Browsing by Author "Silva, I."
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- Acalásia na adolescência – dois casosPublication . Silva, I.; Morais, R.; Ferreira, P.; Cunha, F.Introdução: A acalásia é uma doença rara, particularmente em idade pediátrica. Caracteriza-se por aperistaltismo do esófago e inadequado relaxamento do esfíncter esofágico inferior. A sua etiologia está ainda pouco esclarecida. Casos clínicos: Descrevem-se dois adolescentes com disfagia para sólidos e líquidos, vómitos, perda ponderal e tosse noturna, durante vários meses. Inicialmente foi considerada a hipótese de doença do comportamento alimentar, mas a investigação posterior levou ao diagnóstico de acalásia confirmado por manometria esofágica num caso e por biópsia intraoperatória no outro. Foram submetidos a miotomia de Heller com procedimento antirrefluxo, um por laparoscopia e outro por laparotomia, com evolução favorável. Discussão/conclusões: Destacamos a raridade e desafio diagnóstico destes casos. A sintomatologia inespecífica leva frequentemente ao diagnóstico de doença do comportamento alimentar, protelando o tratamento dirigido. Na persistência de sintomas é mandatório considerar a hipótese de acalásia, sendo a manometria esofágica o exame diagnóstico de escolha. O tratamento de eleição é cirúrgico, salientando-se a eficácia das diferentes técnicas aplicadas.
- Aneurysmal Degeneration of the Brachial Artery after Vascular Access Creation: Surgical Treatment ResultsPublication . Teixeira, S.; Sá-Pinto, P.; Veiga, C.; Silva, I.; Almeida, R.True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms. We recorded patient's demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up. Ten patients were treated for aneurysmal degeneration of the brachial artery. Average aneurysm diameter was 37.5 mm. All cases had, at least, one previous distal AVF, ligated or thrombosed, at the time of diagnosis. The first access was created in mean 137 months before the diagnosis of DBAA. Nine patients had previous medical history of renal transplant and were under immunosuppressive therapy. All patients were symptomatic at the time of diagnosis. In all cases, the treatment was aneurysmectomy followed by interposition bypass. One patient developed a postoperative hematoma with the need of surgical drainage. At 50 months of follow-up, one patient was submitted to percutaneous angioplasty due to an anastomotic stenosis. No other complications occurred during the entire follow-up period (mean: 69 months). The pathogenesis underlying DBAA remains unclear. Increased blood flow after AVF creation, immunosuppressive therapy, and ligation/thrombosis of the AVF may contribute to aneurysm formation. Surgical treatment by aneurysmectomy and bypass, with autogenous conducts, is a safe and effective option.
- AUTOMATED COLLECTION OF QUALITY-OF-LIFE DATA: TOUCH-SCREEN COMPUTER SYSTEMS IN PATIENTS WITH IMMUNE DISEASESPublication . Ribeiro, C.; Silveira, A.; Silva, I.; Ribeiro, C.; Vasconcelos, C.AUTOMATED COLLECTION OF QUALITY-OF-LIFE DATA: TOUCH-SCREEN COMPUTER SYSTEMS IN PATIENTS WITH IMMUNE DISEASES Claúdia Ribeiro1,2,3, Augusta Silveira4,3, Isabel Silva4, Catarina Ribeiro4, Carlos Vasconcelos2,3 1UCP, 2HSA/CHP, 3ICBAS/UP, 4UFP e 5HSMF. Universidade Católica Portuguesa (UCP), Porto. Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto. Universidade Fernando Pessoa (UFP), Porto. Hospital Santa Maria da Feira (HSMF), Porto. Background The increase of technological knowledge and methodology has allowed the practice of redirecting epidemiological research, particularly in the field of chronic disease. Although capable of controlling the accumulation of events and constraints imposed by the treatment can lead to a drastic change in quality of life (QoL) of subjects progressed to varying degrees of disability and death. In this perspective the Quality of Life Related to Health (HRQOL) has taken a leading role and its evaluation is indispensable in Medicine. Aim The aims of this study were (1) analyze the importance of HRQOL assessment as a tool for health promotion and a way of measuring the effectiveness of interventions in daily practice in patients with coexisting chronic immune system (PCSI), (2) evaluation of alternative methods for the automated collection of data on HRQOL and development of an electronic interface in sample of 320 patients, (3) creating a database to ascertain the epidemiological profile of PCSI, and identification of socio-economic, demographic and clinical data of these individuals, (4) using the QoL indicator as a predictor in decision treatment and use the preferences of patients. Methods A total of 473 patients with chronic diseases of the immune system, which were applied Graffar Index, SF-36v2, a demographic questionnaire and identification of clinical variables. Results The results of this investigation suggest that the demographic, socio-economic and clinics are associated with significant differences in QoL cumulative and chronic complications associated with different pathologies. The results verified the existence of significant correlations between the different diagnoses, duration of disease and therapy. In general, patients who have chronic diseases of the immune system such as rheumatoid arthritis, lupus, scleroderma, Bechet's disease, Sjögren's syndrome or infection with human immunodeficiency virus 1 or 2 showed a worse QoL than the general population. The derivations of preferences from the SF-36v2 exhibit strong correlations with the preferences measured with the SF-6D. Conclusions This suggests that both the application of the SF-36v2 as the SF-6D can be important sources of preferences to implement measures in economic evaluation in healthcare. HRQL can and should be integrated into immune clinical practice. The translation of graphical results given to the clinician at the beginning of the consultation, favors the rapid analysis of global values of the patient's HRQL. This assessment can be an excellent diagnostic tool to be used routinely in clinical practice or assisting in disease management and therapeutic decision making. Apresentador: Cláudia Ribeiro, Médica Dentista. Doutoranda, Faculdade de Medicina da Universidade de Santiago de Compostela.
- Carbidopa Alters Tryptophan Metabolism in Breast Cancer and Melanoma Cells Leading to the Formation of Indole-3-Acetonitrile, a Pro-Proliferative MetabolitePublication . Duarte, D.; Amaro, F.; Silva, I.; Silva, D.; Fresco, P.; Oliveira, José Carlos; REGUENGO, HENRIQUE; Gonçalves, J.; Vale, N.Carbidopa is used for the treatment of Parkinson's disease (PD) as an inhibitor of DOPA decarboxylase, and PD patients taking carbidopa have a lower incidence of various tumors, except for breast cancer and melanoma. Recently, it was shown that carbidopa inhibits tryptophan-2,3-dioxygenase (TDO) and kynureninase enzymes. In the present study, the effect of carbidopa on the viability and metabolic profile of breast cancer MCF-7 and melanoma A375 cells was investigated. Carbidopa was not effective in inhibiting MCF-7 and A375 proliferation. Liquid chromatography and mass spectrometry revealed a new compound, identified as indole-3-acetonitrile (IAN), which promoted a concentration-dependent increase in the viability of both cell lines. The results suggest that treatment with carbidopa may alter tryptophan (Trp) metabolism in breast cancer and melanoma leading to the formation of a pro-proliferative Trp metabolite, which may contribute to its failure in reducing breast cancers and melanoma incidence in PD patients taking carbidopa.
- Development and use of touch-screen computer-assisted self interviewing in Portuguese patients with chronic immune diseases: Evaluation of an electronic version of SF-36v2Publication . Ribeiro, C.; Moreira, L.; Silveira, A.; Silva, I.; Gestal, J.; Vasconcelos, C.Abstract Aim:The major purpose of this study was to evaluate alternative automated methods of collecting data on health related quality of life (HR-QoL). In order to achieve this, we developed a study with the following objectives: (1) to evaluated the feasibility of electronic version in patients with different chronic pathologies of the immune system using Short Form 36version2 (SF-36v2), (2) to evaluate the construct validity of SF-36v2 using the electronic data capture, and (3) to compare electronic version questionnaires with paper questionnaires in terms of patients ´ acceptance, data quality, and reliability. Methods:Out-patients with chronic immune diseases (HIV infection, lupus, scleroderma, rheumatoid arthritis, Behçet and Sjögren), were randomly selected to completed electronic and paper SF- 36v2 (n=50) before consultation in Clinical Immunology Unit, in Hospital Santo António-Centro Hospitalar do Porto (CI-HGSA). Results: There were very high correlations in SF- 36v2 responses (p< .001) between the paper and electronic forms. Internal reliability coefficients (Cronbach’s a) showed good internal consistency for all reported responses in either, computer and paper. There were no missing data in electronic version or paper. About 84% of the patients prefer to use the computer version in future. Conclusion: The electronic HR-QoL assessment is technically possible and it can provide reliable and valid clinically significant information which can either be used in routine care appointments.
- FENÓMENO DE RAYNAUD: ÚLCERAS DIGITAISPublication . Silva, I.
- Fluxo mediado pela dilatação: predictivo de úlceras digitais em doentes com Fenómeno de RaynaudPublication . Silva, I.; Loureiro, T.; Vasconcelos, C.; Almeida, R.
- Leucemia aleucémicaPublication . Carvalho, M.; Oliva, T.; Silva, I.; Almeida, M.; Estevinho, N.; Costa, V.; Norton, L.Introdução: O termo leucemia aleucémica é usado quando ocorre infiltração cutânea por células leucémicas na ausência de blastos no sangue periférico e medula óssea, podendo ser a primeira manifestação da doença. Em cerca de 25-30% das leucemias congénitas é documentada infiltração cutânea no decorrer da doença ou como manifestação inicial. A maioria está associada ao tipo mieloide e a detecção do gene MLL (mixed-lineage leukemia gene) confere mau prognóstico, exigindo tratamento com quimioterapia intensiva. Caso Clínico: Apresenta-se o caso de uma lactente do sexo feminino e de raça negra, com diagnóstico de Leucemia Aguda Linfoblástica linhagem B, efectuado aos seis meses de vida, no Hospital de Joanesburgo, através de biópsia de nódulo subcutâneo com três meses de evolução. Admitida no Instituto de Oncologia do Porto, a pedido da mãe, para realização de quimioterapia. Discussão: O caso apresentado documenta uma entidade rara e de mau prognóstico mas que, neste caso, teve uma boa resposta à terapêutica instituída. ABSTRACT Introduction: The term aleukemic leukemia is used when there is skin infiltration by malignant leukocytes in the absence of blasts in peripheral blood and bone marrow, and it can be the first signal of the disease. Infiltration of the skin has been documented in 25-30% of patients with congenital leukemia. Leukemia cutis may be the first manifestation of congenital leukaemia, and may even precede blood or bone marrow leukaemia by several weeks or months. Most are associated with the myeloid lineage. The presence of mixed-lineage leukemia (MLL) gene has been associated with poor prognosis, requiring treatment with intensive chemotherapy. Case report: The authors report the case of a six-year-old black female, with skin lesions for three months, consistent with Acute Lymphoblastic Leukemia. Admitted in our Pediatric Department – Instituto de Oncologia do Porto – Portugal, by mother’s request, for chemotherapy. Discussion: Although a poor prognosis is usually associated with this situation, our patient had a good response to treatment.
- Mastoidite aguda em idade pediátrica – Fatores de risco para complicaçõesPublication . Marques, F.; Silva, I.; Branco, C.; Paiva, M.; Cunha, F.RESUMO Introdução: A mastoidite aguda (MA) é a complicação mais frequente da otite média aguda (OMA). A antibioticoterapia (AB) e a melhoria dos cuidados de saúde diminuíram drasticamente a sua incidência. Porém, na última década assistiu-se ao recrudescimento da doença. Objetivos: Avaliar características sociodemográficas, clínicas, laboratoriais e terapêuticas da MA e identificar fatores de risco para complicações na população pediátrica num hospital de nível II; elaboração de uma proposta de protocolo de atuação. Material e Métodos: Revisão casuística dos processos de internamentos por MA entre 2000-2010. Resultados: Registaram-se 60 internamentos (55 crianças), com predomínio do sexo masculino (53,3%). Mais de 1/3 (36,7%) dos casos ocorreram nos anos 2000 e 2006. A mediana de idades foi cinco anos. Dezanove doentes (31,7%) tinham antecedentes de OMA de repetição e 25 (41,7%) outras patologias do foro ORL. História recente de OMA descrita em 48,3%, todos submetidos a AB. A clínica cursou com febre (75%), otalgia (93,3%), sinais inflamatórios retroauriculares (100%) e otorreia (36,7%). Em nove casos foi colhida zaragatoa do exsudado otológico para exame cultural, isolando-se Pseudomonas aeruginosa num deles. Identificaram-se complicações em oito casos (13,3%). Idade inferior a dois anos, sexo masculino, AB prévia e ausência de otalgia foram mais frequentes nos casos complicados (p ≤ 0,05). Todos fizeram AB endovenosa, 53,3% com cefalosporinas de 2ª/3ª geração, com duração média total AB de 13 dias. Houve intervenção cirúrgica em três casos. Conclusão: Contrariamente ao que alguns autores advogam, não se verificou aumento do número de internamentos por MA ao longo dos anos do estudo. Idade inferior a dois anos, sexo masculino, AB prévia e ausência de otalgia parecem constituir fatores preditivos para complicações. A utilização de AB criteriosa e miringotomia devem ser incentivadas.
- MODELO DE ACTUAÇÃO NA ABORDAGEM AO DOENTE SUBMETIDO A TRANSPLANTE DE ÓRGÃO HEPÁTICOPublication . Silva, E.; Silva, I.; Silva, R.; Oliveira, S.