Browsing by Author "Moura, P"
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- Acute kidney injury in pregnancy: a clinical challengePublication . Machado, S; Figueiredo, N; Borges, A; Pais, MS; Freitas, L; Moura, P; Campos, MThe incidence of acute kidney injury in pregnancy declined significantly over the second half of the 20th century; however, it is still associated with major maternal and perinatal morbidity and mortality. A set of systemic and renal physiological adaptive mechanisms occur during a normal gestation that will constrain several changes in laboratory parameters of renal function, electrolytes, fluid and acid-base balances. The diagnosis of acute kidney injury in pregnancy is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate are not validated in this population. During the first trimester of gestation, acute kidney injury develops most often due to hyperemesis gravidarum or septic abortion. In the third trimester, the differential diagnosis is more challenging for the obstetrician and the nephrologist and comprises some pathologies that are reviewed in this article: preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies.
- Antenatal diagnosis of congenital hepatic hemangioma: a case reportPublication . Cabrita, SV; Gonçalves, S; Rodrigues, H; Guerra, N; Moura, PHepatic tumors in children account for only 1 to 5% of all pediatric tumors. Hepatic hemangioma is, however, the third most common tumor of the liver in childhood. We report a case of an antenatal diagnosis of a hepatic tumor detected on a first obstetric ultrasound, at 26(th) week of gestation. It revealed a complex, predominantly solid hepatic lesion with 3 x 3 cm and a marked, essentially peripheral, Doppler blood flow. Fetal echocardiography showed a normal heart besides a vena cava displacement by the hepatic mass. Fetal Hepatic hemangioma was suspected. Follow-up ultrasounds were unchanged. Pregnancy evolved well. At 36 weeks of gestation was spontaneously delivered a 3300 g boy whose examination revealed a visible thoracoabdominal circulation and a palpable liver. No skin lesions, namely hemangiomas or petechiae were identified. Postnatal magnetic resonance imaging confirmed the diagnosis of Hepatic hemangioma. Treatment was initiated with prednisolone followed by interferon. After 2 years, there is no active lesion.
- Avaliação da sensibilidade médica para o risco de gravidez não planeadaPublication . Nobre-Ramos, V; Rodrigues, A; Sousa, S; Bombas, T; Moura, PABSTRACT: In Portugal, about 94% of sexually active women who don`t want to become pregnant, use a contraceptive method. From these, oral hormonal contraceptives are the most used. Despite this, unplanned pregnancies are a reality. The current study aimed to evaluate physicians’ sensibility to contraceptive counselling on the introduction of new therapies in women with underlying medical conditions and in polymedicated ones. It was a survey study with ten closed-ended questions. Physicians who care for women of reproductive age in a tertiary referral centre (n= 181). It was conducted an opinion survey among physicians who care for women of childbearing age. The differences in medical opinion considering age, sex, medical / surgical specialties and years of clinical practice were analyzed. In the introduction of new therapies, asked about the contraceptive method in use: always 16,6% (n=30) of respondents, nearly always 28,7% (n=52) and sometimes 44,8% (n=81). From these, 62% (n=101) neither provided complete information nor remitted to family planning appointments. When pregnancy was contraindicated 38,7% (n=70) informed about a safe method. About 89,5% (n=162) of the respondents didn't attended updates on contraception in the last year. Even though 64,6% (n= 117) considered it useful taking into account clinical practise. The respondents had poor knowledge about the resources in family planning, 79% (n=118). The female doctor showed a greater information about family planning topics (p=0,001). The younger physicians (<35 years old) and those with few years of clinical practise (<8 years) referred more constantly the importance of professional qualification on family planning (p=0,034; p=0,034). Despite the care of women in childbearing age the issues on drug interactions haven't been addressed constantly. There is evidence of a poor knowledge of the respondents of existing resources which limits an effective contraceptive counselling.
- Diabetes Mellitus insulinodependente que se manifesta como cetoacidose diabética durante a gravidezPublication . Areia, AL; Marta, E; Moura, P
- Doença celíaca do adulto: uma casuística de 12 anosPublication . Cardoso, J; Alexandre, J; Nabais, MJ; Moura, P; Vieira, JD; Alexandrino, MB; Alves-Moura, JJ
- Influência do índice de massa corporal na evolução da diabetes gestacionalPublication . Domingues, AP; Lopes, H; Lobo, AC; Marta, E; Moura, P
- Monoamniotic twins discordant for body stalk anomalyPublication . Tavares, MV; Domingues, AP; Tavares, M; Fonseca, E; Moura, PBody stalk anomaly is a rare malformation. This anomaly in monozygotic twins is extremely unusual. We describe a case of monoamniotic pregnancy discordant for body stalk anomaly diagnosed at 11 weeks. Ultrasound showed a fetus with a large anterior abdominal wall defect, anomaly of the spine and no evidence of lower extremities and other with a normal morphology. As far as our concern, only three monoamniotic pregnancies discordant for this malformation were reported. Our case represents the fourth reported monoamniotic pregnancy discordant for body stalk anomaly with diagnosis made by ultrasound and the second diagnosed in the first trimester.
- Obstetric litigation: the importance of the quality of clinical files and its influence on expertise conclusionsPublication . Domingues, AP; Moura, P; Vieira, DNTo appreciate the Portuguese circumstances concerning situations of obstetric medico-legal conflicts and to evaluate the influence of the quality of files in expert conclusions, an analysis of all cases of obstetric medical responsibility from 2001-11 was carried out. File quality was evaluated by absence or insufficiency of clinical information supplied, by poor quality of document copies and by the registered incongruities among all the health professionals involved. Clinical files sent for forensic analysis were defective in most cases (89.5%). In about 11% of cases, expert opinion was inconclusive as a result of the poor quality of the clinical files sent for technical and scientific analysis. This situation is particularly serious in cases where the reason for the dispute was asphyxia, traumatic lesions of the newborn following instrumented delivery or shoulder dystocia and maternal sequelae, where the lack or absence of information, and poor quality copies were significantly associated with inconclusive opinions.
- Oxidative Stress, DNA, Cell Cycle/Cell Cycle Associated Proteins and Multidrug Resistance Proteins: Targets of Human Amniotic Membrane in Hepatocellular CarcinomaPublication . Mamede, AC; Guerra, S; Laranjo, M; Santos, K; Carvalho, MJ; Carvalheiro, T; Moura, P; Paiva, A; Abrantes, AM; Maia, CJ; Botelho, MFThe anticancer effects of human amniotic membrane (hAM) have been studied over the last decade. However, the action mechanisms responsible for these effects are not fully understood until now. Previously results reported by our team proved that hAM is able to induce cytotoxicity and cell death in hepatocellular carcinoma (HCC), a worldwide high incident and mortal cancer. Therefore, this experimental study aimed to investigate the cellular targets of hAM protein extracts (hAMPE) in HCC through in vitro studies. Our results showed that hAMPE is able to modify oxidative stress environment in all HCC cell lines, as well as its cell cycle. hAMPE differently targets deoxyribonucleic acid (DNA), P21, P53, β-catenin and multidrug resistance (MDR) proteins in HCC cell lines. In conclusion, hAMPE has several targets in HCC, being clear that the success of this treatment depends of a personalized therapy based on the biological and genetic characteristics of the tumor.
- Triplet pregnancies: perinatal outcome evolutionPublication . Almeida, P; Domingues, AP; Belo, A; Fonseca, E; Moura, PPURPOSE: To evaluate the obstetric and perinatal outcomes evolution of triplet pregnancies. METHODS: A prospective observational study was conducted in triplet pregnancies delivered over 16 years in a tertiary obstetric center with differentiated perinatal support. Evaluation of demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were done over a 16 years period. A global characterization of the sample was performed considering the listed parameters. Variables were categorized in three groups according to year of occurrence: 1996-2000, 2001-2006, 2007-2011, and all parameters were compared. RESULTS: Of the 33 triplets included, 72.7% resulted from induced pregnancies. All except one patient received prenatal corticosteroids and five received tocolytics. All women delivered prenatally and no significant differences were seen in the mean gestational age at delivery or birth weight towards time. There were three intrauterine fetal deaths. Neonatal immediate outcomes were not significantly different over the years. CONCLUSION: Despite remarkable progresses in perinatal and neonatal cares, no noticeable impact in triplet gestations' outcomes was seen, sustaining that triplets should be avoided due to their great risk of prematurity and neonatal morbidities, either by limiting the numbers of embryos transferred or by fetal reduction.