Browsing by Author "Freitas, C."
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- Acute kidney injury with active urinary sediment analysis, a positive ANCA test and hypocomplememtemia: A tough situationPublication . Campos, A.; Vizcaíno, J.; Coelho, A.; Freitas, C.; Rocha, G.
- Bone Mineral Density After Simultaneous Kidney–PancreasPublication . Pereira, S.; Pedroso, S.; Martins, L.; Santos, P.; Almeida, M.; Freitas, C.; Dias, L.; Dores, J.; Almeida, R.; Henriques, A.C.; Teixeira, M.ABSTRACT Bone disease and an high risk of fractures are major problems in transplantation. Among diabetic patients undergoing simultaneous kidney–pancreas (SKP) transplantation, there are few studies assessing long-term effects on bone mass. The aim of this study was to evaluate bone mineral density (BMD) over 4 years follow-up after SKP transplantation. Fifty-seven patients had 22.8 5.3 years of prior diabetes, 65% were female, and the overall mean age was 24.3 5.93 years. At the time of transplantation, the lumbar spine and femoral neck T-scores were 1.75 1.05 and 1.95 0.73, respectively; 28% of subjects had evidence of osteoporosis. One year after transplantation, 77.6% of patients displayed improved lumbar T-scores to 1.33 0.94 (.044) with stable femoral neck T-scores. Bone densitometry enhanced gradually through the 4 years follow-up: lumbar T-score to 1.04 0.67 (.004) and femoral neck T-score to 1.69 0.49 (.12). At year 4, no osteoporosis cases were detected but 86.7% of patients did not receive steroids in the immunosuppressive regimen. The graft function remained stable (serum creatinine, 1.2 mg/dL; fasting glucose, 87.7 mg/dL). During the follow-up, BMD improved more significantly at cortical sites. Our study reports a reduced prevalence of fractures (8.7%) compared with the literature, which could be related to a steroid-sparing protocol and/or aggressively treatment of osteoporosis.
- Chemical peritonitis in a patient treated with icodextrin and intraperitoneal vancomycinPublication . Freitas, C.; Rodrigues, A.; Carvalho, M.; Cabrita, A.
- Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-upPublication . Martins, L.; Henriques, A.C.; Dias, L.; Almeida, M.; Pedroso, S.; Freitas, C.; Pereira, S.; Fructuoso, M.; Dores, J.; Oliveira, F.; Almeida, R.; Cabrita, A.; Teixeira, M.ABSTRACT Over years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT) The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complica- tions during follow-up of these 93 patients. Their mean age was 34 years and prior dialysis time was 32 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent surgical reinterventions. Incidence of acute rejection episodes was 11.8%After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%95%and 81% at 1-year; 93%90%and 79% at 5-years; and 93%90% and 79% at 9-years. Although pancreas–kidney transplant patients are complex presenting many management difficulties, our overall results represent positive stimulus for diabetic patients.
- Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC)Publication . Figueiredo, A.; Almeida, M.A.; Almodovar, M.T.; Alves, P.; A, Araujo; Araújo, D.; Barata, F.; Barradas, L.; Barroso, A.; Brito, U.; Camacho, E.; Canário, D.; Cardoso, T.; Chaves, A.; Costa, L.; Cunha, J.; Duarte, J.; Estevinho, F.; Felizardo, M.; Fernandes, J.P.; Ferreira, L.; Ferreira, L.; Fidalgo, Paula; Freitas, C.; Garrido, P.; Gil, N.; Hasmucrai, D.; Jesus, E.; Lopes, J.A.; de Macedo, J.E.; Meleiro, A.; Neveda, R.; Nogueira, F.; Pantorotto, M.; Parente, B.; Pego, A.; Rocha, M.; Roque, J.; Santos, C.; Saraiva, J.; Silva, E.; Silva, S.; Simões, S.; Soares, M.; Teixeira, E.; Timóteo, T.; Hespanhol, V.Objective: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. Methods: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). Results: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. Conclusions: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.
- Tacrolimus, a forgotten agent in kidney transplant leukopeniaPublication . Azevedo, P.; Freitas, C.; Silva, H.; Aguiar, P.; Santos, T.; Cabral, J.; Rocha, G.; Almeida, M.; Pedroso, S.; Martins, L.; Dias, L.; Castro-Henriques, A.; Cabrita, A.Leukopenia in kidney transplant patients is frequent, it causes potentially life-threatening complications, but it is often poorly characterized. Opportunistic infections, immunologic disturbances and drug-related toxicity are principal causes of single or multilineage cytopenias. Tacrolimus-induced leukopenia is a less recognized but frequent complication. We describe one patient with leukopenia developing within seven months after renal transplant. After excluding other potential causes, tacrolimus was switched to cyclosporine, with recovery of white blood cell count. Based on the clinical report, the authors reviewed causes of post-transplant leukopenia, focusing on the diagnostic investigation. Early diagnosis and interventions are fundamental to improve prognosis.