Browsing by Author "Faustino, A"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Acquired left coronary artery fistulae to pulmonary artery and superior vena cavaPublication . Faustino, A; Paiva, LV; Mota, P; Catarino, R
- Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-upPublication . Faustino, A; Providência, R; Mota, P; Barra, S; Silva, J; Fernandes, A; Catarino, R; Basso, S; Costa, M; Leitão-Marques, ABACKGROUND: Doubts remain about atherosclerotic disease and risk stratification of asymptomatic type-2 diabetic patients (T2DP). This study aims to evaluate the usefulness of calcium score (CS) and coronary computed tomography (CT) angiography (CTA) to predict fatal and non fatal cardiovascular events (CVEV) in T2DP. METHODS: Eighty-five consecutive T2DP undergoing CT (Phillips Brilliance, 16-slice) with CS and CTA were prospectively enrolled in a transversal case-control study. Patients were followed for 48 months (range 18 - 68) to assess CVEV: cardiovascular death, acute coronary syndrome, revascularisation and stroke. Potential predictors of CVEV were identified. Predictive models based on clinical features, CTA and CS were created and compared. RESULTS: Performing CT impacted T2DP treatment. Cardiovascular risk was lowered during follow-up but metabolic control remained suboptimal. CVEV occurred in 11.8% T2DP (3.1%/year). CS ≥86.6 was predictor of CVEV over time, with a high negative predictive value, an 80% sensitivity and 74.7% specificity. Although its prognostic value was not independent of the presence/absence of obstructive CAD, adding CS and CTA data to clinical parameters improved the prediction of CVEV: the combined model had the highest AUC (0.888, 95%CI 0.789-0.987, p < 0.001) for the prediction of the study endpoints. CONCLUSIONS: CS showed great value in T2DP risk stratification and its prognostic value was further enhanced by CTA data. Information provided by CT may help predict CVEV in T2DP and potentially improve their outcome.
- Does minimally invasive also stand for minimal patient risk? Lessons from an upper gastrointestinal endoscopyPublication . Vilardouro-Paiva, LM; Faustino, A; Providência, R; Cachulo, MC
- The Portuguese Society of Rheumatology position paper on the use of biosimilarsPublication . Fonseca, JE; Gonçalves, J; Araújo, F; Cordeiro, I; Teixeira, F; Canhão, H; Pereira da Silva, JA; Garcês, S; Miranda, LC; Ramiro, Sofia; Roxo, Ana; Pimentel-Santos, FM; Tavares, V; Neto, A; Sepriano, A; Malcata, A; Faustino, A; Silva, C; Ambrósio, C; Duarte, C; Miguel, C; Barcelos, F; Santos, H; Cunha, I; Ramos, JC; Melo-Gomes, JA; Pimentão, JB; Costa, L; Maurício, L; Silva, M; Bernardes, M; Bogas, M; Coelho, PC; Monteiro, P; Aguiar, R; André, R; Leitão, R; Pimenta, S; Meirinhos, T; Fernandes, S; Las, V; Castelão, WBiotechnological drugs have become a fundamental resource for the treatment of rheumatic patients. Patent expiry of some of these drugs created the opportunity for biopharmaceutical manufacturers to develop biosimilar drugs intended to be as efficacious as the originator product but with a lower cost to healthcare systems. Due to the complex manufacturing process and highly intricate structure of biologicals, a biosimilar can never be an exact copy of its reference product. Consequently, regulatory authorities issued strict preclinical and clinical guidelines to ensure safety and efficacy equivalence and, in September 2013, the biosimilar of infliximab was the first biosimilar monoclonal antibody to be authorized for use in the European Union. The current document is a position statement of the "Sociedade Portuguesa de Reumatologia" (Portuguese Society of Rheumatology) on the use of biosimilar drugs in rheumatic diseases. Two systematic literature reviews were performed, one concerning clinical trials and the other one concerning international position papers on biosimilars. The results were presented and discussed in a national meeting and a final position document was discussed, written and approved by Portuguese rheumatologists. Briefly, this position statement is contrary to automatic substitution of the originator by the biosimilar, defends either a different INN or the prescription by brand name, supports that switching between biosimilars and the originator molecule should be done after at least 6 months of treatment and based on the attending physician decision and after adequate patient information, recommends the registration of all biosimilar treated patients in Reuma.pt for efficacy, safety and immunogenicity surveillance, following the strategy already ongoing for originators, and opposes to extrapolation of indications approved to the originator to completely different diseases and/or age groups without adequate pre-clinical, safety or efficacy data.
- Vacinação em Doentes ReumáticosPublication . Araújo, P; Silva, C; Faustino, A; Pereira da Silva, JAAs doenças infecciosas continuam a ser uma causa importante de morbilidade e de mortalidade nos doentes reumáticos imunodeprimidos. Assim a prevenção das infecções e a avaliação da importância da vacinação devem ser uma prioridade na prática clínica. Neste artigo são apresentadas as principais indicações de vacinação em doentes reumáticos, actualmente recomendadas, salientando a sua eficácia, segurança, doses óptimas, esquema de posologia e factores adjuvantes. O uso de vacinas vivas está contra-indicado nos doentes reumáticos imunodeprimidos, e só deve ser administradas após 3 meses de suspensão da terapêutica imunosupressora. A reintrodução da terapêutica imunossupressora deverá ser efectuada 2 semanas após o uso de uma vacina viva. Se o doente for imunizado durante a toma de imunossupressores pode não atingir uma resposta imune adequada, devendo-se assumir que não está imunizado e repetir a imunização após 3 meses de suspensão da terapêutica. As vacinas que usem uma toxina ou um microorganismo inactivo estão indicadas e na maioria dos casos são bem toleradas e eficazes. As vacinas do tétano, difteria, pneumococica e influenza são eficazes e o seu potencial benefício e de segurança justificam o seu uso nos doentes reumáticos imunodeprimidos.