Browsing by Author "Machado, M"
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- Delayed Diagnosis of Occult Phosphaturic Mesenchymal Tumor in the FootPublication . Correia, J; Machado, M; Gonçalves, R; Jonge, F; Micaelo, M; Pedrosa, C; Portela, JPhosphaturic mesenchymal tumors are the main cause of tumor-induced osteomalacia, a distinctive paraneoplastic syndrome mediated by overproduction of fibroblast growth factor 23, that leads to renal phosphate wasting and hypophosphatemia. Diagnosis of this mesenchymal tumors is difficult and usually delayed for several years. We present the case of a 70-years-old-male with generalized bone pain, multiple pathological fractures and persistent hypophosphatemia, diagnosed with tumor-induced osteomalacia after 4 years of the onset of symptoms. The tumor was localized in the forefoot using Gallium 68-DOTANOC positron emission tomography-computed tomography and successfully surgically treated. This case report highlights the importance of recognizing these rare tumors, as early diagnosis can prevent long-term morbidity.
- A Efetividade de um Programa de Reabilitação na Melhoria de Sintomas da Pessoa com Hipertensão Pulmonar: Protocolo de Revisão Sistemática da LiteraturaPublication . Varão, S; Machado, MIntrodução: A Hipertensão Arterial Pulmonar (HAP) é uma condição fisiopatológica que pode estar associada a várias doenças cardiorrespiratórias, pelo que a sua complexidade exige uma abordagem multidisciplinar, incluindo intervenções como treino de exercício, apoio psicológico, educação e programas de reabilitação pulmonar, melhorando sintomas e qualidade de vida (Humbert et al., 2022). Objetivos: Avaliar a efetividade de programas de reabilitação na melhoria sintomática em pessoas com HAP. Material e Métodos: Definiu-se como pergunta de investigação “Qual a efetividade (O) de programas de reabilitação (I) na melhoria sintomática em pessoas com HAP (P)?”. Consideraram se critérios de inclusão: adultos com HAP (participantes), submetidos a programas de reabilitação (intervenção), com avaliação do impacto na melhoria sintomática (resultados), em qualquer contexto. Incluem-se artigos integrais de estudos quantitativos experimentais (ensaios controlados randomizados), quasi-experimentais, analíticos/descritivos observacionais. Sem limite temporal ou linguístico. A revisão baseia-se na Metodologia JBI para Revisões Sistemáticas de Efetividade, com uma estratégia em três fases: pesquisa preliminar de revisões (PROSPERO, JBI Evidence Synthesis, Cochrane Database, Medline), pesquisa nos cabeçalhos da PubMed e CINAHL (identificação de termos) e pesquisa completa na B-On, CINAHL e PubMed (Tufanaru et al., 2020). Definiu-se como expressão booleana [AB]'effectiveness' OR [AB]'efficacy' OR [AB]'outcome*' OR [AB]'effect*' AND [AB]'rehabilitation*' AND [AB]'pulmonary arterial hypertension'). As referências introduzir-se-ão no Zotero®. Títulos e resumos serão selecionados por 2 revisores, incoporados no JBI SUMARI, seguido da avaliação da qualidade metodológica (incluindo-se limiares superiores a 70%), da síntese narrativa e da avaliação do nível de evidência (abordagem GRADE e criação de Resumo das Conclusões/SoF) (McMaster University and Evidence Prime, 2023; Schünemann et al., 2013). Resultados: Os resultados incluirão impacto na qualidade de vida, dispneia, fadiga, capacidade/tolerância ao exercício, hemodinâmica cardiopulmonar ou consumo máximo de oxigénio (Tufanaru et al., 2020).Conclusões: É essencial pensar nas implicações clínicas do estabelecimento de programas de reabilitação especializados e efetivos.
- Functional Movement Disorders During the COVID ‐19 Pandemic: Back to Charcot's Era at the SalpêtrièrePublication . Machado, M; Tarrano, C; Mesrati, F; Roze, E; Vidailhet, M; Aubignat, M
- Functional Outcome after Mechanical Thrombectomy with or without Previous ThrombolysisPublication . Machado, M; Alves, M; Fior, A; Fragata, I; Papoila, AL; Reis, J; Paiva Nunes, AIntroduction: Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned. Objectives: To compare patients treated with IVT before MT with those treated with MT alone, in a real-world scenario. Methods: Retrospective analysis of AIS patients with LVO of the anterior circulation who underwent MT, with or without previous IVT, between 2016 and 2018. Results: A total of 524 patients were included (347 submitted to IVT+MT; 177 to MT alone). No differences between groups were found except for a higher time from stroke onset to CT and to groin puncture in the MT group (297.5 min vs 115.0 min and 394.0 min vs 250.0 min respectively, p < 0.001). Multivariable analysis showed that age<75 years (OR 2.65, 95% CI 1.71-4.07, p < 0.001), not using antiplatelet therapy (OR 1.93, 95% CI 1.21-3.08, p = 0.006), low prestroke mRS (OR 4.33, 95% CI 1.89-9.89, p < 0.001), initial NIHSS (OR 0.89, 95% CI 0.86-0.93, p < 0.001), absent cerebral edema (OR 7.83, 95% CI 3.31-18.51, p < 0.001), and mTICI 2b/3 (OR 4.56, 95% CI 2.17-9.59, p < 0.001) were independently associated with good outcome (mRS 0-2). Conclusions: Our findings support the idea that IVT before MT does not influence prognosis, in a real-world setting.
- Instabilidade Subtalar: uma Entidade Subdiagnosticada?Publication . Machado, M; Barreira, M; Pereira, B; Andrade, R; Espregueira-Mendes, JA instabilidade subtalar continua a ser um tópico controverso e a sua causa está ainda por conhecer. O mecanismo de lesão e os sintomas clínicos da instabilidade do tornozelo e da instabilidade subtalar sobrepõem-se, resultando muitas vezes em casos de instabilidade subtalar, isolada ou combinada, que não são corretamente diagnosticados. Negligenciar a instabilidade subtalar associada à instabilidade do tornozelo pode levar à falência do tratamento conservador e à evolução para instabilidade crónica com necessidade de tratamento cirúrgico. A compreensão da anatomia e da biomecânica da articulação subtalar é crucial para o diagnóstico correto desta patologia e posterior escolha do tratamento mais adequado. Esta revisão narrativa pretende percorrer à literatura mais recente, de forma a tornar percetível o estado de arte sobre esta entidade, desde a sua anatomia e biomecânica, aos métodos de diagnóstico e, finalmente, aos tipos de tratamentos existentes ao dia de hoje.
- The Ankle Instability Treatment: a Shift in Paradigm?Publication . Machado, M; Balulal, J; Amado, PDespite being the most frequent sports injury worldwide, ankle instabilitry has received very little attention over the years from evidence-based medicine, a trnd that has only been contered in recent years. Several papers have been published that might change the paradigm of the treatment patients in with ankle instability, so it is paramount important that surgeons keep up to date with the best high quality available. This study intends to be an alert to that fact and guide for the search of the newest information.
- Trotinetes Elétricas – É Urgente RegulamentarPublication . Machado, M; Diogo, N
- Validation of the Ottawa Ankle Rules: Strategies for Increasing SpecificityPublication . Morais, B; Branquinho, A; Barreira, M; Correia, J; Machado, M; Marques, N; Ferrão, A; Nóbrega, J; Teixeira, F; Diogo, NIntroduction: The majority of patients with ankle injuries undergo radiological examinations of the foot, ankle or both. The objective of this study was in the first place to validate the Ottawa Ankle Rules (OARs) for the population of our centre. Secondly, an attempt was made to identify parameters that contribute to improve the specificity of the method, with a view to reduce the need for patients to be exposed to radiation as well as optimizing the expenses of the Emergency Ward (EW). Materials and methods: This was a prospective study conducted during a 9-month period. The study population included 148 patients, in 54 (36%) of the patients a fracture was present on the exams performed. Patients were submitted to a sequential protocol in the EW with a form completion, evaluation of OARs, application of the Visual Analog Pain Scale (VAS) and radiographic exams. Results: We found a sensitivity of OARs in ankle injuries of 100%, specificity of 26% and in midfoot injuries of 100% and 62% respectively. All patients with fractures had a VAS of 5 or more points in any of the tested sites. With the VAS criterium, we found a significant increase of global specificity (38% vs 15%), as well as when applied only to the ankle (26% to 47%) or to midfoot trauma (62% to 67%). In both, there would have been a 100% reduction of CT scans. Patients with a fracture or with fractures who required surgical treatment had a mean VAS significantly higher than patients with no fracture or fractures submitted to conservative treatment respectively. Although there was a lower percentage of fractures in the group of injuries in Work Accidents (31% vs 37% Sports Activity and 38% Leisure Activity), there was a statistically significant increase in the sum of average VAS in Accidents at Work vs Leisure Activities and vs Sports Activities. Conclusion: We seek to confirm the usefulness of OARs for our population and we investigated strategies to further reduce the need for unnecessary radiographs. The introduction of parameters for grading pain and adapting to the context of the accident seem promising