Browsing by Author "Miranda, A"
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- Como Retomar a Atividade Cirúrgica Eletiva em Ortopedia Durante a Pandemia COVID-19?Publication . Diogo, N; Miranda, A; Ruano, A; Mendes, E; Mendes, F; Montes, J; Alves, J; Rosa, I; Alegrete, N; Neves, N; Lourenço, P; Felicíssimo, P; Sá Cardoso, P; Gomes, AEste documento foi elaborado pelo Colégio de Ortopedia da Ordem dos Médicos com o objetivo de estabelecer as orientações sobre a retoma da atividade cirúrgica programada em Ortopedia durante a pandemia COVID-19. As presentes normas de orientação: a) definem os critérios que permitem a priorização das cirurgias de acordo com a gravidade da situação clínica, com base em classificações existentes e publicadas; b) fornecem um modelo de organização para a preparação dos doentes, descrevendo os circuitos do doente nos períodos pré-operatório, intraoperatório e pós-operatório; c) realçam as regras de segurança para a realização de cirurgias e desenham um modelo de acompanhamento após a alta de acordo com a evidência científica.
- Emergence of Multidrug-Resistant Mycobacterium Tuberculosis of the Beijing Lineage in Portugal and Guinea-Bissau: a Snapshot of Moving Clones by Whole-Genome SequencingPublication . Perdigão, J; Silva, C; Maltez, F; Machado, D; Miranda, A; Couto, I; Rabna, P; Florez de Sessions, P; Phelan, J; Pain, A; McNerney, R; Hibberd, M; Mokrousov, I; Clark, T; Viveiros, M; Portugal, IThe Beijing genotype comprises a highly disseminated strain type that is frequently associated with multidrug resistant (MDR) tuberculosis (TB) and increased transmissibility but, countries such as Portugal and Guinea-Bissau fall outside the regions phylogeographically associated with this specific genotype. Nevertheless, recent data shows that this genotype might be gradually emerging in these two countries as an underlying cause of primary MDR-TB. Here, we describe the emergence of Mycobacterium tuberculosis Beijing strains associated with MDR-TB in Portugal and Guinea-Bissau demonstrating the presence of the well described superclusters 100-32 and 94-32 in Portugal and Guinea-Bissau, respectively. Genome-wide analysis and comparison with a global genomic dataset of M. tuberculosis Beijing strains, revealed the presence of two genomic clusters encompassing isolates from Portugal and Guinea-Bissau, GC1 (n = 121) and GC2 (n = 39), both of which bore SNP signatures compatible with the 100-32/B0/W148 and 94-32/Central Asia Outbreak clades, respectively. Moreover, GC2 encompasses a cross-border cluster between Portugal, Guinea-Bissau and Brazil thus supporting migration-associated introduction of MDR-TB and subsequent clonal expansion at the community-level. The comparison with global Beijing datasets demonstrates the global reach of the disease and its complex dissemination across multiple countries while in parallel there are clear microevolutionary trajectories towards extensively drug resistant TB.
- Risco Cardiovascular em Doentes com Infecção por Vírus da Imunodeficiência HumanaPublication . Raimundo, P; Miranda, A; Ribeiro, J; Mansinho, KO aumento do risco cardiovascular é considerada uma importante complicação da infecção Infecção por Vírus da Imunodeficiência Humana (VIH) e da terapêutica anti-retroviral (TARV). À disfunção endotelial característica do processo inflamatório crónico desencadeado pela infecção retroviral, associa-se a disfunção metabólica induzida pela terapêutica, predispondo, em conjunto, para a aterogénese precoce. O reconhecimento deste aumento de risco cardiovascular permite-nos elaborar estratégias de prevenção e optimização terapêutica que passam pelo uso criterioso de hipolipemiantes e modificação da TARV, consoante a avaliação do risco cardiovascular global de cada doente.
- Ultrasound-Guided Dissection and Ligation of the Internal Inguinal Ring for Hernia Repair in Pediatrics: An Experimental Animal StudyPublication . Reino-Pires, P; Pêgo, JM; Miranda, A; Barroso, C; España, M; Correia-Pinto, JPURPOSE: We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring suture in rabbits, as a model for inguinal hernia repair in pediatric population. METHODS: Twenty-eight rabbits were divided in 2 groups: group I (female morphology) - persistence of the peritoneal-vaginal duct with gonads placed in intraperitoneal position; group II (male morphology) - persistence of the peritoneal-vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image we tried to perform a complete pre-peritoneal ligation of the peritoneal-vaginal duct at the level of the internal inguinal ring using a 20G peripheral IV catheter and 2-0 non-absorbable suture. Afterwards, an exploratory laparoscopy was performed to evaluate the ligation. RESULTS: Ultrasound allowed characterization of inguinal-crural structures. Group I - complete and reliable suture 66.7%, incomplete but reliable suture 16.7%, inappropriate ligation 16.7%; group II - complete but unreliable suture 76.9%, incomplete and unreliable suture 11.5%, inappropriate suture 11.5%. No acute complications were logged. Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible and likely reliable, namely for female inguinal hernia repair
- Using Genomics to Understand the Origin and Dispersion of Multidrug and Extensively Drug Resistant Tuberculosis in PortugalPublication . Perdigão, J; Gomes, P; Miranda, A; Maltez, F; Machado, D; Silva, C; Phelan, J; Brum, L; Campino, S; Couto, I; Viveiros, M; Clark, T; Portugal, IPortugal is a low incidence country for tuberculosis (TB) disease. Now figuring among TB low incidence countries, it has since the 1990s reported multidrug resistant and extensively drug resistant (XDR) TB cases, driven predominantly by two strain-types: Lisboa3 and Q1. This study describes the largest characterization of the evolutionary trajectory of M/XDR-TB strains in Portugal, spanning a time-period of two decades. By combining whole-genome sequencing and phenotypic susceptibility data for 207 isolates, we report the geospatial patterns of drug resistant TB, particularly the dispersion of Lisboa3 and Q1 clades, which underly 64.2% and 94.0% of all MDR-TB and XDR-TB isolates, respectively. Genomic-based similarity and a phylogenetic analysis revealed multiple clusters (n = 16) reflecting ongoing and uncontrolled recent transmission of M/XDR-TB, predominantly associated with the Lisboa3 and Q1 clades. These clades are now thought to be evolving in a polycentric mode across multiple geographical districts. The inferred evolutionary history is compatible with MDR- and XDR-TB originating in Portugal in the 70's and 80's, respectively, but with subsequent multiple emergence events of MDR and XDR-TB particularly involving the Lisboa3 clade. A SNP barcode was defined for Lisboa3 and Q1 and comparison with a phylogeny of global strain-types (n = 28 385) revealed the presence of Lisboa3 and Q1 strains in Europe, South America and Africa. In summary, Portugal displays an unusual and unique epidemiological setting shaped by >40 years of uncontrolled circulation of two main phylogenetic clades, leading to a sympatric evolutionary trajectory towards XDR-TB with the potential for global reach.