Browsing by Author "Costa, J"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Anatomic variants, congenital anomalies and pathology of the extrahepatic bile ductsPublication . Santiago, I; Maciel, J; Coelho, L; Costa, J; de la Fuente, G; Loureiro, R; Marques, C; Reis, D; Alves, F; Tardáguila, F
- Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT Multicenter RegistryPublication . Baptista, SB; Raposo, L; Santos, L; Ramos, R; Calé, R; Jorge, E; Machado, C; Costa, M; Oliveira, E; Costa, J; Pipa, J; Fonseca, N; Guardado, J; Silva, B; Sousa, MJ; Silva, JC; Rodrigues, A; Seca, L; Fernandes, RPenetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials.
- Infeção VIH: Epidemiologia, História Natural e DiagnósticoPublication . Trigo, D; Costa, JAo longo dos últimos 35 anos, grandes progressos foram alcançados em termos de prevenção, diagnóstico e tratamento de infeção VIH, com redução da incidência de infeção em Portugal, na última década. Ainda assim, continua a existir uma taxa elevada de doentes com diagnóstico tardio, com consequências individuais e populacionais. Este artigo tem como objetivos: apresentar um ponto de situação da infeção VIH em Portugal, rever brevemente a evolução natural da infeção e explicitar o mais recente algoritmo de diagnóstico de infeção VIH, revisto em 2014, reforçando a necessidade de manter um elevado nível de suspeição clínica para o diagnóstico precoce de infeção.
- PROS1 novel splice-site variant decreases protein S expression in patients from two families with thrombotic diseasePublication . Menezes, J; Ventura, C; Costa, J; Parreira, E; Romão, LOur results prove that c.1871-14T>G is causative of type I PS deficiency, highlighting the importance of performing mRNA-based studies in order to evaluate variants pathogenicity. We evidence the increased risk of venous thromboembolism associated with this cryptic splice-site variant if present in patients with PS deficiency.
- Recomendações para o diagnóstico da forma tardia da doença de PompePublication . Brito-Avô, L; Alves, JD; Costa, J; Herrero Valverde, A; Santos, L; Araújo, F; Aguiar, P; Marinho, A; Oliveira, A; Gomes, DINTRODUCTION: Pompe disease is a progressive and debilitating autossomal recessive myopathy due to mutations in lysossomal acid-α-glucosidase. Its late-onset form has a heterogeneous presentation mimicking other neuromuscular diseases, leading to diagnostic challenge. OBJECTIVE: To develop consensus based recommendations for the diagnosis of late-onset Pompe Disease. MATERIAL AND METHODS: Bibliographic review and analysis of an opinion questionnaire applied to a group of specialists with expertise in the diagnosis of several myopathies and lysossomal storage disorders. Discussed in consensus meeting. RECOMMENDATIONS: Patients with a progressive limb-girdle weakness, fatigue, cramps and muscle pain should be evaluated with CK levels, electromyography, dynamic spirometry and muscle biopsy in inconclusive cases. Suspected cases and those in which muscle biopsy could not allow other diagnosis should be screened for lysossomal acid-α-glucosidase deficiency with DBS (dried blood spot). The diagnosis should be confirmed by determination of lysossomal acid-α-glucosidase activity in a second sample and lysossomal acid-α-glucosidase gene sequencing.