Browsing by Author "Machado, A"
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- Decisões Clínicas na Doença de CrohnPublication . Magro, F; Correia, L; Lago, P; Macedo, G; Peixe, P; Portela, F; Amil Dias, J; Barros, L; Belo, T; Caldeira, P; Cerqueira, R; Chagas, C; Correia, M; Ferreira, A; Freire, P; Gonçalves, AR; Gonçalves, R; Herculano, R; Lopes, S; Moura Santos, P; Machado, A; Morna, H; Pimentel, R; Ramos, J; Reis, J; Rodrigues, S; Rosa, I; Salgado, M; Vasconcelos, H; Vieira, AIA doença de Crohn é uma doença inflamatória crónica do trato gastrointestinal. O aumento da incidência e a heterogeneidade desta patologia, com diferentes apresentações e prognóstico leva a uma constante preocupação em desenvolver e melhorar a sua classificação e tratamentoObjectivos: Elaborar recomendações (com base no nível de evidência e grau de recomendação) para 5 questões consideradas como os desafios clínicos na abordagem terapêutica da doença de Crohn na actualidade. Métodos: A metodologia adoptada pelo grupo de trabalho DC2 (Desafios Clínicos na Doença de Crohn) baseou‑se na seleção de 5 questões‑problema, por votação; elaboração, por cada subgrupo, de recomendações e reflexões nacionais para cada questão‑problema; discussão e aprovação das respostas e reflexões de cada questão, em reunião de consenso. Conclusões: Foi possível efectuar conclusões alicerçadas na evidência para as questões colocadas, recomendando‑se: 1) são factores preditivos de mau prognóstico o aparecimento da doença de Crohn antes dos 40 anos, doença estenosante e doença anal; 2) poder‑se‑á ponderar suspender os biológicos em doentes com remissão endoscópica e com biomarcadores normais; 3) os doentes com marcadores bioquímicos de atividade (nomeadamente a PCR e a calprotectina) têm maior probabilidade de recidiva; 4) perante uma falência aos biológicos é essencial assegurar que o tratamento com o primeiro fármaco foi optimizado. No caso do infliximab, está demonstrado que quer a redução do intervalo das administrações ou o aumento da dose permitem recuperar a resposta na larga maioria dos doentes. Em relação ao adalimumab, os doentes deverão passar de terapêutica quinzenal para semanal 5) em situação de doença de Crohn com cirurgia intestinal, o recurso a terapêutica de redução da recorrência pós‑cirurgia, particularmente imunossupressores e biológicos está indicado.
- Fibromuscular Dysplasia With Dissecting Basilar Aneurysm: Endovascular TreatmentPublication . Ribeiro, M; Soares-Fernandes, J; Rocha, J; Machado, A; Cerqueira, J; Moreira-Costa, J; Reis, J
- Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital ProjectPublication . Machado, A; Gomez, V; Panarra, A; Poças, J; Corte-Real, R; Peres, MJ; Nunes, BIntroduction: The project ‘Integrated Monitoring of Vaccines in Europe’ aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.
- Sentinel Node Total Tumour Load As a Predictive Factor for Non-Sentinel Node Status in Early Breast Cancer Patients – The porttle studyPublication . Fougo, JL; Amendoeira, I; Brito, MJ; Correia, AP; Gonçalves, A; Honavar, M; Machado, A; Magalhães, A; Marta, S; Nogueira, M; Peleteiro, B; Pontes, POSNA is a molecular assay for the detection of sentinel node metastasis. TTL emerged as a concept that seems to accurately predict the status of the NSN. Authors tried to confirm this motion. This is a retrospective and multicentric study that analyzed 2164 patients, 579 of whom had positive SN and completion AD. Logistic regression models were performed in order to identify a suitable cutoff to identify patients who benefit from AD. Univariate and multivariate regression analysis showed a relationship between TTL>30000 and the presence of NSN metastasis (OR 2.84, CI 1.99-4.08, p < 0.001). Logistic regression indicated that the cutoff of 30000 copies/μL better discriminates patients with NSN positivity and allows wide use of these criteria. This cutoff value may safely assist clinicians and patients to decide to proceed or not with an AD.