Browsing by Author "Dores, J."
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- Bone Mineral Density After Simultaneous Kidney–PancreasPublication . Pereira, S.; Pedroso, S.; Martins, L.; Santos, P.; Almeida, M.; Freitas, C.; Dias, L.; Dores, J.; Almeida, R.; Henriques, A.C.; Teixeira, M.ABSTRACT Bone disease and an high risk of fractures are major problems in transplantation. Among diabetic patients undergoing simultaneous kidney–pancreas (SKP) transplantation, there are few studies assessing long-term effects on bone mass. The aim of this study was to evaluate bone mineral density (BMD) over 4 years follow-up after SKP transplantation. Fifty-seven patients had 22.8 5.3 years of prior diabetes, 65% were female, and the overall mean age was 24.3 5.93 years. At the time of transplantation, the lumbar spine and femoral neck T-scores were 1.75 1.05 and 1.95 0.73, respectively; 28% of subjects had evidence of osteoporosis. One year after transplantation, 77.6% of patients displayed improved lumbar T-scores to 1.33 0.94 (.044) with stable femoral neck T-scores. Bone densitometry enhanced gradually through the 4 years follow-up: lumbar T-score to 1.04 0.67 (.004) and femoral neck T-score to 1.69 0.49 (.12). At year 4, no osteoporosis cases were detected but 86.7% of patients did not receive steroids in the immunosuppressive regimen. The graft function remained stable (serum creatinine, 1.2 mg/dL; fasting glucose, 87.7 mg/dL). During the follow-up, BMD improved more significantly at cortical sites. Our study reports a reduced prevalence of fractures (8.7%) compared with the literature, which could be related to a steroid-sparing protocol and/or aggressively treatment of osteoporosis.
- Combined Pancreas-Kidney Transplantation: A New Program in Portugal, Results From the First 12 CasesPublication . Martins, L.; Henriques, A.; Dias, L.; Ventura, A.; Seca, R.; Almeida, R.; Dores, J.; Bacelar, C.; Oliveira, F.; Lhamas, A.; Amil, M.; Rua, F.; Coelho, T.; Esteves, S.; Ribeiro, A.; Pereira, R.; Sarmento, A.; Teixeira, M.; Pereira, M.Transplant Proc. 2003 May;35(3):1107-8. Combined pancreas-kidney transplantation: a new program in Portugal, results from the first 12 cases. Martins L, Henriques A, Dias L, Ventura A, Seca R, Almeida R, Dores J, Bacelar C, Oliveira F, Lhamas A, Amil M, Rua F, Coelho T, Esteves S, Ribeiro A, Pereira R, Sarmento A, Teixeira M, Pereira M. Transplantation Department, Hospital Santo António, 4050, Porto, Portugal. lasalete@clix.pt PMID: 12947877 [PubMed - indexed for MEDLINE]
- Diabetes Gestacional como Fator de Risco CardiovascularPublication . Dores, J.
- Impact of gestational weight gain on obstetric and neonatal outcomes in obese diabetic womenPublication . Gante, I.; Amaral, N.; Dores, J.; Almeida, M.Both obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. It is recognized that inadequate gestational weight gain is an independent risk factor for pregnancy-related morbidity. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes.
- Pancreas-Kidney Transplantation and the Evolution ofPublication . Martins, L.; Malheiro, J.; Henriques, A.C.; Dias, L.; Dores, J.; Oliveira, F.; Seca, R.; Almeida, R.; Sarmento, A.M.; Cabrita, A.; Teixeira, M.ABSTRACT The recurrence or persistence of pancreatic autoantibodies after pancreas-kidney trans- plantation (PKT) is an intriguing finding. We prospectively analyzed 77 PKTs, searching for risk factors for the expression of these autoimmune markers and their impact on pancreas graft function. Among the 77 PKTs, 24.7% had HLA matches, 20.8% displayed delayed graft function, and 14.3% had acute rejection episodes. Immunosuppression included antithymocyte globulin (ATG)tacrolimus, mycophenolate mofetil (MMF)and steroids. Sixty-five patients had both grafts functioning as follow-up of more than months. In 11 patients anti–glutamic acid decarboxylase (GAD) positivity persists (8) or has recurred (3)of whom show increasing titers. Two patients maintain positive islet cell antibodies (ICA) and anti-GAD antibodies. The patients positive for ICA included who were negative before PKT and who remain positive. The “positive” group (22 patients with positive ICA and/or anti-GAD) did not differ from the global group of 65 functioning PKT in terms of acute rejection episodes, HLA match, and steroid withdrawal. Among the positive patients, there were with borderline glucose levels; however, among the entire “positive” group, the mean fasting glucose, HbA1c, and C-peptide measurements were not significantly different, when compared with the other 65 PKTs. In conclusion, pancreatic autoantibodies may be persistently positive or recur after PKT, despite appropriate immunosuppression. Its impact on long-term pancreas graft survival is unknown. We could not identify risk factors for their expression. An extended follow-up with monitoring and search for other risk factors may be necessary to increase our knowledge in this field.
- Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-upPublication . Martins, L.; Henriques, A.C.; Dias, L.; Almeida, M.; Pedroso, S.; Freitas, C.; Pereira, S.; Fructuoso, M.; Dores, J.; Oliveira, F.; Almeida, R.; Cabrita, A.; Teixeira, M.ABSTRACT Over years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT) The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complica- tions during follow-up of these 93 patients. Their mean age was 34 years and prior dialysis time was 32 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent surgical reinterventions. Incidence of acute rejection episodes was 11.8%After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%95%and 81% at 1-year; 93%90%and 79% at 5-years; and 93%90% and 79% at 9-years. Although pancreas–kidney transplant patients are complex presenting many management difficulties, our overall results represent positive stimulus for diabetic patients.
- Prenatal Diagnosis and Management of a Fetal Goiter Hypothyroidism due to DyshormonogenesisPublication . Figueiredo, C.; Falcão, I.; Vilaverde, J.; Freitas, J.; Oliveira, M.; Godinho, C.; Dores, J.; Rodrigues, M.; Carvalho, C.; Borges, T.Fetal goiter is a rare disorder not expected to be found during a healthy woman's pregnancy. It can be a prenatal manifestation of congenital hypothyroidism due to thyroid dyshormonogenesis and it can lead to serious perinatal complications. A vascularized fetal neck mass was detected at 29 weeks' gestation of a healthy primigravida. Magnetic resonance was suggestive of goiter causing airway deviation without polyhydramnios. Maternal thyroid function was normal and thyroid antibodies were negative. Two intra-amniotic levothyroxine infusions were performed at 32 and 33 weeks. Serial imaging control showed no progression of the mass. Elective caesarean section was performed at 38 weeks. The male newborn was admitted to the intensive care unit due to cardiorespiratory insufficiency with pulmonary hypertension. Hormonal assays revealed primary congenital hypothyroidism and ultrasonography confirmed diffuse goiter. Levothyroxine was started. Currently, he is 6 years old with adequate growth and normal psychomotor development. Genetic study found a heterozygous mutation in the TPO gene.
- SÍNDROME METABÓLICA NA GRAVIDEZ COMO FACTOR PREDITIVO DE OUTCOMES OBSTÉTRICOS E NEONATAIS ADVERSOSPublication . Teixeira, C.; Dores, J.O reconhecimento da Síndrome Metabólica (SM) durante a gravidez poderá ajudar a identificar um conjunto de mulheres que não só terão um risco aumentado para desenvolver complicações cardiovasculares e metabólicas mais tardiamente na vida, mas também, potencialmente, estarão em risco de desenvolver uma patologia relacionada com a gravidez. A implementação do rastreio da SM, na segunda metade da gravidez, poderá permitir identificar grávidas de alto risco e definir estratégias de intervenção adequadas. Este trabalho teve como objectivos (i) Determinar a prevalência de SM em gestações normais e complicadas; (ii) Avaliar o impacto do diagnóstico de SM na ocorrência de outcomes obstétricos e neonatais adversos.
- Steroid Withdrawal in Simultaneous Pancreas-Kidney Transplantation:Publication . Malheiro, J.; Martins, La Salete; Fonseca, Isabel; Gomes, A.M.; Santos, J.; Dias, L.; Dores, J.; Oliveira, F.; Seca, R.; Almeida, R.; Henriques, A.; Cabrita, A.; Teixeira, M.ABSTRACT Simultaneous pancreas-kidney transplantation (SPK) is the treatment of choice for selected diabetic patients with end-stage renal disease. Maintenance steroid therapy is associated with significant morbidity and mortality among SPK transplant recipients. Steroid withdrawal regimens are becoming more common, albeit with reservations regarding its safety and efficacy. We performed retrospective review of 77 SPK transplant recipients from May 2000 to December 2007. The subjects received induction therapy with thymoglobulin followed by maintenance immunosuppression with tacrolimus and myco- phenolate mofetil. late steroid withdrawal protocol was adopted. The rates of acute rejection, graft and patient survival, and side effects were analyzed. One-year patient, kidney, and pancreas survivals were 93%91%and 86%respectively. Eleven patients experienced acute rejection. Mean follow-up time was 1155.5 776.1 days. Prednisolone withdrawal was carried out between and 12 months posttransplantation in 42 patients (77.8%with at least year follow-up; no case of acute rejection occurred. At present, 72 patients have functioning kidney graft, and 65 patients also have functioning pancreas graft. The mean serum creatinine is 1.12 0.49 mg/dL and the mean HbA1c concentration is 4.5% 0.4%The patients have low prevalence of hypertension, hyperlipidemia, and obesity. Steroid withdrawal was successful and safe in the majority of in-study patients and safe without an increase of immune events. Our patient and graft outcomes are within other international SPK transplant units standards.