Browsing by Author "Reis, M."
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- Dificuldade respiratória neonatal… um caso para Oftalmologia?Publication . Gonçalves, C.; Vaz, A.; Reis, M.Introdução: O dacriocistocelo congénito é uma obstrução rara do canal lacrimo-nasal no recém-nascido, que pode dar sintomatologia precoce. A fisiologia deve-se à obstrução proximal e distal do canal lacrimo-nasal. A apresentação clínica é variada e inclui formações quísticas, infetadas ou não, dificuldade na amamentação ou respiratória. A apresentação clássica é uma massa quística de coloração azulada, abaixo do epicanto interno. O diagnóstico correto implica exames complementares. A intervenção terapêutica está dependente da evolução clínica. O prognóstico é bom e geralmente não tem sequelas futuras. Caso clínico: As autoras apresentam o caso de um recém nascido, internado por dificuldade respiratória de início no segundo dia de vida. Ao exame objetivo tinha sinais de dificuldade respiratória e lesão circinada de aspeto semelhante a hematoma no canto interno do olho esquerdo. Nesta localização houve desenvolvimento posterior de formação quística com sinais inflamatórios, com diagnóstico inicial de dacriocistite. Após realização de tomografia computorizada das órbitas mostrou tratar-se de um dacriocistocelo. Conclusão: A dificuldade respiratória pode mesmo ser um caso oftalmológico.
- 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.
- Urinary ATP may be a dynamic biomarker of detrusor overactivity in women with overactive bladder syndromePublication . Silva-Ramos, M.; Silva, I.; Oliveira, O.; Ferreira, S.; Reis, M.; Oliveira, J.; Correia-de-Sá, P.Background Nowadays, there is a considerable bulk of evidence showing that ATP has a prominent role in the regulation of human urinary bladder function and in the pathophysiology of detrusor overactivity. ATP mediates nonadrenergic-noncholinergic detrusor contractions in overactive bladders. In vitro studies have demonstrated that uroepithelial cells and cholinergic nerves from overactive human bladder samples (OAB) release more ATP than controls. Here, we compared the urinary ATP concentration in samples collected non-invasively from OAB women with detrusor overactivity and age-matched controls. Methods Patients with neurologic diseases, history of malignancy, urinary tract infections or renal impairment (creatinine clearance <70 ml/min) were excluded. All patients completed a 3-day voiding diary, a 24 h urine collection and blood sampling to evaluate creatinine clearance. Urine samples collected during voluntary voids were immediately freeze-preserved for ATP determination by the luciferin-luciferase bioluminescence assay; for comparison purposes, samples were also tested for urinary nerve growth factor (NGF) by ELISA. Results The urinary content of ATP, but not of NGF, normalized to patients’ urine creatinine levels (ATP/Cr) or urinary volume (ATP.Vol) were significantly (P<0.05) higher in OAB women with detrusor overactivity (n = 34) than in healthy controls (n = 30). Significant differences between the two groups were still observed by boosting urinary ATP/Cr content after water intake, but these were not detected for NGF/Cr. In OAB patients, urinary ATP/Cr levels correlated inversely with mean voided volumes determined in a 3-day voiding diary. Conclusion A high area under the receiver operator characteristics (ROC) curve (0.741; 95% CI 0.62–0.86; P<0.001) is consistent with urinary ATP/Cr being a highly sensitive dynamic biomarker for assessing detrusor overactivity in women with OAB syndrome.