Browsing by Author "Rodrigues, P."
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- Astigmatism management in cataract surgery with Precizon(®) toric intraocular lens: a prospective studyPublication . Vale, C.; Menezes, C.; Firmino-Machado, J.; Rodrigues, P.; Lume, M.; Tenedório, P.; Menéres, P.; Brochado, M.PURPOSE: The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon(®) toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. SETTING: Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. DESIGN: This was a prospective clinical study. PATIENTS AND METHODS: A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon(®) toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster(®)). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month's evaluations. RESULTS: The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from -3.35±3.10 D to -0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. CONCLUSION: Precizon(®) toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery.
- AVALIAÇÃO DOS SISTEMAS DE VIGILÂNCIA EPIDEMIOLÓGICA CENTRADA NO LABORATÓRIO - ANÁLISE DOS ÚLTIMOS QUATRO ANOSPublication . Aires, E.; Fernandes, A.; Rodrigues, P.; Santos, C.; Calado, E.; Aragão, I.; Marques, L.; Palma, L.; Lopes, L.; Polónia, J.; Oliveira, J.; Vasconcelos, C.AVALIAÇÃO DOS SISTEMAS DE VIGILÂNCIA EPIDEMIOLÓGICA CENTRADA NO LABORATÓRIO - ANÁLISE DOS ÚLTIMOS QUATRO ANOS Ernestina Aires1, Alexandra Fernandes1, Paula Rodrigues1, Cláudia Santos1,2, Elsa Calado1,2, Irene Aragão1, 3, Laura Marques1, 4, Lígia Palma1, 5, Luísa Lopes1, 5, José Polónia1, 6, Júlio Oliveira1, 7, Carlos Vasconcelos1, 8 1Comissão de Controlo da Infecção (CCI), HSA/CHP; 2Serviço de Microbiologia, HSA/CHP; 3Unidade de Cuidados Intensivos Polivalentes (UCIP), HSA/CHP;4Serviço de Pediatria Médica, HMP/CHP; 5Serviço de Neonatologia, MJD/CHP; 6 Serviço de Cirurgia/Unidade 2, HSA/CHP; 7 Serviço de Medicina A, HSA/CHP; 8Serviço de Imunologia Clinica, HSA/CHP Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Hospital Maria Pia, Centro Hospitalar do Porto (HMP/CHP), Porto. Maternidade Júlio Dinis, Centro Hospitalar do Porto (MJD/CHP), Porto. Introdução A vigilância epidemiológica é a monitorização de todos os aspectos da ocorrência e da propagação da doença que são pertinentes para o seu controlo efectivo. Implica colheita contínua, análise e interpretação dos dados, bem como a divulgação dos mesmos. Os objectivos da VE passam pelo reconhecimento atempado de surtos infecciosos, identificação de doentes infectados/colonizados, implementação de medidas de controlo de infecção adequadas a cada situação, avaliação da eficiência das medidas preventivas e produção de relatórios de acção pela comissão de controlo de infecção. Objectivos O objectivo deste estudo é analisar a incidência de infecção no Hospital Geral de Santo António (HSA), baseado num programa de VE com a finalidade de conhecer a incidência da infecção e promover a utilização dos dados locais na implementação de medidas de controlo de infecção. Material e Métodos Análise dos dados fornecidos pelo laboratório de microbiologia, através da aplicação informática “Vigi@ct”, que disponibiliza à Comissão de Controlo de Infecção os resultados microbiológicos dos produtos biológicos colhidos aos doentes internados no HSA, no período de 2007 a 2010. Resultados As infecções hospitalares têm decrescido. Verifica-se uma diminuição de 5,9 em 2007 para 4,9 infecções por 1000 dias de internamento em 2010. As Infecções do Trato Urinário são as mais frequentes, seguindo-se as Respiratórias. As Infecções da Corrente Sanguínea ocupam o terceiro lugar da tabela e a Infecção do Local Cirúrgico a quarta posição. Os serviços clínicos são envolvidos para discussão dos casos e decisão das medidas de controlo aplicáveis. É uma articulação dinâmica entre os profissionais dos serviços e a CCI, que permite obter resultados positivos no combate à Infecção Nosocomial, e consequente diminuição da incidência das Infecções Associadas aos Cuidados de Saúde. Discussão e Conclusões Os factores que influenciam o desenvolvimento de infecção nosocomial são geralmente a patogenicidade do microrganismo, os factores ambientais, a susceptibilidade do doente e a resistência bacteriana. Globalmente verifica-se que os internamentos têm aumentado, mantendo-se a demora média em cerca de 6 dias. O número de infecções tem reduzido progressivamente. Os microrganismos mais frequentemente identificados foram a Escherichia coli (988 isolados) e a Pseudomonas aeruginosa (778 isolados), seguidas do MRSA com 555 casos isolados. A avaliação dos sistemas de vigilância epidemiológica visa promover a melhor utilização dos recursos do sistema de saúde. Proporciona dados úteis relativamente às tendências das infecções e à eficácia das medidas de controlo de infecção recomendadas pela CCI e implementadas pelos profissionais de saúde. Apresentador: Ernestina Aires, Enfermeira, Comissão de Controlo da Infecção, HSA/CHP; Aluna de Mestrado em Infecções Associadas aos Cuidados de Saúde ECS/UCP.
- Clinical Usefulness of Streptococcus pneumoniae Urinary Antigen in Patients Hospitalized with Non-Nosocomial PneumoniaPublication . Ferreira, J.; Abreu, M.; Rodrigues, P.; Maia, J.; Leuschner, P.; Correia, J.Introduction : Community acquired pneumonia (CAP) is a major cause of hospital admissions and mortality in developed countries. Nevertheless, in about half of the cases a microbial etiology can`t be determined. The need to improve the diagnostic tools of this disease has led to the development of new techniques, such as Streptococcus pneumoniae urinary antigen. Objectives : To analyse the usefulness of the urinary antigen in determining the etiologic diagnosis of pneumonias and its influence in the antibiotherapy modification. Methods : Retrospective analysis of hospitalized patients in 2010 with CAP (n=226) and healthcare associated pneumonia (HCAP) [n=64] diagnosis whose urinary pneumococcal antigen has been analyzed. Results: Median age was significantly greater in HCAP. HCAP patients had more co-morbidities and higher severity scores. Twenty-one patients in the CAP group and 4 patients in the HCAP group had positive pneumococcal antigen. The sensibility of urinary antigen in determining pneumococcal pneumonias was 36% and the specificity 89%. Almost one quarter of the 25 patients with positive urinary antigen had appropriate reductions in antimicrobial spectra, which was not statistically significant when compared with the group with negative urinary antigen. There was a significant relation between a positive urinary antigen and pneumonia severity. Conclusions: Considering its high specificity, the urinary antigen is useful to confirm the presence of pneumococcal pneumonia. Potentially urinary antigen can help to avoid unnecessary treatments in hospitalized patients with CAP.
- Co-selection of the H63D mutation and the HLA-A29 allele: a new paradigm of linkage disequilibrium?Publication . Cardoso, C.; Alves, H.; Mascaranhas, M.; Gonçalves, R.; Oliveira, P.; Rodrigues, P.; Cruz, E.; Sousa, M.; Porto, G.The major histocompatibility complex (MHC) shows a remarkable conservation of particular HLA antigens and haplotypes in linkage disequilibrium in most human populations, suggesting the existence of a convergent evolution. A recent example of such conservation is the association of particular HLA haplotypes with the HFE mutations. With the objective of exploring the significance of that association, the present paper offers an analysis of the linkage disequilibrium between HLA alleles or haplotypes and the HFE mutations in a Portuguese population. Allele and haplotype associations between HLA and HFE mutations were first reviewed in a population of 43 hemochromatosis families. The results confirmed the linkage disequilibrium of the HLA haplotype HLA-A3-B7 and the HLA-A29 allele, respectively, with the HFE mutations C282Y and H63D. In order to extend the study of the linkage disequilibrium between H63D and the HLA-A29-containing haplotypes in a normal, random population, an additional sample of 398 haplotypes was analyzed. The results reveal significant linkage disequilibrium between the H63D mutation and all HLA-A29-containing haplotypes, favoring the hypothesis of a co-selection of H63D and the HLA-A29 allele itself. An insight into the biological significance of this association is given by the finding of significantly higher CD8+ T-lymphocyte counts in subjects simultaneously carrying the H63D mutation and the HLA-A29 allele.
- A good excuse for skipping the test: electrical storm in a teenagerPublication . Rodrigues, P.; Pinheiro-Vieira, A.; Loureiro, M.; Álvares, S.; Anjo, D.; Roque, C.; Sousa, M.; Torres, S.We describe the case of a teenager with a structurally normal heart that presented with torsades de pointes and cardiac arrest. He had a history of epilepsy in childhood, mild cognitive impairment and cognitive visual dysfunction. The baseline electrocardiogram had prominent J waves and a marked early repolarization pattern in all the leads, with normal QT interval. We discuss the differential diagnosis for this interesting case, as well as the patient's management.
- Investigating a Case of Recurrent Pleural EffusionPublication . Rodrigues, P.; Neves, M.; Ferreira, J.; Abreu, M.; Almeida, F.We describe the case of a patient with long-standing Parkinson’s disease and recurrent bilateral pleural effusions. The pleural fluid was an exudate, rich in normal lymphocytes, and the echocardiogram, chest computerized axial tomography, and immunological, microbiological and cytological studies were negative. The patient had been taking bromocriptine, which can be related to chronic pleural effusions. Using Pubmed, we found about 40 cases of pleuropulmonary changes or constrictive pericarditis that were related to bromocriptine. We decided to suspend this drug, with resolution of the pleural effusion and respiratory complaints for more than a year now. We discuss possible underlining mechanisms for this and emphasize the importance of collecting the past medical history and medication and of considering possible iatrogenic effects.
- Left-sided infective endocarditis: analysis of in-hospital and medium-term outcome and predictors of mortalityPublication . Ferreira, J.; Gomes, F.; Rodrigues, P.; Araújo Abreu, M.; Maia, J.; Bettencourt, P.; Luz, A.; Torres, S.; Araújo Correia, J.Abstract Introduction: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a challenging and potentially lethal disease. The prognosis of IE remains poor; in the last 30 years, its incidence and mortality have only been marginally reduced. Early identification of high-risk patients can change the course of the disease and improve outcomes. Objectives and methods: To describe and investigate predictors of mortality during hospital stay and in the six months after discharge in a cohort of left-sided IE patients in two tertiary centers. All patients diagnosed with IE (ICD9 code 133) were registered in a uniform database. Results: One hundred and forty-seven consecutive case patients with left-sided IE were included in this study. Thirty-five patients (23.8%) died during hospital stay. The variables significantly associated with increased mortality in univariate analysis were Charlson index ≥5, use of immunosuppressants, sepsis (severe sepsis and/or septic shock), cardiogenic shock and inappropriate use of antibiotic therapy. Conversely, surgical therapy and hospital length of stay ≥30 days were significantly associated with lower mortality. In multivariate analysis the most important predictors of in-hospital mortality were sepsis (severe and/or shock), use of immunosuppressants and inappropriate use of antibiotic therapy. There was a significant relation between the use of immunosuppressants and the occurrence of sepsis. The presence of significant valve disease after IE significantly increased the risk of heart failure. Conclusions: Our results may help to identify IE patients at increased risk for in-hospital mortality and medium-term disability. These findings can help to identify candidates for earlier and more aggressive management.
- Predisposition, Insult/Infection, Response and Organ Dysfunction (PIRO): A Pilot Clinical Staging System for Hospital Mortality in Patients with InfectionPublication . Cardoso, T.; Teixeira-Pinto, A.; Rodrigues, P.; Aragão, I.; Costa-Pereira, A.; Sarmento, A.Purpose To develop a clinical staging system based on the PIRO concept (Predisposition, Infection, Response and Organ dysfunction) for hospitalized patients with infection. Methods One year prospective cohort study of all hospitalized patients with infection (n = 1035), admitted into a large tertiary care, university hospital. Variables associated with hospital mortality were selected using logistic regressions. Based on the regression coefficients, a score for each PIRO component was developed and a classification tree was used to stratify patients into four stages of increased risk of hospital mortality. The final clinical staging system was then validated using an independent cohort (n = 186). Results Factors significantly associated with hospital mortality were • for Predisposition: age, sex, previous antibiotic therapy, chronic hepatic disease, chronic hematologic disease, cancer, atherosclerosis and a Karnofsky index<70; • for Insult/Infection: type of infection • for Response: abnormal temperature, tachypnea, hyperglycemia and severity of infection and • for Organ dysfunction: hypotension and SOFA score≥1. The area under the ROC curve (CI95%) for the combined PIRO model as a predictor for mortality was 0.85 (0.82–0.88). Based on the scores for each of the PIRO components and on the cut-offs estimated from the classification tree, patients were stratified into four stages of increased mortality rates: stage I: ≤5%, stage II: 6–20%, stage III: 21–50% and stage IV: >50%. Finally, this new clinical staging system was studied in a validation cohort, which provided similar results (0%, 9%, 31% and 67%, in each stage, respectively). Conclusions Based on the PIRO concept, a new clinical staging system was developed for hospitalized patients with infection, allowing stratification into four stages of increased mortality, using the different scores obtained in Predisposition, Response, Infection and Organ dysfunction. The proposed system will likely help to define inclusion criteria in clinical trials as well as tailoring individual management plans for patients with infection
- Stability of blood gases when refrigeratedPublication . Ferreira, J.; Silva, S.; Rodrigues, P.; Abreu, M.; Maia, J.; Carvalho, D.; Carvalho, L.Background: Blood gas analysis is a widely used procedure. In clinical practice, the physicians may not always have a blood gas analyzer in their proximity. Not infrequently, blood gas samples are stored in a fridge or on ice and read retrospectively. Continued anaerobic and aerobic metabolism in the blood may alter blood gases in the interval between drawing arterial blood and its analysis, which may cause a fall in the PaO2 and pH and a rise in the PaCO2. Methods: Two sets of arterial blood samples were obtained from hospitalized patients. After the initial analysis, one sample from each patient was put in raw ice within a specimen bag (0 to +1 oC) and the other in the fridge (+4 to +8 oC). These samples were submitted to serial analysis at 30 minutes, 1 hour and 2 hours after the initial analysis. Results: Two hundred arterial blood gas results from 25 patients were analysed. The mean values of PaO2, PaCO2, HCO3-, Na+, K+, Ca2+ and lactate at 0 minutes, 30 minutes, 1 hour and 2 hours were not signifi cantly different between the two alternatives of storage. However, within each group, signifi cant changes were found over time for PaO2, K+, Na+, Ca2+ and lactate. Conclusions: When using plastic syringes, arterial blood gas analysis should be processed shortly after collecting the sample. Despite the fact that low temperatures can slow down the metabolism, neither the ice nor the fridge preserved all the sample parameters.
- STAPHYLOCOCCUS AUREUS RESISTENTE À METICILINA E ABCESSO HEPÁTICO Análise Retrospectiva de 117 CasosPublication . Ferreira, J.; Abreu, M.; Rodrigues, P.; Carvalho, L.; Correia, J.Introdução: Os abcessos hepáticos constituem uma entidade clínica que coloca desafios no diagnóstico e tratamento, sendo em muito casos necessário um elevado índice de suspeição. A maioria dos abcessos hepáticos piogénicos são polimicrobianos. Os agentes entéricos facultativos e anaeróbios são os mais comuns. Na literatura revista, os abcessos hepáticos a Staphylococcus aureus constituem cerca de 7% dos abcessos hepáticos piogénicos. Esta infecção habitualmente resulta de disseminação hematogénea de microrganismos isolados em infecções à distância. Não existem séries publicadas sobre esta matéria, sendo que a informação disponível se restringe a case-reports. Objectivo e Métodos: Com o objectivo de aprofundar a fisiopatologia, diagnóstico e história natural dos abcessos hepáticos, nomeadamente por Staphylococcus Aureus resistente à meticilina (MRSA), realizou-se um estudo retrospectivo, fazendo a revisão do processo clínico dos doentes com o diagnóstico de abcesso hepático/piemia portal entre Janeiro de 2004 e Dezembro de 2009, num total de 117 doentes. Resultados: Clinicamente, a maior parte dos doentes tinha febre e dor abdominal. A esmagadora maioria dos doentes não dispensou TC abdominal no diagnóstico. Apenas 81,2% dos doentes realizaram algum tipo de colheita para microbiologia. O agente mais frequentemente isolado foi a Escherichia coli. O MRSA estava presente em 7,6% dos abcessos cujo pús foi processado. A terapêutica mais frequentemente seleccionada foi a drenagem percutânea associada a antibioterapia. Todos os MRSA isolados eram sensíveis ao trimetoprim-sulfametoxazol e vancomicina. O grupo de patologia subjacente mais frequentemente encontrada foi o das doenças das vias biliares, seguido dos pós-operatórios recentes. Na esmagadora maioria das infecções a MRSA, o grupo de patologia subjacente mais frequentemente encontrada foi o pós-operatório abdominal. A taxa de mortalidade global foi de 17,9%. No que respeita a abcessos a MRSA, faleceu 1 doente devido a complicações da doença de base. Conclusões: Estes dados confirmam que o MRSA é um patogénio importante em infecções hospitalares, incluindo as intra-abdominais. É de salientar a importância do pós-operatório abdominal como factor de risco para infecção por este agente, um dado pouco descrito na literatura revista. Estes achados acarretam implicações assinaláveis a nível terapêutico, investigacional e prognóstico.