Browsing by Author "Ferreira, A"
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- Estudo de utilização de albumina humana 20% no Hospital Fernando FonsecaPublication . Afonso, R; Costa, C; Elias, C; Fernandes, J; Ferreira, A; Jesus, S; Oliveira, C; Oliveira, I; Oliveira, MJ; Prata, A; Almeida, P
- Gastroenterite a shigella na idade pediátricaPublication . Ferreira, A; Brito, MJ; Sardinha, T; Machado, J; Ferreira, G; Machado, MCA Shigelose é uma causa importante de morbilidade e mortalidade na idade pediátrica. Objectivos Caracterizar a clínica, epidemiologia e alterações laboratoriais da Shigelose numa população infantil da área Amadora-Sintra e identificar factores associados ao aparecimento de complicações. População e Métodos: Estudo retrospectivo de 1/7/1997 a 30/06/2011 Analisaram-se idade, sexo, raça, condições socio-económicas, contexto epidemiológico, quadro clínico e complicações, exames laboratoriais, terapêutica e medidas preventivas. Resultados: De um total de 40 crianças, 67% eram do sexo feminino, 64% de raça negra, 70% tinham entre 1-4 anos de idade e 67% más condições socioeconórnicas. Em 12 casos (30%) havia história de viagem/contacto com viajantes a países africanos. A clínica caracterizou-se por diarreia (l00%) com muco e/ou sangue (60%), alteração do estado geral (85%), desidratação (85%) e febre (83%). Verificaram-se complicações em 11 (28%) crianças: insuficiência renal (7), anemia grave (6), anemia e insuficiência renal por síndrome hemolítico-urémico (5), hipertensão arterial (3), enteropatia grave (6), alterações neurológicas (4), sépsis (2) e morte (1). Identificou-se a espécie em 21 casos ( 52%): 7 (17%) dysenteriae, 7(17%) flexneri, 6 (15%) sonnei e 1 (3%) boydi. As resistências antibióticas foram significativas para o trimetoprim-sulfametoxazol (65%), ampicllina (63%) e amoxicilina-ácido clavulânico (46%). A maioria das crianças (72%) efectuou apenas terapêutica sintomática. A antibioticoterapia foi realizada em 11 (28%) dos doentes e 6 (15%) necessitaram de cuidados intensivos. O contexto epidemiológico foi o único factor com significado estatístico associado às complicações Comentário: A elevada percentagem de complicações, o padrão epidemiológico de países em desenvolvimento e a modificação das resistências antibióticas, tomam necessário um maior investimento nas medidas preventivas.
- Um insucesso de desfibrilhação por CDI resolvido de uma forma pouco habitualPublication . Oliveira, R; Madeira, F; Ferreira, A; Antunes, S; Morais, C; Gil, VMUm Cardioversor Desfibrilhador Implantável (CDI) destina-se a detectar arritmias ventriculares potencialmente fatais e a terminá-las, quer por estimulação ventricular rápida quer através de uma descarga eléctrica. Actualmente, é uma terapia aceite na prevenção primária e secundária da morte súbita cardíaca. A configuração típica de um CDI é de um eléctrodo de sensing e de desfibrilhação no ventrículo direito (VD) com dois coils (um distal, no ventrículo e outro próximal, na junção da veia cava superior (VCS) com a aurícula direita) que juntamente com o gerador, forma a designada “tríade ventricular”. Esta configuração embora seja eficaz na maior parte dos doentes, não é a mais racional do ponto de vista eléctrico pois o vector de choque encontra-se deslocado anteriormente em relação à maior parte do ventrículo esquerdo (VE). Descreve-se um caso de incapacidade de desfibrilhação pelo CDI resolvido com a implantação de um eléctrodo adicional numa veia tributária do seio coronário.
- Nova abordagem da terapêutica do estado de mal em doente de riscoPublication . Melo, L; Aufico, A; Serra, I; Freitas, PT; Tojal, R; Martins, A; Branco, R; Ferreira, A; Barroso, R
- Omalizumab for Severe Asthma: Beyond Allergic Asthma.Publication . Loureiro, C; Anmaral, L; Ferreira, A; Lima, R; Pardal, C; Fernandes, I; Semedo, L; Arrobas, ADifferent subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered
- Satisfação com o Internato Médico em PortugalPublication . Vieira, M; Godinho, P; Gaibino, N; Dias, R; Sousa, A; Madanelo, I; Ribeiro-Mourão, F; Brandão, M; Duarte, S; Meirinhos, T; Catarino, A; Espírito Santo, C; Caiado, R; Marques, R; Ferreira, A; Ramalheira, C; Jorge, J; Losada, M; Santos, M; Oliveira, E; Farias, J; Silva, JINTRODUCTION: In the last years, the global context of medical education and Medical Residency programs in Portugal suffered substantial changes. The primary objective of this study was to evaluate and characterize medical residents ́ satisfaction with medical residency programs in Portugal and to identify features that could be improved. MATERIAL AND METHODS: We utilized as model the survey Postgraduate Hospital Educational Environment Measure that has been developed in the United Kingdom and is speci cally targeted to medical residents. The survey was translated and adapted to the Portuguese reality. The survey was available online during April and May of 2016. RESULTS: A total of 3456 responses were obtained, corresponding to a response rate of 35%. Endocrinology/Nutrition, Cardiology, Anesthesiology, Family Physician and Gastroenterology were the specialties in which the degree of satisfaction was higher, while Forensic Medicine, Medical Oncology, Internal Medicine, General Surgery and Pneumology showed the lowest level of satisfaction. DISCUSSION: This study presented a high response rate when compared to previous studies. Portuguese medical residents presented high levels of satisfaction. Depending on year of medical residency, region, type of specialty and type of hospital marked asymmetries were noticed. CONCLUSION: The survey ́s results should constitute in the future a support tool for the implementation of local and national measures relating to the medical residency. It is advisable to regularly conduct satisfaction surveys to medical residents.
- The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing PoliciesPublication . Sá-Sousa A1, A; Fonseca, JA; Pereira, AM; Ferreira, A; Arrobas, A; Mendes, A; Drummond, M; Videira, W; Costa, T; Farinha, P; Soares, J; Rocha, P; Todo-Bom, A; Sokolova, A; Costa, A; Fernandes, B; Loureiro, C; Longo, C; Pardal, C; Costa, C, et al.The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.