Browsing by Author "Ferreira, J."
Now showing 1 - 10 of 31
Results Per Page
Sort Options
- Anti-Ro52 Antibodies and Interstitial Lung Disease in ConnectiveTissue Diseases Excluding SclerodermaPublication . Ferreira, J.; Almeida, I.; Marinho, A.; Cerveira, C.; Vasconcelos, C.The presence of anti-Ro52 antibodies has been reported in a wide variety of autoimmune diseases, particularly in myositis, scleroderma, and autoimmune liver diseases. Clinical significance of anti-Ro52 antibodies remains controversial, and studies are lacking for clarifying the association of anti-Ro52 with interstitial lung disease (ILD) in connective tissue diseases (CTD). Objectives. To determine if anti-Ro52 antibodies are associated with ILD in CTD other than scleroderma. Methods. Singlecenter, retrospective study based on immunoblotting panel analysis and patients clinical records. Results. In our connective tissue disease cohort, 162 patients had immunoblotting panels with anti-Ro52 reactivity analysis, 41 (25,3%) had inclusion criteria. Among the 41 selected sera, 85.4% (n = 35) had anti-Ro52 reactivity. The prevalence of ILD in the positive anti-Ro52 antibodies was 71.4% (n = 25), and 16.7% (n = 1) in the negative anti-Ro52 group (P = 0.018). Overall sensitivity (96.2%), specificity (83.3%), positive (71.4%) and negative (83.3%) predictive values of anti-Ro52 antibodies to determine ILD in CTD is detailed in this study. Conclusion. Ro52 autoantibodies are associated with ILD in CTD excluding scleroderma. We suggest that the presence of anti-Ro52 reactivity in CTD should increase the clinician curiosity for the search of ILD.
- Antineutrophil cytoplasmatic antibody positive systemic vasculitis in a patient treated with propylthiouracilPublication . Silva, S.; Ferreira, J.; Carvalho, S.; Seabra, F.; Marinho, A.
- Are Anti-Ro52 Antibodies Associated with Pulmonary Involvement in Scleroderma?Publication . Ferreira, J.; Almeida, I.; Marinho, A.; Cerveira, C.; Vasconcelos, C.Abstract Introduction: The presence of anti-Ro52 antibodies has been reported in a wide variety of autoimmune diseases, particularly in myositis, scleroderma and autoimmune liver diseases. Clinical significance of anti-Ro52 antibodies remains controversial. Studies are lacking in clarifying the association of anti-Ro52 with pulmonary involvement in scleroderma. Objectives: To determine if anti-Ro52 antibodies are associated with pulmonary involvement (interstitial, indirect pulmonary hypertension, or both) in scleroderma. Methods: Single center, retrospective study based on immunoblotting panel analysis and patients clinical records. Pulmonary manifestations were sub-grouped in: 1) interstitial (alveolitis and/or fibrosis), 2) pulmonary artery systolic pressure (PASP) ≥40 mmHg plus interstitial pulmonary disease, and 3) isolated PASP≥40 mmHg (purely vascular). Results: Our scleroderma cohort included 200 patients, of which 137 had immunoblotting panels with anti-Ro52 reactivity analysis. The search was conducted between January 2010 and July 2011. The frequency of pulmonary manifestations in patients with positive anti-Ro52 antibodies was 67.7% (n=31), and 60% (n=24) in the negative anti-Ro52 group, showing no significant differences between groups (p=0.621). Still no significant differences were found when pulmonary manifestations were evaluated according to the subgroups (p=0.525). Sensitivity, specificity, positive and negative predictive values of anti-Ro52 reactivity for determining pulmonary involvement in scleroderma were low. Conclusion: No association was found between positive anti-Ro52 antibodies and pulmonary involvement in scleroderma.
- Avaliação da prevalência e caracterização da rinossinusite nos cuidados de saúde primários em PortugalPublication . Barros, E.; Silva, A.; Sousa-Vieira, A.; André, C.; Silva, D.; Prata, J.; Ferreira, J.; Santos, M.; Gonçalves, P.; Leiria, E.; Gonçalves, N.; Andrade, S.Objectivos: Determinar a prevalência da rinossinusite (RS) diagnosticada nos Centros de Saúde (CS) portugueses, aferindo formas de apresentação e tratamento desta patologia. Desenho do Estudo: Estudo epidemiológico, transversal. Material e Métodos: Entre Maio/2008 e Junho/2009 avaliou-se uma coorte de utentes que se dirigiram à consulta de clínica geral, nos CS seleccionados. Resultados: Incluíram-se 1.201 utentes, 71% do sexo feminino com idade média de 41,7±13,2 anos. A prevalência global de RS foi de 19,2%, [n=231; 17,1%, 21,5%; IC 95%]. A prevalência de RS aguda foi de 7,4% [n=89; 6,0%, 9,0%; IC 95%] e a de RS crónica de 13,0% [n=156; 11,2%, 15,0%; IC 95%]. Conclusões: A prevalência pontual de RS calculada foi elevada, principalmente a de RS crónica. Metade dos doentes (50%) já tinha efectuado pelo menos um exame complementar de diagnóstico. Verifica-se algum desfasamento entre as orientações para diagnóstico e tratamento da RS e a prática actual nos CS.
- 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.
- Complexo de Von Meyenburg ou Metástases Hepáticas? Caso Clínico e Revisão da LiteraturaPublication . Silveira, I.; Mota, F.; Ferreira, J.; Dias, R.; Leuschner, P.Hepatic lesions represent a common finding in clinical practice. Bile ducts hamartomas, also known as Von Meyenburg complex, are benign hepatic malformations composed of small dilated cystic bile ducts lined by fibrous stroma. They represent a rare and asymptomatic clinic-pathological entity. Imagiological findings are variable, and may present as multiple small scattered lesions, or rarely as a single nodule. These findings may resemble secondary lesions and, although benign, there are cases of progression to colangiocarcinoma. Thus it is important to include this complex in the differential diagnoses of focal hepatic lesions, being necessary a detailed investigation for their differentiation. This case represents an atypical presentation of a rare and not frequently considered entity in clinical practice
- Complicações da cirurgia endoscópica nasossinusal – Revisão de 667 doentes do Centro Hospitalar do PortoPublication . Ribeiro, R.; Reis, C.; Sousa-Castro, S.; Ferreira, J.; Almeida-Sousa, C.Objectivos: Determinar a taxa de complicações da cirurgia endoscópica nasossinusal (CENS) num centro hospitalar com 20 anos de experiência nesta área. Desenho do estudo: Estudo retrospectivo de 667 pacientes submetidos a CENS. Material e Métodos: Foram analisados os dados relativos aos pacientes submetidos a CENS desde Janeiro de 2006 a Dezembro de 2009, e avaliadas as complicações da técnica cirúrgica no per e pós--operatório, com um período mínimo de follow-up de 3 meses. Resultados: Num total de 677 cirurgias, verificou-se uma taxa de 7,39% de complicações (5,91% minor e 1,48% major). As complicações da CENS variaram de acordo com a extensão do procedimento cirúrgico, sendo mais frequentes nos casos de cirurgia de revisão, estando também relacionadas com a presença e grau de polipose nasossinusal. Conclusões: Duas décadas após a afirmação da CENS, esta ainda está associada a complicações. É fundamental um conhecimento anatómico profundo e um planeamento cirúrgico detalhado, baseado na análise imagiológica rigorosa, para que estas sejam reduzidas ao mínimo.
- Descrição, factores, preditores e prognóstico dos derrames parapneumónicosPublication . Ferreira, J.; Maia, J.; Mendonça, C.; Carvalho, D.; Paiva, P.; Correia, J.Resumo Introdução: A infecção pleural é um problema comum na prática clínica. Uma porção significativa das infecções no espaço pleural representa um processo progressivo que leva à transformação de um derrame simples em complicado. A maioria dos autores sugere que a decisão terapêutica depende do estadio de evolução da doença. Objectivos: Descrever e caracterizar os derrames parapneumónicos quanto à forma de apresentação, características, terapêutica instituída e evolução. Métodos: Estudo observacional, retrospectivo e longitudinal com base na análise dos processos clínicos dos doentes com o diagnóstico de derrame parapneumónico, entre Janeiro de 2005 e Junho de 2011. Trinta e quatro casos cumpriram critérios de inclusão. Resultados: A evolução do quadro clínico parece ser independente do tipo de dreno/catéter usado (p=0,608). Os empiemas associam-se com significado estatístico a não resolução inicial do quadro (p=0,024). A presença de derrames loculados aumentou o tempo de internamento médio em aproximadamente 10 dias (p=0,071) e acarretou um prolongamento no tempo médio de antibioterapia de 13 dias (p=0,049). Conclusões: O derrame parapneumónico com significado clínico parece ter baixa incidência, contudo é uma patologia que acarreta prolongamento no tempo de internamento e potenciais complicações. Deve preferir-se a utilização de catéteres de pequeno diâmetro (10-14F). Os parâmetros que pioram significativamente o prognóstico são a presença de empiema ou de derrames loculados.
- Doença de Behçet e linfoma. Associação fortuita?Publication . Ferreira, J.; Gonçalves, F.; Correia, J.; Xavier, L.; Farrajota, P.A doença de Behçet (DB) caracteriza-se, classicamente, por uma tríade sintomática de úlceras orais recorrentes, úlceras genitais e uveíte. A DB é sistémica, com desenvolvimento de lesões vasculíticas ou vasculopáticas nas áreas afectadas. Estas áreas podem apresentar evidência microscópica de infiltração tecidual com células T e neutrófilos. A associação com Linfoma não-Hodgkin tem sido reportada em raros casos, não permitido afirmar relação causal. Reportamos um caso de Linfoma não-Hodgkin em doente com doença de Behçet, com revisão de literatura neste contexto.
- Enlarging Red Blood Cell Distribution Width During Hospitalization Identifies a Very High-Risk Subset of Acutely Decompensated Heart Failure Patients and Adds Valuable Prognostic Information on Top of HemoconcentrationPublication . Ferreira, J.; Girerd, N.; Arrigo, M.; Medeiros, P.; Ricardo, M.; Almeida, T.; Rola, A.; Tolppanen, H.; Laribi, S.; Gayat, E.; Mebazaa, A.; Mueller, C.; Zannad, F.; Rossignol, P.; Aragão, I.Red blood cell distribution width (RDW) may serve as an integrative marker of pathological processes that portend worse prognosis in heart failure (HF). The prognostic value of RDW variation (ΔRDW) during hospitalization for acute heart failure (AHF) has yet to be studied.We retrospectively analyzed 2 independent cohorts: Centro Hospitalar do Porto (derivation cohort) and Lariboisière hospital (validation cohort). In the derivation cohort a total of 170 patients (age 76.2 ± 10.3 years) were included and in the validation cohort 332 patients were included (age 76.4 ± 12.2 years). In the derivation cohort the primary composite outcome of HF admission and/or cardiovascular death occurred in 78 (45.9%) patients during the 180-day follow-up period.Discharge RDW and ΔRDW were both increased when hemoglobin levels were lower; peripheral edema was also associated with increased discharge RDW (all P < 0.05). Discharge RDW value was significantly associated with adverse events: RDW > 15% at discharge was associated with a 2-fold increase in event rate, HR = 1.95 (1.05-3.62), P = 0.04, while a ΔRDW >0 also had a strong association with outcome, HR = 2.47 (1.35-4.51), P = 0.003. The addition of both discharge RDW > 15% and ΔRDW > 0 to hemoconcentration was associated with a significant improvement in the net reclassification index, NRI = 18.3 (4.3-43.7), P = 0.012. Overlapping results were found in the validation cohort.As validated in 2 independent AHF cohorts, an in-hospital RDW enlargement and an elevated RDW at discharge are associated with increased rates of mid-term events. RDW variables improve the risk stratification of these patients on top of well-established prognostic markers.