Hospital de Santa Maria
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Pancreatite Hipertrigliceridémica: Tratamento Convencional Versus Troca Plasmática Terapêutica
No full textIntroduction: Acute pancreatitis (AP) induced by hypertriglyceridemia
(HTG) can be treated with therapeutic plasma exchange
(TPE), resulting in rapid reduction of triglyceride level.
However, there are no definitive comparative studies that
prove the real benefits of this therapy.
Objectives: Comparison of treatment methods (TPE versus
conventional) in patients with HTG AP during a period of 12
years (2000-2012).
Methods: Retrospective, descriptive and inferential analysis of
37 patients, evaluating: gender, age, personal pathologic history,
severity of disease, HTG values and evolution depending
on treatment with therapeutic plasma exchange (“TPE”) or
with conventional therapy (“C”).
Results: Both groups TPE and C demonstrated homogeneity
considering gender (p = 0.647), age (43.5 ± 9.74 years TPE vs
45.30 ± 9.90 years C; p = 0.320), prior AP episode (40% TPE
vs 40.7% C; p = 1.0), chronic alcohol consumption (50% TPE
vs 70.4% C; p = 0.275) and severity disease scores: APACHE
II (p = 0.054) and Ranson (p = 0.258). More than one secondary
HTG risk factor was presented in 45.95% of patients
. TPE group presented higher TG levels at admission: 4850
± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0.001). No significant
statistical differences were observed considering length
of hospital stay [14.2 ± 6.8 days vs 13.5 ± 9.0 days (p = 0.56)]
or mortality rate (p = 0.47). At discharge, TG reduction was
greater in TPE group: 4433.70 ± 2896.08 mg/dL – 91.41% vs
1582.95 ± 2051.06 mg/dL – 83,92% (p = 0.002). Six minor
complications associated to TPE occurred.
Discussion/Conclusion: Despite the selection bias (retrospective
study), a greater TG reduction was observed with TPE
technique. Complications associated with the technique were
simple to resolveinfo:eu-repo/semantics/publishedVersio
Suppressing inflammation in rheumatoid arthritis: Does patient global assessment blur the target? A practice-based call for a paradigm change
No full textIn current management paradigms of Rheumatoid Arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role.info:eu-repo/semantics/publishedVersio
Próteses invertidas do ombro: Complicações - Caso Clínico Exemplo
No full textOs autores apresentam um caso clínico e a sequência de atitudes e resultados face a complicações de uma artroplastia gleno-umeral invertida. Apresenta-se um paciente de 62 anos do sexo feminino, submetida a artroplastia gleno-umeral invertida Delta 3 por artropatia da coifa dos rotadores à direita. Um mês após a intervenção que decorreu sem intercorrências, iniciou sinais inflamatórios superficiais e dores à mobilização do ombro. Não apresentava febre, a velocidade de sedimentação (VS) era de 85 e a proteína C reativa (PCR) 18. Fez tratamento médico anti-inflamatório, com regressão do quadro inflamatório. Após 4 meses, voltou o mesmo quadro inflamatório e reverteu com betametasona intramuscular. AApós melhoria temporária sofre nova agudização dos sinais Inflamatórios (VS 90 e PCR 5.7), sendo então decidido ser submetida a revisão cirúrgica da prótese. Intraoperatoriamente não se encontraram tecidos suspeitos de infeção e os componentes estavam fixos, pelo que apenas se substitui o polietileno. Cinco meses após a intervenção tem nova agudização que reverte com corticóide em SOS. Três anos após a artroplastia e com controlo de sinais inflamatórios ocasionais com anti-inflamatório, a paciente apresenta sinais radiográficos de notching escapular. Aos 6 anos após a artroplastia, a paciente inicia dores no ombro e apresenta diminuição evidente da sua funcionalidade (incapaz de se pentear). Radiograficamente a prótese está bem implantada, mas apresenta osteólise ao nível do componente epifisário. Passados poucos meses, a paciente recorreu ao serviço de urgência por abcesso na face posterior do braço
direito com evolução de cerca de um mês. Fez ecografia que confirmou a presença de abcesso com 6 cm de maior eixo e foi feita punção, com saída de pequeno conteúdo de liquido de aspecto piogénico. Foi pedido antibiograma que veio negativo. Após tentativas de tratamento médico do abcesso e várias punções sem deteção de microorganismo, surgiu uma fístula na face posterior do terço distal do braço, com drenagem abundante de liquido acinzentado. A zaragatoa teve mais uma vez resultados negativos. A paciente foi então proposta para extração de prótese. Intra-operatoriamente estavam presentes evidentes sinais de metalose, seguidamente confirmada pelo exame histológico. Passado 1 ano após extração da prótese, a paciente apresenta-se sem alterações cutâneas visíveis ou palpáveis, sem dores, com VS 10 e PCR 1.2, já se consegue pentear e mobiliza o ombro sem crepitações. Quando foi perguntado à paciente que pretendia uma nova prótese, a resposta foi: “Para já nem pensar”.
Em conclusão, apresenta-se um caso clínico de inflamações recorrentes de uma artroplastia gleno-umeral invertida sem deteção de causa infeciosa e com sinais evidentes de metalose sem descolamento associado, cujo resultado culminou na extração da prótese, com melhoria clínica e funcional da paciente.info:eu-repo/semantics/publishedVersio
Adrenalectomia parcial laparoscópica – será que vale a pena o esforço?
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Diagnóstico e Seguimento em Oncologia Urológica - Bexiga
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Smoking and antidepressants pharmacokinetics: a systematic review
Get PDFDespite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective.
METHODS:
We present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies.
RESULTS:
Twenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers.
CONCLUSIONS:
There is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.info:eu-repo/semantics/publishedVersio
Real-world outcomes of anti-VEGF treatment for retinal vein occlusion in Portugal
Get PDFPURPOSE:
Retinal vein occlusion (RVO) is an important cause of visual disability in the modern world. We aim to evaluate the real-world outcomes of patients with RVO treated with anti-vascular endothelial growth factor (VEGF) in Portugal.
METHODS:
We performed a retrospective, observational, multicenter study including 8 centers across Portugal and 200 patients treated with either ranibizumab or bevacizumab. Data were collected at 3 time points: time of diagnosis (0 time point) and 6 and 12 months after initiating treatment. Demographic and clinical data were collected.
RESULTS:
Median visual acuity (VA) and central macular thickness (CMT) improved in the branch RVO (BRVO), central RVO (CRVO), bevacizumab, and ranibizumab groups at 6 and 12 months compared to baseline, with CMT improving further only in the CRVO and ranibizumab groups between 6 and 12 months (p = 0.002 and p = 0.001, respectively). The CMT was lower in the ranibizumab group compared to the bevacizumab group both at 6 and 12 months (p<0.02). Median CMT improved in both the good and poor baseline VA groups at 6 and 12 months compared to baseline (p<0.001). Median VA only improved for the group with poor baseline VA at 6 and 12 months of follow-up (p<0.001). Regression analysis identified several baseline variables as predictors of visual outcomes at 6 and 12 months, with different results depending on the analyzed group.
CONCLUSIONS:
Both treatments were effective, although less effective than results reported in clinical trials. The morphologic response was better with ranibizumab compared to bevacizumab, although functionally there were no differences.info:eu-repo/semantics/publishedVersio
Rede Nacional de Cuidados Continuados Integrados – o seu impacto no funcionamento de um Serviço de Urologia
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