Browsing by Author "Henriques, J"
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- Apendicite Aguda - Clínica Versus HistologiaPublication . Henriques, J; Reimão, C; Pereira, S; Figueiredo, B; Vital, VP; Casella, PIntrodução: A apendicite aguda continua a ser um dos principais diagnósticos nos Serviços de Cirurgia Pediátrica. A taxa de apendicectomia negativa (apendicectomia sem evidência histológica de patologia), frequentemente utilizada como índice de qualidade hospitalar, permanece alta, apesar dos esforços para a reduzir, especialmente em crianças com menos de 6 anos. Objectivos: os objectivos primários foram: o cálculo da taxa de apendicectomia negativa, da concordância entre diagnóstico clínico (pós-operatório) e diagnóstico histológico e a caracterização da discordância diagnóstica por tipo de apendicite (fleimonosa, gangrenada, perfurada). A caracterização dos grupos apendicectomia negativa (A) e apendicites perfuradas (B), bem como a relação entre estes dois grupos ao longo dos anos, constituíram objectivos secundários. Material e Método: Estudo retrospectivo dos dados clínicos de 1000 doentes consecutivamente operados com o diagnóstico clínico de apendicite aguda, no Hospital de Dona Estefânia, no período de 1 de Janeiro 2003 – 30 de Setembro 2007, procedendo-se à consulta da folha de requisição de exame histo-patológico enviada para o Serviço de Anatomia Patológica. Foram revistos os dados epidemiológicos, a qualidade da informação da referida folha de requisição e calculada a taxa de apendicectomia negativa nesta amostra. Resultados: O diagnóstico clínico pós-operatório foi concordante com o diagnóstico histológico em cerca de 60% casos, sendo subvalorizado ou sobrevalorizado nos restantes casos. A taxa de apendicectomia negativa observada foi de 5,5%, o que está abaixo dos valores apresentados na literatura. Conclusões: As apendicectomias negativas devem ser um “mal menor” em relação às apendicites perfuradas. A discordância clínico-histológica pode ter implicações médico-legais e tem seguramente implicações clínicas e económicas pelo que urge reavaliar o modelo de abordagem desta patologia tão frequente.
- Gastropexia Laparoscópica em Volvo Gástrico NeonatalPublication . Vital, VP; Pereira, S; Henriques, J; Casella, PIntrodução: O Volvo gástrico é uma doença rara em idade pediátrica. Estão descritos casos crónicos recorrentes e agudos, mas a sua incidência real é desconhecida. Apresentamos a descrição cirúrgica de um caso de volvo gástrico crónico, recorrente, diagnosticado no período neonatal, tratado com sucesso por via laparoscópica. Caso clínico: Recém-nascido, do sexo masculino, portador de anomalia de Ebstein, com vómitos não biliosos recorrentes, desidratação e perda ponderal. O estudo contrastado, do tubo digestivo superior, mostrou volvo gástrico organoaxial, tendo sido submetido a gastropexia por via laparoscópica. Discussão: Segundo a maioria dos autores, a correcção cirúrgica do volvo gástrico é mandatória para prevenção de recorrências e complicações. A gastropexia por via minimamente invasiva é simples e segura.
- Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient MonitorizationPublication . Figueira, J; Henriques, J; Carneiro, A; Marques-Neves, C; Flores, R; Castro-Sousa, JP; Meireles, A; Gomes, N; Nascimento, J; Amaro, M; Silva, RDiabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients' vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3-6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6-8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments.
- HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019Publication . Pingarilho, M; Pimentel, V; Miranda, M; Silva, AR; Diniz, A; Ascenção, B; Piñeiro, C; Koch, C; Rodrigues, C; Caldas, C; Morais, C; Faria, D; Gomes da Silva, E; Teófilo, E; Monteiro, F; Roxo, F; Maltez, F; Rodrigues, F; Gaião, G; Ramos, H; Costa, I; Germano, I; Simões, J; Oliveira, J; Ferreira, J; Poças, J; Saraiva da Cunha, J; Soares, J; Henriques, J; Mansinho, K; Pedro, L; Aleixo, MJ; Gonçalves, MaJ; Manata, MJ; Mouro, M; Serrado, M; Caixeiro, M; Marques, N; Costa, O; Pacheco, P; Proença, P; Rodrigues, P; Pinho, R; Tavares, R; Correia de Abreu, R; Côrte-Real, R; Serrão, R; Sarmento e Castro, R; Nunes, S; Faria, T; Baptista, T; Martins, MR; Gomes, P; Mendão, L; Simões, D; Abecasis, AObjective: To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods: Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results: In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion: Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
- Minimally Invasive Repair of Morgagni Hernia - A Multicenter Case SeriesPublication . Lamas-Pinheiro, R; Pereira, J; Carvalho, F; Horta, P; Ochoa, A; Knoblich, M; Henriques, J; Henriques-Coelho, T; Correia-Pinto, J; Casella, P; Estevão-Costa, JChildren may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.
- Penile Involvement as Initial Manifestation of Henoch-Schönlein PurpuraPublication . Santos, E; Henriques, J; Ladeira, C; Alves, R
- Three-Dimensional Head-Mounted Display System for Ophthalmic Surgical ProceduresPublication . Dutra Medeiros, M; Nascimento, J; Henriques, J; Barrão, S; Fernandes-Fonseca, A; Aguiar-Silva, N; Moura-Coelho, N; Ágoas, V