Browsing by Author "Silva, A"
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- Abdominal Circumference Ratio for the Diagnosis of Intertwin Birth Weight DiscordancePublication . Simoes, T; Julio, C; Cordeiro, A; Cohen, A; Silva, A; Blickstein, IOBJECTIVES: We assessed the accuracy of predicting severe twin birth weight discordance (>25%) using the estimated fetal weights (EFW) and abdominal circumference (AC) ratio. METHOD: A cohort of twin gestations underwent ultrasound examinations within two weeks from birth. We focused on the accuracy of EFW and on the diagnosis of severe birth weight discordance by the difference in EFWs and the AC ratio. RESULTS: The 661 eligible twin pairs included 51 (7.7%) severely discordant pairs. The accuracy of an EFW to predict the actual birth weight was quite poor, with an acceptable specificity (96.4%), but low sensitivity (28.6-40.5%), to detect severely discordant pairs, whereas an AC ratio of 1.3 detected these discordant pairs with sensitivity and specificity of 97.3-100% and 99.6-99.7%, respectively. CONCLUSION: By comparing EFWs, 59.5-71.4% of discordant pairs >25% are missed, whereas an AC ratio >1.3 would identify almost all cases.
- Avaliação da Prevalência e Caracterização da Rinossinusite nos Cuidados de Saúde Primários em PortugalPublication . Barros, E; Silva, A; Sousa Vieira, A; André, C; Silva, D; Branquinho Prata, J; Pinto Ferreira, J; Santos, M; Gonçalves, P; Leiria, E; Gonçalves, N; Andrade, SObjectivos: Determinar a prevalência da rinossinusite (RS) diagnosticada nos Centros de Saúde (CS) portugueses, aferindo formas de apresentação e tratamento desta patologia. Desenho do Estudo: Estudo epidemiológico, transversal. Material e Métodos: Entre Maio/2008 e Junho/2009 avaliouse uma coorte de utentes que se dirigiram à consulta de clínica geral, nos CS seleccionados. Resultados: Incluíramse 1.201 utentes, 71% do sexo feminino com idade média de 41,7±13,2 anos. A prevalência global de RS foi de 19,2%, [n=231; 17,1%, 21,5%; IC 95%]. A prevalência de RS aguda foi de 7,4% [n=89; 6,0%, 9,0%; IC 95%] e a de RS crónica de 13,0% [n=156; 11,2%, 15,0%; IC 95%]. Conclusões: A prevalência pontual de RS calculada foi elevada, principalmente a de RS crónica. Metade dos doentes (50%) já tinha efectuado pelo menos um exame complementar de diagnóstico. Verifica-se algum desfasamento entre as orientações para diagnóstico e tratamento da RS e a prática actual nos CS.
- Blunted Coronary Flow Velocity Reserve is Associated With Impairment in Systolic Function and Functional Capacity in Hypertrophic CardiomyopathyPublication . Aguiar Rosa, S; Rocha Lopes, L; Branco, L; Galrinho, A; Fiarresga, A; Thomas, B; Brás, P; Gonçalves, A; Cardoso, I; Papoila, A; Alves, M; Rio, P; Cruz, I; Selas, M; Silva, F; Silva, A; Cruz Ferreira, R; Mota Carmo, MBackground Coronary microvascular dysfunction constitutes an important pathophysiological feature in hypertrophic cardiomyopathy (HCM). We aimed to assess the association between impaired coronary flow velocity reserve (CFVR) and ventricular systolic function and functional capacity. Methods Eighty-three patients with HCM were enrolled in this prospective cohort study. Patients underwent echocardiogram to evaluate ventricular performance and CFVR in the left anterior descending artery (LAD) and posterior descending artery (PD). Diastolic coronary flow velocity was measured in basal conditions and in hyperemia. CFVR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). The link between CFVR and biventricular systolic function and peak VO2 was studied. Results Age was 55.0(14.4)years, 50 patients (60%) were male; 59 patients (71%) had nonobstructive HCM. Mean CFVR LAD was 1.81(0.49) and CFVR PD was 1.73(0.55). Lower CFVR PD was associated with impaired global longitudinal strain (GLS) 2D (β-estimate:-3.240,95%CI:-4.634;-1.846, p < 0.001), GLS 3D (β-estimate:-2.559,95%CI:-3.932;-1.186, p < 0.001) and area strain (β-estimate:-3.044,95%CI:-5.373;-0.716, p = 0.011). Lower values of CFVR PD related to worse global work index (β-estimate:267.824,95%CI:75.964;459.683, p = 0.007), global constructive work (β-estimate:217.300,95%CI:38.750;395.850, p = 0.018) and global work efficiency (β-estimate:5.656,95%CI:2.229;9.084, p = 0.002). Impaired CFVR LAD (β-estimate:2.826, 95%CI:0.913;4.739, p = 0.004) and CFVR PD (β-estimate:2.801,95%CI:0.657;4.945, p = 0.011) were associated with lower TAPSE. Lower values of CFVR LAD (β-estimate:2.580, 95%CI:0.169;4.991, p = 0.036) and CFVR PD (β-estimate:3.163, 95%CI: 0.721;5.606, p = 0.012) were associated with worse peak VO2. Conclusion Lower CFVR was associated with impairment in biventricular systolic function parameters and functional capacity assessed by pVO2.
- Diagnóstico Pré-Natal das Anomalias do Tracto Urinário e Valor da Cistografia Miccional no Estudo Evolutivo Pós-NatalPublication . Batista, J; Abranches, M; Silva, A; Tavares, MN; Ferra de Sousa, J; Videira-Amaral, JA utilização sistemática da cistouretrografia miccional, no âmbito da investigação pós-natal das anomalias fetais do aparelho urinário, é controversa. A possibilidade de diagnosticar refluxo vesico-ureteral (RVU) antes de surgir infecção urinária é aliciante pela influência que pode ter na história natural da nefropatia do refluxo. Neste artigo, partindo de uma série de 116 casos de anomalia fetal do aparelho urinário num período de 5 anos, apresentam-se as características e evolução de 19 casos de RVU. A cistouretrografia miccional (CUM) efectuada em 109 casos (94%) identificou RVU em 19 (17.4%). Predominou o sexo masculino (5:1). Em 13 casos (19 unidades renais refluentes) o RVU era a única anomalia urinária detectada (grupo I); em 6 casos (8 unidades refluentes) o RVU estava associado a outras anomalias do tracto urinário (grupo II). Em 10 unidades refluentes do grupo I (55%) a avaliação ecográfica pós-natal foi considerada normal. Uma ecografia pós-natal normal não exclui a existência de RVU e, de acordo com os nossos resultados, todos os casos de dilatação da pélvis renal fetal beneficiam, no período pós-natal, de controlos ecográficos seriados e da realização de CUM. A confirmação precoce de RVU e a consequente instituição de quimioprofilaxia podem contribuir para a redução da morbilidade associada à infecção urinária e à nefropatia de refluxo.
- Diagnóstico Pré-Natal das Anomalias do Tracto Urinário: Dez Anos de ExperiênciaPublication . Batista, J; Abranches, M; Silva, A; Ferra de Sousa, JIntrodução: As anomalias do tracto urinário são detectadas com uma frequência cada vez maior devido à sistematização da vigilância ecográfica durante a gravidez aliada à sofisticação técnica e à experiência dos ecografistas. Objectivo: Analisar os principais diagnósticos pós-natais investigados na sequência do estudo evolutivo prolongado das uropatias fetais seguidas no ambulatório da nefrologia pediátrica do Hospital de Dona Estefânia. Doentes e Métodos: Estudo retrospectivo dos 392 casos de uropatia fetal observados num período de dez anos e submetidos ao protocolo de investigação em uso na unidade. Resultados: O estudo inclui 362 casos; excluímos 30 processos que não completaram a investigação. A relação sexo masculino: feminino foi de 2: 1. O diagnóstico pré-natal foi realizado em média às 28.9 semanas e a idade média de admissão foi de 68 dias. No estudo evolutivo pós-natal verificou-se a formulação de um diagnóstico definitivo em 349 (96.4%) das crianças. Em 109 crianças (30%) a anomalia fetal foi transitória. Em 75 (20.7%) a dilatação era funcional. Confirmou-se a existência de uropatia em 165/362 crianças: refluxo vesico-ureteral 70/165 (42.4%), displasia multiquística 21%, síndroma da junção pielo-ureteral 16.4%, entre os principais. Nenhum caso evoluiu para insuficiência renal e há a registar, apenas, um caso de hipertensão arterial por poliquistose renal. Conclusão: A planificação da investigação pós-natal reveste-se ainda de alguma controvérsia e continua a evoluir principalmente no grupo das anomalias unilaterais e assintomáticas.
- Dor à Palpação da TiróidePublication . Pité, H; Moitinho, M; Silva, A; Ortigueira, I; Dias, L; Gomes, VA 37-years-old woman, complaining of fever, malaise, myalgia, sore throat and dysphagia lasting for 15 days, had been taking antibiotics and paracetamol for 7 days, without symptoms' improvement. The clinical examination revealed hyperaemic oropharynx and enlarged, painful thyroid. Further exams showed increased analytic inflammatory serum parameters as well as thyrotoxicosis. The thyroid gland had heterogeneous echostructure, with markedly hypoechoic areas and significant capsular oedema as well as decreased radionuclide uptake in the scintigraphy. Both symptoms and imaging improved with paracetamol and ibuprofen. Thyroid gland function normalized in two months. The patient remains in follow-up. This case reports the clinical features of subacute or De Quervain's thyroiditis. The differential medical approach to the patient with painful thyroid palpation is discussed. The diagnosis is essentially clinic, highlighting the importance of a rigorous physical exam. These patients' follow-up is required, considering the clinical and analytic progression.
- Is a Combined Programme of Manual Therapy and Exercise More Effective than Usual Care in Patients with Non-Specific Chronic Neck Pain? A Randomized Controlled TrialPublication . Domingues, L; Pimentel-Santos, FM; Brazete Cruz, E; Sousa, AC; Santos, A; Cordovil, A; Correia, A; Sá Torres, L; Silva, A; Soares Branco, P; Cunha Branco, JObjective: The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). Design: Randomized controlled trial. Setting: Outpatient care units. Subjects: Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups. Interventions: Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. Main measures: The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. Results: Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25-P75): 6 (3.25-9.81) vs. 15.5 (11.28-20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25-P75): 2 (1-2.51) vs. 5 (3.33-6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group. Conclusion: This study's findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.
- One Year of Lamivudine Therapy for Portuguese Patients with Chronic Hepatitis BPublication . Areias, J; Calinas, F; Porto, A; Carvalho, A; Freitas, D; Macedo, G; Noronha, R; Cotter, J; Meliço-Silvestre, A; Peixe, R; Pratas, J; Barrote, D; Teixeira, R; Augusto, F; Carrilho, I; Campante, F; Velosa, J; Carvalho, L; Duarte, MA; Guerreiro, H; Pires, C; Silva, A; Cotrim, I; Guedes, F; Tomé, L; Marcelino, M; Gonçalves, C; Ferreira, E; Matos, L; Peixe, P; Esteves, J; Valente, T; Simões, C; Marinho, C; Jasmins, L; Vieira, MJ; Marinho, R; Matos, P; Estevens, J; Carrasquinho, J; Salcedo, G; Parada, P; Teixeira, COBJECTIVE: To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients. PATIENTS: This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months. METHODS: Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses. RESULTS: The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive. CONCLUSION: Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.
- Persistência da Veia Cava Superior Esquerda Associada a Atresia do Esófago - Revisão de 5 CasosPublication . Knoblich, M; Silva, A; Ladeira, C; Carmo, S; Murinello, R; Casella, PObjectivos: A atresia do esófago está associada a uma variedade de malformações congénitas de outros órgãos. A persistência da veia cava superior esquerda e uma das malformações venosas torácicas mais comuns, ocorrendo em 0,3% da população. O objectivo deste estudo é caracterizar a persistência da veia cava superior esquerda nos doentes com atresia do esófago tratados no Hospital Dona Estefânia. Métodos: Estudo retrospectivo dos doentes admitidos por atresia do esófago desde Janeiro 2002 a Dezembro 2013. As seguintes variáveis foram estudadas, considerando, idade gestacional, o peso à nascença, o sexo, tipo de atresia do esófago, ecocardiograma no pré-operatório, malformações associadas, abordagem cirúrgica, eventual ecocardiograma no pós-operatório e angioressonância. Resultados: De um total de 107 doentes, em cinco casos foi diagnosticada persistência da veia cava superior esquerda. Destes, apenas um tinha diagnostico pré-natal. A restante investigação revelou um doente com atresia duodenal e outro com malformação do aparelho urinário, coloboma e malformação bilateral dos pavilhões auriculares. Todos os cinco doentes foram submetidos a toracotomia, esofagoesofagostomia primária após laqueação da fístula traqueo-esofágica e angio-ressonância para caracterizar a malformação vascular. Não houve registo de complicações, quer intra-operatórias quer pós-operatórias. Conclusão: Apesar do estudo pré-operatório, apenas se diagnosticou persistência da veia cava superior esquerda num dos doentes. O diagnóstico é geralmente feito de forma incidental durante a colocação rotineira de catéteres venosos centrais à esquerda. É importante identificar estes doentes e caracterizar o seu padrão de retorno venoso cardíaco, pelo risco de complicações embó1icas paradoxais para o sistema arterial.
- Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS StudiesPublication . Amaral, R; Jácome, C; Almeida, R; Pereira, AM; Alves-Correia, M; Mendes, S; Rodrigues, JC; Carvalho, J; Araújo, L; Costa, A; Silva, A; Teixeira, MF; Ferreira-Magalhães, M; Alves, RR; Moreira, AS; Fernandes, RM; Ferreira, R; Leiria-Pinto, P; Neuparth, N; Bordalo, D; Todo Bom, A; Cálix, MJ; Ferreira, T; Gomes, J; Vidal, C; Mendes, A; Vasconcelos, MJ; Silva, PM; Ferraz, J; Morête, A; Pinto, CS; Santos, N; Loureiro, CC; Arrobas, A; Marques, ML; Lozoya, C; Lopes, C; Cardia, F; Loureiro, CC; Câmara, R; Vieira, I; Silva, S; Silva, E; Rodrigues, N; Fonseca, JAWe aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13-17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.