Browsing by Author "Pereira, C."
Now showing 1 - 10 of 15
Results Per Page
Sort Options
- Acute ischemic stroke secondary to glioblastoma. A case reportPublication . Pina, S.; Carneiro, A.; Rodrigues, T.; Samões, R.; Taipa, R.; Melo-Pires, M.; Pereira, C.Glioblastoma is a malignant infiltrative glial tumor occurring most often over 50 years of age, with diverse clinical presentations. We describe a case of temporal lobe glioblastoma with a rare presentation as an acute ischemic stroke, discussing the imaging and histopathological findings, and reviewing the literature. A 77-year-old woman had sudden onset of left hemiparesis and hemihypoesthesia. The neuroradiological studies revealed an acute ischemic lesion in the right lenticulostriate arteries territory and a right anterior temporal lobe tumor, enhancing heterogeneously after contrast with enhancement of the right middle cerebral artery wall. Histopathological analysis of the resected temporal lesion revealed a glioblastoma multiforme with tumoral infiltration of the vascular wall. Glioblastoma should be considered in the etiology of acute ischemic stroke, where neuroimaging plays an important diagnostic role, enabling a more immediate therapeutic approach, with a consequent impact on survival.
- Custos do tratamento da doença arterial obstrutiva infra-poplítea (DAOIP) – análise de uma amostra aleatóriaPublication . Loureiro, L.; Machado, R.; Teixeira, S.; Pereira, C.; Vaz, C.; Loureiro, T.; Silveira, D.; Rego, D.; Ferreira, V.; Gonçalves, J.; Almeida, R.
- Dissecção da artéria vertebral em adolescente orientação diagnóstica e terapêuticaPublication . Carvalho, S.; Lopes, G.; Rios, J.; Pereira, C.; Figueiroa, S.; Temudo, T.O AVC em idade pediátrica é uma situação pouco frequente, representando a dissecção arterial uma pequena percentagem da sua etiologia. Os autores apresentam o caso de um adolescente com AVC isquémico provocado por dissecção da artéria vertebral. A sintomatologia incluiu cefaleias acompanhadas de náuseas e vómitos, tonturas, alteração do estado de consciência, discurso lentificado e flexão cervical intermitente. Após o diagnóstico iniciou terapêutica anticoagulante com melhoria da sintomatologia, mas manteve dificuldade em despertar e dificuldade de evocação. São discutidas a investigação e o tratamento nesta patologia. ABSTRACT Cerebrovascular disease in paediatric age is infrequent and arterial dissection is responsible for a small percentage of its aetiology. The authors present an adolescent with a cerebrovascular ischemic event caused by vertebral artery dissection. The symptoms included headache with nausea and vomiting, dizziness, conscience impairment, slowed speech and intermittent cervical flexion. After the diagnosis, he began anticoagulant therapy with symptom improvement, but maintenance of difficulty in arousal and in evocation. Investigation and treatment in this pathology are discussed.
- 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.
- 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
- Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?Publication . Machado, R.; Teixeira, G.; Oliveira, P.; Loureiro, L.; Pereira, C.; Almeida, R.Introduction: Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender. Methods: A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B). Results: Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates. Conclusion: Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes.
- Epigenome-wide DNA methylation profiling of periprostatic adipose tissue in prostate cancer patients with excess adiposity-a pilot studyPublication . Cheng, Y.; Monteiro, C.; Matos, A.; You, J.; Fraga, A.; Pereira, C.; Catalán, V.; Rodríguez, A.; Gómez-Ambrosi, J.; Frühbeck, G.; Ribeiro, R.; Hu, P.Background: Periprostatic adipose tissue (PPAT) has been recognized to associate with prostate cancer (PCa) aggressiveness and progression. Here, we sought to investigate whether excess adiposity modulates the methylome of PPAT in PCa patients. DNA methylation profiling was performed in PPAT from obese/overweight (OB/OW, BMI > 25 kg m-2) and normal weight (NW, BMI < 25 kg m-2) PCa patients. Significant differences in methylated CpGs between OB/OW and NW groups were inferred by statistical modeling. Results: Five thousand five hundred twenty-six differentially methylated CpGs were identified between OB/OW and NW PCa patients with 90.2% hypermethylated. Four hundred eighty-three of these CpGs were found to be located at both promoters and CpG islands, whereas the representing 412 genes were found to be involved in pluripotency of stem cells, fatty acid metabolism, and many other biological processes; 14 of these genes, particularly FADS1, MOGAT1, and PCYT2, with promoter hypermethylation presented with significantly decreased gene expression in matched samples. Additionally, 38 genes were correlated with antigen processing and presentation of endogenous antigen via MHC class I, which might result in fatty acid accumulation in PPAT and tumor immune evasion. Conclusions: Results showed that the whole epigenome methylation profiles of PPAT were significantly different in OB/OW compared to normal weight PCa patients. The epigenetic variation associated with excess adiposity likely resulted in altered lipid metabolism and immune dysregulation, contributing towards unfavorable PCa microenvironment, thus warranting further validation studies in larger samples.
- Influence of Genetic Polymorphisms in Prostaglandin E2 Pathway (COX-2/HPGD/SLCO2A1/ABCC4) on the Risk for Colorectal Adenoma Development and Recurrence after PolypectomyPublication . Pereira, C.; Queirós, S.; Galaghar, A.; Sousa, H.; Marcos-Pinto, R.; Pimentel-Nunes, P.; Brandão, C.; Medeiros, R.; Dinis-Ribeiro, M.OBJECTIVES: Deregulation of prostaglandin E2 (PGE2) levels reported in colorectal carcinogenesis contributes to key steps of cancer development. Our aim was to evaluate the influence of the genetic variability in COX-2/HPGD/SLCO2A1/ABCC4 PGE2 pathway genes on the development and recurrence of colorectal adenomas. METHODS: A case-control study was conducted gathering 480 unscreened individuals and 195 patients with personal history of adenomas. A total of 43 tagSNPs were characterized using the Sequenom platform or real-time PCR. RESULTS: Ten tagSNPs were identified as susceptibility biomarkers for the development of adenomas. The top three most meaningful tagSNPs include the rs689466 in COX-2 (odds ratio (OR)=3.23; 95% confidence interval (CI): 1.52-6.86), rs6439448 in SLCO2A1 (OR=0.38; 95% CI: 0.22-0.65) and rs1751051 in ABCC4 genes (OR=2.75; 95% CI: 1.58-4.80). The best four-locus gene-gene interaction model included the rs1346271, rs1863642 and rs12500316 single nucleotide polymorphisms in HPGD and rs1678405 in ABCC4 genes and was associated with a 13-fold increased susceptibility (95% CI: 3.84-46.3, P<0.0001, cross-validation (CV) accuracy: 0.78 and CV consistency: 8/10). Interesting, in low-risk patients the ABCC4 rs9524821AA genotype was associated not only with a higher hazard ratio (HR=2.93; 95% CI: 1.07-8.03), but half of these patients had adenoma recurrence at 60 months, considerably higher than the 21% noticed in low-risk patients. CONCLUSIONS: Genetic polymorphisms in COX-2/PGE2 pathway appear to contribute to the development of colorectal adenomas and influence the interval time to adenomas recurrence. The definition of risk models through the inclusion of genetic biomarkers might improve the adherence and optimization of current screening and surveillance guidelines for colorectal cancer prevention.
- Institutional Impact of EVAR's Incorporation in the Treatment of Abdominal Aortic Aneurysm: a 12 Years' Experience AnalysisPublication . Machado, R.; Antunes, I.; Oliveira, P.; Pereira, C.; Almeida, R.Introduction: Endovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR). Objective: To analyze EVAR's incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution. Methods: A retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeon's experience, considering patient clinical risk and aneurysm's anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patient's and aneurysm's characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated. Results: The mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair. Conclusions: Two different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVAR's incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.
- Investigação Bioquímica e Molecular na Morte Súbita do Lactente (SIDS)Publication . Cardoso, M.; Pinheiro, J.; Pereira, C.; Sousa, C.; Nogueira, C.; Tesa, A.; Ramos, A.; Balreira, A.; Lima, C.; Valongo, C.; Couto, D.; Quelhas, D.; Fonseca, H.; Rocha, H.; Almeida, L.; Rodrigues, R.; Santos, R.; Santorelli, F.; Vilarinho, L.RESUMO SIDS (Sudden Infant Death Syndrome) é a designação utilizada para definir a morte súbita do lactente, que permanece inexplicada após uma cuidadosa investigação do caso, a qual incluí a realização de autópsia, o exame do local da morte e a análise da história clínica. Devido à rápida deterioração que provocam, as doenças metabólicas constituem potenciais causas de morte súbita, quer pelas crises que ocasionam com intoxicação e comprometimento da sobrevivência do indivíduo, quer por provocarem alterações que aumentam o risco de falência de determinados orgãos. Objectivos: Com este trabalho pretendemos avaliar o contributo relativo das doenças metabólicas e dos défices energéticos nas situações de morte súbita e inexplicada do lactente, na população portuguesa. Pacientes e Métodos: Foram disponibilizadas para investigação amostras biológicas congeladas de 51 lactentes cuja causa de morte era desconhecida. Os produtos foram colhidos durante a autópsia e incluíram: soro, urina, humor vítreo, músculo e fígado. Nos fluídos biológicos fez-se o estudo dos aminoácidos e dos ácidos orgânicos e nos tecidos sólidos o doseamento da actividade dos vários complexos da cadeia respiratória mitocondrial e do teor em glicogénio. Foi ainda efectuada a extracção de DNA total a partir dos tecidos sólidos acima referidos o qual foi utilizado para estudos moleculares. Resultados: Foi possível identificar através dos estudos moleculares um caso de intolerância hereditária à frutose - HFI (homozigotia para a mutação A149P no gene ALDOB). Nos estudos bioquímicos foi encontrado um caso positivo de very long-chain acyl-CoA dehydrogenase - VLCAD e na maioria das determinações efectuadas, desvios em relação aos controlos normais inerentes ao catabolismo e aos processos de cadaverização, sendo de salientar: valores muito elevados dos aminoácidos séricos e a presença sistemática de grande quantidade de ácido láctico na urina. Conclusões: Nas doenças metabólicas o risco de recorrência existe e a identificação de um caso classificado como SIDS, como sendo na realidade um erro inato do metabolismo, é importante para a família, quer em termos de instituição de tratamento adequado e adopção de medidas preventivas, quer em termos de aconselhamento genético. ABSTRACT SIDS (Sudden Infant Death Syndrome) is the sudden and unexpected death including performance of a complete autopsy, examination of death scene, and review of clinical history. Metabolic disorders can lead to sudden dead because they cause crises of intoxication and life threatening, with dysfunction of several organs, that raise the risk of general failure. Objectives: Our main objective with this study, was to evaluate the significance of metabolic disorders and energy deficiencies in sudden infant death syndrome, in Portuguese population. Patients and Methods: We got biological frozen samples from 51 children whose cause of dead was unknown. The products were collected during autopsy and included: serum, urine, humour vitreous, muscle and liver. In the biological fluids samples we analysed amino acids as well as organic acids, and in referred tissues we determinate the activity of the respiratory chain complexes and the amount of glycogen. It was also possible to get total DNA from solid tissues which was used for molecular studies. Results: Based on molecular findings, it was possible to identify one case of fructose intolerance - HFI (patient homozygous for A149P in ALDOB gene). Biochemical studies revealed one case of very long-chain acyl-CoA dehydrogenase - VLCAD deficiency. However, in the majority of the assays performed deviations from normal controls were found, due to catabolism post-morten (plasmatic increase of amino acids and high excretion of lactic acid in urine). Conclusions: In metabolic disorders the risk of recurrence exists. The misdiagnosed inherited errors of metabolism as SIDS, it is important for the family, in terms of treatment, prevention attitude and genetic counselling. of an infant which remains unexplained