Browsing by Author "Lima, R"
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- Avaliação do Suporte Nutricional numa Unidade de Cuidados Intensivos DiferenciadaPublication . Ruivo, A; Camilo, ME; Tavares, L; Resende, M; Dias, MG; Lima, RO objectivo deste artigo consistiu na avaliação da adequação e execução de um protocolo de nutrição entérica, implementado numa unidade de cuidados intensivos, e que havia sido programado em função dos doentes nela admitidos. Num período de 3 meses, foram seleccionados e avaliados 34 processos clínicos, com internamento superior a 48 horas. Verificou-se que a avaliação nutricional, clínica ou laboratorial, mesmo sumária, ainda não entrou na prática clínica. O registo do suporte nutricional efectuado é insuficiente, embora a nutrição entérica ou parentérica determine maior rigor. A dieta química polimérica é adequada, sendo raramente necessária uma alternativa de mais fácil absorção. O protocolo foi adequado, mas há necessidade de avaliação regular e maior proficiência nos cuidados de aplicação. Propõe-se um novo protocolo com registo e determinação das necessidades de nutrientes de forma individualizada.
- Omalizumab for Severe Asthma: Beyond Allergic AsthmaPublication . Loureiro, CC; Amaral, L; Ferreira, JA; Lima, R; Pardal, C; Fernandes, I; Semedo, L; Arrobas, ADifferent subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered.
- Optimizing the Use of Systemic Corticosteroids in Severe Ssthma (ROSA II Project): a National Delphi Consensus StudyPublication . Marques, J; Duarte-Ramos, F; Ferreira, MB; Lima, R; Lopes, C; Sokolova, A; Tonin, FS; Loureiro, CC
- Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel DiseasePublication . Lopes, AI; Azevedo, S; Cabral, J; Ferreira, MG; Sande-Lemos, P; Ferreira, R; Trindade, E; Lima, R; Antunes, HAnemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), both in pediatric and in adult patients. Iron deficiency is the main cause of anemia in patients with IBD. Anemia is a clinically relevant comorbidity, with impact on patients' quality of life and it should be timely diagnosed and adequately treated. Currently, an active treatment approach is the recommended strategy, with evidence showing efficacy and safety of intravenous iron formulations. However, evidence in pediatric age remains scarce and no clinical recommendations exist for the diagnosis and treatment of this particular age group. The present document represents the first national consensus on the management of anemia in pediatric IBD and is therefore particularly relevant. The authors anticipate that the proposed recommendations will be useful in daily clinical practice for diagnosing and managing iron deficiency and iron-deficiency anemia in the pediatric population with IBD.
- Reducing Oral Corticosteroids in Severe Asthma (ROSA Project): a Nationwide Portuguese ConsensusPublication . Chaves Loureiro, C; Branco Ferreira, M; Ferreira, J; Lima, R; Marques, J; Sokolova, A; Tonin, F; Duarte Ramos, FIntroduction and objectives: We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. Material and methods: A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-'strongly disagree'; 5-'strongly agree'). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). Results: Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients' comorbidities was rated as imperative by all experts. Conclusions: These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients' adherence, and costs.