Browsing by Author "Abreu, M."
Now showing 1 - 7 of 7
Results Per Page
Sort Options
- Clinical Usefulness of Streptococcus pneumoniae Urinary Antigen in Patients Hospitalized with Non-Nosocomial PneumoniaPublication . Ferreira, J.; Abreu, M.; Rodrigues, P.; Maia, J.; Leuschner, P.; Correia, J.Introduction : Community acquired pneumonia (CAP) is a major cause of hospital admissions and mortality in developed countries. Nevertheless, in about half of the cases a microbial etiology can`t be determined. The need to improve the diagnostic tools of this disease has led to the development of new techniques, such as Streptococcus pneumoniae urinary antigen. Objectives : To analyse the usefulness of the urinary antigen in determining the etiologic diagnosis of pneumonias and its influence in the antibiotherapy modification. Methods : Retrospective analysis of hospitalized patients in 2010 with CAP (n=226) and healthcare associated pneumonia (HCAP) [n=64] diagnosis whose urinary pneumococcal antigen has been analyzed. Results: Median age was significantly greater in HCAP. HCAP patients had more co-morbidities and higher severity scores. Twenty-one patients in the CAP group and 4 patients in the HCAP group had positive pneumococcal antigen. The sensibility of urinary antigen in determining pneumococcal pneumonias was 36% and the specificity 89%. Almost one quarter of the 25 patients with positive urinary antigen had appropriate reductions in antimicrobial spectra, which was not statistically significant when compared with the group with negative urinary antigen. There was a significant relation between a positive urinary antigen and pneumonia severity. Conclusions: Considering its high specificity, the urinary antigen is useful to confirm the presence of pneumococcal pneumonia. Potentially urinary antigen can help to avoid unnecessary treatments in hospitalized patients with CAP.
- Economic Impact of Prosthetic Joint Infection - an Evaluation Within the Portuguese National Health SystemPublication . Sousa, A.; Carvalho, A.; Pereira, C.; Reis, E.; Santos, A.; Abreu, M.; Soares, D.; Fragoso, R.; Ferreira, S.; Reis, M.; Sousa, R.Introduction: Prosthetic infection is a devastating complication of arthroplasty and carries significant economic burden. The objective of this study was to analyze the economic impact of prosthetic hip and knee infection in Portuguese National Health System. Material and Methods: Case-control study carried out from January 2014 to December 2015. The mean costs of primary arthroplasties and prosthetic revision surgeries for non-infectious reasons were compared with the costs of prosthetic infections treated with debridement and preservation of the prosthesis or with two-stage exchange arthroplasty.The reimbursement for these cases was also evaluated and compared with its real costs. Results: A total of 715 primary arthroplasties, 35 aseptic revisions, 16 surgical debridements and 15 revisions for infectious reasons were evaluated. The cost of primary arthroplasties was 3,230€ in the hips and 3,618€ in the knees. The cost of aseptic revision was 6,089€ in the hips and 7,985€ in the knees. In the cases treated with debridement and implant retention the cost was 5,528€ in the hips and 4,009€ in the knees. In cases of infections treated with a two-stage revision the cost was 11,415€ and 13,793€ for hips and knees, respectively. Conclusion: As far as we know this is the first study that analyzes the economic impact of prosthetic infection in the Portuguese context. Although direct compensation for treating infected cases is much lower than calculated costs, infected cases push the overall hospital case-mix-index upwards thus increasing financial compensation for the entire cohort of treated patients. This knowledge will allow for more informed decisions about health policies in the future.
- Investigating a Case of Recurrent Pleural EffusionPublication . Rodrigues, P.; Neves, M.; Ferreira, J.; Abreu, M.; Almeida, F.We describe the case of a patient with long-standing Parkinson’s disease and recurrent bilateral pleural effusions. The pleural fluid was an exudate, rich in normal lymphocytes, and the echocardiogram, chest computerized axial tomography, and immunological, microbiological and cytological studies were negative. The patient had been taking bromocriptine, which can be related to chronic pleural effusions. Using Pubmed, we found about 40 cases of pleuropulmonary changes or constrictive pericarditis that were related to bromocriptine. We decided to suspend this drug, with resolution of the pleural effusion and respiratory complaints for more than a year now. We discuss possible underlining mechanisms for this and emphasize the importance of collecting the past medical history and medication and of considering possible iatrogenic effects.
- Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome - a case reportPublication . Guerra, M.; Videira, T.; Morais, H.; Santos, T.; Taipa, Ricardo; Abreu, M.; Vieira; da Fonseca; Dos Santos; PintoBackground: Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. Case report: A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. Conclusion: This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.
- Stability of blood gases when refrigeratedPublication . Ferreira, J.; Silva, S.; Rodrigues, P.; Abreu, M.; Maia, J.; Carvalho, D.; Carvalho, L.Background: Blood gas analysis is a widely used procedure. In clinical practice, the physicians may not always have a blood gas analyzer in their proximity. Not infrequently, blood gas samples are stored in a fridge or on ice and read retrospectively. Continued anaerobic and aerobic metabolism in the blood may alter blood gases in the interval between drawing arterial blood and its analysis, which may cause a fall in the PaO2 and pH and a rise in the PaCO2. Methods: Two sets of arterial blood samples were obtained from hospitalized patients. After the initial analysis, one sample from each patient was put in raw ice within a specimen bag (0 to +1 oC) and the other in the fridge (+4 to +8 oC). These samples were submitted to serial analysis at 30 minutes, 1 hour and 2 hours after the initial analysis. Results: Two hundred arterial blood gas results from 25 patients were analysed. The mean values of PaO2, PaCO2, HCO3-, Na+, K+, Ca2+ and lactate at 0 minutes, 30 minutes, 1 hour and 2 hours were not signifi cantly different between the two alternatives of storage. However, within each group, signifi cant changes were found over time for PaO2, K+, Na+, Ca2+ and lactate. Conclusions: When using plastic syringes, arterial blood gas analysis should be processed shortly after collecting the sample. Despite the fact that low temperatures can slow down the metabolism, neither the ice nor the fridge preserved all the sample parameters.
- STAPHYLOCOCCUS AUREUS RESISTENTE À METICILINA E ABCESSO HEPÁTICO Análise Retrospectiva de 117 CasosPublication . Ferreira, J.; Abreu, M.; Rodrigues, P.; Carvalho, L.; Correia, J.Introdução: Os abcessos hepáticos constituem uma entidade clínica que coloca desafios no diagnóstico e tratamento, sendo em muito casos necessário um elevado índice de suspeição. A maioria dos abcessos hepáticos piogénicos são polimicrobianos. Os agentes entéricos facultativos e anaeróbios são os mais comuns. Na literatura revista, os abcessos hepáticos a Staphylococcus aureus constituem cerca de 7% dos abcessos hepáticos piogénicos. Esta infecção habitualmente resulta de disseminação hematogénea de microrganismos isolados em infecções à distância. Não existem séries publicadas sobre esta matéria, sendo que a informação disponível se restringe a case-reports. Objectivo e Métodos: Com o objectivo de aprofundar a fisiopatologia, diagnóstico e história natural dos abcessos hepáticos, nomeadamente por Staphylococcus Aureus resistente à meticilina (MRSA), realizou-se um estudo retrospectivo, fazendo a revisão do processo clínico dos doentes com o diagnóstico de abcesso hepático/piemia portal entre Janeiro de 2004 e Dezembro de 2009, num total de 117 doentes. Resultados: Clinicamente, a maior parte dos doentes tinha febre e dor abdominal. A esmagadora maioria dos doentes não dispensou TC abdominal no diagnóstico. Apenas 81,2% dos doentes realizaram algum tipo de colheita para microbiologia. O agente mais frequentemente isolado foi a Escherichia coli. O MRSA estava presente em 7,6% dos abcessos cujo pús foi processado. A terapêutica mais frequentemente seleccionada foi a drenagem percutânea associada a antibioterapia. Todos os MRSA isolados eram sensíveis ao trimetoprim-sulfametoxazol e vancomicina. O grupo de patologia subjacente mais frequentemente encontrada foi o das doenças das vias biliares, seguido dos pós-operatórios recentes. Na esmagadora maioria das infecções a MRSA, o grupo de patologia subjacente mais frequentemente encontrada foi o pós-operatório abdominal. A taxa de mortalidade global foi de 17,9%. No que respeita a abcessos a MRSA, faleceu 1 doente devido a complicações da doença de base. Conclusões: Estes dados confirmam que o MRSA é um patogénio importante em infecções hospitalares, incluindo as intra-abdominais. É de salientar a importância do pós-operatório abdominal como factor de risco para infecção por este agente, um dado pouco descrito na literatura revista. Estes achados acarretam implicações assinaláveis a nível terapêutico, investigacional e prognóstico.
- Treatment of Prosthetic Joint Infection with Debridement, Antibiotics and Irrigation with Implant Retention - a Narrative ReviewPublication . Sousa, R.; Abreu, M.Prosthetic joint infection usually requires combined medical and surgical therapy. While revision surgery is widely considered to be the gold standard surgical procedure, debridement, antibiotics and irrigation with implant retention is a very appealing alternative. There is however great controversy regarding its real worth with success rates ranging from 0% to over 90%. A number of different patient and host related variables as well as specific aspects of surgical and medical management have been described as relevant for the final outcome. Along this paper, the authors will provide the readers with a critical narrative review of the currently available literature while trying to provide concise and practical treatment recommendations regarding adequate patient selection criteria, proper surgical technique and optimal antibiotic therapy.