Browsing by Author "Leal, I"
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- Anemia Megaloblástica Aguda por Inalação de Óxido Nitroso em Doente com Patologia Autoimune MúltiplaPublication . Barbosa, L; Leal, I; Timóteo, AT; Matias, TAs anemias megaloblásticas são habitualmente vistas como doenças crónicas de aparecimento insidioso. No entanto, um estado megaloblástico pode aparecer em apenas alguns dias devido à deficiência aguda de ácido fólico ou vitamina B12. Uma das causas mais comuns, embora pouco relatada, é acção tissular do óxido nitroso (NO2), substancia volátil utilizada comummente em anestesia. Efectivamente, o N02 inactiva a metilcobalamina, levando ao rápido desenvolvimento de uma hematopoiese megaloblástica. Este fenómeno pode ocorrer mesmo em doentes sem défice prévio de vitamina B12, sendo no entanto frequente e mais grave quando há um estado carencial de base. Apresentamos o caso clínico de uma doente com fractura do colo do fémur, que desenvolveu anemia aguda no pós-operatório cuja investigação permitiu identificar uma anemia pemiciosa latente e patologia tiroideia autoimune em doente com vitiligo desde longa data.
- Association Between Alcohol Intake and Cardiac RemodelingPublication . Rodrigues, P; Santos-Ribeiro, S; Teodoro, T; Veloso Gomes, F; Leal, I; Reis, JP; Goff, DC; Gonçalves, A; Lima, JBackground: Alcohol-induced cardiotoxicity is incompletely understood. Specifically, the long-term impact of alcohol use on ventricular remodeling or dysfunction, its modulators, and effect thresholds among young adults remain controversial. Objectives: The authors sought to evaluate a potential relationship between alcohol intake and cardiac remodeling, assessed by echocardiography, over 20 years of follow-up. Methods: Among the CARDIA (Coronary Artery Risk Development in Young Adults) study cohort, the authors studied all subjects without baseline heart disorders who provided adequate information on their drinking habits and underwent echocardiographic evaluation at years 5 and 25 of the study. The echocardiographic outcomes were left ventricular (LV) ejection fraction, indexed LV end-diastolic volume and LV mass, and left atrial diameter. Participants were grouped according to their weighted-average weekly drinking habits. An additional analysis used the estimated cumulative alcohol consumption. Regression models and multivariable fractional polynomials were used to evaluate the association between alcohol consumption and the outcomes. Results: Among the 2,368 participants, alcohol consumption was an independent predictor of higher indexed LV mass (p = 0.014) and indexed LV end-diastolic volume (p = 0.037), regardless of sex. No significant relationship between alcohol intake and LV ejection fraction was found. Drinking predominantly wine was associated with less cardiac remodeling and there was a nonsignificant trend for a harmful effect of binge drinking. Conclusions: After 20 years of follow-up, alcohol intake was associated with adverse cardiac remodeling, although it was not related with LV systolic dysfunction in this initially healthy young cohort. Our results also suggest that drinking predominantly wine associates with less deleterious findings in cardiac structure.
- Choosing Wisely Portugal - Wise Health DecisionsPublication . Bigotte Vieira, M; Ferreira Santos, G; Carvalho, CR; Dias, CV; Sousa, DC; Leal, I; Valente Jorge, J; Alves, M; Morgado, M; Baptista, RB; Fortunato, P; Vaz Carneiro, A; Guimarães, M
- Choosing Wisely Portugal: a Visão dos Médicos PortuguesesPublication . Morgado, M; Alves, M; Reis Carvalho, C; Viegas Dias, C; Cordeiro Sousa, D; Ferreira-dos-Santos, G; Leal, I; Valente Jorge, J; Bigotte Vieira, M; Fortunato, P; Baeta Baptista, R; Vaz-Carneiro, A
- Enterocolite Necrosante com Perfuração e Drenagem Peritoneal no Recém-Nascido de Muito Baixo Peso: Um Caso Clínico de Evolução FavorávelPublication . Leal, I; Duarte, L; Alves, R; Magalhães, J; Videira-Amaral, JA enterocolite necrosante (ECN) constitui o problema gastrointestinal mais grave e mais frequente no recém-nascido (RN) de baixo peso. A melhoria na taxa de sobrevivência tem sido atribuída ao diagnóstico mais precoce e à experiência adquirida no tratamento do recém-nascido pré-termo em estado crítico. Desde 1977 que a drenagem peritoneal como actuação prioritária nos quadros de ECN tem sido preconizada nos recém- -nascidos de peso inferior a 1500 g com perfuração intestinal, e nos de peso superior a 1500 g com instabilidade hemodinâmica. Neste artigo relata-se o caso de um recém-nascido, com 1473 g de peso e 30 semanas de idade gestacional, ECN, sinais de perfuração intestinal e de instabilidade hemodinâmica, o qual foi submetido a drenagem peritoneal com evolução favorável e sem sequelas. Na discussão faz-se referência especial, de acordo com dados de literatura, aos mecanismos que explicam os bons resultados do procedimento em cerca de 2/3 dos casos de ECN com perfuração, os quais estão relacionados com as características particulares da cicatrização nos tecidos imaturos. Em conclusão, admite-se que a drenagem peritoneal deverá constituir a forma de actuação prioritária nos casos de ECN com perfuração e instabilidade hemodinâmica em RN pré-termo de muito baixo peso.
- Síndroma Nefrótico CorticorresistentePublication . Leal, I; Ferreira, S; Silva, A; Ferra de Sousa, JOs autores apresentam o caso clínico de uma criança de 18 meses, sexo masculino, raça branca,internada na Unidade de Nefrologia com o diagnóstico de síndroma nefrótico - crise inaugural. Atendendo à idade, aos parâmetros bioquímicos e estudo imunológico negativo, admite-se síndroma nefrótico de lesões mínimas e inicia corticoterapia na dose 60mg/m2/dia. Porqua às seis semanas mantinha edema refractário e comportava-se como corticorresistente, efectuou-se biópsia renal que revelou glomerunefrite membranosa com profileração de crescentes depósitos de IgG, IgA, IgM, C1, C3, C4, C1q, a favor da doença imunológica de base e sugestiva de nefropatia lúpica. O protocolo terapêutico foi revisto e iniciou terapêutica de seis ciclos mensais de ciclofosfamida endovenosa. A resposta clínica laboratorial foi favorável a partir do quarto ciclo e está em remissão após os seis ciclos efectuados e seguimento em ambulatório de 14 meses.
- The 2021 Portuguese Society of Ophthalmology Joint Guidelines with Paediatric Rheumatology on the Screening, Monitoring and Medical Treatment of Juvenile Idiopathic Arthritis-Associated UveitisPublication . Leal, I; Miranda, V; Fonseca, C; Barbosa-Breda, J; Cordeiro Sousa, D; Mesquita-Marques, P; Araújo, J; Silva, MI; Pedrosa, AC; Palmares, J; Furtado, MJ; Macedo, M; Lages, V; Fonseca, S; Gonçalves, R; Ruão, M; Gomes Rodrigues, F; Ribeiro, M; Proença, R; Almeida, M; Liverani, M; Morais Pina, S; Bernardo, M; Nogueira, V; Guerra Pinto, R; Pinto Ferreira, F; Pinto Proença, R; Domingues, I; Guedes, M; Cordeiro, M; Fragata, F; Berens, O; Gregório, T; Brito, I; Oliveira-Ramos, F; Fonseca, JE; Figueira, LAim: To develop the first Ophthalmology joint guidelines with Paediatric Rheumatology with recommendations on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis (JIA-U), endorsed by the Portuguese Society of Ophthalmology (SPO). Methods: A systematic literature review was conducted to include publications up to July 14th 2020, with no language restrictions, in order to include all the international position papers/guidelines concerning the medical management of JIA-U and randomised clinical trials assessing the efficacy and safety of medical treatment in this field. We searched through MEDLINE (PubMed), Scopus, Web of Science and Cochrane Library. The Delphi modified technique to generate consensus was used. Preliminary evidence statements were subject to an anonymous agreement assessment and discussion process using an online survey, followed by further discussion and update at a national meeting. A draft of the manuscript with all recommendations was then circulated among all participants and suggestions were incorporated. The final version was again circulated before publication. Results: Twenty-six recommendations were developed focusing on the following topics: general management (3), screening and follow-up of uveitis (4), treatment (17) and health education in JIA-U among patients and families (2). Conclusion: These guidelines were designed to support the shared medical management of patients with JIA-U and emphasize the need for a multidisciplinary approach between Ophthalmology and Paediatric Rheumatology regarding the comprehensive care of JIA-U. We acknowledge that updating these recommendations will be warranted in the future, as more evidence becomes available.
- The Role of Psychological Adjustment in the Decision-Making Process for Voluntary Termination of PregnancyPublication . Sereno, S; Leal, I; Maroco, JBACKGROUND: This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. METHODS: In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. RESULTS: The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. CONCLUSION: Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.