Browsing by Author "Moreira, R"
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- Abordagem da Displasia de Desenvolvimento da Anca Irredutível. Resultados Provisórios dos Doentes Tratados Cirurgicamente nos Últimos 5 AnosPublication . Guerra Pinto, F; Varela, E; Ramos, A; Martins, JC; Moreira, R; Tavares, D; Sant'Anna, F; Cassiano Neves, MProcedemos à revisão retrospetiva dos processos clínico e radiológico de todas as crianças submetidas a artrografia ou cirurgia por displasia de desenvolvimento da anca nos últimos 5 anos, na nossa instituição. Foram excluídos todos os casos teratológicos ou com seguimento inferior a 2 anos, para melhor avaliação da incidência de necrose avascular ou outras complicações do tratamento instituído. Descrevemos em pormenor o tratamento invasivo realizado em 84 ancas, consoante a idade de tratamento (0-6 meses, 7-18 meses, 19 meses a 4 anos), do grau de displasia (segundo Tonnis), a aplicação do protocolo do Serviço e a incidência de necrose avascular. Apurámos necrose avascular em 13% das crianças submetidas a artrografia ou cirurgia até ao 6º mês de vida, em 9% das crianças entre os 7 e os 18 meses e em 19% das crianças tratadas invasivamente entre os 19 meses e os 4 anos.
- Artrodese do Joelho. Revisão Teórica e Resultados Retrospectivos de 22 Casos ConsecutivosPublication . Camacho, A; Barbosa, J; Moreira, R; Moreira, JA artrodese do joelho foi amplamente utilizada no passado para tratamento de dor e instabilidade do joelho, actualmente a sua indicação principal é o tratamento da falência séptica da artroplastia do joelho. Neste artigo os autores procuram rever as indicações, contraindicações, planeamento e técnicas disponíveis para a artrodese. Os resultados e complicações de 22 doentes operados na nossa instituição entre 2000 e 2008 também são apresentados e discutidos. Os meios de artrodese utilizados na nossa instituição são o fixador externo, as cavilhas endomedulares modulares inseridas pelo joelho e placas de compressão. A perda de capital ósseo é o factor que mais influencia o sucesso da artrodese. Com base nos resultados obtidos os autores recomendam a utilização de duas placas colocadas a 90º, como técnica de artrodese, em todos os casos que os tecidos moles o permitam.
- Complications Relating to Accuracy of Reduction of Intertrochanteric Fractures Treated with a Compressive Hip ScrewPublication . Guerra Pinto, F; Dantas, P; Moreira, R; Mamede, R; Amaral, LIntertrochanteric fracture is the most frequent type of fracture in the proximal femur and the compressive hip screw is one of the most popular methods of treatment. The reduction criteria for this type of fracture are ill-defined. The purpose of this study was to validate 3 reduction criteria: displacement, alignment in the anteroposterior and in the lateral plane. We reviewed a cohort of 430 intertrochanteric fractures treated with a compression hip screw. The type of fracture, quality of reduction and technical complications were noted. We observed a relationship between accuracy of reduction and the incidence of complications, even among fractures of the same severity. A displacement bigger than 4mm and failure to accomplish correct alignment (a neck-shaft angle over 125 masculine and less than 20 degrees angulation on the lateral view) was considered a poor reduction and was associated with more complications.
- Coronary Microvascular Dysfunction in Dilated CardiomyopathyPublication . Teixeira, R; Moreira, R
- Portuguese-Brazilian Evidence-Based Guideline on the Management of Hyperglycemia in Type 2 Diabetes MellitusPublication . 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, CBackground: 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.
- The Prognostic Value of the Cardiorespiratory Optimal Point During Submaximal Exercise Testing in Heart FailurePublication . Ferreira Reis, J; Valentim Gonçalves, A; Brás, P; Moreira, R; Pereira-da-Silva, T; Timóteo, AT; Soares, RM; Cruz Ferreira, RIntroduction: Peak oxygen consumption (pVO2) is a key parameter for assessing the prognosis of heart failure with reduced ejection fraction (HFrEF). However, it is less reliable when the cardiopulmonary exercise test (CPET) is not maximal. Objective: To compare the prognostic power of various exercise parameters in submaximal CPET. Methods: Adult patients with HFrEF undergoing CPET in a tertiary center were prospectively assessed. Submaximal CPET was defined as a respiratory exchange ratio ≤1.10. Patients were followed for one year for the primary endpoint of cardiac death and urgent heart transplantation (HT). Various CPET parameters were analyzed as potential predictors of the combined endpoint and their prognostic power (area under the curve [AUC]) was compared using the Hanley-McNeil test. Results: CPET was performed in 442 HFrEF patients (mean age 56±12 years, 80% male), of whom 290 (66%) had a submaximal CPET. Seventeen patients (6%) reached the primary endpoint. The cardiorespiratory optimal point (COP) had the highest AUC value (0.989, p<0.001), and significantly higher prognostic power than other tested parameters, with pVO2 presenting an AUC of 0.753 (p=0.001). COP ≥36 had significantly lower survival free of HT during follow-up (p<0.001) and presented a sensitivity of 100% and a specificity of 89% for the primary endpoint. Conclusion: COP had the highest prognostic power of all parameters analyzed in a submaximal CPET. This parameter can help stratify HFrEF patients who are physiologically unable to reach a maximal level of exercise.