Browsing by Author "Nery, F."
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- Efficacy and Safety of Direct-Acting Oral Anticoagulants Use in Acute Portal Vein Thrombosis Unrelated to CirrhosisPublication . Nery, F.; Valadares, D.; Morais, S.; Teixeira-Gomes, M.; De Gottardi, A.In acute portal vein thrombosis (APVT) unrelated to cirrhosis, anticoagulant therapy is classically started with low molecular weight heparin or vitamin K antagonists. New direct-acting oral anticoagulants (DOACs) are used in the treatment of venous thrombosis outside the splanchnic vascular bed, but not in the latter. We report a young female with APVT occurring in a non-cirrhotic liver linked to heterozygosity of factor V-Leiden and prothrombin G20210A gene mutations. Rivaroxaban was started, with total recanalization of the left and partial recanalization of the right portal vein branches, without complications. New DOACs do not need daily subcutaneous injections nor routinely blood coagulation control tests, making its use attractive, eventually increasing patient's compliance. If proved to be safe and effective in the future studies, its use may be extended to PVT treatment. This case shows that rivaroxaban was safe, not only prevented the extension of thrombosis in the portal tract, but also resolved PVT, at least partially.
- From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected PatientsPublication . Nery, F.; França, M.; Almeida, I.; Vasconcelos, c.Background Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural history of PML infection in a population of HIV patients. Methods We retrospectively reviewed, from 1992 to 2009, PML cases in a population of 724 HIV infected patients followed in our institution. Clinical, biological, imagery features and outcomes were characterized. Results Twenty-five (3.45%) patients were identified as having PML. The mean time between HIV and PML diagnosis was 20.4 months. PML was the presentation of HIV infection in 40% of the patients, and 92% had CD4 T cell count lower than 200/mm3. Paresis was the most common clinical presentation. No specific characteristics were found in cerebrospinal fluid and JCV DNA was positive in 3 of 7 patients. MRI revealed characteristic findings. Combined antiretroviral therapy was started or changed in 96% of the patients. Neurological condition got worse in 12 patients. From the 14 deaths, 5 were directly attributed to PML progression. Follow-up was lost in 8 patients. Conclusions PML was the presentation of HIV infection in more than 1/3 of patients, frequently associated with advanced immunocompromise. MRI sensitivity to PML is high, and JCV DNA determination in CSF was not revealed to be sensible. PML diagnosis should be taken into account in HIV patients presenting any neurological symptoms, and HIV infection should be suspected when radiological findings suggest PML lesions even in previously healthy individuals.
- Tratamento com inibidores do tnf-alfa em doentes com infecção prévia por vírus da hepatite b – estarão estes doentes em risco de reactivar a doença?Publication . Torres, T.; Nery, F.; Selores, M.Estima-se que cerca de 2 mil milhões de pessoas estejam infectados pelo vírus da hepatite B (VHB) e que mais de 350 milhões sejam portadores crónicos. Os doentes que apresentam anticorpos para o antigénio core (Ac anti-HBc) com negatividade para antigénio de superfície (AgHBs), não têm hepatite crónica, mas contactaram com o vírus no passado. Este estado serológico corresponde, na maioria das vezes, a uma eliminação vírica completa. Contudo, um subgrupo de doentes poderá apresentar ADN-VHB hepático detectável, definindo um estado de por- tador oculto. A reactivação do VHB é uma complicação descrita desde há vários anos em doentes submetidos a transplantes de medula óssea e quimioterapia para tratamento de neoplasias. Esta reactivação ocorre principalmente em doentes com hepatite B crónica (AgHBs+), mas foi igualmente descrita em doentes previamente infectados pelo VHB, que aparentemente teriam eliminado o vírus. Este risco de reactivação da replicação do VHB em doentes com hepatite B crónica (AgHBs+) submetidos a terapêutica anti-TNF-α está igualmente bem estabelecido, contudo, a informa- ção relativamente ao uso destes fármacos em doentes Ac anti-HBc+/AgHBS- é muito mais escassa. Recentemente, identificou-se uma taxa de reactivação do VHB em doentes Ac anti-HBc+/AgHBs- tratados com agentes anti-TNF-α de 5%, demonstrando que, apesar de baixo, este risco é real. Desde o final de 2010 que todos os doentes do Serviço de Dermatologia do Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA) que iniciam terapêutica biológica para o tratamento de psoríase/artrite psoriática e que apresentam positividade para o Ac anti-HBc são também observados em consulta de Medicina Interna/Hepatologia do CHP-HSA no sentido de estabelecer da existência de doença hepática crónica, e de verificar se existe indicação para o início de terapêutica profilática anti-viral. Com este artigo, os autores pretendem alertar para a necessidade de rastreio obrigatório do VHB em todos os do- entes que vão iniciar terapêutica biológica com inibidores TNF-α, situação relativamente consensual na comunidade científica, mas especialmente para a necessidade de vigilância e monitorização apertada dos doentes com potencial infecção oculta pelo VHB, pelo risco possível de reactivação do mesmo.