Browsing by Issue Date, starting with "2015"
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- MS Prevalence and Patients' Characteristics in the District of Braga, PortugalPublication . Figueiredo, J; Silva, A; Cerqueira, JJ; Fonseca, J; Pereira, PAMultiple Sclerosis (MS) is a chronic autoimmune disease of the Central Nervous System causing inflammation and neurodegeneration. There are only 3 epidemiological studies in Portugal, 2 in the Centre and 1 in the North, and there is the need to further study MS epidemiology in this country. The objective of this work is to contribute to the MS epidemiological knowledge in Portugal, describing the patients' epidemiological, demographic, and clinical characteristics in the Braga district of Portugal. This is a cross-sectional study of 345 patients followed in two hospitals of Braga district. These hospitals cover a resident population of 866,012 inhabitants. The data was collected from the clinical records, and 31/12/2009 was established as the prevalence day. For all MS patients, demographic characteristics and clinical outcomes are reported. We have found an incidence of 2.74/100,000 and a prevalence of 39.82/100,000 inhabitants. Most patients have an EDSS of 3 or lower and a mean age of 42 years. The diagnosis was done at mean age of 35, with RRMS being the disease type in more than 80% of patients. In this cohort, we found a female : male ratio of 1.79. More than 50% of patients are treated with Interferon β-1b IM or IFNβ-1a SC 22 μg.
- Noninvasive anatomical and functional assessment of coronary artery disease.Publication . Ramos, V; Bettencourt, N; Silva, J; Ferreira, N; Chiribiri, A; Schuster, A; Leite-Moreira, A; Silva-Cardoso, J; Nagel, E; Gama, VINTRODUCTION AND OBJECTIVE: In suspected coronary artery disease (CAD), invasive coronary angiography (ICA) is traditionally the diagnostic tool of choice. However, patients often have no significant disease. Moreover, assessment of fractional flow reserve (FFR) has been shown to have prognostic implications. Recently, coronary computed tomography angiography (CTA) and cardiac magnetic resonance (CMR) myocardial perfusion imaging (CMR-Perf) have gained increasing attention through their accurate anatomical and functional assessment, respectively. We studied the added value of integrating these tests (CT+CMRint) in the diagnosis of CAD, with FFR as the reference standard. METHODS: We included 101 patients consecutively referred for outpatient assessment of CAD who underwent CTA and CMR-Perf prior to ICA with FFR assessment. Lesions were considered positive by CT+CMRint only if positive in the two tests alone. The mean follow-up was 2.9±0.6 years. RESULTS: All patients completed the study protocol without adverse effects. Forty-four patients had CAD by FFR. CTA had excellent sensitivity and negative predictive value (100%) but, as expected, its specificity and positive predictive value were lower (61% and 67%, respectively). Diagnostic accuracy by FFR was 78% for CTA, 88% for CMR-Perf and 92% for CT+CMRint. Regarding diagnostic accuracy, CT+CMRint showed statistically significant superiority (AUC=0.917, 95% CI 0.845-0.963) compared with CTA (AUC=0.807, 95% CI 0.716-0.879, p=0.0057) or CMR-Perf (AUC=0.882, 95% CI 0.802-0.938, p=0.0398) alone. Regarding prediction of revascularization, the integrated protocol maintained its superior performance. CONCLUSIONS: CT+CMRint showed superior diagnostic accuracy and could thus lead to a considerable reduction in invasive procedures for CAD diagnosis, with less risk and greater patient comfort.
- Late miscarriage caused by Serratia marcescens: a rare but dire disease in pregnancy.Publication . Vale-Fernandes, E; Moucho, M; Brandão, O; Montenegro, N
- Double aortic arch: a cause of stridor to rememberPublication . Baptista, V; Azevedo, I; Rio, G; Moreira, C
- Response.Publication . Lopes, L; Dinis-Ribeiro, M; Rolanda, CResponse: Luís Lopes, MD, PhD Mário Dinis-Ribeiro, MD, PhD Carla Rolanda, MD, PhD Show more doi:10.1016/j.gie.2015.01.001 Refers To: Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Christos Zavos, Jannis Kountouras The endoscopic morphology of major papillae influences the selected precut technique for biliary access Gastrointestinal Endoscopy, Volume 81, Issue 4, April 2015, Page 1056
- Hypertrophic olivary degeneration and cerebrovascular disease: movement in a triangle.Publication . Santos, AF; Rocha, S; Varanda, S; Pinho, J; Rodrigues, M; Ramalho Fontes, J; Soares-Fernandes, J; Ferreira, CHypertrophic olivary degeneration is a rare kind of trans-synaptic degeneration that occurs after lesions of the dentatorubro-olivary pathway. The lesions, commonly unilateral, may result from hemorrhage due to vascular malformation, trauma, surgical intervention or hypertension, tumor, or ischemia. Bilateral cases are extremely rare. This condition is classically associated with development of palatal tremor, but clinical manifestations can include other involuntary movements. We describe 2 cases: unilateral hypertrophic olivary degeneration in a 60-year-old man with contralateral athetosis and neurologic worsening developing several years after a pontine hemorrhage and bilateral hypertrophic olivary degeneration in a 77-year-old woman with development of palatal tremor, probably secondary to pontine ischemic lesions (small vessel disease).
- Traumatismo craneoencefálico penetrante en el seno sagital superior. Caso clínico de su ligadura emergente y con un excelente resultado neurológico.Publication . Ramos, R; Moreira, R; Amorim, J; Almeida, R
- Hérnia Inguinal: Anatomia, Patofisiologia, Diagnóstico e TratamentoPublication . Goulart, A; Martins, SA hérnia inguinal é uma das patologias mais frequentes que se coloca ao Cirurgião Geral. Muitas vezes considerada de menor importância, esta acarreta um impacto importante quer pela interferência na qualidade de vida diária do doente quer em termos sociais pelo absentismo laboral. A evolução do conhecimento anatómico e da técnica cirúrgica permitiu ao cirurgião dispor de diversas técnicas, colocando hoje em dia o problema na seleção da melhor técnica cirúrgica para cada doente. Neste artigo, os autores descrevem a anatomia da região inguinal do ponto de vista da abordagem cirúrgica, os fatores predisponentes e desencadeantes do aparecimento da hérnia inguinal, o diagnóstico desta patologia e a evolução da cirurgia; abordando alguns temas de controvérsia atual no tratamento desta patologia.
- Reversible parkinsonism and cognitive deficits due to vitamin B12 deficiencyPublication . Santos, AF; Rodrigues, M; Abreu, P; Ferreira, C
- Cardiogenic shock complicating acute coronary syndromesPublication . Abreu, G; Arantes, C; Galvão-Braga, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Salgado, A; Gaspar, A; Rocha, S; Marques, JINTRODUCTION: Despite advances in the treatment of patients with acute coronary syndromes (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. PURPOSE: Determine characteristics and management of patients with an ACS complicated by CS. Determine predictors of development of CS during hospitalization and predictors of in-hospital mortality. METHODS: Retrospective study of 2064 patients consecutively admitted for ACS in a Coronary Unit over a period of 4 years. RESULTS: During the years under study, 111 patients (5.4%) developed CS. Patients with CS were more likely to be older (69.8 ± 13.2 vs 63.5 ± 13.1 years, p<0.001); there were no significant differences in other clinical characteristics. Myocardial Infarction with ST segment elevation (STEMI) was more frequent in patients with CS (p<0.001). Patients with CS underwent less often coronary angiography (p<0.001), revascularization (p = 0.004) and were less treated with β-blocker (p <0.001) and ACE inhibitors therapy (p <0.001). In multivariate analysis, predictors of occurrence of CS during hospitalization were: tachycardia (OR 3.2, 95% CI 1.6-6.3), systolic blood pressure <100 mmHg (OR 4.1, 95% CI 2.1-8.0), GFR <60ml/min (OR 2.5, 95% CI 1.2-5.2), STEMI (OR 4.1, 95% CI 2.0-8.0) and Killip class > 1 (OR 3.5, 95% CI 1.8-6.8) at admission. The in-hospital mortality of patients with CS was 45%, compared with 1.7% in those who did not develop CS. Factors associated with an increased mortality in patients with CS included absence of coronary revascularization (OR 4.9, 95% CI 1.5-16.0), GFR <60ml/min (OR 4.4, 95% CI 1.3-15.6), advanced age (OR 6.4, 95% CI 1.6-26.2) and LVEF ≤ 35 % (OR 3.9, 95% CI 1.3-12.4). CONCLUSION: According to the literature, our review showed that CS in the context of ACS is associated with a high mortality. We identified clinical markers that are associated with the development of CS and may spot patients at risk earlier. Absence of coronary revascularization remains an independent predictor of mortality in CS.