Browsing by Author "Santos, E"
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- Acute Haemorrhagic Oedema of Infancy as a Manifestation of COVID-19Publication . Martins Saraiva, B; Bento Lobato, M; Santos, E; Garcia, AM
- Adesão ao Programa "PSIC" - Uma Análise DescritivaPublication . Mesquita Reis, J; Jorge, S; Ferreira, B; Maia, T; Santos, E; Maximiano, J; Ribeiro, C; Fernandes, C; Roquette, TIntrodução: A intervenção preconizada no primeiro episódio psicótico (PEP) engloba o recurso a psicofármacos e a intervenções psicossociais. A adesão à medicação e o cumprimento dos tratamentos psicossociais são essenciais para o sucesso das intervenções. Estima-se que a não adesão à medicação no primeiro ano após o diagnóstico de psicose ocorra em cerca de metade dos doentes, sendo também elevada a taxa de abandono relativa às intervenções psicossociais. Vários estudos têm procurado determinar quais os fatores que contribuem para a não adesão à intervenção. No serviço de Psiquiatria do Hospital Prof. Dr. Fernando Fonseca (HFF) desenvolve-se um protocolo de avaliação e intervenção no PEP, o “PSIC”, o qual visa a avaliação global da sintomatologia e do funcionamento do indivíduo e a aplicação de intervenções específicas. Objetivos: Caraterização do perfil sociodemográfico, clínico e de adesão ao tratamento numa amostra de pacientes com PEP. Métodos: Realizou-se um estudo transversal, cujos dados foram obtidos a partir do preenchimento de um questionário com variáveis sociodemográficas, clínicas e de adesão, relativos aos pacientes referenciados ao “PSIC”, desde inicio de 2014 a 2017. Adicionalmente, analisou-se, retrospectivamente, a adesão à medicação e às intervenções psicossociais. Os dados foram tratados em SPSS®(v10.0.1). Resultados: Da amostra inicial foram elegíveis 28 pacientes. Os pacientes apresentaram bons índices de adesão à medicação, tendencialmente superiores aos existentes na literatura. No que respeita às intervenções psicossociais os resultados encontram-se em conformidade com os encontrados por outros grupos. Não se encontrou associação entre a adesão ao protocolo ou à medicação e o género, ser imigrante, escolaridade e história de consumos. Contudo, encontrou-se uma associação estatisticamente significativa entre a má adesão ao protocolo e a inexistência de atividade laboral à entrada no protocolo (p 0,049*), assim como com a ausência de atividade socio-ocupacional durante o protocolo de intervenção (p 0,036*). Encontrou-se uma associação estatisticamente significativa entre a boa adesão ao protocolo e um envolvimento positivo da família (p 0,046*). Conclusões: O reconhecimento antecipado de fatores de não adesão é essencial na estruturação de intervenções a eles dirigidas (como por exemplo a promoção de intervenção familiar), favorecendo a adesão ao projeto terapêutico e modificando o curso da doença.
- Chronic Gastric VolvulusPublication . Santos, E; Morão, S; Knoblich, M; Alves, R
- Late Onset Neuromyelitis Optica Spectrum Disorders (LONMOSD) from a Nationwide Portuguese Study: Anti-AQP4 Positive, Anti-MOG Positive and Seronegative SubgroupsPublication . Santos, E; Moura, J; Samões, R; Sousa, AP; Mendonça, T; Abreu, P; Guimarães, J; Correia, I; Durães, J; Sousa, L; Ferreira, J; de Sá, J; Sousa, F; Sequeira, M; Correia, AS; André, AL; Basílio, C; Arenga, M; Brás Marques, I; Perdigão, S; Alves, I; Santos, M; Salgado, V; Palos, A; Guerreiro, R; Isidoro, L; Boleixa, D; Carneiro, P; Neves, E; Martins Silva, A; Gonçalves, G; Sá, MJIntroduction: Several neuroimmunological disorders have distinct phenotypes according to the age of onset, as in multiple sclerosis or myasthenia gravis. It is also described that late onset NMOSD (LONMOSD) has a different phenotype. Objective: To describe the clinical/demographic characteristics of the LONMOSD and distinguish them from those with early onset (EONMOSD). Methods: From a nationwide Portuguese NMOSD study we analyzed the clinical/demographic characteristics of the LONMOSD. Results: From the 180 Portuguese patients 45 had disease onset after 50 years old, 80% were female. 23 had anti-AQP4 antibodies (51.1%), 13 anti-MOG antibodies (28.9%) and 9 were double seronegative (20.0%). The most common presenting phenotypes in LONMOSD were transverse myelitis (53.3%) and optic neuritis (26.7%), without difference from EONMOSD (p = 0.074). The mean EDSS for LONMOSD was 6.0 (SD=2.8), after a mean follow-up time of 4.58 (SD=4.47) years, which was significantly greater than the mean EDSS of EONMOSD (3.25, SD=1.80)(p = 0.022). Anti-AQP4 antibodies positive LONMOSD patients had increased disability compared to anti-MOG antibodies positive LONMOSD (p = 0.022). The survival analysis showed a reduced time to use a cane for LONMOSD, irrespective of serostatus (p<0.001). Conclusions: LONMOSD has increased disability and faster progression, despite no differences in the presenting clinical phenotype were seen in our cohort.
- Neuromyelitis Optica in Portugal (NEMIPORT) - A Multicentre StudyPublication . Domingos, J; Isidoro, L; Figueiredo, R; Brum, M; Capela, C; Barros, P; Santos, E; Macário, MC; Pinto Marques, J; Pedrosa, R; Vale, J; Sá, MJBACKGROUND: Neuromyelitis Optica (NMO) is an inflammatory demyelinating disease of the CNS. There have been few epidemiologic studies on NMO, none in Portugal. OBJECTIVE: To analyze the clinical, biological and MRI characteristics from a cohort of Portuguese patients who fulfilled the Wingerchuk 2006 NMO/NMOSD criteria. To identify and characterize those who had concomitant autoimmune disease or circulating autoantibodies. METHODS: We performed an observational, retrospective, multicenter study in 5 Hospital Centers in Portugal. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. They were mainly Caucasian, 55 female. Median age at onset was 32.0 years and mean follow-up 7.4±6.0 years. Twenty-one patients were definite NMO and optic neuritis (ON) the most frequent initial presentation. Forty-six were classified as NMO spectrum disorders. The main subtypes were recurrent ON and single longitudinally extensive transverse myelitis. Twenty-four patients had positive AQP4-IgG. Twenty-three had other circulating autoantibodies. Fifteen out of 67 patients had concomitant autoimmune disease. There was a significant correlation between the presence of autoimmune disease and the positivity for AQP4-IgG. Five patients died, all definite NMO. CONCLUSION: This is the first study about this rare disease in Portugal. Demographic features were similar to other studies. The existence of concomitant autoimmune disease was significantly associated with seropositivity for AQP4-IgG.
- Neuromyelitis Optica Spectrum Disorders: a Nationwide Portuguese Clinical Epidemiological StudyPublication . Santos, E; Rocha, AL; Oliveira, V; Ferro, D; Samões, R; Sousa, AP; Figueiroa, S; Mendonça, T; Abreu, P; Guimarães, J; Sousa, R; Melo, C; Correia, I; Durães, J; Sousa, L; Ferreira, J; Sá, J; Sousa, F; Sequeira, M; Correia, AS; André, AL; Basílio, C; Arenga, M; Mendes, I; Brás Marques, I; Perdigão, S; Felgueiras, H; Alves, I; Correia, F; Barroso, C; Morganho, A; Carmona, C; Palavra, F; Santos, M; Salgado, V; Palos, A; Nzwalo, H; Timóteo, A; Guerreiro, R; Isidoro, L; Boleixa, D; Carneiro, P; Neves, E; Martins Silva, A; Gonçalves, G; Leite, MI; Sá, MJIntroduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits. Objective: To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics. Methods: This was a nationwide multicenter study. Twenty-four Portuguese adult and 3 neuropediatric centers following NMOSD patients were included. Results: A total of 180 patients met the 2015 Wingerchuk NMOSD criteria, 77 were AQP4-antibody positive (Abs+), 67 MOG-Abs+, and 36 seronegative. Point prevalence on December 31, 2018 was 1.71/100,000 for NMOSD, 0.71/100,000 for AQP4-Abs+, 0.65/100,000 for MOG-Abs+, and 0.35/100,000 for seronegative NMOSD. A total of 44 new NMOSD cases were identified during the two-year study period (11 AQP4-Abs+, 27 MOG-Abs+, and 6 seronegative). The annual incidence rate in that period was 0.21/100,000 person-years for NMOSD, 0.05/100,000 for AQP4-Abs+, 0.13/100,000 for MOG-Abs+, and 0.03/100,000 for seronegative NMOSD. AQP4-Abs+ predominated in females and was associated with autoimmune disorders. Frequently presented with myelitis. Area postrema syndrome was exclusive of this subtype, and associated with higher morbidity/mortality than other forms of NMOSD. MOG-Ab+ more often presented with optic neuritis, required less immunosuppression, and had better outcome. Conclusion: Epidemiological/clinical NMOSD profiles in the Portuguese population are similar to other European countries.
- Penile Involvement as Initial Manifestation of Henoch-Schönlein PurpuraPublication . Santos, E; Henriques, J; Ladeira, C; Alves, R
- Polymerase Chain Reaction Screening for Fungemia and/or Invasive Fungal Infections in Patients with Hematologic MalignanciesPublication . Ribeiro, P; Costa, F; Monteiro, A; Caldas, J; Silva, M; Ferreira, G; Veiga, J; Sousa, MO; Viegas, MP; Santos, E; Gonçalves, AJ; Botelho de Sousa, AINTRODUCTION: Invasive fungal infections (IFIs) are a life-threatening complication in patients with hematologic malignancies, mainly in acute leukemia patients, following chemotherapy. IFI incidence is increasing, and associated mortality remains high due to unreliable diagnosis. Antifungal drugs are often limited by inadequate antimicrobial spectrum and side effects. Thus, the detection of circulating fungal DNA has been advocated as a rapid, more sensitive diagnostic tool. PATIENTS AND METHODS: Between June 01 and January 03, weekly blood samples (1,311) were screened from 193 patients undergoing intensive myelosuppressive or immunosuppressive therapy. IFI cases were classified according to European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Fungal DNA was extracted from whole blood and amplified using polymerase chain reaction (PCR) published primers that bind to the conserved regions of the fungal 18S rRNA gene sequence. In our study, two or more consecutive positive samples were always associated with fungal disease. RESULTS: PCR screening predicted the development of IFI to be 17 days (median). This test had a specificity of 91.1% and a sensitivity of 75%. IFI incidence was 7.8%. DISCUSSION: Therefore, our results confirm the potential usefulness of PCR serial screening and the clinical applicability in everyday routine. PCR screening offers a noninvasive repeatable aid to the diagnosis of IFI.