o tratamento apropriado. Assim, no sentido de se poder proceder a uma melhor planificação e gestão de recursos realizou-se uma análise do movimento assistencial de uma Equipa de Pedopsiquiatria entre 2004 e 2007 bem como uma análise descritiva detalhada da população de utentes do ano 2007. No período de quatro anos estudado foram observadas 1923 crianças num total de 9609 consultas. Verificou-se um predomínio claro de crianças e adolescentes do sexo masculino e a média etária observada foi de 9,89 anos. A caracterização da população consultada no ano de 2007 (480 utentes), revelou também uma preponderância das estruturas familiares nucleare e, ao nível da área de residência destaca-se um predomínio de crianças do concelho de Sintra (71%). Quanto à origem do pedido, em 29% os casos foram referenciados pelo Médico Assistente e em 26% pela Escola; os motivos de consulta mais frequentes foram os problemas de comportamento (30%) e as dificuldades de aprendizagem escolar (15%). Foi possível ainda caracterizar os pedidos de consulta por fonte de referenciação. No que concerne ao diagnóstico, a nível psicodinâmico, a Organização Depressiva predomina (56%) enquanto, quando analisados os diagnósticos do Eixo I de acordo com a DSM-IV-TR, se verifica um predomínio das Perturbações do Humor (30%) seguindo-se as Perturbações do Comportamento e Défice de Atenção (24,8%). Os tempos de espera médios entre o pedido e a primeira consulta variaram entre 55 dias (casos provenientes do Serviço de Urgência) e os 141 dias (casos sinalizados pela escola). Apenas com uma análise aprofundada da realidade assistencial nesta área permitirá a planificação e implementação de medidas que visem optimizar os Serviços e a resposta que estes dão às crianças, adolescentes e famílias.
- Caso Clínico ARP Nº10: Hemangioendotelioma EpitelioidePublication . Torres, D; Barbosa, L; Correia, M; Bilhim, T; Gomes, F; Coimbra, E
- Complication of Deep Brain Stimulation for Parkinson's DiseasePublication . Costa, C; Gomes, F; Monteiro, J; Bento, L
- Diversidade e inclusão no CHULC, sabia que… na consulta de pedopsiquiatria no HDE existem grupos terapêuticos de pais e crianças?...Publication . Gomes, F; Santos, I; Martinho, S; Correia, S; Barca, C
- Nocardia Cyriacigeorgica and Aspergillus Co-Infection in a Patient with Giant-Cell ArteritisPublication . Gomes, F; La Feria, P; Costa, C; Teixeira, HImmunosuppressed patients are at greater risk of unusual infections. The authors present the case of a woman with giant-cell arteritis, on oral steroids, who developed cavitating pneumonia due to co-infection with Aspergillus and Nocardia. Reports of such co-infection are rare in the literature. This case highlights the importance of considering rare pathogens in immunosuppressed patients who present with non-specific symptoms, as well as the impact of such pathogens on clinical management. Another important issue is the need for prophylaxis against Nocardia spp. in immunocompromised patients. Learning points: In patients with vasculitis on systemic corticosteroid therapy or other immunosuppressive treatment, suspicion of uncommon infection should increase in parallel with the cumulative dose of these drugs.Obtaining an accurate diagnosis and early treatment is essential, but can be very challenging.Regular prophylactic therapy should be considered. However, more research is needed to determine whether higher doses of TMP/SMX would provide adequate coverage.
- Non-Uremic Calciphylaxis: a Rare Diagnosis with Limited Therapeutic StrategiesPublication . Gomes, F; La Feria, P; Costa, C; Santos, RCalciphylaxis is a rare condition characterized by the emergence of non-healing skin ulcers secondary to arterial calcification and thrombosis, typically diagnosed in patients with end-stage kidney disease (ESKD). When it develops in patients without ESKD, it is called non-uremic calciphylaxis (NUC). The latter is an even rarer diagnosis with an uncertain pathophysiology and a high mortality rate (52%), mainly due to sepsis (50%). Cutaneous biopsy is diagnostic. Therapeutic measures recommended for NUC are limited to wound debridement, analgesia, and control of infection and risk factors. Other therapeutic options exist but with a low level of evidence. We present the case of a 78-year-old woman with NUC in her lower limbs who died of sepsis. NUC is a therapeutic challenge lacking efficient strategies. Learning points: Calciphylaxis in the absence of end-stage kidney disease is called non-uremic calciphylaxis (NUC).This disease is a diagnostic and therapeutic challenge.As therapeutic strategies for NUC mainly derive from those for uremic calciphylaxis, more efficient therapeutic measures and evidence-based recommendations are needed.
- Targeting DNA Damage in SCLCPublication . Foy, V; Schenk, MW; Baker, K; Gomes, F; Lallo, A; Frese, KK; Forster, M; Dive, C; Blackhall, FSCLC accounts for 15% of lung cancer worldwide. Characterised by early dissemination and rapid development of chemo-resistant disease, less than 5% of patients survive 5 years. Despite 3 decades of clinical trials there has been no change to the standard platinum and etoposide regimen for first line treatment developed in the 1970's. The exceptionally high number of genomic aberrations observed in SCLC combined with the characteristic rapid cellular proliferation results in accumulation of DNA damage and genomic instability. To flourish in this precarious genomic context, SCLC cells are reliant on functional DNA damage repair pathways and cell cycle checkpoints. Current cytotoxic drugs and radiotherapy treatments for SCLC have long been known to act by induction of DNA damage and the response of cancer cells to such damage determines treatment efficacy. Recent years have witnessed improved understanding of strategies to exploit DNA damage and repair mechanisms in order to increase treatment efficacy. This review will summarise the rationale to target DNA damage response in SCLC, the progress made in evaluating novel DDR inhibitors and highlight various ongoing challenges for their clinical development in this disease.