Browsing by Author "Batista, F"
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- Changes in Iron Metabolism Induced by Anti-Interleukin-6 Receptor Monoclonal Antibody are Associated with an Increased Risk of InfectionPublication . Ribeiro, R; Batista, F; Paula, F; Alves, JD(1) Background: Treatment of patients with rheumatoid arthritis (RA) with an anti-IL-6 receptor (anti-IL-6R) monoclonal antibody (tocilizumab) has been found to influence iron metabolism. The objective of the present study was to ascertain whether changes in iron metabolism induced by anti-IL-6R biologic therapy were independently associated with an increased infection risk. (2) Methods: A prospective longitudinal study of patients with RA treated with tocilizumab was conducted. RA patients treated with an antitumor necrosis factor α monoclonal antibody were also included as a control group. The primary outcome was occurrence of infection during the first 24 months of biologic therapy. (3) Results: A total of 15 patients were included, with a mean age of 51.0 ± 4,1 and 73.3% (n = 11) female. A multivariate survival regression model, adjusted for confounding factors, was fitted for each of the iron metabolism variables. Hazard ratios for being above the median of each parameter was considered. Transferrin saturation above the median value (>32.1%) was associated with a higher infection risk (HR 4.3; 95%CI 1.0-19.69; p = 0.05). Similarly, although non-significantly, higher serum iron was strongly associated with infection occurrence. (4) Conclusions: This study identified a probable association between infection risk and higher serum iron and transferrin saturation in patients with RA on anti-IL-6R biologic therapy. We suggest that both these parameters should be considered relevant contributing factors for infection occurrence in patients on anti-IL-6R therapy.
- Effects of lower limb strengthening on balance and function in persons who suffered a strokePublication . Fernandes, B; Batista, F; Beckert, P; Evangelista, I; Ferreira, MJ; Prates, L; Sérgio, JIntroduction - Cerebrovascular diseases, and among them, cerebral vascular accidents, are one of the main causes of morbidity and disability at European Union countries. Clinical framework resulting from these diseases include important limitations in functional ability of the these patients Postural control dysfunctions are one of the most common and devastating consequences of a stroke interfering with function and autonomy and affecting different aspects of people’s life and contributing to decrease quality of life. Neurological physiotherapy plays a central role in the recovery of movement and posture, however it is necessary to study the efficacy of techniques that physiotherapists use to treat these problems. Objectives - The aim of this study was to investigate the effects of a physiotherapy intervention program, based on oriented tasks and strengthening of the affected lower limb, on balance and functionality of individuals who have suffered a stroke. In addition our study aimed to investigate the effect of strength training of the affected lower limb on muscle tone.
- Etiology, Treatment and Prognosis of Acute PericarditisPublication . Serodio, J; Trindade, M; Achega, M; Faria, D; Maurício, J; Batista, F; Favas, C; Alves, JDIntroduction: Acute pericarditis is a common inflammatory condition of the pericardium usually assumed to be viral or idiopathic. Despite recent treatment improvements, information is scarce regarding etiology and prognosis. Our aim was to determine the incidence of pericarditis with a known etiology and assess clinical prognostic predictors. Material and Methods: A clinical retrospective analysis of hospitalized patients with acute pericarditis was conducted from 2012 to 2016. Population was characterized according to etiology, clinical presentation, treatment and prognosis. Outcomes of interest, evaluated at one year after hospital discharge, were pericarditis recurrence, hospitalization, constriction and overall mortality. Results: A total of 94 patients were enrolled, median age 46 years (inter-quartile range 32-61), 65% were male. Idiopathic etiology was responsible for 68% of cases. A specific etiology was found in the remaining 32% of patients, being the most frequent autoimmune disease (12%) and malignancy (5%). Idiopathic pericarditis was associated with myopericarditis (p = 0.049) and a known etiology with pericardial effusion (p = 0.001) and cardiac tamponade (p = 0.027). Recurrence of pericarditis was found in 13% of patients. Corticosteroid treatment in patients with an identified etiology was not associated with an increase in recurrence (p = 0.220). Overall 1-year mortality was 9%. A defined etiology was the only independent predictor of mortality at multivariate analysis (OR 40.3; 95% CI 1.9 – 137.2; p = 0.016). Conclusion: Up to one third of hospitalized patients with acute pericarditis have an identified cause of pericarditis and these patients are at increased risk of mortality.
- Knee muscle strength, balance and functional independence in persons with strokePublication . Fernandes, B; Batista, F; Beckert, P; Ivangelista, I; Ferreira, MJ; Prates, L; Sérgio, JPurpose: To investigate the relationship between knee muscle strength, balance and functional independence within the first month after stroke. Relevance: Cerebral vascular disease is one of the main causes of morbidity, disability and mortality in developed countries. Problems with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke and addresses impairments related to movement and posture in order to improve motor recovery and restore function. Participants: Subjects were recruited at Physiotherapy Department of Hospital Fernando Fonseca within the first month after stroke. We studied 8 patients, all males, mean age 62,5±6,2y, with unilateral stroke (7 ischemic, 1 hemorrhagic), in the middle cerebral artery territory, who were admitted to physiotherapy department. All subjects have no cognitive impairment according to Mini Mental State, no history of lower limb orthopedic problems and no other disease that could interfere with physiotherapy treatments. All subjects gave their informed consent to participate in this investigation. Methods: A test protocol was set up. Knee muscle strength (extensors and flexors) was measured on an isokinetic dynamometer. Balance and functional independence were assessed using the Berg Balance Scale (BBS) and the Modified Barthel Index (MBI) respectively. Analysis: The results were analyzed in an SPSS program version 17.0. Descriptive statistics were used to characterize the participants. A correlation analysis was performed using knee muscle strength, BBS and MBI. The significance level was set at p < 0,05. Results: Knee extensors from the affected lower limb show a deficit of 26,6% regarding knee extensors from the opposite knee. For knee flexors the deficit is 34,5%. Mean score for BBS is 29,63 ± 14,81 in a 56 point scale which indicates risk of fall. MBI mean score of 65,63 ± 17,33 indicates functional dependence. The correlation analysis demonstrates a positive correlation between BBS and MBI (Spearman correlation coefficient is 0,898 with p value = 0,002 < 0,01. These results indicate that function increase with balance. Conclusions: After stroke knee strength from the affected lower limb is impaired. It appears to be important to improve knee muscle strength from the affected lower limb to reduce weakness. In addition persons with stroke have higher risk of falls and are functionally dependent. There is evidence that balance is an important feature for functional independence in persons with stroke. Further research is needed to investigate the effect of knee muscle strength training on balance and function. Implications: These results indicate that early physiotherapy is needed after stroke. Intervention must focus on strength and balance training in order to improve stability and help persons with stroke to become functionally independent .
- Malária grave a plasmodium falciparum – a experiência de uma unidade de cuidados intensivosPublication . Maia, R; Batista, F; Ornelas, E; Fernandes, A; Carvalho, R; Ramos, AIntrodução: A malária é uma doença potencialmente fatal na ausência de tratamento dirigido e atempado. A sua forma grave é causada quase exclusivamente por Plasmodium falciparum. Material e Métodos: Estudo retrospetivo dos doentes com malária grave a Plasmodium falciparum admitidos no serviço de medicina intensiva (SMI) do Hospital de Cascais de Fevereiro/09 a Junho/17, com revisão do perfil clínico, terapêutica e outcome dos doentes, tendo em conta a gravidade da doença e o grau de parasitémia. Resultados: Treze doentes foram internados no SMI: 8 em cuidados intensivos e 5 em cuidados intermédios. Nenhum cumpriu quimioprofilaxia. Todos os doentes cursaram com trombocitopenia grave; 8 necessitaram de ventilação mecânica invasiva (VMI), dos quais 6 por acute respiratory distress syndrome; 4 doentes necessitaram de suporte aminérgico e 2 necessitaram de técnica dialítica. Os doentes com parasitémia ≥5% foram mais frequentemente ventilados com VMI (80 vs. 50%) e mais precocemente (2,5 vs. 4,0 dias); tiveram maior disfunção de órgão (4 vs. 2 órgãos afectados) e apresentaram internamentos mais prolongados (11 vs. 6 dias). Verificou-se ainda um aumento da prevalência de infecções com o tempo de internamento (p=0,005, se tempo de internamento ≥8 dias). A taxa de mortalidade foi de 15% - 2 doentes, ambos em regime de cuidados intensivos, com uma mediana de idade 11 anos superior aos restantes. Conclusão: Como reportado em estudos anteriores, o grau de parasitémia parece estar relacionado com a gravidade da doença. Paralelamente, a idade dos doentes e as intercorrências infecciosas também parecem determinantes do prognóstico da doença.
- Manifestações oftalmológicas de doenças sistémicasPublication . Pina, S; Coutinho, I; Amaral, N; Bernardo, M; Melo, A; Paula, F; Batista, F; Amaral, M; Alves, JD
- Methaemoglobinemia Induced by Poppers and Bupropion Intoxication in the Emergency Department.Publication . Batista, F; Alves, C; Trindade, M; Duarte, JA; Marques, RA 40-year-old man presented to the emergency department with dyspnoea and fatigue after bupropion and popper consumption. Clinical examination was remarkable for central cyanosis not responding to supplementary oxygen. Arterial blood gas analysis showed a methaemoglobin value of 30.3%. Methaemoglobinemia was diagnosed and the patient was treated with methylene blue. However, during methylene blue administration, the patient developed a generalized tonic-clonic seizure that was successfully managed with diazepam. Combined intoxications can be a critical problem in the emergency department. Early recognition and treatment of poisoning are key for good patient outcome. LEARNING POINTS: Distinguishing toxidromes is critical for adequate treatment of patients with drug intoxication; the most common side effect of bupropion consumption is dose-dependent seizures.The diagnosis of methaemoglobinemia requires a high index of suspicion, particularly in a patient presenting with central cyanosis not responding to supplementary oxygen.Treatment with methylene blue is recommended when the percentage of methaemoglobin is above 30% or when the patient has symptoms related to methaemoglobinemia.
- Reabilitação no AVC: normas orientadoras e percurso no HFFPublication . Bettencourt, F; Damião, L; Prates, L; Rosa, C; Morais, J; Batista, F; Alves, A; Silva, A; Patinha, D; Castro, C; Vera-Cruz, C; Beckert, P
- Síndrome de RowellPublication . Batista, F; Ferreira, I; Amaral, M