Browsing by Author "Gomes, M"
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- Análise económica do rituximab, em associação com ciclofosfamida, vincristina e prednisolona no tratamento de doentes com linfoma folicular avançado em PortugalPublication . Braga, P; Carvalho, S; Gomes, M; Guerra, L; Lúcio, P; Marques, H; Negreiro, F; Pereira, C; Silva, C; Teixeira, AOBJECTIVE: Evaluate costs and benefits of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP), in previously untreated patients with indolent non-Hodgkin lymphoma (NHL), compared to CVP alone from a Portuguese National Health System (NHS) perspective. METHODS: Cost-effectiveness (Life Years Gained--LYG) and cost-utility analysis (Quality Adjusted Life Years--QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (progression free survival, progression and death) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis. RESULTS: The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and Quality adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. CONCLUSIONS: This study demonstrates that the combination R-CVP in previously untreated indolent NHL patients improves life expectancy and is a cost-effective alternative to CVP in Portugal.
- Caso radiológicoPublication . Nascimento, J; Gomes, M; Moreira, C; Macedo, F
- Dry Eye Disease: What the pa/ents say and what we observe... are they correlated?Publication . Sousa, K; Casal, I; Monteiro, S; Gomes, M; Oliveira, L; Torres, P
- Granuloma eosinofílico na clavícula. Apresentação atípica de uma patologia raraPublication . Gomes, M; Tavares, N; Leal, F; Resende, V; Varanda, P; Silva, BO granuloma eosinofílico de localização óssea é uma lesão benigna e apresenta geralmente um curso indolente. Esta entidade foi descrita em 1940 por Lichtenstein e Jaffe e a sua etiologia permanece desconhecida, sendo sugerida a sua associação a outros síndromes. A sua localização mais comum é a nível do crânio, fémur e coluna vertebral e pode apresentar-se como uma lesão simples ou lesões múltiplas. Tem geralmente bom prognóstico, não havendo contudo um consenso quanto ao seu tratamento. Os autores presentam o caso de um homem de 36 anos que apresentava um granuloma eosinofílico de localização atípica – a clavícula – complicado com fratura patológica. Foi submetido a tratamento cirúrgico com excisão da massa tumoral e estabilização com placa e enxerto de ilíaco tricortical autólogo. Foi conseguido um excelente resultado funcional que se mantinha no follow-up a três anos. Não existe na literatura, ao conhecimento dos autores, qualquer descrição de um caso de fratura patológica na apresentação de um granuloma eosinofílico.
- The rs5743836 polymorphism in TLR9 confers a population-based increased risk of non-Hodgkin lymphomaPublication . Carvalho, A; Cunha, C; Almeida, AJ; Osório, NS; Saraiva, M; Teixeira-Coelho, M; Pedreiro, S; Torrado, E; Domingues, N; Gomes-Alves, AG; Marques, A; Silva MG; Lacerda, JF; Gomes, M; Pinto, AC; Torres, F; Rendeiro, P; Tavares, P; Di Ianni, M; Heutink, P; Bracci, PM; Conde, L; Ludovico, P; Pedrosa, J; Maciel, P; Pitzurra, L; Aversa, F; Marques, H; Paiva, A; Skibola, CF; Romani, L; Castro, AG; Rodrigues, FNon-Hodgkin lymphoma (NHL) has been associated with immunological defects, chronic inflammatory and autoimmune conditions. Given the link between immune dysfunction and NHL, genetic variants in toll-like receptors (TLRs) have been regarded as potential predictive factors of susceptibility to NHL. Adequate anti-tumoral responses are known to depend on TLR9 function, such that the use of its synthetic ligand is being targeted as a therapeutic strategy. We investigated the association between the functional rs5743836 polymorphism in the TLR9 promoter and risk for B-cell NHL and its major subtypes in three independent case-control association studies from Portugal (1160 controls, 797 patients), Italy (468 controls, 494 patients) and the US (972 controls, 868 patients). We found that the rs5743836 polymorphism was significantly overtransmitted in both Portuguese (odds ratio (OR), 1.85; P=7.3E-9) and Italian (OR, 1.84; P=6.0E-5) and not in the US cohort of NHL patients. Moreover, the increased transcriptional activity of TLR9 in mononuclear cells from patients harboring rs5743836 further supports a functional effect of this polymorphism on NHL susceptibility in a population-dependent manner.
- Transvesical peritoneoscopy with rigid scope: feasibility study in human male cadaverPublication . Branco, F; Giovannalberto, P; Osório, L; Cavadas, V; Versos, R; Gomes, M; Autorino, R; Correia-Pinto, J; Lima, EBACKGROUND: Transvesical port refers to the method of accessing the abdominal cavity through a natural orifice (i.e., urethra) under endoscopic visualization. Since its introduction in 2006, various reports have been published describing different surgical interventions using a rigid ureteroscope in a porcine model. The aim of this study was to test the access and feasibility of peritoneoscopy by using a rigid ureteroscope in a human male cadaver. METHODS: Two adult male cadavers were used to perform the procedures. A rigid ureteroscope was used for the creation of transvesical access into the peritoneal cavity. Peritoneoscopy, liver biopsy, and identification and manipulation of the ileocecal appendix were performed. RESULTS: Transvesical access into the peritoneal cavity was quickly established. The rigid ureteroscope easily allowed visualization of the abdominal cavity with good image quality. Liver biopsy and manipulation of ileocecal appendix were carried out without difficulties. CONCLUSIONS: Peritoneoscopy, liver biopsy, and ileocecal appendix manipulation using a rigid ureteroscope through a transvesical port is feasible in a cadaver model. The development of a specific rigid scope for the transvesical port might herald a promising future for this NOTES access.
- Tuberculosis incidence rate among the homeless population: The impact of socio-demographic and health-related variablesPublication . Vieira, AL; Oliveira, O; Gomes, M; Gaio, R; Duarte, R