Browsing by Author "Soares, C"
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- Achieving K/DOQI Targets with Cinacalcet in Dialysis Patients with Secondary Hyperparathyroidism. A Portuguese Observational StudyPublication . Macário, F; Frazão, JM; Ferreira, A; Weigert, A; Mota, M; Machado, D; Birne, R; Neto, R; Baldaia Moreira, A; Soares, C; Ribeiro, S; Mendes, T; Alves, R; Gomes, H; Raposo, HSecondary hyperparathyroidism is a common complication of chronic kidney disease. The elevated serum intact parathyroid hormone, phosphorus, calcium and calcium x phosphorus product have been independently associated with an increased relative risk of mortality. The standard therapy for secondary hyperparathyroidism, including active vitamin D analogues and phosphate binders, is often insufficient to allow patients to achieve the recommended Kidney Disease Outcomes Quality Initiative targets for bone and mineral metabolism. Randomised controlled phase III clinical studies in chronic kidney disease patients with secondary hyperparathyroidism have shown that cinacalcet treatment increases the proportion of patients achieving the recommended Kidney Disease Outcomes Quality Initiative targets for intact parathyroid hormone, phosphorus, calcium and calcium x phosphorus product. Aims: This observational multicentre study aims to evaluate cinacalcet’s ability to achieve and maintain Kidney Disease Outcomes Quality Initiative targets in a population with secondary hyperparathyroidism on chronic haemodialysis in Portugal. Patients and Methods: Patients on chronic dialysis that received cinacalcet during a free sampling programme were enrolled. Retrospective and prospective monthly data were collected from 3 months before until 6 months after the beginning of cinacalcet treatment. Additional assessment included a 12 month evaluation of all parameters. Results: 140 dialysis patients with secondary hyperparathyroidism were enrolled, 60% male, mean age 57.4±14.1 years. The mean intact parathyroid hormone, calcium, phosphorus, and calcium x phosphorus product values at baseline were 751.7±498.8 pg/ml, 9.7±3.8 mg/dl, 5.5±1.5 mg/dl, and 52.7±25.3 mg2/dl2, respectively. After 6 months’ cinacalcet treatment, 26.2%, 53.6%, 59.3%, and 81.0% of the patients achieved the Kidney Disease Outcomes Quality Initiative recommended levels for intact parathyroid hormone, calcium, phosphorus, and calcium x phosphorus product, respectively. The mean dose of cinacalcet at 6 months was 57.1±29.7 mg/day. Conclusions: The use of cinacalcet in clinical practice is an effective option for the treatment of secondary hyperparathyroidism in chronic dialysis patients, allowing more patients to reach and maintain the Kidney Disease Outcomes Quality Initiative targets.
- Avaliação Bem-Estar Fetal Intra-Parto. Cardiotocografia e Electrocardiograma FetalPublication . Valadares, S; Videira, A; Ramos, L; Soares, C; Dâmaso, JA asfixia intra-parto é um evento raro, sendo o seu diagnóstico difícil. Pensa-se que a introdução e uso generalizado da cardiotocografia tenha permitido a identificação do feto em sofrimento, presumivelmente antes de ocorrer uma lesão permanente. O objectivo desta revisão é mostrar as bases da interpretação do CTG e as tentativas para uniformização de critérios na sua avaliação, bem como novas soluções para a descriminação dos “verdadeiros” casos de sofrimento fetal.
- Bem Estar Fetal Intraparto: Papel da EcografiaPublication . Videira, A; Valadares, S; Ramos, L; Soares, C; Dâmaso, JA realização de ecografia está disponível em praticamente todos os Serviços de Urgência de Ginecologia/Obstetrícia. A sua utilidade na avaliação do bem-estar fetal ante-parto é indiscutível. Este trabalho tem por objectivo rever as indicações da Ecografia realizada durante o Trabalho de Parto.
- Cardiac Rehabilitation After Acute Coronary Syndrome: Do All Patients Derive the Same Benefit?Publication . Aguiar Rosa, S; Abreu, A; Marques Soares, R; Rio, P; Filipe, C; Rodrigues, I; Monteiro, A; Soares, C; Ferreira, V; Silva, S; Alves, S; Cruz Ferreira, RINTRODUCTION: Cardiac rehabilitation (CR) has been demonstrated to improve exercise capacity in acute coronary syndrome (ACS), but not all patients derive the same benefit. Careful patient selection is crucial to maximize resources. OBJECTIVE: To identify in a heterogeneous ACS population which patients would benefit the most with CR, in terms of functional capacity (FC), by using cardiopulmonary exercise testing (CPET). METHODS: A retrospective analysis of consecutive ACS patients who underwent CR and CPET was undertaken. CPET was performed at baseline and after 36 sessions of exercise. Peak oxygen uptake (pVO2), percentage of predicted pVO2, minute ventilation/CO2 production (VE/VCO2) slope, VE/VCO2 slope/pVO2 and peak circulatory power (PCP) (pVO2 times peak systolic blood pressure) were assessed in two moments. The differences in pVO2 (ΔpVO2), %pVO2, PCP and exercise test duration were calculated. Patients were classified according to baseline pVO2 (group 1, <20 ml/kg/min vs. group 2, ≥20 ml/kg/min) and left ventricular ejection fraction (group A, <50% vs. group B, ≥50%). RESULTS: We analyzed 129 patients, 86% male, mean age 56.3±9.8 years. Both group 1 (n=31) and group 2 (n=98) showed significant improvement in FC after CR, with a more significant increase in pVO2, in group 1 (ΔpVO2 4.4±7.3 vs. 1.6±5.4; p=0.018). Significant improvement was observed in CPET parameters in group A (n=34) and group B (n=95), particularly in pVO2 and test duration. CONCLUSION: Patients with lower baseline pVO2 (<20 ml/kg/min) presented more significant improvement in FC after CR. CPET which is not routinely used in assessement before CR in context of ACS, could be a valuable tool to identify patients who will benefit the most.
- Collagen Type IV-Related Nephropathies in Portugal: Pathogenic COL4A5 Mutations and Clinical Characterization of 22 FamiliesPublication . Nabais Sá, MJ; Sampaio, S; Oliveira, A; Alves, S; Moura, CP; Silva, SE; Castro, R; Araújo, JA; Rodrigues, M; Neves, F; Seabra, J; Soares, C; Gaspar, MA; Tavares, I; Freitas, L; Sousa, TC; Henriques, AC; Costa, FT; Morgado, E; Sousa, FT; Sousa, JP; da Costa, AG; Filipe, R; Garrido, J; Montalban, J; Ponce, P; Alves, R; Faria, B; Carvalho, MF; Pestana, M; Carvalho, F; Oliveira, JPAlport syndrome (AS) is caused by pathogenic mutations in the genes encoding α3, α4 or α5 chains of collagen IV (COL4A3/COL4A4/COL4A5), resulting in hematuria, chronic renal failure (CRF), sensorineural hearing loss (SNHL) and ocular abnormalities. Mutations in the X-linked COL4A5 gene have been identified in 85% of the families (XLAS). In this study, 22 of 60 probands (37%) of unrelated Portuguese families, with clinical diagnosis of AS and no evidence of autosomal inheritance, had pathogenic COL4A5 mutations detected by Sanger sequencing and/or multiplex-ligation probe amplification, of which 12 (57%) are novel. Males had more severe and earlier renal and extrarenal complications, but microscopic hematuria was a constant finding irrespective of gender. Nonsense and splice site mutations, as well as small and large deletions, were associated with younger age of onset of SNHL in males, and with higher risk of CRF and SNHL in females. Pathogenic COL4A3 or COL4A4 mutations were subsequently identified in more than half of the families without a pathogenic mutation in COL4A5. The lower than expected prevalence of XLAS in Portuguese families warrants the use of next-generation sequencing for simultaneous COL4A3/COL4A4/COL4A5 analysis, as first-tier approach to the genetic diagnosis of collagen type IV-related nephropathies.
- Corticoterapia em ObstetríciaPublication . Lima, J; Borges, A; Serrano, F; Soares, CDevido às suas potentes propriedades anti-inflamatórias e imunossupressoras, os corticosteróides sistémicos são utilizados no tratamento de várias doenças na gravidez, nomeadamente na asma, na artrite reumatóide, na doença inflamatória do intestino e no lúpus disseminado eritematoso. Os ensaios clínicos randomizados, demonstraram que a administração de 2 injecções de corticosteróides à grávida, antes do parto pré-termo, reduz o síndroma de dificuldade respiratória, a mortalidade neonatal e a hemorragia intraventricular. O uso de corticosteróides no síndroma de HELLP, parece melhorar a saúde materna e fetal com o benefício adicional de promover uma rápida recuperação materna pós-parto. No entanto, esta classe de fármacos pode potencialmente causar múltiplos efeitos adversos. Neste artigo são abordados alguns aspectos práticos relacionados com o uso de corticosteróides na gravidez.
- Experiência da Consulta de Gravidez e Diabetes da Maternidade Dr. Alfredo da Costa (1989-1993)Publication . Soares, C; Anjos, F; Rocha, T; Nogueira, MEm 1989 foi criada na Maternidade Dr. Alfredo da Costa uma consulta de diabetes e gravidez. Desde essa altura, 300 grávidas diabéticas foram vigiadas nesta consulta: 210 com diabetes gestacional e 90 com diabetes pré-gestacional. Os problemas obstétricos mais frequentemente encontrados foram a doença hipertensiva e as infecções do tracto génito-urinário. A prematuridade, a macrossomia e as anomalias congénitas foram as complicações mais importantes no grupo dos RN filhos de mãe com diabetes pré-gestacional e a macrossomia o principal problema nos filhos de mãe com diabetes gestacional.
- Follow-Up da Diabetes GestacionalPublication . Pargana, L; Caetano, P; Lima, J; Barbosa, C; Aleixo, F; Soares, C; Rocha, T107 mulheres que tiveram Diabetes Gestacional, vigiadas na consulta de Diabetes da MAC, de 1990 a 1997, foram reclassificadas 1 a 8 anos após o diagnóstico; 14% como diabéticas, 22% como portadoras de Alterações da Homeostase da Glicose e 64% sem alterações, usando os critérios de OMS. O perfil lipídico e a função renal apresentavam-se dentro dos valores de referência para os três grupos, apesar das mulheres com diabetes actual apresentarem algum grau de complicação da doença. A Diabetes Gestacional é factor de risco para alterações do metabolismo da glicose. É função fundamental do clínico que vigia a grávida com Diabetes Gestacional motivá-la para a aderência ao Follow-Up.
- Gender Dysphoria: Concepts, Diagnosis and Clinical ManagementPublication . Alves Rodrigues, C; Marguilho, M; Ferreira, B; Nascimento, S; Nascimento, M; Cardoso, S; Silva, M; Pablo, AC; Soares, C; Fernandes, C; Gonçalves, MGender dysphoria is defined as a condition characterized by mental suffering associated with the incongruence between one's experienced gender and their birth-assigned sex. Gender as a construct and gender dysphoria as a condition in need of multidisciplinary intervention have developed as swiftly as their visibility in society, making it mandatory to promote the literacy and education of all healthcare professionals in this area. This article aims to review information based on scientific evidence on people with gender dysphoria and its clinical approach, while contributing to a safe, inclusive, and non-discriminatory practice of healthcare.
- Has Carotid Intima-Media Thickness Prognostic Impact in Patients with High Cardiovascular Risk? A Long-Term Cohort StudyPublication . Timóteo, AT; Mota Carmo, M; Soares, C; Cruz Ferreira, RBACKGROUND: Carotid intima-media thickness (CIMT) is an established surrogate marker for cardiovascular events in patients with intermediate risk. In patients with high cardiovascular risk or established cardiovascular disease, the impact of CMIT measurement on risk stratification for future events is less clear. Our objective was to evaluate the impact of CIMT on the occurrence of cardiovascular events in a cohort of individuals with high cardiovascular risk, in long-term follow-up. METHODS: We analyzed 296 individuals, mean follow-up of 6.9 ± 2.2 years. Individuals were divided into tertiles according to CIMT. Tertiles were compared in terms of baseline characteristics and outcomes during follow-up-all-cause mortality and composite outcome (mortality, acute coronary syndromes, coronary revascularization, stroke/transient ischemic attack, heart failure, or cardiovascular admission). RESULTS: Our population had a mean age of 65 ± 9 years at the beginning of the study, 55% males. Patients with higher CIMT showed a trend for higher cardiovascular mortality (P = 0.084) and for the composite outcome (P = 0.049). A CIMT ≥ 0.85 mm was also associated with higher rate of events; however, CIMT was not an independent predictor of outcome after adjustment for age and gender. CIMT assessment was useful in patients with hypertension, hyperlipidemia, and metabolic syndrome and in nondiabetic patients. For the composite outcome, it was also useful in females, smokers, and in patients without coronary artery disease. CONCLUSIONS: Patients with higher CIMT have worst outcome, but this was mainly driven by age and gender. CIMT is useful as a prognostic marker in specific subsets of patients.