Browsing by Issue Date, starting with "2019"
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- Mesa 4 –“Armadilhas” urológicas: Casos clínicos; O “erro” em Medicina – Oportunidade de aprendizagemPublication . Ribeiro, P; Eliseu, M; Rolo, F
- Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen?Publication . Fernandes, L; Sargento-Freitas, J; Milner, J; Silva, A; Novo, A; Gonçalves, T; Marinho, AV; Mariano Pego, G; Cunha, L; António, NOral anticoagulants have proved to be highly effective in preventing atrial fibrillation (AF)-related strokes. The occurrence of stroke despite oral anticoagulation is unexpected and little is known about the mechanisms responsible. The aim of this study was to assess possible mechanisms for stroke occurrence, such as poor treatment adherence and inappropriate dosage, in patients chronically anticoagulated for AF.
- Fenómeno de Raynaud com isquémia acral – um caso de crioglobulinémia essencialPublication . Ferreira, DM; Nogueira, AR; Gomes, JP; Aragão, A; Santos, L
- Megapróteses revestidas a prataPublication . Gameiro, D; Freitas, J; Judas, FAs endomegapróteses representam cada vez mais uma solução cirúrgica em situações de perdas ósseas significativas no contexto da cirurgia oncológica, em cirurgia reconstrutiva traumática e em cirurgia de recolocações de próteses articulares. Todavia, estão sujeitas a diferentes tipos de complicações que podem levar, a curto ou a longo prazo, à sua falência mecânica. A principal e mais devastadora é a infeção periprotética (IPP). Esta complicação desenvolve-se, uma vez que a alargada superfície da prótese permite a colonização bacteriana, com produção de biofilme, tornando a infeção difícil de erradicar. A prata, aliando a sua ação antibacteriana à baixa toxicidade, tem sido utilizada para revestir estas MP com o intuito de prevenir e tratar esta complicação. Apesar disso, efeitos adversos relacionados com a prata, como a argiria local, já foram descritos. A implantação de megapróteses revestidas a prata (MPR) é uma opção cirúrgica relativamente recente, no entanto a sua utilização parece estar associada a uma menor incidência da IPP, bem como a um tratamento mais eficaz e menos agressivo desta complicação, quando comparada com o uso de megapróteses não revestidas (MPNR). A implantação de MP tem demonstrado bons resultados funcionais e não parece haver diferença entre doentes com MPR e doentes com MPNR. Quanto à argiria, o desenvolvimento desta complicação parece ser idiossincrático, uma vez que não foi encontrada relação com a massa de prata da prótese utilizada, nem com os níveis séricos de prata iónica (Ag+). No entanto, são precisos mais estudos, preferencialmente prospetivos, controlados e randomizados, com grupos de doentes mais numerosos, com maiores períodos de recuo clínico, sobretudo na área da cirurgia de trauma e revisão de prótese para confirmar estes resultados, para que no futuro as MPR sejam a escolha de eleição sempre que as MP estejam indicadas.
- Diagnostic testing for penicillin allergy: A survey of practices and cost perceptionsPublication . Sousa‐Pinto, B; Blumenthal, KG; Macy, E; Bavbek, S; Benić, MS; Alves‐Correia, M; Dursun, AB; Jerschow, E; Kong‐Cardoso, B; Kopač, P; Lefèvre, S; Lombardo, C; Marraccini, P; Moral, L; Norton, AE; Petrişor, C; Poziomkowska‐Gęsicka, I; Regateiro, FS; Santos, N; Saretta, F; Turkalj, M; Veličković, J; Wöhrl, S; Yazicioglu, M; Zidarn, M; Pereira, M; Rebelo‐Gomes, E; Pereira, AM; Delgado, L; Almeida Fonseca, J
- Cerebral Venous Thrombosis as Rare Presentation of Herpes Simplex Virus EncephalitisPublication . Leite, J; Ribeiro, A; Gonçalves, D; Sargento-Freitas, J; Trindade, L; Duque, VHerpes simplex virus 1 is a prevalent neurotropic pathogen that infects and establishes latency in peripheral sensory neurons. It can migrate into the central nervous system and cause encephalitis. The association between herpes simplex virus encephalitis and cerebral venous thrombosis is rare, with a very limited number of case reports described in the literature, despite the recognized thrombogenic effects of the virus. A 44-year-old man was brought to the emergency department with generalized tonic-clonic seizures requiring sedation and ventilation to control it. Initial brain computed tomography revealed cortical and subcortical edema on the left frontal lobe, and a subsequent contrast-enhanced exam showed absence of venous flow over the anterior half of the superior sagittal sinus. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 1, and the patient was started on acyclovir and anticoagulation, with clinical improvement. Acyclovir administration was maintained for 14 days and oral anticoagulation for one year, with no recurrence of thrombotic events or other complications. A well-timed treatment has a validated prognostic impact on herpes simplex encephalitis, making early recognition of its clinical aspects of main importance.
- Association between Adipokines and Biomarkers of Alzheimer's Disease: A Cross-Sectional StudyPublication . Letra, L; Matafome, P; Rodrigues, T; Duro, D; Lemos, R; Baldeiras, I; Patrício, M; Castelo-Branco, M; Caetano, G; Seiça, R; Santana, IBACKGROUND: Adipose tissue dysfunction has been implicated in the pathophysiology of Alzheimer's disease. However, the involvement of adipokines, particularly adiponectin, remains unclear. OBJECTIVE: To compare serum and cerebrospinal fluid (CSF) levels of adiponectin, leptin and leptin-to-adiponectin ratio in patients within the spectrum of Alzheimer's disease and evaluate their relationship with classical biomarkers and their value as markers of progression. METHODS: Amnestic mild cognitive impairment (MCI, n = 71) and Alzheimer's dementia (AD, n = 53) subjects were consecutively recruited for serum and CSF adiponectin and leptin determination using an analytically validated commercial enzyme-linked immunosorbent assay (ELISA). Correlations were explored using adjusted Spearman's correlation coefficients. A logistic regression model and ROC analysis were performed to evaluate the staging predictive value of adipokines. RESULTS: Serum adiponectin was 33% higher in AD when compared to MCI patients. Adiponectin CSF levels, similar in both groups, were positively correlated with Aβ42 and cognitive function, though only in women. The area under the ROC curve was 0.673 (95% CI:0.57-0.78) for serum adiponectin as predictor of dementia stage and the cut-off 10.85μg/ml maximized the sum of specificity (87%) and sensitivity (44%). CONCLUSION: Although longitudinal studies are required, we hypothesize that higher serum adiponectin in AD patients constitutes a strategy to compensate possible central signaling defects. In addition, adiponectin might be specifically assigned to neuroprotective functions in women and eventually involved in the female-biased incidence of Alzheimer's disease.
- Mesa 7 – Carcinoma da próstata: Fatores de risco e prevenção; Rastreio e diagnóstico precoce; Novidades no estadiamento; Como tratar em 2019Publication . Furriel, F; Pereira, J; Serra, S
- Pru p 3 sublingual immunotherapy ultra-rush protocol is safe and clinically effectivePublication . Moura, AL; Pereira, C; Regateiro, FS; Azevedo, J; Todo Bom, A; Carrapatoso, IIntroduction. Sublingual immunotherapy (SLIT) with Pru p 3 can prevent severe allergic reactions to LTP-containing foods, but the standard initiation protocol is time-consuming. Objectives. Establish the safety of a novel ultra-rush initiation protocol for SLIT with Pru p 3. Methods. Prospective study comparing the side effects of the standard vs novel ultra-rush initiation protocols of SLIT with Pru p 3 in patients with anaphylaxis to LTP. Results. Fifteen patients were included (standard initiation, 5; ultra-rush initiation, 10), 80% females. All patients had oropharyngeal pruritus during initiation, 80% with spontaneous recovery, but no other gastro-intestinal, respiratory, cutaneous or systemic side effects occurred in any patient of both groups. Conclusion. The novel ultra-rush protocol halved the build-up time without increasing side effects.
- Histomorphometric analysis of the human internal thoracic artery and relationship with cardiovascular risk factorsPublication . Fonseca, DA; Antunes, PE; Antunes, MJ; Cotrim, MDIn this study, we aimed at performing a histomorphometric analysis of human left internal thoracic artery (ITA) samples as well as at correlating the histomorphometric findings with the clinical profile, including risk factors and medication. Distal segments of ITA were obtained from 54 patients undergoing coronary artery bypass grafting. Histological observation was performed in paraffin-embedded transverse sections of ITA through four staining protocols: hematoxylin-eosin, van Gieson, Masson's trichrome and von Kossa. Morphometric analysis included the intimal width (IW), medial width (MW) and intima/media ratio (IMR). No overt atherosclerotic lesions were observed. Mild calcifications were observed across the vascular wall layers in almost all samples. Multivariable linear regression analysis showed associations between IW and IMR and the following clinical variables: age, gender, kidney function expressed as eGFR and myocardial infarction history. Age (odds ratio = 1.16, P = 0.004), female gender (odds ratio = 11.34, P = 0.011), eGFR (odds ratio = 1.03, P = 0.059) and myocardial infarction history (odds ratio = 4.81, P = 0.040) were identified as the main clinical predictors for intimal hyperplasia. Preatherosclerotic lesions in ITA samples from patients undergoing coronary revascularization were associated not only with classical cardiovascular risk factors such as age and gender, but also with other clinical variables, namely kidney function and myocardial infarction history.