Browsing by Author "Marques, A."
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- Endocrinology in Portugal - Census 2016. Board of the Portuguese College of Endocrinology and Nutrition of the Portuguese Medical AssociationPublication . Guimarães, J.; Afonso, A.; Carvalho, D.; Marques, A.; Martins, T.; Mascarenhas, M.; Pereira, C.; Rodrigues, D.; Saraiva, C.; Cardoso, H.INTRODUCTION: On September 2016, the Board of the College of Endocrinology and Nutrition of the Portuguese Medical Association carried out a national survey, about all Endocrinology, Diabetes and Metabolism Departments of the public hospitals included in the Portuguese National Health Service and a simplified version of this survey was sent to all endocrinologists working in Portugal and registered with the Portuguese Medical Association. MATERIAL AND METHODS: Data related to organizational and human resources were collected, reporting the situation by the end of year 2015. The census registered 107 individuals and 27 Departments. RESULTS: The ratio of endocrinologists-population was 1.4, much lower than in the other European countries (varies between 2 to 4), resulting in alarming shortages of services in some areas of Portugal and in worse quality indicators. DISCUSSION: These data suggest that actions should be taken to increase the number of endocrinologists and departments in the country. CONCLUSION: In recent years, the number of residents has significantly increased, which will make it possible to correct this situation
- Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and MetabolismPublication . Santos, A.; Vinagre, J.; Soares, P.; Claro, I.; Sanches, A.; Gomes, L.; Fernandes, I.; Catarino, A.; Preto, J.; Pereira, B.; Marques, A.; Rodrigues, F.; Amaral, C.; Rocha, G.; Mellidez, J.; Simões, H.; Lopes, J.; Bugalho, M.Background: The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been increasing in the last five decades, but there is no large-scale data regarding these tumours in Portugal. We conducted a cross-sectional, multicentric study in main Portuguese centers to evaluate the clinical, pathological, and therapeutic profile of GEP-NENs. Methods: From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform. Results: Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading. Conclusion: In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal. Methods: From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform. Results: Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading. Conclusion: In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal.
- HEALTH-STATE UTILITIES IN CHRONIC IMMUNE DISEASES: PILOT STUDYPublication . Ribeiro, C.; Silveira, A.; Marques, A.; Ribeiro, C.; Santos, I.; Vasconcelos, C.HEALTH-STATE UTILITIES IN CHRONIC IMMUNE DISEASES: PILOT STUDY Claúdia Ribeiro1,2,3, Augusta Silveira4,3, Augusta Marques5, Catarina Ribeiro4, Isabel Santos6,2,3, Carlos Vasconcelos2,3 1UCP, 2HSA/CHP, 3ICBAS/UP, 4UFP, 5HPA e 6HSMF. Universidade Católica Portuguesa (UCP), Porto Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto. Universidade Fernando Pessoa (UFP), Porto. Hospital Privado da Arrábida (HPA), Porto. Hospital Santa Maria da Feira (HSMF), Porto. Background Utility scores are used to estimate Quality Adjusted Life Years (QALYs), applied in determining the cost-effectiveness of health care interventions. In studies where no preference based measures are collected, indirect methods have been developed to estimate utilities from clinical instruments. Aim The aim of this study was to evaluate a published method of estimating the Short Form-6D (SF-6D) (preference based) in patients with chronic immune diseases from Unidade de Imunologia Clínica do Hospital de Santo António - Centro Hospitalar do Porto and evaluate the impact of socio demographics economics and clinical characteristics on quality of life (QoL) and potential predictors for QoL improvements. Methods We enrolled 320 patients with chronic immune diseases (104 men and 226 women with a mean age: 45.21; 84 people living with HIV and 236 with chronic autoimmune diseases. All responders to the Portuguese SF-36 version 2.0 questionnaire can be assigned an SF-6D score provided the 11 items used in the SF-6D have been completed using a computerized administration. To assess socioeconomic status, we use the Graffer’s scale, clinical and demographic variables were assessed by a questionnaire specifically designed for the present study. Results The mean utility value was .595. Male, gender, young, single, individuals with high educational attainment level and Graffer’s scale Class high reported higher utility levels. As expected, those who takes therapeutics’ or have a higher length disease reported lower mean utility levels than those who were in a less severe stadium of the disease or without therapeutic. Conclusion This paper provides the first utilities obtained from a populations leave with chronic immune diseases. The preference-based measures used in this study distinguish patient groups with chronic immune diseases’ in terms of socio-demographics characteristics and clinical groups. The normative values can be used economic evaluation and clinical studies as they incorporate patient’s preferences and translate the value attribute to patients´ health state. Apresentador: Cláudia Ribeiro, Médica Dentista. Doutoranda, Faculdade de Medicina da Universidade de Santiago de Compostela.
- Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohortsPublication . Jácome, C.; Pereira, A.; Almeida, R.; Ferreira-Magalhães, Manuel; Couto, M.; Araujo, L.; Pereira, M.; Correia, M.; Loureiro, C.; Catarata, M.; Maia Santos, L.; Pereira, J.; Ramos, B.; Lopes, C.; Mendes, A.; Cidrais Rodrigues, J.; Oliveira, G.; Aguiar, A.; Afonso, I.; Carvalho, J.; Arrobas, A.; Coutinho Costa, J.; Dias, J.; Todo Bom, A.; Azevedo, J.; Ribeiro, C.; Alves, M.; Leiria Pinto, P.; Neuparth, N.; Palhinha, A.; Gaspar Marques, J.; Pinto, N.; Martins, P.; Todo Bom, F.; Alvarenga Santos, M.; Gomes Costa, A.; Silva Neto, A.; Santalha, M.; Lozoya, C.; Santos, N.; Silva, D.; Vasconcelos, M.; Taborda-Barata, L.; Carvalhal, C.; Teixeira, M.; Alves, R.; Moreira, A.; Sofia Pinto, C.; Morais Silva, P.; Alves, C.; Câmara, R.; Coelho, D.; Bordalo, D.; Fernandes, R.; Ferreira, R.; Menezes, F.; Gomes, R.; Calix, M.; Marques, A.; Cardoso, J.; Emiliano, M.; Gerardo, R.; Nunes, C.; Câmara, R.; Ferreira, J.; Carvalho, A.; Freitas, P.; Correia, R.; Fonseca, J.Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). Conclusion: Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
- Síndroma de Churg-Strauss na criançaPublication . Nordeste, A.; Marques, A.; Robalo, C.; Estanqueiro, P.; Salgado, M.A síndroma de Churg-Strauss é uma vasculite sistémica de etiologia desconhecida extremamente rara em crianças. Caracteriza-se pela presença de pelo menos quatro dos seguintes critérios: asma, eosinofilia (superior a 10% do diferencial de leucócitos), mononeuropatia ou polineuropatia, infiltrados pulmonares, anomalias dos seios perinasais e eosinófilos extra-vasculares na biópsia. Descreve-se o caso de uma menina de 11 anos com síndrome febril prolongado, astenia, anorexia, emagrecimento, dor abdominal, poliartrite, polineuropatia e exantema violáceo. Tinha antecedentes de asma, infiltrados pulmonares, sinusite e pólipos nasais. A investigação revelou reagentes de fase aguda muito aumentados, eosinofilia (19%) e anticorpos anticitoplasma de neutrófilos com padrão perinuclear e especificidade antimieloperoxidase (pANCA-MPO) positivos. Foi medicada inicialmente com prednisolona e aos três anos e meio de evolução foi associada azatioprina, com boa resposta. Pretende-se lembrar esta patologia, que apesar de rara, pode ocorrer na população pediátrica, devendo ser considerada quando asma e eosinofilia se associam a vasculite sistémica. ABSTRACT Churg-Strauss syndrome is a systemic vasculitis of unknown etiology extremely rare in children. This disorder is characterized by the presence of at least four of these criteria: asthma, eosinophilia >10%, mononeuropathy or polyneuropathy, pulmonary infiltrates, paranasal sinus abnormality and extravascular eosinophils. We describe a 11-year-old girl who presented with prolonged fever, asteny, anorexia, weight loss, abdominal pain, polyarthritis, polyneuropathy and a bluish- purple exanthem. She had a history of asthma, pulmonary infiltrates, sinusitis and nasal polyps. The laboratory studies showed elevated acute phase reactants, eosinophilia (19%) and perinuclear-ANCA with MPO-ANCA. She was initially treated with prednisolone and in combination with azathioprine three years and half after diagnosis, with good response. We report this case to remind this serious uncommon disease, that may affect the pediatric population and must be considered when asthma, eosinophilia and systemic vasculitis are present.