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Ferreira do Couto ML, Fonseca S, Pozza DH. Pharmacogenetic Approaches in Personalized Medicine for Postoperative Pain Management. Biomedicines 2024; 12:729. [PMID: 38672085 PMCID: PMC11048650 DOI: 10.3390/biomedicines12040729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Despite technical and pharmacological advancements in recent years, including optimized therapies and personalized medicine, postoperative pain management remains challenging and sometimes undertreated. This review aims to summarize and update how genotype-guided therapeutics within personalized medicine can enhance postoperative pain management. Several studies in the area have demonstrated that genotype-guided therapy has the ability to lower opioid consumption and improve postoperative pain. Gene mutations, primarily OPRM1, CYP2D6, CYP2C9, COMT and ABCB1, have been shown to exert nuanced influences on analgesic response and related pharmacological outcomes. This review underscores the integration of pharmacogenetic-guided personalized medicine into perioperative care, particularly when there is uncertainty regarding opioid prescriptions. This approach leads to superior outcomes in terms of postoperative pain relief and reduced morbidity for numerous patients.
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Affiliation(s)
- Maria Leonor Ferreira do Couto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
| | - Sara Fonseca
- Anesthesiology Department, São João University Hospital Centre, 4200-135 Porto, Portugal;
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal;
- Institute for Research and Innovation in Health and IBMC (i3S), University of Porto, 4200-135 Porto, Portugal
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2
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Oliveira F, Fonseca D, Fernandes M, Teles AR, Fonseca S. Infected Spinal Hematoma After Accidental Exteriorization of an Epidural Catheter: A Case Report. Cureus 2023; 15:e47722. [PMID: 38021824 PMCID: PMC10676040 DOI: 10.7759/cureus.47722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Optimal treatment and outcome after spinal hematoma remain unclear. Close neurological monitoring is the key to successful treatment. Here, we present a case of an infected spinal hematoma management. We report the case of a 51-year-old male patient, American Society of Anesthesiologists physical status I, admitted to a level I hospital due to right lower limb necrotizing fasciitis. A lumbar epidural catheter was placed for pain control without complications. On the 26th day of hospitalization, three hours after the accidental exteriorization of the epidural catheter, the patient developed severe back pain not relieved by systemic analgesia. Prophylactic low-molecular-weight heparin had been administered less than six hours before. The patient had inflammatory signs and digital pressure pain at the catheter insertion site and a positive Brudzinski sign. Sensory-motor deficits were never felt. An urgent dorsolumbar MRI exhibited a significant hematic collection at the subdural and anterior epidural level, and an infected epidural hematoma was assumed. Empirical antibiotics and hourly monitoring of sensory-motor deficits, meningeal signs, and fever were initiated. The patient remained on absolute bed rest. Low-molecular-weight heparin was stopped. The pain disappeared on the third day after the MRI. Citrobacter koseri was isolated. A re-evaluation CT scan did not show spinal compression. The patient was discharged on the 27th day after an MRI in an asymptomatic condition and was referred to acute pain consultation. Neurological deficits are usually expected at the time of spinal hematoma diagnosis. However, the classic triad of pain, sensory deficits, and motor deficits is only seen in less than half of patients. Our patient only developed severe lumbar pain. In selected cases, diagnostic MRI associated with tight monitoring and conservative management can be applied.
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Affiliation(s)
- Flávia Oliveira
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Diana Fonseca
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Mariana Fernandes
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Ana Rita Teles
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Sara Fonseca
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, PRT
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Teixeira SC, Saraiva E, Fonseca S, Sousa-Neves F. AZOOR with unilateral disc edema: An atypical case report. Arch Soc Esp Oftalmol (Engl Ed) 2023:S2173-5794(23)00086-5. [PMID: 37247666 DOI: 10.1016/j.oftale.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/23/2023] [Indexed: 05/31/2023]
Abstract
Acute zonal occult outer retinopathy (AZOOR) diagnosis is challenging and frequently delayed. Atypical findings were described, nevertheless optic disc edema has not been consistently reported. In this study we pretend to describe a challenging diagnosis of AZOOR. In our case, a 19-year-old female presented painless vision loss in her right eye for 2 weeks. Fundus examination revealed optic disc hyperaemic edema and the visual field (VF) an enlarged blind spot. Non-infectious optic neuritis was assumed and intravenous corticotherapy administered. Four months later, VA had improved, but a VF defect persisted. Funduscopic examination showed mild peripapillary atrophy and autofluorescence zonal hyperautofluorescence around optic disc. Optical coherence tomography demonstrated diffuse loss of outer retinal layers and electroretinogram weakened signal at the corresponding region. In conclusion, unilateral optic disc edema, generally not associated with AZOOR typical presentation, hamper an early diagnosis and expresses this case relevance.
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Affiliation(s)
- S C Teixeira
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho Vila Nova de Gaia, Portugal.
| | - E Saraiva
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho Vila Nova de Gaia, Portugal
| | - S Fonseca
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho Vila Nova de Gaia, Portugal
| | - F Sousa-Neves
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho Vila Nova de Gaia, Portugal
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Dias P, Tavares I, Fonseca S, Pozza DH. Outcomes of a QST Protocol in Healthy Subjects and Chronic Pain Patients: A Controlled Clinical Trial. Biomedicines 2023; 11:biomedicines11041023. [PMID: 37189640 DOI: 10.3390/biomedicines11041023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Chronic pain is an important cause of disability with a high burden to society. Quantitative sensory testing (QST) is a noninvasive multimodal method used to discriminate the function of nerve fibers. The aim of this study is to propose a new, reproducible, and less time-consuming thermal QST protocol to help characterize and monitor pain. Additionally, this study also compared QST outcomes between healthy and chronic pain subjects. Forty healthy young/adult medical students and fifty adult/elderly chronic pain patients were evaluated in individual sessions including pain history, followed by QST assessments divided into three proposed tests: pain threshold, suprathreshold, and tonic pain. In the chronic pain group, a significantly higher pain threshold (hypoesthesia) and a higher pain sensibility (hyperalgesia) were demonstrated at threshold temperature when compared to healthy participants. The sensitivity to the suprathreshold and tonic stimulus did not prove to be significantly different between both groups. The main results demonstrated that the heat threshold QST tests can be helpful in evaluating hypoesthesia and that the sensitivity threshold temperature test can demonstrate hyperalgesia in individuals with chronic pain. In conclusion, this study demonstrates the importance of using tools such as QST as a complement to detect changes in several pain dimensions.
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Gouveia D, Fonseca S, Carvalho C, Cardoso A, Almeida A, Gamboa Ó, Canejo-Teixeira R, Ferreira A, Martins Â. Clinical Occurrences in the Neurorehabilitation of Dogs with Severe Spinal Cord Injury. Animals (Basel) 2023; 13:ani13071164. [PMID: 37048421 PMCID: PMC10093106 DOI: 10.3390/ani13071164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
This prospective observational clinical study in a population of tetraplegic and paraplegic dogs (n = 488) with or without deep pain sensation, similar to humans ASIA A and B, investigated the prevalence of clinical occurrences in a rehabilitation center with a hospitalization regime between 15 days and 9 months. A checklist of occurrences was used for easy identification and monitoring, resulting in a total of 79.5% occurrences. There were 58% of dogs with neurogenic bladder, 35.5% with diarrhea, 21.3% with urinary incontinence, and 20.5% with fecal incontinence. A low incidence of respiratory problems (e.g., pneumonia) and urinary tract infections may suggest the efficacy of some applied measures in this study, such as thoracic and abdominal POCUS evaluation, positioning strategies, physical exercises, respiratory kinesiotherapy, and early implementation of a functional neurorehabilitation protocol. These can be essential measures to prevent clinical occurrences, mainly in breeds such as the French Bulldog and the Dachshund.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital, Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, 1749-024 Lisboa, Portugal
| | - Sara Fonseca
- Arrábida Veterinary Hospital, Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Faculty of Veterinary Medicine, Lusófona University, 1749-024 Lisboa, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital, Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Ana Cardoso
- Arrábida Veterinary Hospital, Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Rute Canejo-Teixeira
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, 1749-024 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital, Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, 1749-024 Lisboa, Portugal
- Correspondence:
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Handa S, Villasis-Keever A, Shenoy M, Anandan S, Bhrushundi M, Garodia N, Fife D, De Doncker P, Shalayda K, Hu P, Fonseca S, Cure-bolt N. No evidence of resistance to itraconazole in a prospective real-world trial of dermatomycosis in India. PLoS One 2023; 18:e0281514. [PMID: 36787305 PMCID: PMC9928099 DOI: 10.1371/journal.pone.0281514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/12/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The prevalence of superficial fungal infections in India is believed to have increased substantially in the past decade. We evaluated the treatment outcomes and risk factors associated with clinical response to a treatment course of itraconazole for the management of dermatomycosis in India. METHODS In this real-world, prospective pilot study (August 2019 to March 2020), adult participants (18-60 years), diagnosed with T. cruris or T. corporis, received itraconazole 200 mg/day (any formulation) orally for 7 days, and were followed for an additional 7 days. RESULTS The study was terminated early due to the COVID-19 pandemic. Of 40 enrolled participants (mean [SD] age, 35.5 [12.73] years; {62.5%}] male; 37 received itraconazole and 20 (50%) completed the study. The median (range) Clinical Evaluation Tool Signs and Symptoms total score at baseline was 5.5 (2-10). Clinical response of "healed" or "markedly improved" based on the Investigator Global Evaluation Tool at day 7 (primary objective) was 42.9% (12/28; 95% CI: 24.53%, 61.19%). Itraconazole minimum inhibitory concentration for identified microorganisms, T. mentagrophytes species complex (91.7%) and T. rubrum (8.3%), was within the susceptibility range (0.015-0.25 mcg/mL). At day 14, 8/13 (61.5%) participants achieved a mycological response, 2/13 participants (15.4%) had a mycological failure and 90% showed a clinical response. CONCLUSION COVID-19 pandemic affected patient recruitment and follow-up, so the findings call for a careful interpretation. Nevertheless, this real-world study reconfirmed the clinical efficacy and microbial susceptibility to itraconazole for the fungi causing dermatophytosis in India. TRIAL REGISTRATION Trial registration number: Clinicaltrials.gov NCT03923010.
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Affiliation(s)
- S. Handa
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - A. Villasis-Keever
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - M. Shenoy
- Yenepoya Medical College Hospital, Mangalore, Karnataka, India
| | - S. Anandan
- Sri Ramchandra Hospital, Chennai, Tamil Nadu, India
| | - M. Bhrushundi
- Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - N. Garodia
- Janssen Medical Affairs, Mumbai, Maharashtra, India
| | - D. Fife
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - P. De Doncker
- Janssen Infectious Diseases-Diagnostics, Beerse, Belgium
| | - K. Shalayda
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - P. Hu
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - S. Fonseca
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - N. Cure-bolt
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
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Fonseca S, Pereira S, Martins A, Dias CC, Faria C, Abreu C. Travel-Related Diseases and Injuries in Children and Adolescents: A Post-Travel Surveillance Questionnaire Assessment. ACTA MEDICA PORT 2022; 35:816-822. [PMID: 35659316 DOI: 10.20344/amp.16782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Children and adolescents are a relevant and increasing proportion of travelers. Injuries and infectious diseases in children are safety concerns when traveling. However, data on diseases and injuries during international travels in children are not available. The aims of this study were to analyze travel-related diseases and injuries among pediatric travelers during and after international trips, to identify risk factors for travel-associated disease, and to evaluate the compliance and effectiveness of the recommendations provided in pre-travel appointments. MATERIAL AND METHODS We enrolled travelers aged under 18 years attending a pre-travel clinic, in a tertiary hospital (2017 - 2019); 223 of the 370 pediatric travelers attending the pre-travel clinic were included. The study was based on a questionnaire designed to address health and safety issues - vaccines and chemoprophylaxis, including side effects, the occurrence of disease or injury, diagnosis, treatment, and outcomes. RESULTS The median age at pre-travel evaluation was eight years; 39.7% of the travelers were adolescents, 52.5% were female. The participants traveled to 40 countries across four continents, with a median travel duration of 14.5 days. Asia was the most visited continent. Traveling was safe for 84.8%. From 34 travelers who had illness/injury, gastrointestinal symptoms were elicited in 41.2%. Sixteen (47.1%) travelers required an urgent medical appointment at the destination, and no one was hospitalized. Destinations in Africa and longer trips were significantly associated with a higher occurrence of disease/injury (p = 0.023 and p < 0.001, respectively). In a multivariable model, traveling to Africa was still significantly associated with travel-related disease/injury [OR = 2.736 (1.037 - 7.234)]. CONCLUSION Disease/injury occurred in 15.2% of pediatric travelers. Even though 47.1% of the travelers required an urgent medical appointment, the developed conditions were not severe enough to warrant hospitalization. Travels to Africa and longer trips seem to be associated with a higher risk of disease and injury.
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Affiliation(s)
- Sara Fonseca
- Department of Pediatrics. Centro Hospitalar Universitário São João. Porto; Department of Obstetrics, Gynecology, and Pediatrics. Faculty of Medicine. University of Porto. Porto. Portugal
| | - Sara Pereira
- Department of Infectious Diseases. Centro Hospitalar Universitário São João. Porto. Portugal
| | - António Martins
- Department of Infectious Diseases. Centro Hospitalar Universitário São João. Porto. Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS). Porto. Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS). Faculty of Medicine. University of Porto. Porto. Portugal
| | - Carolina Faria
- Department of Obstetrics, Gynecology, and Pediatrics. Faculty of Medicine. University of Porto. Porto. Pediatric Infectious Diseases and Immunodeficiencies Unit. Department of Pediatrics. Centro Hospitalar Universitário São João. Porto. Portugal
| | - Cândida Abreu
- Department of Infectious Diseases. Centro Hospitalar Universitário São João. Porto. Instituto de Inovação e Investigação em Saúde (I3S). Porto. Instituto Nacional de Engenharia Biomédica (INEB). Porto. Department of Medicine. Faculty of Medicine. University of Porto. Porto. Portugal
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Marco JH, Fonseca S, Fernandez-Felipe I, García-Palacios A, Baños R, Perez S, Garcia-Alandete J, Guillen V. Family connections vs treatment at usual optimized in the treatment of relatives of people with suicidal behavior disorder: study protocol of a randomized control trial. BMC Psychiatry 2022; 22:335. [PMID: 35570289 PMCID: PMC9107725 DOI: 10.1186/s12888-022-03965-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatives of people diagnosed with suicidal behavior disorder (SBD) feel guilty, afraid, hopeless, depression and anxiety. It is necessary to help the relatives of people with SBD to reduce their discomfort and burden. Family Connections (FC) is a program that has been shown to be effective in reducing burden, depression, and anxiety, and increasing dominance and validating behaviors in relatives of people with borderline personality disorder. However, there are no RCTs that demonstrate the efficacy of the FC program in patients with SBD. Our research team adapted FC for relatives of people with SBD for delivery in the Spanish population (FC-SBD). The FC-SBD program contains 12 two-hour sessions held once a week. The first aim is to verify the efficacy of the FC-SBD intervention for relatives of people diagnosed with SBD in a randomized control trial with a Spanish sample. The second objective is to analyze the feasibility and acceptance of FC-SBD in relatives. The third aim is to analyze whether the changes produced in the psychological variables in the relatives after the intervention are related to changes in the psychological variables of the patients. This paper presents the study protocol. METHODS The study design consists of a two-arm randomized controlled trial with two conditions: FC-SBD or Treatment as usual optimized (TAU-O). Participants will be relatives of patients who meet DSM-5 criteria for SBD. The caregivers` primary outcome measures will be the BAS. Secondary outcomes will be DASS-21, FES, DERS, QoL. The patient's primary outcome measures will be the frequency of critical incidents with the family member with SBD. Secondary measures will be the INQ, PHQ-9, OASIS. Participants will be assessed at pretreatment, post-treatment, and 6-month follow-up. The intention-to-treat principle will be used when analyzing the data. DISCUSSION This study will provide results that confirm the efficacy of the FC-SBD in relatives of people with SBD. These results will also confirm its good acceptance by family members and help us to find out whether it is a good program to improve the prevention of suicidal behaviors in the family environment. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05157607 . Registered 15 December 2021.
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Affiliation(s)
- José H. Marco
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
| | - Sara Fonseca
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Isabel Fernandez-Felipe
- grid.9612.c0000 0001 1957 9153Universitat Jaume I de Castelló, España. Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón, España
| | - Azucena García-Palacios
- grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España ,grid.9612.c0000 0001 1957 9153Universitat Jaume I de Castelló, España. Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón, España
| | - Rosa Baños
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
| | - Sandra Perez
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Joaquín Garcia-Alandete
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Verónica Guillen
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
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Fonseca S, Silva S, Magalhães A, Lago R, Estevinho N, Bom-Sucesso MD, Azevedo I. Endobronchial mucoepidermoid carcinoma in a child with postinfectious bronchiolitis obliterans. Pediatr Pulmonol 2021; 56:4063-4065. [PMID: 34583420 DOI: 10.1002/ppul.25685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
Endobronchial mucoepidermoid tumors are rare neoplasms. Due to nonspecific symptoms, diagnosis can be challenging, but early diagnosis and treatment are crucial for prognosis. We present the case of a boy, with chronic respiratory insufficiency due to bronchiolitis obliterans, that presented worsening exertional dyspnea at 12 years. Spirometry showed unexpected deterioration of respiratory function and a computed tomography scan revealed an obstructive polypoid mass in the intermediate bronchus. Given the severe basal ventilatory compromise and risk associated with surgical treatment, rigid bronchoscopy, and laser photocoagulation were performed, with clinical and functional improvement. The histological examination revealed a low-grade mucoepidermoid carcinoma. The option for a minimally invasive procedure requires careful follow-up due to the risk of tumor recurrence.
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Affiliation(s)
- Sara Fonseca
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Sónia Silva
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Adriana Magalhães
- Pneumology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rita Lago
- Radiotherapy Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Norberto Estevinho
- Pediatric Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria do Bom-Sucesso
- Pediatric Oncology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Gynecology, Obstetrics and Pediatrics Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Azevedo
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Gynecology, Obstetrics and Pediatrics Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,EpiUnit, Public Health Institute, University of Porto, Porto, Portugal
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10
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Fonseca S, Magalhães T, Teixeira B, Lisboa L, Rodrigues E, Trindade E, Ferreira S, Costa C, Castro-Correia C. Liver dysfunction and hypoglycaemia as presentations of hypopituitarism in a child. Endokrynol Pol 2021; 72:672-673. [PMID: 34647612 DOI: 10.5603/ep.a2021.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Sara Fonseca
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal. .,Department of Obstetrics, Gynaecology, and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Tiago Magalhães
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Obstetrics, Gynaecology, and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Beatriz Teixeira
- Pediatrics Department, Centro Materno Infantil do Norte, Porto, Portugal.,Pediatrics Department, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Portugal, Portugal
| | - Lurdes Lisboa
- Pediatric Intensive Care Unit, São João University Hospital Centre, Porto, Portugal, Portugal
| | - Esmeralda Rodrigues
- Reference Centre for Inborn Errors of Metabolism of São João University Hospital Centre, Porto, Portugal
| | - Eunice Trindade
- Pediatric Gastroenterology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
| | - Sofia Ferreira
- Pediatric Endocrinology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
| | - Carla Costa
- Pediatric Endocrinology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
| | - Cíntia Castro-Correia
- Department of Obstetrics, Gynaecology, and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,Pediatric Endocrinology Unit, Paediatrics Department, São João University Hospital Centre, Porto, Portugal
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Fonseca S, Lacerda L, Teixeira C, Reis-Melo A, Tavares M. Sexually transmitted infections in Portuguese adolescents. An Pediatr (Barc) 2021; 96:454-455. [PMID: 34526245 DOI: 10.1016/j.anpede.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sara Fonseca
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal.
| | - Luísa Lacerda
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Cláudia Teixeira
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal; Facultad de Medicina, Universidad de do Porto, Oporto, Portugal; UCIBIO-REQUIMTE, Universidad de do Porto, Oporto, Portugal
| | - Ana Reis-Melo
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Margarida Tavares
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
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Morais J, Fonseca S. Cognitive conversion disorder (functional cognitive disorder) – what’s new? Eur Psychiatry 2021. [PMCID: PMC9471642 DOI: 10.1192/j.eurpsy.2021.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Some patients present with significant subjective cognitive symptoms, sometimes interfering with day-to-day live, that are not compatible with any recognizable psychiatric, neurodegenerative or systemic condition. Recent studies have proposed that these patients can be diagnosed with Conversion Disorder (Subtype Cognitive), also known as Functional Cognitive Disorder (FCD). This is a relatively recent concept, that still lacks consensus. Objectives Review the current state of knowledge regarding prevalence, diagnosis criteria, core clinical features and proposed treatment of Functional Cognitive Disorder. Methods Bibliographic review of the literature published in English in the last 5 years, in the databases Pubmed, PsycINFO and Cochrane. The keywords used were: Functional Cognitive Disorder; Cognition; Conversion Disorder. A review of the titles and abstracts of the resulting articles was made, and selected according to their relevance to the study. Results Ten articles related to prevalence, diagnosis, clinical associations and treatment of Functional Cognitive Disorder were selected, of which two were systematic reviews, three descriptive studies, three cross sectional clinical studies of memory clinics attendants, one cohort prospective study and one article was a case series report. Conclusions The prevalence of FCD is estimated between 11.6% and 56% of patients presenting to memory clinics. However, the prevalence of FCD is hindered by the lack of consensus regarding its definition. Recently, Ball et al proposed a definition in line with the DSM-5 definition of Conversion Disorder with emphasis on positive criteria with the identification of positive evidence of internal inconsistency. Treatment discussion is still limited, and the approach is similar to other conversion disorders.
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Fonseca S, Lacerda L, Teixeira C, Reis E Melo A, Tavares M. [Sexually transmitted infections in Portuguese adolescents]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00224-1. [PMID: 34304983 DOI: 10.1016/j.anpedi.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sara Fonseca
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal.
| | - Luísa Lacerda
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Cláudia Teixeira
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal; Facultad de Medicina, Universidade do Porto, Oporto, Portugal; UCIBIO-REQUIMTE, Universidade do Porto, Oporto, Portugal
| | - Ana Reis E Melo
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Margarida Tavares
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
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Marco JH, Fernandez-Felipe I, Fonseca S, Garcia-Palacios A, Baños R, Guillen V. Confirmatory factor analysis and psychometric properties of the Emotion Regulation Questionnaire in participants with personality disorders. Clin Psychol Psychother 2021; 28:1598-1606. [PMID: 33909332 DOI: 10.1002/cpp.2605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
Emotional dysregulation is a key symptom in participants with personality disorders. The Emotional Regulation Questionnaire (ERQ) has been studied with nonclinical samples; however, it is necessary to confirm the factorial structure of the ERQ in participants with personality disorders. The aims of the present study were to confirm the factorial structure of the Spanish version of the ERQ and analyse its psychometric properties as well as the association between the ERQ and the Borderline Symptoms List (BSL-23) and the Difficulties in Emotion Regulation Scale (DERS). The overall sample was composed of 250 patients with personality disorders, of whom 195 met the criteria for borderline personality disorder. Confirmatory factor analysis was conducted. The two-factor model showed an acceptable fit, similar to the original structure, in the participants with personality disorders and with borderline personality disorder. Cognitive reappraisal was negatively correlated with the DERS and BSL-23, and expressive suppression was positively correlated with the BSL-23. The ERQ is a reliable and valid instrument to evaluate emotional dysregulation in participants with personality disorders and participants with borderline personality disorder.
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Affiliation(s)
- José H Marco
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Valencia, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Isabel Fernandez-Felipe
- Facultad de Ciencias de la Salud, Universitat Jaume I de Castelló, Castelló de la Plana, Castellón, Spain
| | - Sara Fonseca
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Valencia, Spain
| | - Azucena Garcia-Palacios
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
- Facultad de Ciencias de la Salud, Universitat Jaume I de Castelló, Castelló de la Plana, Castellón, Spain
| | - Rosa Baños
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Valencia, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Verónica Guillen
- Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Valencia, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
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Campos MG, Peixoto AR, Fonseca S, Santos F, Pinho C, Leite D. Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort. Braz J Anesthesiol 2021; 72:605-613. [PMID: 33887339 PMCID: PMC9515676 DOI: 10.1016/j.bjane.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
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Affiliation(s)
- Marta G Campos
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal.
| | - Ana R Peixoto
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Sara Fonseca
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Francisca Santos
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Cristiana Pinho
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Diana Leite
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
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Miranda J, Silva L, Almeida C, Figueiredo I, Machado D, Fonseca S. Bleuler’s a or autism spectrum disorder in adults? Eur Psychiatry 2021. [PMCID: PMC9475672 DOI: 10.1192/j.eurpsy.2021.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Nowadays we know that autism spectrum disorders (ASD) and Schizophrenic spectrum (SS) are different types of disorders in their etiology, symptoms and prognosis, but the clinical distinction is often difficult to make due to comorbidity and similar symptoms. Objectives With this project, the authors intend to explore the differential diagnosis between ASD and SS specially when we talk about critical ages of onset. Methods An analysis of articles searched on Pubmed (articles between 2010-2020) with the key words “adult autism”, “childhood onset schizophrenia”, “childhood psychosis”. Results Early-onset schizophrenia (EOS) is defined as occurring before age 18 years. The condition share key diagnostic symptoms with adult-onset schizophrenia (AOS) but his prognoses and comorbidities differ. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by difficulties since early childhood across reciprocal social communication and restricted interests and behaviors. ASD is a lifelong neurodevelopmental disorder, however there is a lack of answers and research for adults with ASD. There are shared aspects of odd thinking, rigid behaviors and impaired socialization in schizophrenia and ASD and COS seems to have a strong relationship with ASD, being comorbid in up to 50% of cases. Conclusions Usually the evaluation of the developmental history of the person, prodrome and onset, its course and the presence of positive symptoms of schizophrenia is enough to help us find a diagnosis. Unfortunately, in some ages the conclusion is not so easy to find. However is essential to determine whether the clinical manifestations belong to the autistic spectrum, the schizophrenic or result from comorbidity.
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Morais J, Esteves P, Fonseca S. Transcranial magnetic stimulation and eating disorders, any efficacy? Eur Psychiatry 2021. [PMCID: PMC9471352 DOI: 10.1192/j.eurpsy.2021.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionEating Disorders (ED) tend to evolve chronically, with resistance to different therapeutic strategies. Chronicity is associated with high mortality rates, so it is necessary to study new therapeutic strategies. Transcranial Magnetic Stimulation (TMS) is a non-invasive, safe treatment method, whose application has been studied in several pathologies.ObjectivesDetermine the therapeutic potential of Transcranial Magnetic Stimulation in the treatment of Eating Disorders.MethodsBibliographic review of the literature published in English in the last 10 years, in the databases Pubmed, PsycINFO and Cochrane. The keywords used were: TMS, Transcranial Magnetic Stimulation, Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder. A review of the titles and abstracts of the resulting articles was made, and selected according to their relevance to the study.ResultsEighteen articles related to the treatment of ED with TMS were selected, either as primary or secondary outcome, of which six were review articles, ten were randomized controlled trials (RCT), one article was an oral communication and another article was a case report. Three RCTs showed improvement in bulimia nervosa, specifically in symptoms of “food craving”. Four RCT and one case report showed improvement in the symptoms of anorexia nervosa, one RCT showed no improvement in anorexia nervosa.ConclusionsTMS appears to have some therapeutic potential for the treatment of ED, particularly in reducing food craving, despite some contradictory results. This work reinforces the need for more robust studies to evaluate the effectiveness of TMS, preferably randomized, with a longer follow-up and a cost-benefit analysis.
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Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
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Domingues R, Fonseca S, Leal M, Aquino E, Menezes G. Unsafe abortion in Brazil: a systematic review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In Brazil, abortion is legally allowed in cases of risk to the woman's life, pregnancy resulting from rape and cases of fetal anencephaly. Despite the restrictive legislation, studies estimated that around 1 million abortions took place in the country in 2005. Abortions occurred regardless of womeńs socioeconomic position, race, age and religion, but unsafe practices were more common among young women, with low educational levels, single, students or domestic workers. This study sought to update knowledge on unsafe abortion in Brazil.
Methods
We carried out a systematic review with study search on Medline and LILACS, with no language restriction, from 2008 to 2018. We evaluated article quality using the Joanna Briggs Institute instruments. We evaluated 50 articles.
Results
There was a decrease in the ratio of induced abortions by 1,000 women of reproductive age reaching 16 per 1,000 in 2013. However, direct estimates do not indicate a decrease in the prevalence of induced abortion, estimated to be 13% in 2016. Higher prevalences were observed in more socially vulnerable populations. Half of all women reported using medications for terminating pregnancies and the number of hospital admissions due to complications from abortion decreased from 1992 to 2009. Maternal morbimortality from abortion had a reduced frequency but it is likely that maternal deaths from abortion are under-reported.
Conclusions
Abortion is frequently used in Brazil, especially in less-developed regions and by more socially-vulnerable women. Access to safer methods probably contributed to the reduction of complications, hospitalizations and morbimortality from abortion. However, half of all women still used other unsafe methods and the number of admissions due to complications from abortion is still high. The small scientific production and lack of methodological adequacy led to the development of a special issue on Abortion in Brazil in the jornal Reports in Public Health.
Key messages
Restrictive legislation does not prevent abortion, but limits access to safe abortion and makes it diffiult to prevent morbidity and mortaliity from abortion. Restrictive legislation and the stigma associated with abortion make studies difficult to estimate the rates, complications and factors associated with abortion.
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Affiliation(s)
- R Domingues
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro, Brazil
| | - S Fonseca
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brazil
| | - M Leal
- Department de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca/Fiocruz, Rio de Janeiro, Brazil
| | - E Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - G Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Figueiredo M, Leão A, Moreno C, Fernandes M, Hernandez A, Correia JM, Gouveia M, Ramos P, Fonseca S, Faria T, Santos P, Oliveira R, Gomes S. Anaesthesia Department Preparedness and Response for the COVID-19 Outbreak in Portugal: A Perspective from CUF Porto Hospital. GM 2020. [DOI: 10.29315/gm.v7i2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A global health emergency has been declared by the World Health Organization (WHO) as the SARS-CoV-2 outbreak spread across the world. Patients infected with SARS-CoV-2 are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to health workers providing care.1 In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here we described the measures for the outbreak adopted by the anesthesia department of a private tertiary care level hospital in Porto. These include engineering controls such as: identification and preparation of an isolation operating rooms, administrative measures such as: modification of workflow and processes, introduction of personal protective equipment, and formulation of clinical guidelines for anaesthetic management. We discuss how the hierarchy of controls should be a framework to plan, the necessary measures during each phase of a pandemic, and review the evidence of the procedures taken. [...]
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Fonseca S, Reis C, Monteiro L, Monteiro C, Serrano M. Hearing Screening in Preschool Children of a Rural Community in Portugal - A 10-year Experience. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction Preschool hearing screening programmes would identify later onset or progressive hearing losses and conductive hearing loss, due to the high prevalence of otitis media with effusion in childhood. Hearing loss associated with otitis media with effusion can have a great impact on reading, writing, central auditory processing and balance.
Objectives The present study aims at characterising the audiological alterations found in preschool children screened in a rural community in Portugal, and the correlation between audiological findings and otoscopy.
Methodology This is an observational study using the results obtained in a ten year audiological and otological screening of preschool children. Otoscopy, Tympanometry and Audiometry (1, 2 and 4 KHz presented at 40 and 20 dB intensity) were performed at the first stage of the screening and the results were classified as “pass” or “refer”. Every non-normal result of any category would imply a second stage consisting of observation by an ENT specialist at the site and the establishing of a follow-up plan. Written Informed Consent was obtained from the parents prior to initiating the study.
Results 595 children aged 5 and 6 years were screened between 2007 and 2017, of whom 192 (32.3%) required referral to the second stage. The most frequent alteration was found in the tympanogram. The tympanograms showed a significant correlation with the otoscopy performed by the ENT doctor, mainly type B tympanograms. The pass/refer audiometry also showed a statistically significant correlation with the medical otoscopy, although weak in all frequencies studied.
Conclusion It’s extremely important to perform a hearing screening in the age range of 5-6 years (with a high predisposition to middle ear problems), with the main objective of identifying and referring for treatment children who present alterations in order to reduce the consequences of the hearing impairment.
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Affiliation(s)
- S Fonseca
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Audiologia, Portugal
| | - C Reis
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Audiologia, Portugal
| | | | | | - M Serrano
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Audiologia, Portugal
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Vande Berg P, Fonseca S, Al-Awa A, Rezai Monfared M, Delande S, Chamlou R, Etogo-Asse FE, Van Maele P. A rectal metastasis of an unknown lobular breast carcinoma and its management. Acta Gastroenterol Belg 2020; 83:327-330. [PMID: 32603055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Breast cancer is the most common cancer in women but gastro- intestinal metastases of breast cancer are rare. They can occur years after the diagnosis or at the diagnosis of breast cancer. We report the case of a patient complaining of dyschesia, tenesmus and anal incontinence leading to the discovery of a rectal metastasis of an unknown breast neoplasia. Given the oligo-metastatic condition, multidisciplinary and aggressive management was the chosen therapy.
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Affiliation(s)
- P Vande Berg
- Université catholique de Louvain, Bruxelles, Belgium
| | - S Fonseca
- Clinique Saint Jean, Bruxelles, Belgium
| | - A Al-Awa
- Vrije Universiteit Brussel, Belgium
| | | | - S Delande
- Clinique Saint Jean, Bruxelles, Belgium
| | - R Chamlou
- Clinique Saint Jean, Bruxelles, Belgium
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Campos I, Marques A, Sousa L, Fonseca S, Apolinario I, Costa Oliveira C, Veira C, Costeira Pereira A, Salome N, Pereira VH, Marques Pires C, Medeiros P, Marques J, Brandao I. P1313 A curious case of endocarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Nonbacterial thrombotic endocarditis (NBTE) is a rare form ofnoninfectious endocarditis in which a small sterile vegetations deposited on the heart valves (mostly aortic and mitral).It has been reported in every age group, most commonly affecting patients between the fourth and eighth decades of life with no sex predilection. Patients with advanced malignancy and those with systemic lupus erythematosus are the most common populations affected by NBTE, and they are typically asymptomatic until embolization occurs. Here, we report a case of a female patient with rheumatoid arthritis whose diagnosis was made prior to any thromboembolic event.
CASE REPORT DESCRIPTION
An 83-year-old female patient with a 10-year history of rheumatoid arthritis, was admitted for urinary tract infection with exacerbation of chronic renal disease and decompensated heart failure of unknown etiology. On physical examination, she was febrile (38,3ºC) with a blood pressure of 130/70 and pulse rate of 90 beats/min. Cardiac auscultation revealed a sistolic murmur of grade 1/4 in the fifth left intercostal space. A joint deformities in the hands were noted, such as interosseous atrophy and ulnar deviation. To evaluate this new sistolic murmur,the transthoracic echocardiogramwas performed and showed a vegetation in the mitral valve. Then, a transesophageal echocardiogram(TEE) was requested to better characterize this vegetation, showing a vegetation of 19x4mm involving the posterior cusp of the mitral valve leaflet, with moderate mitral regurgitation,being the hypothesis of infective endocarditis (IE) proposed. There were no other significant abnormalities in the remaining echocardiogram. Empirical antibiotic therapy to IE was initiated. The TEE was repeated after 4 weeks of antibiotic therapy with maintenance of the referred vegetation and mention of a smaller one (10x2mm). Clinical investigation didn’t show any infectious process. Hence, the hypothesis of NBTE was established. Anti-coagulation therapy was started immediately. The NBTE lesion disappeared in the follow-up echocardiography three months post anti-coagulation treatment.
CONCLUSION
Although NBTE is an uncommon and difficult diagnosis that requires a high degree of suspicion, its timely diagnosis is essential since it allows the prevention of thromboembolic events, resulting in a positive impact on patients" quality of life. In addition, the existence of this clinical condition may allow the diagnosis of another underlying disease, such as a hidden neoplasia. Thus, the authors believe that the sharing of this clinical case will allow a reflection on this entity emphasizing the importance in the hypotheses of vegetation diagnosis. From the authors" knowledge, from the available medical literature, the clinical case presented is one of the few NBTEs described in patients with rheumatoid arthritis, with mitral valve involvement and whose diagnosis was made before any thromboembolic event.
Abstract P1313 Figure. A vegetation of mitral valve
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - A Marques
- Hospital de Braga, Internal Medicine, Braga, Portugal
| | - L Sousa
- Hospital de Braga, Internal Medicine, Braga, Portugal
| | - S Fonseca
- Hospital de Braga, Cardiology, Braga, Portugal
| | - I Apolinario
- Hospital de Braga, Internal Medicine, Braga, Portugal
| | | | - C Veira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
| | - I Brandao
- Hospital de Braga, Internal Medicine, Braga, Portugal
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Durães Campos I, Marques AR, Sousa L, Fonseca S, Oliveira C, Vieira C, Apolinário I, Brandão I. Nonbacterial thrombotic endocarditis. Rev Port Cardiol 2019; 38:511-514. [PMID: 31522938 DOI: 10.1016/j.repc.2018.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 01/06/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022] Open
Abstract
An 83-year-old woman with a 10-year history of rheumatoid arthritis was admitted for urinary tract infection with exacerbation of chronic kidney disease and decompensated heart failure of unknown etiology. Transesophageal echocardiography (TEE) showed a vegetation involving the posterior mitral valve leaflet, and a hypothesis of infective endocarditis was proposed. Empirical antibiotic therapy was initiated. TEE was repeated after antibiotic therapy, and showed persistence of the original vegetation and revealed the presence of another, smaller vegetation. Clinical investigation revealed no infectious process, and so a diagnosis of nonbacterial thrombotic endocarditis (NBTE) was established. Anticoagulant therapy was started immediately. The NBTE lesion had disappeared on the follow-up echocardiogram two months after anticoagulant therapy.
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Affiliation(s)
| | - Ana Rita Marques
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
| | - Luciana Sousa
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
| | - Sara Fonseca
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
| | - Cátia Oliveira
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
| | - Catarina Vieira
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
| | - Isabel Apolinário
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
| | - Ilídio Brandão
- Serviço de Cardiologia e Medicina Interna, Hospital de Braga, Braga, Portugal
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Abstract
Thrombocytopaenia can be associated with an autoimmune mechanism. Immune thrombocytopaenia can be associated with thyroid autoimmune disease. The authors present a case of a teenager with a history of thrombocytopaenia who complained of tiredness. Laboratory investigation showed thyroid autoantibodies. The co-existence of thrombocytopaenia and thyroiditis lead to further investigation and antibodies against platelet glycoprotein IIbIIIa were found. This case illustrates the association of the overlap aspects between thyroid and platelet autoimmunity.
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Affiliation(s)
- Sara Fonseca
- Pediatrics, Centro Hospitalar São João, Porto, Portugal
| | - Catarina Lacerda
- Pediatrics, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Ines Ganhão
- Pediatrics, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Sofia Castro
- Pediatrics, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
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Durães Campos I, Marques AR, Sousa L, Fonseca S, Oliveira C, Vieira C, Apolinário I, Brandão I. Nonbacterial thrombotic endocarditis. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
BACKGROUND Choroidopathy is a rare manifestation of systemic lupus erythematosus (SLE). This entity is associated with active phases of severe SLE and it is frequently accompanied by acute kidney failure, central nervous system involvement and coagulopathy. PURPOSE To evaluate the choroid thickness of patients with lupus nephritis (LN) without choroidopathy, and to compare this with that of age-matched SLE patients without LN and healthy control subjects. STUDY DESIGN Cross-sectional case control study. MATERIAL AND METHODS Fifteen women with LN in remission phase (study group), 15 women with SLE in remission without LN (SLE control group), and 15 healthy women (healthy control group), without ocular diseases or significant refractive error, were recruited. Full ophthalmological examination and a macular optical coherence tomography in enhanced depth imaging mode were performed. The choroid thickness was measured at nine macular points and six lines of mean choroidal thickness were determined. A comparative analysis between the three groups was performed using the one-way ANOVA test and the paired t-test. The choroid thickness of patients under corticotherapy was also compared to that of patients without corticotherapy. Additionally, the correlation between choroid thickness and disease duration was evaluated using the Pearson analysis. RESULTS The mean macular choroidal thickness was 295.73 ± 67.62 μm in the study group, 233.34 ± 41.01 µm in the SLE control group, and 240.98 ± 37.93 μm in the control group ( p = 0.00006 and p = 0.0003, respectively). Additionally, the choroid thickness was significantly thicker than in the SLE and healthy control groups at the foveal ( p = 0.004 and p < 0.000), nasal ( p < 0.000 and p = 0.001), superior ( p = 0.002 and p < 0.000) and inferior ( p < 0.000 and p = 0.001) mean lines. The choroidal thickness in this group was not associated with the duration of the disease. The subgroup of patients with LN under corticotherapy did not reveal a significantly different choroidal thickness. CONCLUSION This study suggests a relationship between LN and choroidal changes, which may represent an increased risk for choroidopathy in these patients. Choroid thickening was not related with the duration of the disease. This thickening may be correlated with histopathological changes similar to those occurring in kidney glomeruli.
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Affiliation(s)
- J Braga
- 1 Centro Hospitalar de Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| | - R Rothwell
- 2 Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - M Oliveira
- 1 Centro Hospitalar de Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| | - D Rodrigues
- 1 Centro Hospitalar de Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| | - S Fonseca
- 1 Centro Hospitalar de Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| | - R Varandas
- 1 Centro Hospitalar de Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
| | - L Ribeiro
- 1 Centro Hospitalar de Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal
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Macieira A, Barros D, Vaz-Velho M, Pinheiro R, Fonseca S, Albano H, Teixeira P. Effects of Lactobacillus plantarum Bacteriocinogenic Culture on Physicochemical, Microbiological, and Sensorial Characteristics of “Chouriço Vinha d´Alhos”, a Traditional Portuguese Sausage. J Food Qual Hazards Control 2018. [DOI: 10.29252/jfqhc.5.4.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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29
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Marinho R, Sousa M, Machado F, Fonseca S, Guedes L. Cerebrospinal fluid cutaneous fistula after neuraxial anesthesia: an effective treatment approach. Scand J Pain 2018; 18:739-741. [DOI: 10.1515/sjpain-2018-0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/27/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Cerebrospinal fluid cutaneous fistula is a rare but potentially serious complication of epidural analgesia. We report the case of a patient submitted to total knee arthroplasty under subarachnoid block and placement of lumbar epidural catheter for post-operative analgesia. The epidural catheter was found exteriorised on the fourth post-operative day, and the patient presented with a moderate fluid leak from the puncture site that was confirmed to be cerebrospinal fluid by cytological and chemical analysis. The initial therapeutic approach consisted of bed rest, hydration and prophylactic antibiotic therapy for 3 days, but it was ineffective as the leak persisted. A suture was placed at the epidural insertion site with immediate resolution of the leak. The suture was maintained for 5 days. The patient progressed satisfactorily without requiring further therapies.
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Affiliation(s)
- Ramiro Marinho
- Department of Anesthesiology , Centro Hospitalar S. João, Largo do Prof. Abel Salazar 4099-001 , Porto , Portugal
| | - Mara Sousa
- Department of Anesthesiology , Centro Hospitalar S. João, Largo do Prof. Abel Salazar 4099-001 , Porto , Portugal
| | - Filipa Machado
- Department of Anesthesiology , Centro Hospitalar S. João, Largo do Prof. Abel Salazar 4099-001 , Porto , Portugal
| | - Sara Fonseca
- Department of Anesthesiology , Centro Hospitalar S. João, Largo do Prof. Abel Salazar 4099-001 , Porto , Portugal
| | - Luísa Guedes
- Department of Anesthesiology , Centro Hospitalar S. João, Largo do Prof. Abel Salazar 4099-001 , Porto , Portugal
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Barros D, Vaz Velho M, Pinto R, Pinheiro R, Fonseca S, Macieira A, Albano H, Morais A, Teixeira P. The effect of the addition of fresh and dried starter cultures on microbiological and chemical parameters of a smoked sausage “Alheira”. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Costa C, Fonseca S, Guedes L, Leão A, Sousa A. Epidural catheter anchored in the posterior lateral epidural space: How to manage it. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:59-61. [PMID: 28757216 DOI: 10.1016/j.redar.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/29/2017] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
We describe a case of an epidural catheter entrapment without knotting, kinking, shearing or breakage confirmed by CT scan and how to manage it. A patient was admitted for tibial fracture repair under general anesthesia with an epidural. At discharge day, multiple attempts to retrieve the catheter were made. Contrast CT scan showed the catheter anchored in the left posterior-lateral epidural space. Despite the absence of guidelines regarding epidural catheter entrapment, all the methods described in the literature were used. This is a rare complication and it may be associated with neurological and infectious complications. Radiologic imaging should be obtained to better characterize the catheters' position and plan removal. In this case, tension in the paraspinal muscles or in the supraspinous and intraspinous ligaments could explain the entrapment. General anesthesia with the non-depolarising muscle relaxant allowed muscles and ligaments to relax and we were able to retrieve the catheter intact.
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Affiliation(s)
- C Costa
- Servicio de Anestesia, Centro Hospitalar de São João, Porto, Portugal.
| | - S Fonseca
- Servicio de Anestesia, Centro Hospitalar de São João, Porto, Portugal
| | - L Guedes
- Servicio de Anestesia, Centro Hospitalar de São João, Porto, Portugal
| | - A Leão
- Servicio de Anestesia, Centro Hospitalar de São João, Porto, Portugal
| | - A Sousa
- Servicio de Ortopedia y Traumatología, Centro Hospitalar São João, Porto, Portugal
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Melim J, Batista A, Tarelho A, Araújo R, Fonseca S. Behavioral manifestations post hemispherectomy due to Sturge–Weber syndrome–A case of success. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionSturge-Weber syndrome or encephalotrigeminal angiomatosis is an uncommon neurocutaneous syndrome that manifests with vascular malformations involving the brain, eye and skin; Severe cases present with refractory seizures, sometimes requiring major surgery such as hemispherectomy. Most of the times, some degree of mental retardation and behavioral problems are associated, requiring use of psychotropic medication and other contention strategies. This report describes the case of a 19-year-old boy who was submitted to a left hemispherectomy by the age of one, and was still able to successfully complete basic education. He started presenting severe behavioral problems, with aggressive outbursts, by the beginning of adulthood, having been committed to psychiatry ward. By the age of 22, the patient finds himself calm and functional considering his limitations, with no need for hospital admission for 2 years.Objectives/aimsTo describe a clinical case whilst reviewing literature concerning this matter.MethodsCase report with complete clinical history and medical data. Non-systematic review of PubMed database under the terms “Sturge-Weber disease”, “Hemisferectomy”, “behavioral disorder due to organic causes”, “post hemisferectomy out-comes”.Results/discussionAlthough presenting with severe arteriovenous malformation, refractory epilepsy and left hemispherectomy, the patient was able to conclude basic instruction; He has lived with his family until the age of 19, when he started displaying disruptive behaviour; after 3 hospital admissions and perfecting psychotropic drugs treatment, the patient was admitted to an institution for rare diseases patients Since then he has experienced a calm and functional life, with trained professionals who can offer the non-pharmacological approaches he needs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Moreno CADSS, Fonseca S. Afonia após cirurgia do ombro: relato de caso. Braz J Anesthesiol 2016. [DOI: 10.1016/j.bjan.2013.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Moreno CADSS, Fonseca S. Aphonia after shoulder surgery: case report. Braz J Anesthesiol 2016; 66:321-3. [PMID: 27108832 DOI: 10.1016/j.bjane.2013.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/13/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022] Open
Abstract
In this case report we highlight the uniqueness of aphonia as, to the best of our knowledge, cases of aphonia related to interscalene brachial plexus block (IBPB) are not described in the literature. Although hoarseness is a common complication of IBPB, aphonia is not. Therefore, we think it is important to publicize the first case of aphonia after IBPB, which may have arisen only because of a recurrent laryngeal nerve chronic injury contralateral to the IBPB site.
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Dias Amaral A, Peixoto M, Cortiñas A, Fonseca S, Curral R. The Psychiatry consultation in primary health care setting at an Oporto Area: Sociodemographic and clinical data. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThe Psychiatry consultation is a collaborative approach between primary health care services and community mental health teams. Our clinic provides support to three Oporto areas (Bonfim/Paranhos, Campanhã and Maia/Valongo) corresponding to a population of 350,000 inhabitants.ObjectivesTo analyze and collect Psychiatry consultation data of the first semester of 2015 in Maia/Valongo region. We aim to describe our population's sociodemographic characteristics, the most common referral motive, diagnosis and therapeutics, and orientation.MethodsPsychiatry consultation data of the first semester of 2015 were collected and analyzed using SPSS software (version 20).ResultsOne hundred and sixty-one patients were evaluated. A total of 26.09% were male and 73.91% were female. The mean age was 51.61 years old. The most frequent referral motives were depressive (47.82%) and anxiety (23.60%) symptoms. The two most common diagnostic groups according to the International Classification of Diseases (version 10) were F30-F39–Mood affective disorders (57.76%) and F40-F48–Neurotic, stress-related and somatoform disorders (18.63%). 22.36% of the patients were referred without medication, but only four were discharged drug-free, corresponding to bereavement situations. 34.16% of our population were previously prescribed two or more psychotropic drugs, increasing to 63.98% after assessment. Only 18.63% met criteria to hospital referral.ConclusionsThe Psychiatry consultation selects the most severe patients and allows a faster evaluation of mentally ill patients awaiting hospital consultation, thus preventing unnecessary access to the emergency room. Authors consider that all the patients referred to a hospital consultation should be previously evaluated by a consultant psychiatrist on a primary health care setting.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Prete R, Ramos P, Fonseca S, Andrade C, Scarpato V. MON-PP200: Analysis of Nasogastric Tube Loss Causes in Hospitalized Patients in Intensive Care Unit. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pinto C, Mota Oliveira M, Ribeiro A, Fonseca S. The Interface Between Depression and Dementia. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lorenzo JM, Fonseca S, Gómez M, Domínguez R. Physicochemical and sensory properties of Celta dry-ripened “salchichón” as affected by fat content. Grasas y Aceites 2015. [DOI: 10.3989/gya.0709142] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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Mourão-Carvalhal I, Costa C, Fonseca S, Coelho E. Childhood Obesity and School Failure in Disadvantaged Contexts: Effect of a Multidisciplinary Intervention Program. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mendonça L, Fonseca S, Bittencourt N, Ocarino J, Gonçalves G, Verhagen E. FACTORS ASSOCIATED TO PATELLAR TENDINOSIS IN ATHLETES: PROVIDING A BASE FOR INJURY MECHANISM AND PREVENTION. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bittencourt N, Ocarino J, Sorrentino F, Jales F, Gabriel S, Mendonça L, Fonseca S. NORMATIVE DATA FOR MUSCLE FLEXIBILITY IN MALE SOCCER PLAYERS. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mendonça L, Bittencourt N, Zuin A, Barreto R, Ocarino J, Fonseca S. SCREENING ATHLETES WITH PATELLAR TENDINOSIS: CLINICAL INFORMATION TO GUIDE PREVENTIVE ATTITUDES. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roebeling PC, Rocha J, Nunes JP, Fidélis T, Alves H, Fonseca S. Using the soil and water assessment tool to estimate dissolved inorganic nitrogen water pollution abatement cost functions in central portugal. J Environ Qual 2014; 43:168-176. [PMID: 25602550 DOI: 10.2134/jeq2011.0400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Coastal aquatic ecosystems are increasingly affected by diffuse source nutrient water pollution from agricultural activities in coastal catchments, even though these ecosystems are important from a social, environmental and economic perspective. To warrant sustainable economic development of coastal regions, we need to balance marginal costs from coastal catchment water pollution abatement and associated marginal benefits from coastal resource appreciation. Diffuse-source water pollution abatement costs across agricultural sectors are not easily determined given the spatial heterogeneity in biophysical and agro-ecological conditions as well as the available range of best agricultural practices (BAPs) for water quality improvement. We demonstrate how the Soil and Water Assessment Tool (SWAT) can be used to estimate diffuse-source water pollution abatement cost functions across agricultural land use categories based on a stepwise adoption of identified BAPs for water quality improvement and corresponding SWAT-based estimates for agricultural production, agricultural incomes, and water pollution deliveries. Results for the case of dissolved inorganic nitrogen (DIN) surface water pollution by the key agricultural land use categories ("annual crops," "vineyards," and "mixed annual crops & vineyards") in the Vouga catchment in central Portugal show that no win-win agricultural practices are available within the assessed BAPs for DIN water quality improvement. Estimated abatement costs increase quadratically in the rate of water pollution abatement, with largest abatement costs for the "mixed annual crops & vineyards" land use category (between 41,900 and 51,900 € tDIN yr) and fairly similar abatement costs across the "vineyards" and "annual crops" land use categories (between 7300 and 15,200 € tDIN yr).
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Mil-Homens M, Costa AM, Fonseca S, Trancoso MA, Lopes C, Serrano R, Sousa R. Characterization of heavy-metal contamination in surface sediments of the Minho river estuary by way of factor analysis. Arch Environ Contam Toxicol 2013; 64:617-631. [PMID: 23299253 DOI: 10.1007/s00244-012-9861-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 12/11/2012] [Indexed: 06/01/2023]
Abstract
Surface sediments were collected in August 2009 from 49 sites along the Minho estuary (between Tui and Caminha) and analyzed for grain size, organic carbon (Corg) and total nitrogen (Ntot) contents, and major (silicon [Si], aluminum [Al], iron [Fe], calcium [Ca], magnesium [Mg], sodium [Na], potassium [K], titanium [Ti], and mangesese [Mn]) and trace element (arsenic [As], chromium [Cr], copper [Cu], mercury [Hg], lithium [Li], lead [Pb], rubidium [Rb], tin [Sn], and zinc [Zn]) concentrations. Factor analysis was used to decrease 22 selected variables into 4 factors accounting for 85.9 % of the total variance explained, suggesting distinct elemental sources or sediment components affecting their spatial distributions. Although factors 1 (detrital component; elements strongly associated with fine- [Na, Mg, Ti, Li, Cr, Cu, Fe, Al, Zn, Ca, and As] and coarse-grained sediments [Si, K, Rb; mean grain-size [MGS]) and 3 (Fe-Mn oxyhydroxide sediment component; Fe, Mn, As, fine fraction) are interpreted as reflecting predominance of natural contributions, factors 2 (urban and industrial contamination: sediment components [Pb, Hg, organic carbon [Corg], total nitrogen [Ntot] and 4 (components associated with contamination by nautical activities; the association of tin [Sn] and calcium [Ca]) seem to indicate anthropogenic contributions). Nevertheless, the influence of elemental contributions derived from tungsten (W)-Sn mineralizations and those resulting from mining activities can also contribute to the obtained geochemical associations and should be considered. Spatial distribution of dominant factor scores shows the dominance of factors 2 and 4 between Tui and Vila Nova de Cerveira, whereas samples dominated by factors 3 and 1 are found between Ilha da Boega and Seixas and in the Caminha areas, respectively. Despite the dominance of factor score 1 in the Caminha area, the distribution pattern of dominant factor scores shows samples dominated by other factor scores that can be explained by dredging activities in this river sector that restore ancient sedimentary characteristics or expose contaminated sediments. Through the identification of sample locations dominated by factors associated with contamination, it will be possible to select them as priority areas where new environmental (e.g., toxicity tests, organic Sn compounds, tracers of sewage contamination) studies should be implemented in the future.
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Affiliation(s)
- M Mil-Homens
- Instituto Português do Mar e da Atmosfera, I.P., Av. Brasília, 1449-006, Lisbon, Portugal.
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Bastian N, Fonseca S, Clemens CR, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. [Predictive near-infrared SLO signs for tears of the retinal pigment epithelium due to age-related macular degeneration]. Klin Monbl Augenheilkd 2013; 230:270-4. [PMID: 23508756 DOI: 10.1055/s-0032-1328159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to identify potential predictive markers in confocal scanning laser ophthalmoscopy (cSLO)-based imaging for tears of the retinal pigment epithelium (RPE) in the presence of pigment epithelial detachments (PED) due to age-related macular degeneration (AMD). METHODS Fifteen eyes of 15 patients (mean age 77 years, SD ± 6) with RPE tears and pre-existing PEDs were retrospectively analysed for the presence of increased signals on near-infrared imaging (NIR) using confocal scanning laser ophthalmoscopy (cSLO). RESULTS In 87 % of the cases increased reflectance signals on NIR in the area of the PED were noted prior to the development of an RPE tear. On average, these signals were recorded 58 days (SD ± 40) before the rip was diagnosed. In 62 % of the patients these signals were localised opposite to the rip location at the rim of the PED. CONCLUSION Increased reflectance signals on NIR imaging may serve as a predictive marker for RPE tears in patients with PED in AMD. These signals recordable with a non-invasive imaging method should be prospectively validated in a larger cohort of patients with PEDs. It may be useful in the management of patients exhibiting this manifestation of exudative AMD.
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Affiliation(s)
- N Bastian
- Augenklinik, Universität Bonn, Germany.
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Batista M, Dugernier T, Simon M, Haufroid V, Capron A, Fonseca S, Bonbled F, Hantson P. The spectrum of acute heart failure after venlafaxine overdose. Clin Toxicol (Phila) 2013; 51:92-5. [DOI: 10.3109/15563650.2012.763133] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Faria-Correia F, Barros-Pereira R, Queirós-Mendanha L, Fonseca S, Mendonça L, Falcão M, Brandão E, Falcão-Reis F, Carneiro A. Characterization of Neovascular Age-Related Macular Degeneration Patients with Outer Retinal Tubulations. Ophthalmologica 2013; 229:147-51. [DOI: 10.1159/000346854] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 12/29/2012] [Indexed: 11/19/2022]
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Sousa A, Paiva JA, Fonseca S, Raposo F, Valente L, Vyas D, Ribeiro O, Pinto R. Rhabdomyolysis: risk factors and incidence in polytrauma patients in the absence of major disasters. Eur J Trauma Emerg Surg 2012; 39:131-7. [PMID: 26815069 DOI: 10.1007/s00068-012-0233-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 10/07/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Rhabdomyolysis is a syndrome caused by musculoskeletal tissue damage that leads to the release of large amounts of intracellular elements, which particularly affect renal function. The most common causes are severe trauma, ischemia, surgical procedures, and drug abuse. We aimed to determine the incidence of rhabdomyolysis by measuring muscle injury markers (CK, myoglobin), to identify pre/post-admission as well as iatrogenic risk factors for rhabdomyolysis in severe polytrauma, to clarify the relevance of orthopedic injuries and surgical treatment in the onset/worsening of rhabdomyolysis, and to correlate risk factors with its main complication-acute renal failure (ARF). METHODS Prospective study of severe polytrauma patients (Injury Severity Score (ISS) >15), with CK and myoglobin values measured at admission and after 24, 48, and 72 h. Peak values, variations between admission and peak, and variations between admission and day 3 were all determined. The correlations of those values with the onset of ARF and other negative outcomes were assessed. RESULTS A total of 57 consecutive patients with a median ISS of 29 were included. ARF was present in 20 patients (38 %). CK-0 level was correlated with male gender (p < 0.027) and ISS (0.014); Mb-0 level was correlated with hypovolemic shock (0.003) and skeletal fracture (p < 0.043). CK-max was correlated with surgery (p < 0.038) and surgery duration (p < 0.014); Mb-max was correlated with surgery (p < 0.002) and anesthesia duration (p < 0.005). Δ-CK was correlated with surgery (p < 0.01) and surgery duration (p < 0.017), and Δ0-3-CK was correlated with surgery (p < 0.042). Logistic regression analysis found relationships between Δ0-3-CK and both ICU admission (p < 0.003) and MODS (p < 0.012), and between Mb-max and ARF (p < 0.034). CONCLUSION We found that a large number of factors are implicated in CK and Mb variations. Rhabdomyolysis is a very frequent complication, but increase in CK marker alone does not seem to be correlated with the incidence of ARF. Therefore, Mb level should be considered in this group of patients.
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Affiliation(s)
- A Sousa
- Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
| | - J A Paiva
- Emergency and Intensive Care Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
| | - S Fonseca
- Anesthesiology Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
| | - F Raposo
- Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
| | - L Valente
- Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
| | - D Vyas
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
| | - O Ribeiro
- Department of Decision and Information Sciences in Health, Faculdade de Medicina da UP, Alameda Prof. Hernani Monteiro, Porto, Portugal.
| | - R Pinto
- Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.
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Raposo R, Barroso M, Fonseca S, Costa S, Queiroz JA, Gallardo E, Dias M. Determination of eight selected organophosphorus insecticides in postmortem blood samples using solid-phase extraction and gas chromatography/mass spectrometry. Rapid Commun Mass Spectrom 2010; 24:3187-3194. [PMID: 20941767 DOI: 10.1002/rcm.4765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A simple, rapid and sensitive method is described for the determination of omethoate, dimethoate, diazinon, chlorpyrifos, parathion-ethyl, chlorfenvinphos, quinalphos and azinphos-ethyl in postmortem whole blood samples. The analytes and internal standard (ethion) were isolated from the matrix by solid-phase extraction, and were analysed by gas chromatography/mass spectrometry in the selected ion monitoring mode. The method has shown to be selective after analysis of postmortem samples of 40 different origins. Calibration curves were established between 0.05 (0.1 for omethoate) and 25 µg/mL, and the values obtained for intra- and interday precision and accuracy were within the criteria usually accepted for bioanalytical method validation. Lower limits of quantitation were 50 ng/mL for all compounds, except for omethoate (100 ng/mL); the limits of identification of the method were 25 ng/mL for all analytes, except for omethoate, for which 50 ng/mL was obtained. Absolute recovery was determined at three concentration levels, and ranged from 31 to 108%. The proposed method is simple and fast, and can be routinely applied in the determination of these compounds in postmortem whole blood samples within the scope of forensic toxicology. In addition, mass spectrometry has demonstrated to be a powerful and indispensable tool for the unequivocal identification of the analytes, since the acceptance criteria were accomplished even at very low levels, thus allowing obtaining forensically valid and sound results.
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Affiliation(s)
- R Raposo
- CICS - Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Avenida Infante D. Henrique, 6201-001 Covilhã, Portugal
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Fonseca S, Coutinho-Silva A, Rodrigues D, Marti L, Moreira-Filho C, Segurado A, Kallás E, Kalil J, Cunha-Neto E. P16-53. Distinct subsets of memory T lymphocytes from HIV-1-infected subjects secrete IFN-γ and IL-2 in response to novel CD4+ T-cell HIV-1 epitopes. Retrovirology 2009. [PMCID: PMC2767784 DOI: 10.1186/1742-4690-6-s3-p282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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