Browsing by Author "Rodrigues, C"
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- COVID-19 in Two Children with New-Onset Diabetes: Case ReportsPublication . Rodrigues, C; Diamantino, C; Lança, A; Fitas, ALDelayed diagnosis, low socioeconomic status and infection have been associated with diabetic ketoacidosis (DKA) at type 1 diabetes mellitus presentation. A teenager from a low socioeconomic status family, with longstanding weight loss, polyphagia, polyuria, vomiting and abdominal pain, attended the emergency department, also complaining of anosmia and odynophagia. He was diagnosed with COVID-19 and new-onset DKA. The second child had 2 weeks of diabetes symptoms and was admitted with new-onset mild DKA. SARS-CoV-2 RT-PCR test was positive, although asymptomatic. Persistent hyperglycaemia with high insulin requirements was a common feature to both patients. Both cases support that SARS-CoV-2 may have an association with rapidly increasing insulin daily needs. In case one, not only fear of COVID-19 delayed hospital attendance but also the setting of a low socioeconomic status family appears to have enhanced the risk for late diagnosis and challenging disease management.
- HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019Publication . Pingarilho, M; Pimentel, V; Miranda, M; Silva, AR; Diniz, A; Ascenção, B; Piñeiro, C; Koch, C; Rodrigues, C; Caldas, C; Morais, C; Faria, D; Gomes da Silva, E; Teófilo, E; Monteiro, F; Roxo, F; Maltez, F; Rodrigues, F; Gaião, G; Ramos, H; Costa, I; Germano, I; Simões, J; Oliveira, J; Ferreira, J; Poças, J; Saraiva da Cunha, J; Soares, J; Henriques, J; Mansinho, K; Pedro, L; Aleixo, MJ; Gonçalves, MaJ; Manata, MJ; Mouro, M; Serrado, M; Caixeiro, M; Marques, N; Costa, O; Pacheco, P; Proença, P; Rodrigues, P; Pinho, R; Tavares, R; Correia de Abreu, R; Côrte-Real, R; Serrão, R; Sarmento e Castro, R; Nunes, S; Faria, T; Baptista, T; Martins, MR; Gomes, P; Mendão, L; Simões, D; Abecasis, AObjective: To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods: Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results: In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion: Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
- Prevenção e Controlo do Risco de Exposição Ocupacional à Tuberculose Pulmonar no CHL/Hospital de S. JoséPublication . Rodrigues, C; Ramalho, F; Xavier, MJ; Armeiro, S; Louro, F; Paes Duarte, AA Tuberculose é uma doença altamente contagiosa que atinge sobretudo idosos e pessoas com maior vulnerabilidade, embora afecte também a população activa, em particular os mais expostos como os profissionais de saúde. A sua transmissão é potenciada por factores demográficos, pela urbanização, pelo aparecimento de formas resistentes à medicação habitual e pela associação à infecção por VIH. Apresenta-se o modelo, estratégia, métodos e resultados da intervenção de prevenção do risco profissional de Tuberculose no CHL/Hospital S. José desenvolvida pelo Serviço de Saúde Ocupacional (SSO). O SSO é constituído por equipa multiprofissional composta por Medicina do Trabalho, Ergonomia, Higiene e Toxicologia, Psicologia e Segurança do Trabalho, e inclui uma componente técnica orientada para os problemas de saúde no trabalho e a prevenção dos riscos ocupacionais, e uma componente clínica vocacionada para os problemas de saúde individual e o atendimento na doença aguda e crónica, assegurando cuidados de saúde personalizados e integrados (primários, secundários e terciários), com ênfase na prevenção primária e promoção da saúde no trabalho. A equipa de Enfermagem intervém na mediação e personalização dos cuidados da Medicina do Trabalho e da área clínica, interagindo com a equipa técnica no que se refere aos problemas da saúde no trabalho. No Hospital trabalham cerca de 2500 profissionais (68%do sexo feminino), dos quais os grupos profissionais mais representativos correspondem à enfermagem (29%), auxiliares (25,8%) e médicos (19,5%), apresentando diferentes factores de vulnerabilidade, predisposição e doença associados a hábitos, comportamentos e estilos de vida, e a riscos particulares das tarefas da sua actividade. O SSO iniciou a intervenção sistemática de prevenção e controlo do risco de Tuberculose nos profissionais do Hospital em Abril de 1996 com a disponibilização do rastreio activo, em colaboração com o Centro de Diagnóstico Pneumológico da Praça do Chile, o qual representa, até ao presente, a maior adesão registada em hospitais do país. Reflecte-se o nível de risco de exposição ocupacional dos profissionais à tuberculose, particularidades de risco dos cenários e adequação da protecção individual, isolamento e ventilação; o rastreio activo (Mantoux, Rx tórax) inicial, periódico conforme o nível de risco, após exposição e em profissionais com vulnerabilidade – Mantoux negativos, imunocomprometidos (VIH, corticoterapia, imunossupressão, insuficiência renal, …); a informação personalizada aos profissionais, formação individual e de grupo, em sala e no local de trabalho; e os resultados (taxa de Tuberculose latente, taxa de viragem tuberculínica, quimioprofilaxia, Tuberculoses profissionais).
- A Promoção da Saúde Oral nos Profissionais de Saúde do Centro Hospitalar de Lisboa Central: Contributo para a Vigilância da Saúde e Bem-Estar em Contexto OcupacionalPublication . Armeiro, S; Rodrigues, C; Tolentino, D; Manzano, MJ
- Quality of Life Among Adults with Repaired Tetralogy of Fallot: a Literature ReviewPublication . Rodrigues, C; Silva, M; Cerejo, R; Rodrigues, R; Sousa, L; Trigo, C; Branco, LM; Agapito, A; Fragata, JTetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect. Survival into adulthood is currently expected following surgical repair, leading to a growing population of adults with repaired TOF. In this literature review, we aim to summarize the current state of knowledge on the quality of life of adults with repaired TOF. A search was conducted on PubMed and results were reviewed for articles published between January of 2010 and June of 2020. Search terms included "Tetralogy of Fallot", "repaired", "adults" and "quality of life". For the subjective health status evaluation, most published studies used Short-Form-36. Most studies agree that physical complex status is poorer for adult patients with repaired TOF than for controls. Mental complex status was also lower. Patients reported similar satisfaction with their lives and levels of social participation. Most patients had a college or university degree. Higher education, male gender and having a partner were positively associated with being employed. Studies found no difference in the proportion of patients that are married or living with a partner, compared to control groups. Patients operated for TOF have a lower reproduction rate compared with the background population. A consistent finding of these studies is abnormal physical parameters compared to psychosocial issues. The diverse needs of adults with repaired TOF require a multidisciplinary care, that takes into consideration all aspects that affect their quality of life. Despite abnormal physical functional status, it is reassuring that most adult patients with TOF lead independent and productive lives.
- Surgical Ablation of Atrial Fibrillation and Left Atrial Appendage Occlusion by a Totally Videothoracoscopic Approach - New Paradigm?Publication . Rodrigues, C; Silva, M; Cerejo, R; Portugal, G; Cunha, PS; Rodrigues, R; Oliveira, MM; Fragata, JIntroduction: Atrial fibrillation (AF) contributes to increased morbidity and mortality. Pharmacological and percutaneous catheter therapies are unsatisfactory, with potential serious adverse effects. Cox-Maze III/IV surgery, with higher rates of success, has not been widely adopted because of the associated complexity of the procedure. Methods: We performed a retrospective analysis of the first patients submitted to surgical ablation of AF with occlusion of the left atrial appendage with a totally videothoracoscopic (VATS) approach in our institution. We describe the surgical technique and our results, including duration of surgery, hospital stay, complications and maintenance of sinus rhythm after surgery, at 6, 12 and 18 months of follow-up. Results: We studied 15 patients (ages ranging from 39 to 75 years old; 54,5% female gender). Mean time since the diagnosis of AF was 5,75 years. All had been submitted to prior catheter ablation (mean of 2 attempts). Mean diameter and volume of the left atrium was 42 mm (M-mode) and 70 ml (43 ml/m2), respectively. Mean duration of surgery was 2 hours and 22 minutes. In one patient we had to convert the surgery to median sternotomy. Mean hospital stay was 4,8 days. Mean time of follow-up was 12 months. During follow-up, 91%, 90% and 80% of the patients were in sinus rhythm at 6, 12 and 18 months, respectively. Conclusion: This surgical approach represents a real benefit for those patients with multiple attempts of catheter ablation without success. However, a larger sample of patients with a longer period of follow-up is necessary for further conclusions.
- Thromboembolic Risk in COVID-19 Patients: Is There a Hidden Link?Publication . Cidade, J; Pinheiro, H; Dias, A; Santos, M; Nascimento, B; Figueiredo, C; Pinto, R; Pereira, L; Rodrigues, C; Maltez, FBackground Although evidence has emerged indicating that patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia present a high risk of venous thromboembolism (VTE), its real incidence and best diagnosis course remain unclear. In this study, we aimed to determine the incidence of pulmonary embolism in these patients and the role of D-dimer serum level as a predictive factor of a new VTE event. Methodology This was a single-center retrospective observational cohort study conducted in a tertiary hospital. All patients admitted to the infectious diseases ward with SARS-CoV-2 pneumonia with clinical or laboratory criteria for suspected VTE events were eligible for inclusion in the study. The t-test or Mann-Whitney U test was used to analyze the differences between the with-VTE group and the without-VTE group. Results Overall, VTE incidence was registered to be 30%. Chest computed tomography angiography data revealed thrombus mainly in segmental (five patients, 71%) and subsegmental pulmonary artery branches (four patients, 57%). No thrombus on major branches was documented. D-dimer serum levels (collected at hospital admission, 48 hours before the suspected VTE event date and at suspected VTE event date) were analyzed, and, despite a consistent tendency of higher values in the with-VTE group, no statistical difference was observed. Moreover, no statistical difference was observed between the two groups in mortality rates. Conclusions A clear higher risk of VTE events in SARS-CoV-2 pneumonia patients was not documented, and a link between the impact of VTE occurrence and a worse prognosis was not demonstrated. Therefore, we suggest that the use of D-dimer serum level should not be used as a predictor of VTE in SARS-CoV-2 pneumonia patients.