Browsing by Author "Almeida, M"
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- Entire hemithorax irradiation for Masaoka stage IVa thymomasPublication . Soares, A; Louro, LV; Almeida, M; Sousa, OThymomas are rare neoplasms that have an indolent growth with a preferentially intra-thoracic dissemination pattern. Surgery is currently the standard treatment of thymomas; however radiotherapy is often used in an adjuvant setting due to a high sensitivity of these tumors to such treatment. Postoperative entire hemithoracic irradiation has been used in selected Masaoka stage IVa cases after complete surgical excision of metastatic lesions. In the present article, the authors report three cases of Masaoka stage IVa thymoma that underwent entire hemithorax irradiation after surgical excision of metastatic lesions. The first two patients presented as stage IVa thymomas. The third case consisted of a pleural recurrence of a thymoma. Hemithoracic irradiation with low doses has been used by different authors; the available data shows that it is a well-tolerated treatment that could potentially lead to better loco-regional control and increased overall survival.
- Linfoma cerebral: caso clínico de remissão espontâneaPublication . Ramos, R; Moreira, R; Oliveira, L; Cruz, M; Moreira, T; Fernandes, J; Almeida, M; Almeida, R
- Linfomas não-Hodgkin extraganglionares: uma análise retrospectivaPublication . Trindade, I; Almeida, M; Coimbra, F; Portela, C; Esperança, S; Marques, HNa maioria dos linfomas não-Hodgkin (LNH), o envolvimento extra-ganglionar surge durante o curso da doença. Contudo alguns LNH têm origem em locais que não os gânglios linfáticos ou o baço, sendo designados por LNH extra-ganglionares. Este estudo tem como objectivo ilustrar as características clínico-patológicas dos doentes com LNH extra-ganglionares primários (LNH-EP). Foram avaliados 125 casos de LNH, dos quais 37 (30%) foram considerados LNH-EP. A proporção entre os sexos foi de 1:1, com uma média de idades de 61 anos. Surgiram 8 casos (20%) de LNH de fenótipo T e 29 casos (80%) de LNH de fenótipo B. Os locais mais atingidos foram a pele em 12 casos (32,4%) e o trato gastrointestinal em 11 (29,7%); 24% tinham sintomas B; 81% eram localizados (estadio IE e IIE). De acordo com a histologia, segundo a classificação da OMS, 1 caso (3%) era altamente agressivo (linfoma de Burkitt), 68% agressivos e 29% indolentes. O linfoma B difuso de grandes células (LNH B DGC) constitui 51% e o linfoma de MALT 14% de todos os casos. O índice de prognóstico internacional (IPI) demonstrou que 7% dos doentes pertenciam ao grupo de risco alto, 3% intermédio alto, 20% risco intermédio baixo e 70% risco baixo. Em conclusão, os LNH-EP são um grupo heterogéneo de doenças, sendo as localizações mais frequentes a pele e o trato gastrointestinal. Há uma maior percentagem de LNH T extra-ganglionar do que o descrito para o LNH ganglionar. O tipo histológico mais frequente foi o LNH B DGC. O IPI revelou-se discriminativo relativamente à sobrevivência, mas a sua aplicabilidade nos LNH extra-ganglionares é questionável, porque não divide homogeneamente os doentes. (Discussão) (...) A classificação hematológica das neoplasias para a OMS divide as neoplasias em células B, células T e células 'natural killer'. A importância desta classificação histológica reside no comportamento clínico (indolente, agressivo, muito agressivo) do LNH em questão. Os LNH indolentes (centro-folicular, zona marginal incluíndo MALT, micose fungóide) têm sobrevivência longa mesmo sem tratamento; os LNH agressivos e muito agressivos têm cura mas são rapidamente fatais se não forem tratados ou se se revelarem resistentes. No nosso estudo não foi possível estabelecer uma relação entre sobrevivência aos 12 meses nos LNH indolentes comos agressivos. No grupo dos LNH muito agressivos (l. Burkitt) só existiu 1 caso, que permaneceu vivo e sem doença até ao fim do estudo. Os que tinham doença localizada tiveram sobrevivência maior do que os que tinham doença disseminada, não sendo possível contudo estabelecer uma correlação estatisticamente significativa. Este achado parece-nos relevante, e pode não ser inteiramente inesperado: o sistema de estadiamento de Ann Arbor foi criado para a estratificação de doentes com linfoma de Hodgkin, que ao contrário dos LNH evolui e progride por patamares sequenciais, atingindo as cadeias ganglionares a partir de um gânglio patológico. Quanto à biologia do LNH, o processo é diferente, podendo haver doença extra-ganglionar ou atingimento da medula óssea apesar de escassa massa tumoral ganglionar, o que traduz uma insuficiente correlação entre a massa tumoral e o patamar de evolução, mensurado pelo sistema de Ann Arbor no caso de LNH. A incapacidade discriminativa deste sistema para medir a massa tumoral e o prognóstico levou ao aparecimento do IPI (índice prognóstico internacional), especificamente adaptado ao LNH de alto grau. Posteriormente surgiram o FLIPI e MIPI adaptados do linfoma folicular e de células do manto, respectivamente. Neste trabalho confirmou-se que o sistema de Ann Arbor não é útil para os LNH extra-ganglionares. Demonstrou-se que existe uma correlação estatisticamente significativa nos doentes com DHL elevada e IPI de alto grau, associando-se uma maior mortalidade. A utilidade clínica do IPI no LNH extra-ganglionar levanta no entanto alguma dificuldade, já que estratifica mal os doentes; a maioria pertencia ao grupo de baixo risco e só 10% estavam no grupo de alto risco, onde se pode prever uma evolução mais agressiva. Uma vez que o nosso estudo é retrospectivo e tem uma amostra reduzida, as conclusões devem ser tomadas com precaução. Será necessário um aumento da amostra em estudo e/ou a conjugação com dados de outros centros para se estabelecerem premissas com maior poder estatístico. (Conclusão) Os linfomas cutâneos e do trato gastrointestinal demonstraram ser os mais prevalentes, assim como o subtipo histológico de LNH difuso de grandes células. O IPI demonstrou ser um factor discriminatório na sobrevida dos doentes, mas não estratifica os doentes por grupos homogéneos, e portanto é de utilização duvidosa nos LNH extra-ganglionares.
- Microbiology of healthcare-associated infections and the definition accuracy to predict infection by potentially drug resistant pathogens: a systematic review.Publication . Cardoso, T; Almeida, M; Carratalà, J; Aragão, I; Costa-Pereira, A; Sarmento, AE; Azevedo, LBACKGROUND: Healthcare-associated infections (HCAI) represent up to 50 % of all infections among patients admitted from the community. The current review intends to provide a systematic review on the microbiological profile involved in HCAI, to compare it with community-acquired (CAI) and hospital-acquired infections (HAI) and to evaluate the definition accuracy to predict infection by potentially drug resistant pathogens. METHODS: We search for HCAI in MEDLINE, SCOPUS and ISI Web of Knowledge with no limitations in regards to publication language, date of publication, study design or study quality. Only studies using the definition by Friedman et al. were included. This review was registered at PROSPERO Systematic Review Registration with the Number CRD42014013648. RESULTS: A total of 21 eligible studies with 12,096 infected patients were reviewed; of these 3497 had HCAI, 2723 were microbiologically documented. Twelve studies were on pneumonia involving 1051 patients with microbiological documented HCAI, the application of the current guidelines for this group of patients would result in an appropriate antibiotic therapy in 95 % of cases at the expense of overtreatment in 73 %; the application of community-acquired pneumonia guidelines would be adequate in only 73-76 % of the cases; an alternative regimen with piperacillin-tazobactam or aztreonam plus azithromycin would increase antibiotic adequacy rate to 90 %. Few studies were found on additional focus of infection: endocarditis, urinary, intra-abdominal and bloodstream infections. All studies included in this review showed an association of the HCAI definition with infection by PDR pathogens when compared to CAI [odds ratio (OR) 4.05, 95 % confidence interval (95 % CI) 2.60-6.31)]. The sensitivity of HCAI to predict infection by a PDR pathogen was 0.69 (0.65-0.72), specificity was 0.67 (0.66-0.68), positive likelihood ratio was 1.9 and the area under the summary ROC curve was 0.71. CONCLUSIONS: This systematic review provides evidence that HCAI represents a separate group of infections in terms of the microbiology profile, including a significant association with infection by PDR pathogens, for the main focus of infection. The results provided can help clinician in the selection of empiric antibiotic therapy and international societies in the development of specific treatment recommendations.
- A Rare Case of Spontaneous Remission and Relapse of a Primary Central Nervous System LymphomaPublication . Ramos, R; Fernandes, JS; Almeida, M; Almeida, RPrimary central nervous system lymphoma remission after steroid treatment is a well-known phenomenon, but remission without any type of treatment is extremely rare. We present a rare case of spontaneous remission of a diffuse large B-cell lymphoma of the central nervous system as well as its subsequent reappearance in another location. The atypical presentation misled the neurosurgeons and neurologists, delaying diagnosis and treatment. The patient underwent brain biopsy after the relapse and started radiotherapy and chemotherapy with cytarabine + methotrexate + rituximab. As of 32 months after the diagnosis, the patient remained asymptomatic, with no focal neurological deficits and the disease in complete remission. A PubMed search of the literature up to June 2017 regarding spontaneous remission central nervous system lymphoma was also carried out.
- Stent for Life in Portugal: This initiative is here to stayPublication . Pereira, H; Pinto, FJ; Calé, R; Pereira, E; Marques, J; Almeida, M; Mello, S; Dias Martins, L; behalf of the participating centres in the Stent for Life Initiative in PortugalAIMS: Portugal has one of the lowest rates of primary percutaneous coronary intervention (p-PCI) in Western Europe. This study assessed the progress of Portuguese p-PCI performance indicators one year after Portugal joined the Stent for Life (SFL) initiative. METHODS AND RESULTS: Two national surveys were carried out, each covering a period of one month: the first when Portugal joined the SFL in 2011 (Moment Zero), and the second one year later (Moment One). A total of 397 consecutive patients with probable ST-segment elevation myocardial infarction were enrolled (201 at Moment Zero and 196 at Moment One) from 15 centers. During this period, the number of patients who arrived at a local hospital without p-PCI decreased (62-47%; p=0.004) and transportation to a p-PCI hospital by the National Institute for Medical Emergencies (INEM) increased significantly (13-37%; p<0.001). Shorter times to revascularization were observed, due to shorter patient delay (118-102 min; p=0.008). Door-to-balloon delay and system delay remained unchanged. CONCLUSIONS: Improvements in performance indicators for p-PCI demonstrate the success of the first year of the local SFL plan, which was mainly focused on raising public awareness of the need to use the INEM emergency services, which has reduced patient delay, and on improving secondary transportation.
- Trends in coronary angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional CardiologyPublication . Pereira, H; Campante Teles, R; Costa, M; Canas da Silva, P; da Gama Ribeiro, V; Brandão, V; Martins, D; Matias, F; Pereira-Machado, F; Baptista, J; Farto E Abreu, P; Santos, R; Drummond, A; Cyrne de Carvalho, H; Calisto, J; Silva, JC; Pipa, JL; Marques, J; Sousa, P; Fernandes, R; Cruz Ferreira, R; Ramos, S; Oliveira, E; Almeida, MINTRODUCTION AND OBJECTIVES: The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. METHODS: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. RESULTS: In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. CONCLUSION: During the reporting period there was a three-fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach.