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  • Fístula Coronária: Causa Rara de Sopro Cardíaco
    Publication . Diamantino, C.; Machado, R.; Anjos, R.; Ferreira, R.; Martins, F.
    As fístulas coronárias congénitas são raras, representando cerca de 0,2% a 0,4% das anomalias cardíacas congénitas. Na maioria dos casos são anomalias assintomáticas, condicionando a existência de um sopro cardíaco contínuo, que constitui o principal motivo de estudo do doente. Descreve-se o caso clínico de uma criança de 16 meses, assintomática, referenciada à consulta de cardiologia por um sopro contínuo e cujo ecocardiograma revelou fístula coronária direita de alto débito para a aurícula direita e comunicação interauricular multifenestrada, condicionando dilatação das cavidades direitas. Foi realizado com sucesso o encerramento electivo, por via percutânea, da fístula coronária. Este caso demonstra claramente a importância de um exame clínico cuidadoso, que permitiu o diagnóstico, e a possibilidade de tratamento por cateterismo, seguro e eficaz. Coronary arterial fi stula is a rare congenital cardiac anomaly. It accounts for 0.2%-0.4% of all congenital cardiac anomalies. The majority of the patients is asymptomatic and is referred because of a murmur. We describe the case of a 16 month year old girl, asymptomatic, with a continuous murmur. Echocardiographic study revealed a signifi cant right coronary arterial fi stula draining to the right atrium, a fenestrated atrial septal defect and enlarged right atrium and ventricle. The patient underwent percutaneous closure of the fistula.
    2010-03Journal article Open access Show more
  • Alcohol consumption among patients with hepatitis B infection in northern Portugal considering gender and hepatitis B virus genotype differences
    Publication . Mota, A.; Guedes, F.; Areias, J.; Pinho, L.; Cardoso, M.
    Alcohol. 2010 Mar;44(2):149-56. Epub 2010 Jan 29. Alcohol consumption among patients with hepatitis B infection in northern Portugal considering gender and hepatitis B virus genotype differences. Mota A, Guedes F, Areias J, Pinho L, Cardoso MF. SourceInstituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal. Abstract Alcohol abuse is an important public health problem. In Portugal with a population of 10 millions of inhabitants, there are around 10% of alcoholics or excessive alcohol drinkers and 1% of chronically infected patients with hepatitis B virus (HBV). To examine the characteristics of patients with higher levels of alcohol consumption and to investigate the association between alcohol consumption and liver damage a total of 298 chronically infected individuals, with HBV genotyped and submitted to liver biopsy, were classified with Child's grading and separated by habits of alcohol intake, less and greater than 20g/day. No significant differences were observed about genotype but genotypes A and D were predominant in both of them. A higher percentage of males (P<.001) were observed in the group with alcohol intake above 20g/day, as well a lower proportion of patients with HBeAg negativity (P< or =.035). In this group, biochemistry parameters, such as alanine aminotransferase (P=.006), aspartate aminotransferase (P=.001), gamma-glutamyl transferase (P<.001) were elevated in a significantly higher proportion than in the other group. The analysis of hematological parameters showed significantly lower values of platelets (P=.042) and mean corpuscular volume (P<.001) and significantly higher values of prothrombin time (P<.001) in the group with higher levels of alcohol consumption. The characteristics of biopsy (P<.001) and Child-Phug's classification (P=.002) revealed more severe results in this group. Logistic regression showed a positive association between liver damage and alcohol intake, increasing with age. In female patients, a strong positive association between alcohol intake and liver damage was also found (odds ratio: 9.379; 95% confidence interval: 0.859-468.422; P = .037); however, the most severe cases were only observed in women older than 45 years. In patients with HBV infection, alcohol is associated with a more severe liver disease. No evidence was found concerning association with HBV genotype. 2010 Elsevier Inc. All rights reserved.
    2010-03Journal article Open access Show more