Browsing by Author "Reis, E."
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- ABCESSOS PULMONARES: REVISÃO DE 60 CASOSPublication . Magalhães, L.; Valadares, D.; Oliveira, J.; Reis, E.
- 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.
- Multicentric Genome-Wide Association Study for Primary Spontaneous PneumothoraxPublication . Sousa, I.; Abrantes, P.; Francisco, V.; Teixeira, G.; Monteiro, M.; Neves, J.; Norte, A.; Robalo-Cordeiro, C.; Moura-Sá, J.; Reis, E.; Santos, P.; Oliveira, M.; Sousa, S.; Fradinho, M.; Malheiro, F.; Negrão, L.; Feijó, S.; Oliveira, S.Despite elevated incidence and recurrence rates for Primary Spontaneous Pneumothorax (PSP), little is known about its etiology, and the genetics of idiopathic PSP remains unexplored. To identify genetic variants contributing to sporadic PSP risk, we conducted the first PSP genome-wide association study. Two replicate pools of 92 Portuguese PSP cases and of 129 age- and sex-matched controls were allelotyped in triplicate on the Affymetrix Human SNP Array 6.0 arrays. Markers passing quality control were ranked by relative allele score difference between cases and controls (|RASdiff|), by a novel cluster method and by a combined Z-test. 101 single nucleotide polymorphisms (SNPs) were selected using these three approaches for technical validation by individual genotyping in the discovery dataset. 87 out of 94 successfully tested SNPs were nominally associated in the discovery dataset. Replication of the 87 technically validated SNPs was then carried out in an independent replication dataset of 100 Portuguese cases and 425 controls. The intergenic rs4733649 SNP in chromosome 8 (between LINC00824 and LINC00977) was associated with PSP in the discovery (P = 4.07E-03, ORC[95% CI] = 1.88[1.22-2.89]), replication (P = 1.50E-02, ORC[95% CI] = 1.50[1.08-2.09]) and combined datasets (P = 8.61E-05, ORC[95% CI] = 1.65[1.29-2.13]). This study identified for the first time one genetic risk factor for sporadic PSP, but future studies are warranted to further confirm this finding in other populations and uncover its functional role in PSP pathogenesis.
- Recurrent orthodeoxia and patent foramen ovale.Publication . Magalhães, L.; Pinto, R.; Oliveira, J.; Oliveira, F.; Reis, E.Introdução: Foramen ovale patente (FOP) ocorre em até 25% dos adultos saudáveis. Pode favorecer embolização paradoxal, enxaqueca e insuficiência respiratória (IR). Apresenta-se caso de IR e ortodeoxia por shunt direito-esquerdo via FOP sem evidência prévia de aumento da pressão intra-auricular direita. Encerramento do FOP resolveu eficazmente IR. Caso clínico: Homem, 52 anos. Mieloma múltiplo IgA/k diagnosticado um ano antes. Internado por IR hipoxémica grave com ortodeoxia e má resposta à oxigenoterapia, após colocação de cateter venoso central (CVC) na subclávia direita. Referia parestesias e alterações visuais inespecíficas, após manipulações do CVC. Características da IR sugeriam shunt entre circulação pulmonar e sistémica. Sem evidência clínica ou imagiológica de shunt intra-pulmonar. Ecocardiograma transtorácico com contraste: shunt direito- -esquerdo. Ecocardiograma transesofágico: FOP. Cateterismo cardíaco (após resolução espontânea da IR): sem shunt. Uma semana depois recorreu IR grave, que resolveu (bem como queixas neurológicas) com encerramento do FOP. Discussão: IR por shunt intra-cardíaco sem aumento da pressão nas cavidades direitas é de difícil interpretação hemodinâmica. Raros relatos (em adultos) associam esta entidade a anomalias anatómicas, que favorecerão shunt por orientação preferencial do fluxo sanguíneo para o FOP. São exemplos parésia diafragmática direita e ectasia da aorta ascendente, identificadas no doente apresentado. O papel do CVC, colocado imediatamente antes da IR, é especulativo. O completo sucesso terapêutico após encerramento do FOP apoia o diagnóstico. Conclusão: Avaliar correctamente IR (pesquisar ortodeoxia e resposta à oxigenoterapia) permite suspeitar de shunt, que se diagnostica utilizando meios acessíveis, seguros e rentáveis. Shunt intra-cardíaco sem aumento da pressão à direita deve ser considerado porque tem tratamento eficaz. Background: Patent foramen ovale (PFO) occurs in 25% of healthy adults. It can lead to paradoxical embolization, migraine and respiratory failure (RF). The authors present a case of RF and orthodeoxia due to a rightto- left shunt via a PFO without previous elevation of right atrial pressure. Closure of the PFO effectively resolved the RF. Case report: A 52-year-old man, with IgA-k multiple myeloma diagnosed one year before, was admitted for severe hypoxemic RF, with orthodeoxia and poor response to oxygen supplementation, after placement of a central venous catheter (CVC) in the right subclavian vein. The patient reported paresthesia and nonspecific visual changes after manipulation of the CVC. The RF suggested a shunt between the pulmonary and systemic circulations. There was no clinical or radiological evidence of an intrapulmonary shunt. Contrast echocardiography showed a right-to-left shunt and transesophageal echocardiography revealed a PFO. Cardiac catheterization, after spontaneous resolution of the RF, showed no shunt. A week later, severe RF recurred. Complete resolution of respiratory dysfunction and neurological symptoms was seen after PFO closure. Discussion: RF due to an intracardiac shunt without increased right-sided pressure is hemodynamically difficult to interpret. A few reports (in adults) relate this entity to anatomical anomalies, which can lead to a shunt by directing blood flow preferentially to the PFO. Examples include right diaphragmatic paresis and ectasia of the ascending aorta, which were observed in this patient. The role of the CVC, which was placed immediately before the RF, is uncertain. Complete therapeutic success after closure of the PFO supports the diagnosis. Conclusion: Correct evaluation of RF (by investigating orthodeoxia and response to oxygen therapy) enables the suspicion of a shunt, which can be confirmed through simple, safe and cost-effective exams. Intracardiac shunt without increased rightsided pressure should be considered because it can be successfully treatment.
- Spontaneous Pneumothorax: A 5-Year ExperiencePublication . Sousa, C.; Neves, J.; Sa, N.; Gonçalves, F.; Oliveira, J.; Reis, E.BACKGROUND: Spontaneous pneumothorax (SP) is defined by the presence of air in the pleural space without history of trauma. It is classified as secondary if coexisting with underlying pulmonary disease. Its an entity with considerable incidence and treatment particularities which give reason for a reflection on the subject. We present a 5-year casuistry, characterizing the SP epidemiology, clinical presentation, investigation and therapeutic choices. METHODS: Sixty-six patients were included in the study, corresponding to 93 episodes of SP. RESULTS: We have found male predominance and the mean age was 34.5 years old. In 60.6% of cases there was history of tobacco use; 36.4% of cases were classified as secondary; 30.1% of patients with secondary SP and 21.7% with primary SP recurred; 89.2% had an acute presentation. The most frequent initial symptom was chest pain (90.3%) and 81.7% had diminished breath sounds. In 17.3% it was documented a physical strain associated. We did not identify statistically significant association between the SP occurrence and the variation of the atmospheric pressure, on the first day of symptoms. In 12.9% of episodes the initial treatment option was observation. In most of the episodes the lung totally expanded. However, in 29.1% of the episodes surgical treatment was needed. CONCLUSIONS: Our results are similar to the literature. Some clinical records are incomplete, demanding the implementation of rules to improve knowledge about this matter.