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Browsing by Author "Silva, C"

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  • Bone Densitometry Versus Bone Histomorphometry in Renal Transplanted Patients: A Cross‐Sectional Study
    Publication . Ferreira, AC; Mendes, M; Silva, C; Cotovio, P; Aires, I; Navarro, D; Caeiro, F; Salvador, R; Correia, B; Cabral, G; Nolasco, F; Ferreira, A
    Bone loss leads to increase risk of fractures in renal transplantation. The aim of this study was to analyse the relationship between bone densitometry (DXA) findings, bone histomorphometry and bone-related molecules 1-year after renal transplantation. We performed a cross-sectional study of de novo renal transplanted patients that agreed to perform a bone biopsy and a DXA examination 1 year after transplantation. All patients underwent a laboratory evaluation, bone biopsy, DXA examination and cardiac CT 1 year after transplantation. 67 patients were included, 16 had a normal examination, and 18 patients were classified as having osteoporosis by DXA. Correlations between bone mineral density and T-scores of total femur and femoral neck were the ones that best correlated with bone volume assessed by a bone biopsy. The sensitivity of DXA for osteoporosis diagnosis was 47.0%, and the specificity was 81.2%. The positive predictive value was 50.0%, and the negative predictive value (NPV) was 80.0%. DXA parameters also correlated with klotho and sclerostin serum levels. In this population, a normal examination excluded the presence of osteoporosis, helping in identifying patients that would not benefit from therapy. Overall, densitometry in total femur and femoral neck correlated well with bone volume measured by bone biopsy.
    2021Journal article Open access Show more
  • Candidíase Invasiva em Doentes Pediátricos Hospitalizados
    Publication . Silva, C; Madureira, I; Brito, MJ; Gouveia, C
    Introdução: A candidíase invasiva (CI) está associada a morbilidade e mortalidade hospitalar significativa, sendo uma causa cada vez mais importante de infeção em crianças. As recomendações para o tratamento da CI nas crianças não são consensuais. Na Europa a prescrição de antifúngicos é muito variável e depende da epidemiologia local. Objetivos: Determinar a prevalência de candidíase invasiva, identificar os fatores de risco e as estirpes envolvidas e caracterizar a terapêutica e complicações. Métodos:Estudo retrospetivo descritivo de crianças> 1 mês internadasno Hospital Dona Estefânia com isolamento de Candida em locaisestéreis, entre Janeiro de 2008 e Dezembro de 2016 (8 anos). Resultados:Identificadas 30 crianças com mediana de idades de 15 meses. Tinham patologia subjacente 28 (93%): síndrome malformativo (47%),prematuridade (19%), doença neurológica (6%), neoplasia (9%), hepatopatia crónica (3%), doença granulomatosa crónica (3%) e infeção VIH (3%). A maioria (96%) apresentava pelo menos um fator de risco, os mais frequentes: antibioterapia (83%) e cateter venoso central (80%). C.albicans foi a espécie mais frequente (60%),seguida por C. parapsilosis (30%), C. famata (7%) e C. lusitaniae (3%). Foi identificada 1 resistência de C. parapsilosisà anidulafungina (2016). A duração média do tratamento foi 18,6 dias, a anfotericina B foi o fármaco mais utilizadoaté 2010 (83%) e o fluconazolfoi o mais utilizado entre 2011 e 2016 (58%). Surgiram complicações em 15 doentes (50%), as mais frequentes: renais (27%) e respiratórias(20%). Ocorreram 6 óbitos (20%), 16,6% antes de 2011 e 3,3% depois de 2011. Conclusões :A maioria dos doentes tinham patologia subjacente e pelo menos um fator de risco, tal como descrito na literatura .C. albicans foi a espécie mais frequente, mas também se confirmou a emergência/aumento de espécies não albicans, sobretudo C. parapsilosis. De acordo com as orientações locais e internacionais, na ausência de fatores de risco e critérios de gravidade, ofluconazol pode ser utilizado no tratamento das infeções por C. albicans e C. parapsilosis com bons resultados. Estão descritas na literatura taxas de mortalidade atribuíveis à doença na ordem dos 10%, tivemos uma mortalidade superior (20%) mas apenas de 3,3% depois de 2011.
    2018Other Open access Show more
  • Combined Lung-Kidney Transplantation: First Case in Portugal
    Publication . Silva, D; Dantas, C; Santos, AS; Silva, C; Aires, I; Remédio, F; Carrelhas, S; Pena, A; Eurico Reis, J; Calvinho, P; Semedo, L; Cardoso, J; Nolasco, F; Fragata, J
    A significant dysfunction of another organ is usually considered an absolute contraindication for lung transplantation, unless multiorgan transplantation is indicated and practical, as is the case of combined lung-kidney transplantation. Few cases of combined lung-kidney transplantation have been described in the literature; however, it is known that, in certain cases, it is the only way to offer an opportunity to selected patients with renal and lung dysfunction. The authors are not aware of any previously published case of a patient receiving both extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration as a bridge for combined kidney-lung transplantation. The authors present the first case of combined lung-kidney transplantation performed in Portugal.
    2021Journal article Open access Show more
  • Custo-Efetividade do Liraglutido: Comparação de Custos e Benefícios Relativamente a Insulina Glargina e Sitagliptina
    Publication . Cardoso, C; Silva, C; Silva Nunes, J; Fonseca, A
    Introdução: O liraglutido é um agonista do glucagon-like peptide-1 para tratamento da diabetes tipo 2, associado a antidiabéticos orais ou insulina basal. Objectivo: Determinar o custo-utilidade do liraglutido 1,2 mg/dia versus insulina glargina 24 UI/dia e sitagliptina 100 mg/dia, durante 35 anos, na perspetiva do Serviço Nacional de Saúde, seguindo orientações oficiais. Materiais e Métodos: O modelo farmacoeconómico Diabetes CORE v7.0 estimou a incidência de complicações, anos de vida, anos de vida ajustados pela qualidade e custos, com dados de ensaios e consumo de recursos estimado por um painel de peritos portugueses e custos unitários obtidos a partir de fontes oficiais nacionais, com uma taxa de atualização de 5%/ano. Resultados: O tratamento com liraglutido associa-se a um ganho de 0,11 anos de vida/0,13 QALYs versus insulina glargina e de 0,08 anos de vida/0,11 QALYs versus sitagliptina. Tratar com liraglutido versus insulina glargina ou sitagliptina implica um gasto adicional de 2.374 € e 2.237 €, traduzido em rácios de custo-efetividade incremental de 17.807 €/QALY e 20.743 €/QALY, respetivamente. Análises de sensibilidade confirmaram a robustez do modelo. Conclusões: Os rácios obtidos encontram-se consideravelmente abaixo do limiar de custo-efetividade 30.000 €/QALY, utilizado noutros países da União Europeia. O liraglutido 1,2 mg/dia é custo-efetivo no tratamento da diabetes tipo 2 em Portugal.
    2015Journal article Open access Show more
  • Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients?
    Publication . Navarro, D; Ferreira, AC; Caeiro, F; Nolasco, F; Cotovio, P; Aires, I; Silva, C; Remédio, F; Ferreira, A; Viana, H; Carvalho, F
    Subclinical rejection following renal transplant is associated with worse outcomes, which can be prevented if recognized early. Protocol allograft biopsies have emerged as an option to identify and allow treatment of subclinical rejection, but optimal timing for their performance is not established. We retrospectively evaluated a cohort of 52 low immunological risk patients, who were submitted, from 2007 to 2010, to de novo renal transplant. We separated them into two groups depending on performing an early graft protocol biopsy before hospital discharge: Group A – 32 patients (61.5%) performed a protocol biopsy, and group B – 20 patients (38.5%) did not, the biopsy being considered not essential for various reasons. We analysed patients’ demographics, biopsy complications, graft function, rejection episodes, and patient and graft survival for a median follow-up time of 63.3 months (50.3-83.7). Group A and group B differed in gender (more female patients were biopsied), dialysis vintage (higher in group A), human leucocyte antigen mismatch (higher in group A), and induction protocol (more patients submitted to thymoglobulin than to basiliximab in group A). Protocol biopsy detected histological changes in four patients (12.5%) in group A (2 cellular and 2 borderline rejections), and all were treated accordingly. Moderate peri-graft hematoma was reported in two cases (3.9%). Despite the increased risk in group A, renal function at discharge was better than in group B (p < 0.05 for serum creatinine and eGFR). During follow-up, rejection episodes were similar in the two groups. By the end of follow-up (median 63.3 months), proteinuria and renal function were similar between the two groups. Using a multivariate regression model, and despite the initial differences, at the end of follow-up, patients submitted to early protocol biopsies had similar excellent prognosis as the very low-risk patients who were not biopsied. (p = 0.5). Following our results, we propose that timing of early protocol biopsy should be individualized according to the patient’s clinical and immunological risk.
    2015Journal article Open access Show more
  • Emergence of Multidrug-Resistant Mycobacterium Tuberculosis of the Beijing Lineage in Portugal and Guinea-Bissau: a Snapshot of Moving Clones by Whole-Genome Sequencing
    Publication . 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, I
    The 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.
    2021Journal article Open access Show more
  • Encefalite Anti-Receptor N-Metil-D-Aspartato (NMDAR) Pós Infeção por Herpes Vírus 2
    Publication . Silva, C; Milheiro Silva, T; Gouveia, C; Candeias, F; Vieira, JP; Brito, MJ
    Introdução: A encefalite herpética (EH) é uma infeção grave do sistema nervoso central que pode complicar-se com ativação de um processo imunomediado como a encefalite anti-NMDAR. Relato de caso: Recém-nascido de termo, gestação vigiada, sem intercorrências, mãe sem história conhecida de herpes genital. Aos 13 dias de vida inicia quadro clínico de sonolência, difícil despertar, febre, recusa alimentar eclonias dos membros superiores. Foimedicado na admissão com fenobarbital e levetiracetam .Apresentava vesículas no cotovelo direito sugestivas de infeção herpética e a PCR HSV 2foi positiva no líquor e líquido vesicular pelo que realizouaciclovirev1500mg/m2/dia durante 21 dias. O EEG apresentava atividade paroxística multifocal bihemisférica de predomínio temporal e a RMN-CE lesões multifocais com componente hemorrágico, bihemisféricas corticais e subcorticais com efeito de massa e apagamento dos sulcos corticais. Observou-se melhoria clínica gradual mas em D21 de doença reiniciou clonias dos membros superiores, movimentos orofaciais e convulsões de difícil controlo sob clonazepam, topiramato, vigabatrina e fenitoína. Repetiu RMN-CE que revelou evolução paraleucoencefalopatia multiquística. Os anticorpos anti-NMDAR no sangue e líquor foram positivos, mas conhecidos apenas em D59 de doença, sendo medicado com Igev, 1gr/kg/dia durante 2 dias. Teve alta em D80 de internamento com aciclovir profilático e terapêuticaantiepilética. Após 6 meses, apresenta tetraparésiaespástica, epilepsia refratária (com evolução para síndrome de West) emicrocefalia com grave atraso global do desenvolvimento. Conclusões: A EH deve ser suspeitada nos RN com febre, alterações neurológicas e vesículas herpéticas, devendo-se proceder à colheita de líquor para confirmação e iniciar de imediato tratamento. Apesar da evolução terapêutica nos últimos anos, a EH ainda tem um prognóstico reservado, sendo necessário realizar mais estudos acerca da patogénese e tratamento da EH.A encefalite anti-NMDAR tipicamente manifesta-se na criança mais velha, pelo que um quadro clínico muito precoce, como neste caso, é raro e muito difícil de diagnosticar.
    2018Other Open access Show more
  • Glucose Homeostasis in Obese Women Is Not Associated to Unacylated Ghrelin Plasma Levels
    Publication . Veiga, L; Brito, M; Silva, C; Silva-Nunes, J
    Introduction: Unacylated ghrelin (UAG) is the major form of circulating ghrelin. Initially considered as a nonfunctional peptide, soon after, UAG has been associated to an insulin sensitizing action and to a negative action on energy balance. The aim of this study was to analyze the association between the serum levels of UAG and glucose metabolism parameters in obese women, independently from eventual influence of anthropometrics. Methods: One hundred lean and 254 obese Caucasian women were studied. Each woman was characterized for anthropometrics, fasting glucose, insulin, HbA1c, and UAG. In addition, obese women were subjected to a classic oral glucose tolerance test (oGTT) to assess glucose and insulin at 120 minutes. Insulin resistance was assessed by the homeostasis model assessment (HOMA-IR). Obese women were classified in 3 glycemic status subgroups (normoglycemia, prediabetes, and diabetes) according to HbA1c and to fasting and oGTT glucose values. Results: In comparison with the lean group, significantly lower levels of UAG were observed in obese women. However, no significant difference was observed through obesity classes I to III. UAG levels were not significantly different among glycemic status subgroups and did not show any association with glucose, insulin, HOMA-IR, or HbA1c. Conclusions: Although anthropometry can influence the level of the unacylated form of ghrelin, UAG plasma levels do not associate to glucose homeostasis parameters.
    2020Journal article Open access Show more
  • Haemophilia A: Health and Economic Burden of a Rare Disease in Portugal
    Publication . Café, A; Carvalho, M; Crato, M; Faria, M; Kjollerstrom, P; Oliveira, C; Pinto, PR; Salvado, R; Dos Santos, AA; Silva, C
    Haemophilia A is a hereditary bleeding disorder, which has been considered rare and chronic. The burden of this disease in Portugal remains unknown. The aim of this study was to estimate the annualized cost and health burden of haemophilia A in Portugal.
    2019Journal article Open access Show more
  • Improvement of Mineral and Bone Disorders After Renal Transplantation
    Publication . Ferreira, AC; Mendes, M; Silva, C; Cotovio, P; Aires, I; Navarro, D; Caeiro, F; Ramos, R; Salvador, R; Correia, B; Cabral, G; Nolasco, F; Ferreira, A
    Background: Posttransplant mineral and bone diseases are causes of fractures, and their association with cardiovascular events is being studied. Methods: We analyzed the evolution of biochemical, histological, and imaging parameters pre- and 1 y post-renal transplantation in 69 patients and correlated mineral and bone findings with coronary calcifications. At inclusion and after 12 mo, clinical data and echocardiographic findings were recorded, and laboratory evaluations, radiography of the pelvis and hands, and bone biopsy were performed. Noncontrast cardiac computed tomography was performed during the second evaluation. Results: Serum levels of fibroblast growth factor 23 and sclerostin decreased in all patients, parathyroid hormone levels decreased in 89.8% of patients, bone alkaline phosphatase levels decreased in 68.1% of patients, and alpha-Klotho levels increased in 65.2% of patients. More than half of the patients presented with renal osteodystrophy at both biopsies, but histological findings improved: a significant transition from high to normal or low turnover and no significant differences in volume, mineralization defect, or cortical porosity at the 2 evaluations. Alpha-Klotho, sclerostin, and bone alkaline phosphatase shifts affect bone changes. Neither echocardiographic findings nor vascular calcification scores differed between the 2 points. Both the pretransplant period (dialysis vintage, sclerostin, and low bone volume at baseline) and the maintenance of abnormalities in the posttransplant period (high turnover posttransplant) were the most reliable predictors of the severity of the coronary calcification percentile. Conclusions: Renal transplantation improved bone and mineral abnormalities. The pretransplant period determines the severity of calcification.
    2022-05Journal article Open access Show more