ULS2-Artigos (em revistas ou actas indexadas)
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- A case of sclerosing angiomatoid nodular transformation of the spleen: Imaging and histopathological findingsPublication . Eusébio, Marta; Sousa, Ana Lucia; Vaz, Ana Margarida; da Silva, Silvia Gomes; Milheiro, Maria Adelaide; Peixe, Bruno; Caldeira, Paulo; Guerreiro, HorácioA 62-year-old woman presented with left upper quadrant pain and anorexia for 1 month. She had a past medical history of nephrolithiasis, extramembranous glomerulonephritis and a relevant atopic background. Physical examination as well as laboratory tests were unremarkable. Abdominal computed tomography, performed without endovenous contrast due to patient’s atopic history, highlighted a nodular density between the pancreatic tale and splenic hilum. On unenhanced magnetic resonance imaging this corresponded to a vascular structure, next to the spleen, with a ‘‘serpentine’’ shape and apparently in continuity with this organ. Additionally, within the spleen there were three, well circumscribed, macronodular lesions, with lobular borders, the biggest measuring 2.5 cm in greater diameter. These lesions were isointense on T1-weighted sequences and hypointense with mildly hyperintense septa on T2 and FATSAT Fiesta sequences. No other relevant lesions were identified.
- Accuracy of faecal calprotectin and neutrophil Gelatinase B-associated Lipocalin in evaluating subclinical inflammation in UlceRaTIVE colitis-the ACERTIVE studyPublication . Magro, Fernando; Lopes, Susana; Coelho, Rosa; Cotter, Jose; Castro, Francisca Dias de; Sousa, Helena Tavares; Salgado, Marta; Andrade, Patrícia; Vieira, Ana Isabel; Figueiredo, Pedro; Caldeira, Paulo; Sousa, A.; Duarte, Maria A.; Avila, Filipa; Silva, João; Moleiro, Joana; Mendes, Sofia; Giestas, Silvia; Ministro, Paula; Sousa, Paula; Gonçalves, Raquel; Gonçalves, Bruno; Oliveira, Ana; Chagas, Cristina; Torres, Joana; Dias, Claudia Camila; Lopes, Joanne; Borralho, Paula; Afonso, Joana; Geboes, Karel; Carneiro, FátimaBackground and Aims: Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. Methods: This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. Results: Macroscopic lesions [i.e. endoscopic Mayo score >= 1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 mu g/g for faecal calprotectin and 12 mu g/g for neutrophil gelatinase B-associated lipocalin were proposed. Conclusions: Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.
- Admission severity of atrial-fibrillation-related acute ischemic stroke in patients under anticoagulation treatment: a systematic review and meta-analysisPublication . Garcia, Catarina; Silva, Marcelo; Araújo, Mariana; Henriques, Mariana; Margarido, Marta; Vicente, Patrícia; Nzwalo, Hipólito; Macedo, AnaIn non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS). We sought to analyze the literature to assess the association between pre-admission anticoagulation (VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001 and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC.
- Altered serum levels of FGF-23 and magnesium are independent risk factors for an increased albumin-to-creatinine ratio in type 2 diabetics with chronic kidney diseasePublication . Silva, Ana Paula; Mendes, Filipa; Fragoso, André; Jerónimo, Teresa; Pimentel, Ana; Gundlach, Kristina; Büchel, Janine; Santos, Nélio; Neves, Pedro LeãoAims: To investigate the role of FGF-23 and magnesium in relation to the albumin-to-creatinine ratio in type 2 diabetics with chronic kidney disease (CKD) stages 2-4.Methods: In a cross-sectional study we included all eligible type 2 diabetic patients with CKD stages 2-4, followed in our outpatient Diabetic Kidney clinic. We used descriptive statistics, the Student's t-test, ANOVA and the chi-square tests. Our population was divided according to the UACR (G1 30-300 mg/g and G2 >= 300 mg/g), and compared these groups regarding several biological and laboratorial parameters. We employed a multiple regression model to identify risk factors of increased UACR.Results: The patients in G2 displayed a lower eGFR (p = 0.0001) and, had lower levels of magnesium (p = 0.004) as well as higher levels of FGF-23 (p = 0.043) compared to patients in Gl.FGF-23 (beta = 0.562, P = 0.0001) and the magnesium (beta = - 8.916, p = 0.0001) were associated with increased UACR.Conclusions: A dysregulation of mineral metabolism, reflected by altered levels of magnesium and FGF-23, correlates with an increased UACR in type 2 diabetic patients with CKD stages 2-4. (C) 2016 Elsevier Inc. All rights reserved.
- Angels and demons regarding cardiovascular disease in diabetic renal patients: the role of FGF-23 Andklotho on the pulse pressurePublication . Silva, Ana Paula; Mendes, Filipa; Fragoso, André; Santos, Nélio; Rato, Fátima; Faísca, Marilia; Neves, Pedro LeãoThe last decade have shown thatFGF23 and Klotho may have relevant independent actions on the renal and cardiovascular systems. Theyinterfere with vascular functions and may playa role in vascularcalcification, atherosclerosis and arteriolosclerosis. On the other hand, pulse pressureis awell-known risk factorof cardiovascular morbidityand mortality in renal patients. The aim of this study isto investigate the relationship between FGF-23 and Klothowith pulse pressure in type 2 diabetic with chronic kidney disease (CKD) stages 2-3.
- Assessing the medical waste management practices and associated risk perceptions in Algarve hospitals, PortugalPublication . Ferreira, Vera; Ribau Teixeira, MargaridaIn the past few years, there has been an increase in public concern about the medical wastes management on a global basis and a significant effort has been directed toward proper and safe management of hazardous medical wastes. However, if there is not a clear understanding of the risks, inadequate management practices are often implemented. The objective of this study was to analyse the medical waste management practice of hospitals in Algarve (Portugal), analyse the risk perception of medical staff (nurses, doctors and housekeepers) and assess the risk for medical staff. This study was carried out in the three hospitals, one public and two private. Field visits and questionnaires survey method was implemented to collect information regarding different medical waste management aspects and the perception of risk associated with medical wastes by the medical staff. The risk assessment was based in real injuries data associated with sharps and needles (estimate of infections) and in inadequate wastes separation, i.e. frequency of errors in separation. There are some problems in the medical waste management in all hospitals due to lack of training and resources. Nurse’s group show slightly higher knowledge about medical wastes separation, with 71.6% correct answers, and doctor’s group lower knowledge, with 64.8% correct answers. Only 26% of doctors participated in training programs and this medical staff group evidences a lower perception of risk associated of the infectious wastes (group IV wastes). The separation about pharmaceuticals, cytotoxic and pathological waste has more errors, which in reality can be reflected in a higher percentage of inadequate treatment and final disposal, and has impacts in medical workers and environment. Most injuries from needlestick/sharp occur during patient care, but there are medical wastes risk associated, mainly linked to the deposition in containers and separation errors of this material. However, only HVB is likely to occur in hospitals, in coming years if the prophylaxis is not 100%. Results indicate the waste management is affected by perception of risk and training programs.
- Calcific uraemic arteriolopathy - A mini-reviewPublication . Mendes, Filipa; Rocha, Sofia Couto; Agapii, Rodica; Silva, Ana; Fragoso, Andr?; Jerónimo, Teresa; Pimentel, Ana; Neves, Pedro LCalcific Uraemic Arteriolopathy (CUA) or calciphylaxis, is a thrombotic disorder of skin and subcutaneous tissue which typically presents with painful purpuric nodules that may progress to necrotic ulcers, and is a severe, life-threatening condition. CUA is an uncommon clinical entity that affects mostly haemodialysis (HD) patients. Although the process of vascular calcification was initially thought to be the result of a passive deposition of calcium-phosphate crystals, current knowledge suggests a distinct mechanism, including cellular activity with differentiation of vascular smooth muscle cells (VSMCs) into chondrocyte as well as osteoblast-like cellular phenotypes and deficiencies in calcification inhibitors. Although multiple studies suggest a potential relationship between warfarin and CUA, larger prospective studies are needed in order to better evaluate this association, and randomised controlled trials are needed to assess the benefit of distinct interventions in this setting. In this article the topic of CUA is reviewed based on a clinical case of a 65-year-old man undergoing haemodialysis, who underwent an aortic valve replacement one year earlier, receiving a mechanical heart valve, and who has been under warfarin therapy since then
- Calprotectin and the Magnitude of Antibodies to Infliximab in Clinically-stable Ulcerative Colitis Patients are More Relevant Than Infliximab Trough Levels and Pharmacokinetics for Therapeutic EscalationPublication . Magro, Fernando; Afonso, Joana; Lopes, Susana; Coelho, Rosa; Gonçalves, Raquel; Caldeira, Paulo; Lago, Paula; Sousa, Helena Tavares; Ramos, Jaime; Gonçalves, Ana Rita; Ministro, Paula; Rosa, Isadora; Vieira, Ana Isabel; Andrade, Patrícia; Soares, João-Bruno; Carvalho, Diana; Sousa, Paula; Meira, Tania; Lopes, Joanne; Moleiro, Joana; Dias, Cláudia Camila; Falcão, Amilcar; Geboes, Karel; Carneiro, FátimaAlthough infliximab (IFX) is an efficient therapy for ulcerative colitis (UC) patients, a considerably high rate of therapeutic failures still occurs. This study aimed at a better understanding of IFX pharmacokinetics and pharmacodynamics among clinically-asymptomatic UC patients. This was a multicentric and prospective study involving 65 UC patients in the maintenance phase of IFX therapy. There were no significant differences between patients with positive and negative clinical, endoscopic and histological outcomes concerning their IFX trough levels (TLs), area under the IFX concentration vs. time curve (AUC), clearance and antibodies to infliximab (ATI) levels. However, the need to undergo therapeutic escalation later in disease development was significantly associated with higher ATI levels (2.62 mu g/mL vs. 1.15 mu g/mL, p=0.028). Moreover, and after adjusting for disease severity, the HR (hazard ratio) for therapeutic escalation was significantly decreased for patients with an ATI concentration below 3 mu g/mL (HR = 0.119, p = 0.010), and increased for patients with fecal calprotectin (FC) level above 250 mu g/g (HR = 9.309, p = 0.018). In clinically-stable UC patients, IFX pharmacokinetic features cannot predict therapeutic response on a short-term basis. However, high levels of ATIs or FC may be indicative of a future therapeutic escalation. (C) 2017 The Authors. Published by Elsevier B.V.
- Clinical course and outcomes of small supratentorial intracerebral hematomasPublication . Behrouz, Reza; Misra, Vivek; Godoy, Daniel A.; Topel, Christopher H.; Masotti, Luca; Klijn, Catharina J. M.; Smith, Craig J.; Parry-Jones, Adrian R.; Slevin, Mark A.; Silver, Brian; Willey, Joshua Z.; Masjuan Vallejo, Jaime; Nzwalo, Hipólito; Popa-Wagner, Aurel; Malek, Ali R.; Hafeez, Shaheryar; Di Napoli, MarioBackground and Purpose: Intracerebral hemorrhage (ICH) volume, particularly if >= 30 mL, is a major determinant of poor outcome. We used a multinational ICH data registry to study the characteristics, course, and outcomes of supratentorial hematomas with volumes <30 mL. Methods: Basic characteristics, clinical and radiological course, and 30-day outcomes of these patients were recorded. Outcomes were categorized as early neurological deterioration (END), hematoma expansion, Glasgow Outcome Scale (GOS), and in-hospital death. Poor outcome was defined as composite of in-hospital death and severe disability (GOS = 3). Comparison was conducted based on hemorrhage location. Logistic regression using dichotomized outcome scales was applied to determine predictors of poor outcome. Results: Among 375 cases of supratentorial ICH with volumes <30 mL, expansion and END rates were 19.2% and 7.5%, respectively. Hemorrhage growth was independently associated with END (odds ratio: 28.7, 95% confidence interval [CI]: 8.51-96.5; P < .0001). Expansion rates did not differ according to ICH location. Overall, 13.9% (exact binomial 95% CI: 10.5-17.8) died in the hospital and 29.1% (CI: 24.5-34.0) had severe disability at 30 days; there was a cumulative poor outcome rate of 42.9% (CI: 37.9-48.1). Age, admission Glasgow Coma Scale, intraventricular extension, and END were independently associated with poor outcome. There was no difference in poor outcome rates between lobar and deep locations (40.2% versus 43.8%, P = .56). Conclusion: Patients with supratentorial ICH <30 mL have high rates of poor outcome at 30 days, regardless of location. Nearly 1 in 5 hematomas <30 mL expands, leading to END or death.
- Clinical features and natural history of PRKAG2 Variant Cardiac GlycogenosisPublication . Lopez-Sainz, Angela; Dominguez, Fernando; Rocha Lopes, Luis; Pablo Ochoa, Juan; Barriales-Villa, Roberto; Climent, Vicente; Linschoten, Marijke; Tiron, Coloma; Chiriatti, Chiara; Marques, Nuno; Rasmussen, Torsten B.; Angeles Espinosa, Maria; Beinart, Roy; Quarta, Giovanni; Cesar, Sergi; Field, Ella; Garcia-Pinilla, Jose M.; Bilinska, Zofia; Muir, Alison R.; Roberts, Angharad M.; Santas, Enrique; Zorio, Esther; Luisa Pena-Pena, Maria; Navarro, Marina; Fernandez, Adrian; Palomino-Doza, Julian; Azevedo, Olga; Lorenzini, Massimiliano; Garcia-Alvarez, Maria I.; Bento, Dina; Jensen, Morten K.; Mendez, Irene; Pezzoli, Laura; Sarquella-Brugada, Georgia; Campuzano, Oscar; Gonzalez-Lopez, Esther; Mogensen, Jens; Pablo Kaski, Juan; Arad, Michael; Brugada, Ramon; Asselbergs, Folkert W.; Monserrat, Lorenzo; Olivotto, Iacopo; Elliott, Perry M.; Garcia-Pavia, PabloBACKGROUND PRKAG2 gene variants cause a syndrome characterized by cardiomyopathy, conduction disease, and ventricular pre-excitation. Only a small number of cases have been reported to date, and the natural history of the disease is poorly understood. OBJECTIVES The aim of this study was to describe phenotype and natural history of PRKAG2 variants in a large multicenter European cohort. METHODS Clinical, electrocardiographic, and echocardiographic data from 90 subjects with PRKAG2 variants (53% men; median age 33 years; interquartile range [IQR]: 15 to 50 years) recruited from 27 centers were retrospectively studied. RESULTS At first evaluation, 93% of patients were in New York Heart Association functional class I or II. Maximum left ventricular wall thickness was 18 +/- 8 mm, and left ventricular ejection fraction was 61 +/- 12%. Left ventricular hypertrophy (LVH) was present in 60 subjects (67%) at baseline. Thirty patients (33%) had ventricular pre-excitation or had undergone accessory pathway ablation; 17 (19%) had pacemakers (median age at implantation 36 years; IQR: 27 to 46 years), and 16 (18%) had atrial fibrillation (median age 43 years; IQR: 31 to 54 years). After a median follow-up period of 6 years (IQR: 2.3 to 13.9 years), 71% of subjects had LVH, 29% had AF, 21% required de novo pacemakers (median age at implantation 37 years; IQR: 29 to 48 years), 14% required admission for heart failure, 8% experienced sudden cardiac death or equivalent, 4% required heart transplantation, and 13% died. CONCLUSIONS PRKAG2 syndrome is a progressive cardiomyopathy characterized by high rates of atrial fibrillation, conduction disease, advanced heart failure, and life-threatening arrhythmias. Classical features of pre-excitation and severe LVH are not uniformly present, and diagnosis should be considered in patients with LVH who develop atrial fibrillation or require permanent pacemakers at a young age. (c) 2020 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.