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Browsing by Author "Melo, M"

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  • Doenças Hepáticas num Serviço de Medicina Interna
    Publication . Colaço, MI; Melo, M; Coelho, M; Ribeiro, L; Barros Veloso, AJ
    As doenças hepáticas constituem uma das causas frequentes de internamentos em serviços de Medicina Interna. Os autores fizeram um trabalho de revisão de cinco anos dos internamentos num Serviço de Medicina Interna cujos diagnósticos foram de doença hepática crónica, hepatite aguda e carcinoma hepatocelular. Concluíram que houve uma diminuição de internamentos por doença hepática crónica ao longo dos anos e um crescente aumento de hepatites agudas, a maioria delas associada a doentes toxicodependentes e com SIDA.
    1998Journal article Open access Show more
  • Effect of Empagliflozin Beyond Glycemic Control: Cardiovascular Benefit in Patients with Type 2 Diabetes and Established Cardiovascular Disease
    Publication . Monteiro, P; Aguiar, C; Matos, P; Silva-Nunes, J; Birne, R; Branco, P; Calado, J; Melo, M; Polónia, J
    The prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D. This article explores the various trials already performed and under development in this field, with particular focus on the EMPA-REG OUTCOME trial. In this trial, empagliflozin, a sodium-glucose co-transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations. With this reduction in risk for major CV events in patients with T2D, the EMPA-REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities.
    2019Journal article Open access Show more
  • Empagliflozina e a Nova Era no Tratamento da Diabetes Tipo 2: Para Além do Controlo Glicémico
    Publication . Silva Nunes, J; Aguiar, C; Birne, R; Branco, P; Calado, J; Matos, P; Melo, M; Monteiro, P; Polónia, J
    A diabetes mellitus tipo 2 (DMT2) tem associado um risco aumentado de mortalidade, principalmente, por doença cardiovascular (DCV). Interessa ter disponíveis opções terapêuticas que permitam o controlo glicémico mas que considerem, igualmente, a atuação sobre fatores de risco cardiovascular e a redução de eventos micro e macrovasculares. Nos últimos anos foram desenvolvidos vários inibidores do transporte renal de glicose via cotransporte de sódio/glicose (iSGLT), nomeadamente a empagliflozina, para promover a excreção urinária de glicose filtrada pelo rim. A empagliflozina é um inibidor competitivo, reversível, altamente potente e seletivo dos SGLT2, indicada no tratamento da hiperglicemia da DMT2. O EMPA-REG OUTCOME®, um ensaio clínico de resultados cardiovasculares aleatorizado, em dupla ocultação, controlado com placebo, que incluiu 7020 indivíduos com DMT2 e DCV estabelecida, avaliou o efeito da empagliflozina versus placebo, associado ao tratamento standard, na ocorrência de um compósito de 3 pontos MACE (Major Adverse Cardiovascular Events) - morte por causa cardiovascular, acidente vascular cerebral não fatal ou enfarte agudo de miocárdio não fatal. Com os resultados do EMPA-REG OUTCOME®, a empagliflozina foi o primeiro iSGLT2 a demonstrar uma redução de morbilidade cardiovascular em indivíduos com DMT2 com elevado risco cardiovascular, adicionando a proteção cardiovascular ao efeito anti-hiperglicémico do fármaco e abrindo uma nova era no tratamento e gestão da DMT2.
    2017Journal article Open access Show more
  • Glossectomia Total na Era de Preservação de Órgão - Resultados Funcionais e Sobrevida
    Publication . Pereira, S; Fino, R; Montalvão, P; Mariano, M; Melo, M; Castelhano, L; Magalhães, M
    Objetivos: Avaliação de doentes submetidos a glossectomia total (GT). Material e Métodos: Estudo retrospetivo que incluiu os doentes submetidos a GT entre 2009 e 2018 no serviço de Otorrinolaringologia do IPOLFG. Resultados: Foram incluídos 27 doentes. A vasta maioria dos doentes (78%) apresentava tumor em estadio avançado (IV). A GT foi realizada como tratamento de resgate em 56% dos casos. A reconstrução foi maioritariamente realizada recorrendo a retalho de grande peitoral (59%). 93% dos doentes foram laringectomizados. 30% dos doentes alcançaram função da deglutição adequada. No período de follow-up médio de 21 meses, 14 (52%) doentes recidivaram. As taxas de sobrevida a 1 e 5 anos foram de 52% e 22%. Conclusões: A GT foi maioritariamente realizada em casos de recidiva de doença após protocolo de preservação de órgão. Tem um impacto na qualidade de vida ao afetar quer a deglutição quer a fala. São doentes com recidiva locoregional elevada e com taxa de sobrevida baixa, mas é uma opção importante quando as alternativas terapêuticas são limitadas.
    2021Journal article Open access Show more
  • Heterogeneity Amongst GLP-1 RA Cardiovascular Outcome Trials Results: Can Definition of Established Cardiovascular Disease Be the Missing Link?
    Publication . Melo, M; Gavina, C; Silva-Nunes, J; Andrade, L; Carvalho, D
    Atherosclerotic cardiovascular diseases are the leading cause of adverse outcomes in patients with type 2 diabetes, and all new anti-diabetic agents are mandated to undergo cardiovascular outcome trials (CVOTs). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are incretin mimetics that reduce blood glucose levels with a low associated risk of hypoglycaemia. CVOTs with different GLP-1 RAs yielded different results in terms of major cardiovascular composite outcome (MACE), with some trials showing superiority in the treatment arm, whereas other simply displayed non-inferiority. More importantly, the significance of each component of MACE varied between drugs. This begs the question of whether these differences are due to dissimilarities between drugs or other factors, namely trial design, are at the root of these differences. We analyse the trial designs for all CVOTs with GLP-1 RAs and highlight important differences between them, namely in terms of definition of established cardiovascular disease, and discuss how these differences might explain the disparate results of the trials and preclude direct comparisons between them. We conclude that a fair comparison between GLP-1 RA CVOTs would involve post-hoc analysis re-grouping the patients into different cardiovascular risk categories based upon their baseline clinical parameters, in order to even out the criteria used to classify patients.
    2021Journal article Open access Show more
  • Importância do Diagnóstico Laboratorial no Síndrome de HELLP
    Publication . Pereira, A; Roque, A; Viegas, M; Melo, M
    O Síndrome de Hellp (S. Hellp) é uma situação clínica que surge aproximadamente em 10% dos casos de pré-eclâmpsia grave. É uma disfunção multiorgânica em que a tríade laboratorial que o caracteriza, H-hemólise, EL-elevated liver enzymes (enzimas hepáticos elevados) e LP-low platelets (trombocitopenia) permite efectuar e monitorizar correctamente o diagnóstico e tratamento aplicado. O S. Hellp pode surgir inicialmente numa fase mais lenta, em que se verificam níveis moderadamente elevados de desidrogenase láctica (LDH), trombocitopenia ligeira (100.000-150.000/ul) e diminuição da haptoglobina. Posteriormente, torna-se evidente a existência de disfunção hepática, pela elevação dos níveis séricos do aspartato amino transferase (AST) e alanina amino transferase (ALT), acompanhados de concentrações ainda mais elevadas de LDH e trombocitopenia grave (<50.000/ul). Surge a anemia hemolítica microangiopática e verificam-se igualmente alterações significativas da coagulação. Outras perturbações podem ocorrer, nomeadamente a nível renal, cardiovascular e respiratório.
    2005Journal article Open access Show more
  • Portuguese-Brazilian Evidence-Based Guideline on the Management of Hyperglycemia in Type 2 Diabetes Mellitus
    Publication . Bertoluci, M; Nunes Salles, JE; Silva-Nunes, J; Cordeiro Pedrosa, H; Moreira, R; Calado da Silva Duarte, R; Maurício da Costa Carvalho, D; Trujilho, F; Cancela dos Santos Raposo, JF; Parente, E; Valente, F; Ferreira de Moura, F; Hohl, A; Melo, M; Araújo, F; de Araújo Principe, RM; Kupfer, R; Costa e Forti, A; Valerio, C; Ferreira, HJ; Duarte, JM; Kerr Saraiva, JF; Rodacki, M; Gurgel Castelo, MH; Pereira Monteiro, M; Quadros Branco, P; Patrício de Matos, PM; Pereira de Magalhães, P; Betti, R; Réa, R; Trujilho, T; Ferreira Pinto, L; Bauermann Leitão, C
    Background: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5-7.5%. When HbA1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30-60 mL/min/1.73 m2 or eGFR 30-90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.
    2020Journal article Open access Show more