Browsing by Issue Date, starting with "2019-06"
Now showing 1 - 10 of 16
Results Per Page
Sort Options
- Practical Guide for the Use of PCSK9 Inhibitors in PortugalPublication . Fontes-Carvalho, R; Marques da Silva, P; Rodrigues, E; Araújo, F; Gavina, C; Ferreira, J; Morais, JReducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategies for reducing the risk of cardiovascular events. However, in clinical practice, a high proportion of patients do not achieve recommended LDL-C levels through lifestyle and lipid-lowering therapy with statins and ezetimibe. PCSK9 inhibitors (PCSK9i) are a new therapeutic option that significantly (50-60%) reduces LDL-C levels, which in clinical trials translates into an additional reduction in risk for cardiovascular events, and has a good safety profile. However, it is a high-cost therapy, and therefore its use in clinical practice should take its cost-effectiveness into account. Priority should be given to use in patients at higher cardiovascular risk and those in whom high LDL-C levels persist despite optimal lipid-lowering therapy. This consensus document aims to summarize the main data on the clinical use of PCSK9i and to make recommendations for Portugal on the profile of patients who may benefit most from this therapy.
- Fibroma Periférico: Quando o Subtipo Influencia o ResultadoPublication . Tavares, AT; Pereira, A; Proença, F; Figueiredo, L; Prates, M; Varela, MCIntrodução O fibroma periférico ossificante é uma entidade relativamente comum, correspondendo a 9% de todas as tumefações gengivais. É caracterizada por uma neoformação reativa com aumento do volume gengival e um padrão histomorfológico específico. A etiologia é desconhecida, embora seja colocada a hipótese que tenha origem no ligamento periodontal, córion gengival ou periósteo. Também está documentado que pode representar uma maturação de um granuloma telangiectásico ou granuloma periférico de células gigantes preexistentes. Localiza-se, em 60% dos casos, na maxila e mais de 50% dos casos ocorrem na região dos incisivos e caninos. Atinge sobretudo crianças e adultos jovens e tem predileção pelo sexo feminino. A sua apresentação típica é uma massa firme, com 0,5 a 2 cm de diâmetro, bem definida, séssil ou pediculada. Normalmente a lesão é coberta por epitélio normal, mas pode ulcerar ao longo da evolução, com variação da coloração entre rosa e vermelha. Histopatologicamente, apresenta-se como uma proliferação fibroblástica com componente mineralizado, como osso, cimento ou calcificação distrófica. Pode ainda apresentar infiltrado inflamatório crónico e células gigantes multinucleadas. O seu correspondente central é designado por fibroma ossificante: uma lesão localmente agressiva que pode levar à destruição óssea acentuada e à lesão de estruturas vasculonervosas circundantes. Apesar do bom prognóstico após excisão cirúrgica, o fibroma periférico ossificante tem uma elevada taxa de recidiva quando não excisado por completo. Com este caso clínico pretendemos demonstrar a importância do diagnóstico histológico que permitiu a deteção precoce da recidiva. Caso Clínico Mulher de 33 anos, saudável, recorre ao Serviço de Urgência do Hospital de São José em fevereiro de 2019 por tumefação da gengiva do 4º quadrante, sem saber especificar o início de aparecimento e sem qualquer outra sintomatologia associada. Objetivamente apresentava múltiplas raízes retidas e identificou-se uma tumefação gengival avermelhada, não ulcerada, não sangrante e indolor à palpação, com 2cm de maior eixo, na face vestibular do 4º quadrante, adjacente às raízes do 4.6 e 4.7. Foi requisitada uma Ortopantomografia que revelou apenas raízes retidas de 3.6, 3.7, 4.6 e 4.7. Após rotinas laboratoriais sem alterações, a doente foi submetida a exodontia do dente 4.8 e raízes de 4.6 e 4.7. Concomitantemente realizou-se uma biópsia excisional da lesão do 4º quadrante, associada a uma curetagem dos ligamentos periodontais e periósteo e antibioterapia (Amoxicilina 1g: 1 comprimido de 8 em 8 horas). Posteriormente extraíram-se as raízes de 3.6 e 3.7. O resultado anatomopatológico foi “Fibroma ossificante”. Na consulta de reavaliação em setembro apresentava novamente e na mesma localização uma lesão ulcerada, não sangrante e indolor à palpação com cerca de 1,5cm de maior eixo, com 1 mês de evolução. Pediu-se nova Ortopantomografia que revelou alvéolos livres exceto nos dentes remanescentes, sem qualquer lesão intraóssea. Procedeu-se a nova biópsia excisional com regularização do rebordo alveolar. O Serviço de Anatomia Patológica comparou estes fragmentos com aqueles obtidos na primeira biópsia tendo concluído: “Fibroma periférico. Lesão do tipo ossificante (porção central) e do tipo células gigantes (porção periférica). A celularidade do estroma aponta para variante juvenil. A lesão interessa as margens”. Após 18 dias a doente estava assintomática, a ferida operatória com boa evolução cicatricial e agendou-se consulta de reavaliação aos 3 meses. Discussão e Conclusão Os fibromas periféricos são lesões hiperplásicas reativas que ocorrem exclusivamente na gengiva. O fibroma periférico ossificante é o subtipo com maior frequência de recidiva, sendo fundamental o seguimento periódico de doentes com este diagnóstico. Apesar da Ortopantomografia não apresentar lesões ósseas, o resultado histopatológico inicial podia levar-nos a suspeitar da variante central do fibroma ossificante. Dadas as características agressivas desta lesão, a consulta de reavaliação foi agendada numa cronologia que nos permitiu a deteção precoce da recidiva. A comparação das lâminas entre a primeira e segunda biópsias foi essencial para um diagnóstico definitivo. Não obstante apresentar algumas características celulares mais frequentemente observáveis no fibroma ossificante juvenil, a classificação desta lesão como fibroma periférico permitiu-nos uma abordagem mais conservadora, sem compromisso do prognóstico. A doente encontra-se assintomática e com consultas periódicas no Serviço de Estomatologia do Hospital de São José.
- CT-Guided Percutaneous Embolization of a Rasmussen Aneurysm with Ethylene Vinyl Alcohol CopolymerPublication . Conde Vasco, I; Costa, NV; Luz, JH; Veloso Gomes, F; Bilhim, T; Coimbra, E
- Diabetic Foot Infection: Causative Pathogens and Empiric Antibiotherapy Considerations-The Experience of a Tertiary CenterPublication . Neves, JM; Duarte, B; Pinto, M; Formiga, A; Neves, JMost moderate-to-severe diabetic foot infections (DFIs) require hospitalization with urgent surgical approach and administration of empiric antibiotherapy. To ensure optimal antibiotic coverage, regular microbiological background updates are imperative. The purpose is to characterize the microbiological profile and the antibiotic sensitivity pattern of the DFI causative pathogens isolated within a specialized DFI unit of a tertiary hospital, in order to establish evidence-based policies regarding empirical antibiotic use. A cross-sectional study was conducted. Microbiological cultures and corresponding antibiotic sensitivity tests collected from moderate-to-severe DFIs as a first approach to the hospitalized patient were retrieved and analyzed during a 12-month period. Two groups were analyzed: inpatients that had been previously followed at the diabetic foot clinic of the hospital and inpatients without a previous contact with the hospital services. A total of 125 isolates obtained from 87 patients were deemed for analysis. Globally, a predominance of Gram-positive bacteria was observed (60%). Staphylococcus aureus was the most common pathogen. The global ratio of methicillin-sensitive S aureus to methicillin-resistant S aureus (MRSA) was 1.3:1, with similar findings in both groups. According to the antibiotic sensitivity test results, and within the recommended empiric antibiotic regimens for DFI, piperacillin/tazobactam seems to be the most suitable option. Gram-positive bacteria prevail as the main isolates in DFIs. Screening for MRSA-specific risk factors is mandatory. When going for a first empiric therapy, piperacillin/tazobactam is recommended in this institution, and an anti-MRSA agent should be added early, if necessary. We encourage continuous monitoring for the bacterial prevalence in Portuguese diabetic foot centers as it is paramount for the decision making regarding DFI protocols.
- Bicuspid Aortic Valve Aortopathies: an Hemodynamics Characterization in Dilated AortasPublication . Oliveira, D; Aguiar Rosa, S; Tiago, J; Cruz Ferreira, R; Agapito, A; Sequeira, ABicuspid aortic valve (BAV) aortopathy remains of difficult clinical management due to its heterogeneity and further assessment of related aortic hemodynamics is necessary. The aim of this study was to assess systolic hemodynamic indexes and wall stresses in patients with diverse BAV phenotypes and dilated ascending aortas. The aortic geometry was reconstructed from patient-specific images while the aortic valve was generated based on patient-specific measurements. Physiologic material properties and boundary conditions were applied and fully coupled fluid-structure interaction (FSI) analysis were conducted. Our dilated aortic models were characterized by the presence of abnormal hemodynamics with elevated degrees of flow skewness and eccentricity, regardless of BAV morphotype. Retrograde flow was also present. Both features, predicted by flow angle and flow reversal ratios, were consistently higher than those reported for non-dilated aortas. Right-handed helical flow was present, as well as elevated wall shear stress (WSS) on the outer ascending aortic wall. Our results suggest that the abnormal flow associated with BAV may play a role in aortic enlargement and progress it further on already dilated aortas.
- Prevenção e Rastreio do Cancro OralPublication . Martins, A; Prates, M
- Impact of Body Mass Index on Tumor Recurrence Among Patients Undergoing Curative - Intent Resection of Intrahepatic Cholangiocarcinoma - a Multi-institutional International AnalysisPublication . Merath, K; Mehta, R; Hyer, JM; Bagante, F; Sahara, K; Alexandrescu, S; Pinto Marques, H; Aldrighetti, Luca; Maithel, SK; Pulitano, C; Weiss, MJ; Bauer, TW; Shen, F; Poultsides, GA; Soubrane, O; Martel, G; Koerkamp, BG; Guglielmi, A; Itaru, E; Ejaz, A; Pawlik, TMBackground: The association between body mass index (BMI) and long-term outcomes of patients with ICC has not been well defined. We sought to define the presentation and oncologic outcomes of patients with ICC undergoing curative-intent resection, according to their BMI category. Methods: Patients who underwent resection of ICC were identified in a multi-institutional database. Patients were categorized as normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2) and obese (BMI≥30 kg/m2) according to the World Health Organization (WHO) definition. Impact of clinico-pathological factors on recurrence-free survival (RFS) was assessed using Cox proportional hazards model among patients in the three BMI categories. Results: Among a total of 790 patients undergoing curative-intent resection of ICC in the analytic cohort, 399 (50.5%) had normal weight, 274 (34.7%) were overweight and 117 (14.8%) were obese. Caucasian patients were more likely to be obese (66.7%, n = 78) and overweight (47.1%, n = 129) compared with Asian (obese: 18.8%, n = 22; overweight: 46%, n = 126) and other races (obese: 14.5%, n = 17; overweight: 6.9%, n = 19)(p < 0.001). There were no differences in the presence of cirrhosis (10.9%, vs. 12.8%, vs. 12.9%), preoperative jaundice (8.6% vs. 9.5% vs. 12.0%), or levels of CA 19-9 (75, IQR 24.6-280 vs. 50.9, IQR 17.9-232 vs. 43, IQR 16.9-192.7) among the BMI groups (all p > 0.05). On multivariable analysis, increased BMI was an independent risk factor for tumor recurrence (OR 1.16, 95% CI 1.02-1.32, for every 5 unit increase). Conclusion: Increasing BMI was associated with incremental increases in the risk of recurrence following curative-intent resection of ICC. Future studies should aim to achieve a better understanding of BMI-related factors relative to prognosis of patients with ICC.
- Importance of Cardiac Implantable Eletronic Devices in the Diagnosis of Sleep Apnea SyndromePublication . Ribeiro, S; Bonito, L; Guimarães, MJ; Português, J; Rodrigues, B; Alves, A; Durães, C; Ferreira, D; Sanfins, V; Lourenço, AIntroduction: Sleep Apnea Syndrome (SAS) is a prevalent respiratory disease with marked expression in the population with cardiovascular disease. The diagnosis is based on polysomnography. In patients with cardiac implantable electronic devices (CIED), the prevalence of SAS may reach 60%. The objective of this study was to evaluate the value of DEC in the SAS screening. Methods: Prospective study that included patients with CIED with sleep apnea algorithm. The frequency response function was activated and simplified polygraphy was performed. The data of the device were collected on the day of the polygraph. Results: The sample included 29 patients, with a mean age of 76.1 years, 71.4% of the male gender. The prevalence of SAS was 77%. For SAS, the agreement between polysomnography and the Pacemaker was Kappa = 0.54 (p = 0.001), 95% CI (0.28, 0.81) (moderate agreement); for moderate to severe SAS, the agreement was Kappa = 0.73 (p <0.001), 95% CI (0.49, 0.976) (substantial agreement). Severe SAS was obtained: sensitivity 60%, specificity 100%, positive predictive value 100%, negative predictive value 60% and diagnostic accuracy 75%; for moderate to severe SAS: sensitivity of 90%, specificity of 83%, positive predictive values of 90% and negative of 87.5%, with a diagnostic accuracy of 87.5%. Conclusion: SAS is highly prevalent in patients with CIED. The values obtained through these devices have a strong positive correlation with the Apnea-Hypopnea Índex, which makes them a good tool for the screening of severe SAS.
- Animal Models of Acute Gastric Mucosal Injury: Macroscopic and Microscopic EvaluationPublication . Simões, S; Lopes, R; Dias Campos, MC; Marruz, MJ; Meirinhos da Cruz, ME; Corvo, LAcute gastric mucosal injury is a common disorder of the gastrointestinal tract and the search for new therapeutics is ongoing. The aim of this study is to update and expand the information related to the most widely used rat models of acute gastric ulcer, the ethanol-induced ulcer and the indomethacin-induced ulcer. These two models are compared in terms of macroscopic and microscopic features. Experimentally, ethanol was given orally in a single dose and indomethacin was subcutaneously injected into male Wistar rats. After ulcerative challenges, the stomachs were removed and visually inspected. Anti-ulcerative drugs were used to validate the models. Histological analysis of the stomachs determined the microscopic score. The methodology used for model evaluation applied to macroscopic and microscopic gastric lesions. With these methods it was possible to induce lesions in the gastric mucosa. Microscopic evaluation permitted assessment of the inflammatory and apoptotic impact in the mucosa not observable by macroscopic evaluation. Groups of animals were treated with two standard drugs: sulcralfate suspension or lansoprazole solution. Both drugs reduced macroscopic and microscopic lesions, particularly the hemorrhagic ones. Both models induced acute gastric mucosal injury and no single evaluation method can address all the aspects of the pathology of gastric lesions. As a complement to macroscopic evaluation, microscopy appears to be a relevant tool to selectively identify specific aspects of the development of mucosal injury, quantify the extent of lesions, and contribute to an appropriate interpretation of results. The score systems established here offer a reliable method for testing antiulcer drugs.
- Avaliação da Dor na Pessoa Idosa com DemênciaPublication . Bentes Pinto, AFCom o envelhecimento da população, aumenta também a prevalência da demência. Devido às várias comorbilidades associadas ao envelhecimento, a dor é um sintoma comum nesta população especial. Os défices cognitivos e alterações comportamentais associados à demência, dificultam o auto relato da experiência de dor, tornando mais complexa a sua avaliação. Como consequência, os idosos com demência, têm frequentemente a dor subavaliada e subtratada. Objetivo: Fazer uma revisão do tema focando os princípios gerais na avaliação e tratamento da dor e escalas comportamentais validadas e adaptadas culturalmente para a língua portuguesa. Metodologia: Foi realizada uma revisão narrativa da literatura com pesquisa nas bases de dados EBSCOhost - research databases (CINAHL Plus with full text; Nursing & Allied Health Collection full text; Cochrane Plus Collection full text; MedicLatina e MEDLINE with full text.) e Google académico de artigos em inglês e português publicados entre janeiro de 1999 e dezembro de 2016. Resultados: A avaliação da dor na pessoa idosa é um processo complexo. É necessário seguir alguns princípios gerais para a sua avaliação, existindo várias escalas comportamentais para tentar dar resposta a este problema. Conclusão: É imprescindível a utilização destes instrumentos de avaliação específicos, seguindo as boas práticas no controle e gestão da dor, permitindo assim uma melhoria da qualidade de vida. Especialmente nesta população específica, o enfermeiro assume um papel relevante na avaliação e controle da dor.