Browsing by Author "Soares, P."
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- Convulsões Neonatais - Qual a etiologia?Publication . Sarmento, A.; Soares, P.Introdução: as convulsões representam uma disfunção do SNC e caracterizam- se por uma alteração súbita das funções neurológicas. Nos recém nascidos (RNs) a sua incidência estima-se entre 0,15 a 3,5%. Neste grupo etário, a maioria das convulsões não correspondem a verdadeiros quadros epilépticos, mas a crises ocasionais resultantes de distúrbios funcionais, metabólicos ou orgânicos. Objectivos: rever os casos de convulsões internados na Unidade de Cuidados Intensivos Neonatais (UCIN) da Maternidade Júlio Dinis (MJD) e determinar as respectivas etiologias. Material e Métodos: procedeu-se à análise retrospectiva dos processos clínicos dos RNs internados com convulsões, durante os anos de 2000 e 2001. Em cada caso foram colhidos dados referentes à anamnese, exame objectivo ao nascimento, semiologia das convulsões, exames auxiliares de diagnóstico, tipo de tratamento e evolução clínica. Resultados: analisaram-se 25 casos, o que correspondeu a uma incidência de 3,3 casos por 1000 nados vivos na MJD e a 3 % dos internamentos no período referido. As etiologias encontradas incluíram: encefalopatia hipoxico-isquémica (EHI) (52 %), hipocalcemia (12 %), hemorragia intracraniana (4%), meningite (4%), enfarte cerebral (4%) e malformação cerebral (4%). O início das convulsões teve relação com as causas subjacentes: nas 1as horas os casos de EHI e no fim da 1ª semana o caso de infecção do SNC. O tratamento baseado na correcção de alterações metabólicas transitórias permitiu o controle em dois casos de hipocalcemia. O anticonvulsivante de primeira linha foi o fenobarbital. A mortalidade foi de 28 % e a morbilidade, entre os 12 e os 24 meses, de 24 %. Conclusões: salientamos a importância de esclarecer a etiologia das convulsões neste grupo etário. Na maioria das vezes é encontrada uma causa específica que permite um tratamento dirigido, com vista ao controlo dos episódios convulsivos e à interrupção do mecanismo de lesão cerebral subjacente. NEONATAL SEIZURES - WHICH ETIOLOGY? ABSTRACT Introduction: seizures represent a dysfunction of the nervous system and are characterized for a sudden alteration of the neurological functions. Neonatal seizures occur in 0,15 to 3,5% of all newborns. In this age group, the majority of the seizures result of functional, metabolic or organic disturbance. Objectives: to review the cases of seizures admitted in neonatal intensive care unit of the Júlio Dinis‘ Maternity and to determine the respective etiologies. Population and methods: we made a retrospective analysis of admitted newborns with the diagnosis of seizures in the Júlio Dinis‘ Maternity, between 2000 and 2001. Some of variables collected were: dates relative to gestation and delivery, physical examination, types of seizures, diagnostic testing, treatment and clinical evolution. Results: we analyzed 25 cases, that correspond to an incidence of 3,3 cases for 1000 live births in the Júlio Dinis‘ Maternity and 3 % of the internments in the cited period. The following etiologies were identified: hipoxic ischemic encephalopathy (HIE) (52%), hypocalcaemia (12%), intracranial hemorrhage (4%), meningitis (4%), cerebral infarct (4%) and cerebral malformation (4%). The beginning of the convulsions was related to the underlying causes: in the first 48 hours of life the HIE cases and in the end of the first week of life, the case of infection of the nervous system. The treatment based on the corrections of transitory metabolic alterations allowed the control in two cases of hypocalcaemia. The anticonvulsant agent of first line was phenobarbital. Mortality was 28% and morbidity 24% (between 12 and 24 months). Conclusions: we emphasize the need to clarify the etiology of the seizures in the neonatal period. In the majority of cases it is possible to identify a specific cause. This allows an adquate tratment in order to control convulsive episodes and to avoid further cerebral damage.
- Fenitoína – fronteiras do tratamentoPublication . Antunes, J.; Araújo, L.; Carrilho, I.; Soares, P.; Proença, E.Introdução: As crises convulsivas são manifestações clínicas frequentes no período neonatal. Continua pouco claro qual a melhor abordagem terapêutica, nao existindo ainda consenso entre os diversos protocolos. A terapêutica antiepiletica usada tradicionalmente e, muitas vezes, pouco eficaz e pode originar efeitos secundários importantes. Caso Clínico: Apresenta-se o caso clínico de um recém-nascido que iniciou convulsões no primeiro dia de vida. Por persistência das crises após terapêutica com fenobarbital, foi iniciada fenitoina, tendo desenvolvido um quadro de encefalopatia devida a intoxicação por este fármaco, apesar do seu uso em doses habituais. Dado que a investigacao complementar foi normal, concluiu-se que esta se deveu provavelmente a susceptibilidade individual. Conclusão: Atendendo aos potenciais efeitos secundários da fenitoina, mais frequentes e graves em recém-nascidos, este fármaco tende a ser menos usado como segunda linha no tratamento das convulsões neste grupo etário, considerando-se atualmente as benzodiazepinas e a lidocaina alternativas mais eficazes e seguras.
- Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and MetabolismPublication . Santos, A.; Vinagre, J.; Soares, P.; Claro, I.; Sanches, A.; Gomes, L.; Fernandes, I.; Catarino, A.; Preto, J.; Pereira, B.; Marques, A.; Rodrigues, F.; Amaral, C.; Rocha, G.; Mellidez, J.; Simões, H.; Lopes, J.; Bugalho, M.Background: The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been increasing in the last five decades, but there is no large-scale data regarding these tumours in Portugal. We conducted a cross-sectional, multicentric study in main Portuguese centers to evaluate the clinical, pathological, and therapeutic profile of GEP-NENs. Methods: From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform. Results: Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading. Conclusion: In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal. Methods: From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform. Results: Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading. Conclusion: In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal.
- Infecção congénita por CMV - caso clínicoPublication . Lira, S.; Lopes, L.; Soares, P.; Dias, M.; Carvalho, C.A infecção congénita por Citomegalovirus (CMV) representa actualmente a infecção congénita mais frequente nos países desenvolvidos, podendo considerar-se um problema de saúde pública nestes países. Apresenta-se o caso clínico de uma trombocitopenia grave, inicialmente interpretada como uma trombocitopenia aloimune, mas cujo diagnóstico diferencial revelou tratar-se de uma infecção congénita por CMV. Na evolução clínica identificaram-se sequelas neurológicas graves, traduzidas num atraso global do desenvolvimento e surdez unilateral. Discute-se a abordagem diagnóstica e controvérsias da terapêutica, alertando-se para a frequência e importância deste agente. ABSTRACT The cytomegalovirus (CMV) congenital infection represents actually the most frequent congenital infection in developed countries, and us considered a public health problem. The authors present a case of severe thrombocytopenia, initially interpreted as alloimmune, but in the course of differential diagnosis revealed to be a CMV congenital infection. The clinical evolution identifi ed serious neurological sequelae, with global development retardation and unilateral deafness. The diagnostic approach and therapeutics are discussed, with focus on the frequency and importance of this agent.
- Prediction of one year mortality in extremely premature newborns using classification treesPublication . Januário, A.; Gouveia, S.; Pinto da Costa, J.; Sá, M.; Almeida, A.; Carvalho, C.; Saraiva, J.; Fonte, M.; Soares, P.
- Preterm infants under 27 weeks gestational age: outcomes in a tertiary hospitalPublication . Sá, M.; Fonte, M.; Carvalho, C.; Soares, P.; Almeida, A.; Januário, A.; Gouveia, S.; Saraiva, J.Introduction: Over the last decades, survival of extremely preterm infants improved but there´s still significant morbidity among this group. We pretend to evaluate if specific attitudes/characteristics are associated with higher survival or survival without severe disabilities and elaborate predicting outcome models. Material and Methods: Observational descriptive study, including the 205 liveborn/stillborn infants -gestational age 22w0d-26w6d- born at an Obstetrics Unit or transferred to a Neonatology Unit of a Level III Hospital, from January-2000 to December-2009. We collected variables related to management in the prenatal/neonatal period, neonate performances and psychomotor development (18-24 months). Significant associations between variables/outcomes were identified by chi-square test or t-test; multivariate logistic regression models were used to describe and predict mortality/morbidity. Results: Advanced Gestational Age (GA) (p=0.001), antenatal corticotherapy(p=0.001), cesarean section(p=0.001), inborn delivery(p=0.021) and increased weight(p=0.001) were associated with survival. Absence of Intraventricular Hemorrhage (IVH) grade 3-4(p=0.001) and absence of Periventricular Leukomalacia (PVL) (p=0.005) were associated with survival without severe neurossensorial deficit. According to multivariable models, advanced GA (OR=0.353,CI95% 0.208-0.599), increased weight (OR=0.996,CI95% 0.993-0.999) and antenatal corticotherapy (OR=0.150,CI95% 0.044-0.510) were associated with lower mortality risk. Rupture of membranes less than 12 h duration was associated with higher mortality risk (OR=3.88,CI95% 1.406-10.680). IVH grades 3-4 was associated with higher morbidity risk (OR=16.931,CI95% 2.744-104.452). Mortality and severe morbidity models predicted correctly the outcome in 78.1% and 85.7% of the cases, respectively. Conclusions: Mortality/morbidity models might be valuable tools providing insight in the prediction of the outcome of these neonates and helping parental counseling.