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Browsing by Author "Moura, JJ"

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  • 1998Journal article Open access Show more
  • Doença celíaca: revisão de conceitos e novos desenvolvimentos
    Publication . Pedro, N; Lopes, S; Szantho, A; Costa, A; Moura, JJ
    2009Journal article Open access Show more
  • Intoxicação Por Agonista Beta Adrenérgico
    Publication . Carrola, P; Devesa, N; Silva, JM; Ramos, F; Alexandrino, MB; Moura, JJ
    Os autores descrevem dois casos clínicos (pai e filha), que recorreram ao Serviço de Urgência com tremor das extremidades, ansiedade, palpitações, náuseas, cefaleias e tonturas, duas horas após ingestão de fígado de vaca. Analiticamente apresentavam leucocitose com neutrofilia, hipocaliémia e hiperglicémia. Após tratamento com potássio e.v. e propranolol, houve desaparecimento da sintomatologia no SU. Os sintomas reapareceram em casa, pois os doentes não tomaram a medicação prescrita, e persistiram durante cinco dias. A análise posterior do soro de ambos os doentes revelou presença de clembuterol (65,5 hg/ml no pai e 58 hg/ml na filha). O fígado do animal apresentava uma concentração de 1,42 mg/ kg. O clembuterol é um agonista β-adrenérgico pouco específico, com algumas indicações veterinárias. No entanto, este fármaco é usado ilegalmente como promotor do crescimento. Os autores pretendem deste modo alertar os médicos para este problema, nomeadamente aqueles que realizam Urgência Hospitalar.
    2003Journal article Open access Show more
  • Síndrome Cardio-Renal: os desafios no tratamento da insuficiência cardíaca
    Publication . Martins, H; Pedro, N; Castellano, M; Monteiro, P; Moura, JJ; Providência, LA
    Heart failure is a chronic and progressive disease that is estimated to affect approximately 20 million people worldwide and is one of the major public health problems. Its prevalence is reaching epidemic levels with about 550,000 new cases diagnosed annually, partly due to increased life expectancy in developed countries. And as it is a systemic disease, it can cause dysfunction in various organs, but especially in the kidney. The renal failure is often associated with heart failure and, when present together, make the treatment more complex and the prognosis is worse. This is the cardio-renal syndrome. The definition of cardio-renal syndrome varies according to the working groups, and there isn't a consensus. The exact cause of deterioration of renal function and the mechanism behind this interaction are complex, multifactorial in nature and not fully known at present. The treatment available is the one used for the treatment of heart failure. It is necessary to maintain the normal function of filtration, secretion and reabsorption in kidney to have a real improvement of the clinical condition of the patient. Patients with higher risk of developing nephropathy and those who have diagnosed renal failure should have prescribed drugs that are handled very carefully. But as in many other clinical situations, there aren't perfect drugs available to treat cardio-renal syndrome and the existing ones may have serious side effects in medium/long term causing the deterioration of renal function and possibly an increased mortality. The treatment is truly challenging in patients with severe fluid overload that is refractory to diuretics. This article aims to present the existing definitions of cardio-renal syndrome, its epidemiology, describe the current knowledge about the pathophysiology and its relationship to therapeutic interventions, some actual strategies and future technologies in an attempt to preserve the kidney, mainly during the decompensation of chronic heart failure.
    2011Journal article Open access Show more
  • The diseases we cause: Iatrogenic illness in a department of internal medicine
    Publication . Madeira, S; Melo, M; Porto, J; Monteiro, S; Pereira de Moura, JM; Alexandrino, MB; Moura, JJ
    BACKGROUND: The aim of this study was to estimate the incidence, main causes, and risk factors of iatrogenic disease occurring in a department of internal medicine. METHODS: Over a 1-year period, physicians systematically filled out a 2-page questionnaire for all patients admitted to the ward. A database was created and the data were statistically analyzed. Patients undergoing immunosuppressive, chemo-, or radiation therapy were excluded. Missing data were completed by reviewing the patients' charts. The patients were then divided into two groups: those with and those without iatrogenic disease. The groups were compared using several parameters including gender, age, social features, days of hospitalization, associated illness, functional status, medical impression, prognosis, associated renal or liver function impairment, drugs taken daily, and outcome. In the group with iatrogenic disease, the type, severity, and predictability were also analyzed. RESULTS: Of the 879 patients admitted to the ward, 445 completed questionnaires and were included in the study. A total of 102 patients (22.9%) developed 121 iatrogenic events. Forty-four patients (43.1%) were admitted for iatrogenic illness, 10 (9.8%) developed life-threatening events, and in 3 (6.8%) it was the cause of death. Fifty-eight patients (56.8%) registered 77 episodes of iatrogenic disease during their hospital stay, 20 (19.6%) developed life-threatening events, and 9 (11.7%) died, 4 (5.2%) of an iatrogenic cause (nosocomial infections). Significant differences were found in 20 out of 26 parameters studied (p<0.005 for all cases; 95% confidence interval). Eighteen percent of all iatrogenic disease was severe, 61.9% predictable, 54.5% avoidable, and 59% drug-related, 80% of which was due to side effects or adverse reactions. Infection and metabolic and electrolyte disorders were the most frequent effects. CONCLUSIONS: It is possible to identify risk factors for iatrogenic events. Chronically ill elderly inpatients are the main target of iatrogenic events.
    2007Journal article Open access Show more