Browsing by Author "Baptista, Alexandre"
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- Drug-associated acute kidney disease – data from a world pharmacovigilance databasePublication . Baptista, Alexandre; Marreiros, Ana; Macedo, Ana; Coelho, AndréBackground Drugs are a frequent cause of nephrotoxicity, especially in the context of acute kidney disease (AKD), with a significant number of cases being drug-associated. The WHO's VigiBase is a powerful tool for identifying drugs described and associated with the development of AKD. Methods We retrieved data from the period 1968 to 2022 regarding notifications of adverse drug reactions (ADR). The extracted medications were evaluated for their nephrotoxicity based on the bibliographic score (BS) developed through pre-selected references. The main medications involved were classified as 'non-nephrotoxic', 'potentially nephrotoxic', and 'nephrotoxic'. We utilized the IC025 and reporting odds ratio (ROR) disproportionality indexes to study the relationship between medications and the odds of being included in an AKD notification. Results During the period, a total of 33,932,051 notifications were obtained, revealing 435,677 cases related to drug-associated AKD following MedDRA term filtering, predominantly affecting males aged 45-64. We identified 8,991 active ingredients or suspected combinations associated with AKD development, with the ATC class A - Alimentary Tract and Metabolism being the most frequently described. Among the medications most strongly associated with this phenotype, classes J and N stood out. Among the most notable medications collected, 8.3% were classified as "non-nephrotoxic," 16.7% as "potentially nephrotoxic," and 75% as "known nephrotoxic." Notable active ingredients included cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil (IC025 8.7; ROR 786.96), inotersen (IC025 7.7; ROR 604.57), emtricitabine + tenofovir disoproxil (IC025 7.9; ROR 432.36), esomeprazole (IC025 6.8; ROR 184.23), and pantoprazole (IC025 6.3; ROR 109.86), with proton pump inhibitors dominating the top four positions among the most frequently involved medications. Conclusion AKD is a frequent adverse reaction in VigiBase, with a significantly high reported mortality rate. Evaluation of the notifications revealed medications with a high disproportionality index and a strong association with AKD. We also highlight the potential nephrotoxic role of less suspected medications. This study emphasizes the need to consider AKD as a condition potentially associated with iatrogenic etiology, highlighting various medications and their respective involvement in the various possible manifestations of AKD.
- Incidence and case-fatality from spontaneous intracerebral hemorrhage in a southern region of PortugalPublication . Nzwalo, Hipólito; Nogueira, Jerina; Félix, Catarina; Guilherme, Patrícia; Baptista, Alexandre; Figueiredo, Teresa; Ferreira, Fatima; Marreiros, Ana; Thomassen, Lars; Logallo, NicolaBackground: There is scarce information on incidence and case fatality of spontaneous intracerebral hemorrhage (SICH) in certain regions of the world, including in Europe. There is no community-based data on SICH in Southern Portugal. Aim: To determine the incidence and early case-fatality from SICH in Algarve, the southernmost region of Portugal. Methods: The recommended criteria for stroke incidence studies was used to identify cases of incident first-ever SICH from January 1st to December 31st 2015 in a subregion with 280,081 inhabitants. Crude incidence rates per age group and gender; standardized rates to the European population; and age adjusted case fatality rates were calculated. Results: Eighty-two first-ever cases of SICH (64.6% men) occurred. The mean age was 72.3 years (SD +/- 12.1); women were 3 years older than men on average and had more frequently lobar SICH. The crude annual incidence rate was 29.2/100,000 (95% CI 23.4- 38.6; p < 0.001); higher in men (39.7/100,000) than women (19.8/100,000). The standardized to the European population incidence was 15.1/100,000 (95% CI 3.6-18.9; p < 0.05); 26.9 and 10.9/100,000 for men and women respectively. The 30-day case-fatality was 40 % (95% CI 29-51) and increased steeply with age Conclusion: The incidence of SICH in Southern Portugal was high, but within the figures found in some parts of Europe. However, a marked predominance of males was found and the case-fatality rate was amongst the highest reported in western countries. (C) 2017 Elsevier B.V. All rights reserved.
- Pantoprazole-induced liver injury in the setting of diabetic ketoacidosisPublication . de Oliveira, Raquel; Almeida, Manuel; Lavado, Pedro; Baptista, AlexandreCritically ill patients are at higher risk of acquired liver in-jury, given the multiple coexisting potential causes of injury.1They are also at risk of stress ulcers, and prophylaxis with proton pump inhibitors (PPIs) is common in Intensive Care Units (ICUs). A 54-year-old woman was admitted to the ICU due to diabetic ketoacidosis (DKA). On admission, she was hemo-dynamically stable, with a Glasgow Coma Scale score of 7 (E2V1M4). Her abdominal examination was normal, without palpable organomegalies, and her liver blood tests were within the normal range. She was intubated for airway pro-tection and started on intravenous fluids, insulin perfusion, and prophylaxis with intravenous pantoprazole 40 mg/day.
- Tratamento Endovascular no Acidente Vascular Cerebral Isquémico: “Urgência na Redução das Assimetrias”Publication . Nzwalo, Hipólito; Botelho, Ana; Gil, Inês; Baptista, Alexandre; Fidalgo, Ana PaulaLemos com bastante satisfação o estudo de Dias et al1 publicado na Acta Médica Portuguesa que revelou as assimetrias nacionais no acesso ao tratamento endovascular (TEV) no acidente vascular cerebral (AVC) isquémico por oclusão de grande vaso proximal (OVP). Felizmente, no período em análise houve melhoria nacional das taxas de TEV, mais evidente nos distritos próximos de hospitais com TEV (HCTEV), tendo-se demonstrado a disparidade regional nos tempos de atraso da TEV. Nesse sentido, realçamos que a mediana do tempo AVC - primeira porta de entrada na via verde foi 13 minutos inferior nos doentes transferidos num hospital sem TEV (HSTEV) em comparação com os doentes cuja primeira porta foi um HCTEV. É um dado que possivelmente reflete a pressão de seleção com prejuízo dos doentes que chegam no limite temporal para TEV nos HSTEV.