Browsing by Author "Ferreira, J"
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- Anemia e deficiência de ferro na insuficiência cardíacaPublication . Gil, VM; Ferreira, JHeart failure is a common problem and a major cause of mortality, morbidity and impaired quality of life. Anemia is a frequent comorbidity in heart failure and further worsens prognosis and disability. Regardless of anemia status, iron deficiency is a common and usually unidentified problem in patients with heart failure. This article reviews the mechanisms, impact on outcomes and treatment of anemia and iron deficiency in patients with heart failure.
- Avaliação da prevalência e caracterização da rinossinusite nos cuidados de saúde primários em PortugalPublication . Barros, E; Silva, A; Vieira, A; André, C; Silva, D; Prata, J; Ferreira, J; Santos, M; Gonçalves, P; Leiria, E; Gonçalves, N; Andrade, SAbstract: To determine RS prevalence, diagnosed at the Portuguese Primary Health Care Centres (PHCC), and to assess diagnostic and treatment practices. Study Design: Epidemiologic, cross-sectional study. Material and Methods:A cohort of subjects attending general practice medical appointments, in selected PHCC, was evaluated. Results: Between May/2008 and June/2009, 1,201 subjects were included with a mean age of 41.7+13.2 years, of which 71% were female. The total prevalence of RS was 19.2%, [n=231; 17.1%, 21.5%; 95% CI]. The prevalence of acute RS was 7.4%, [n=89; 6.0%; 9.0%; 95% CI], and of chronic RS was 13.% [n=156; 11.2%, 15.0%; IC 95%]. The estimated prevalence of RS is high. About 92% of patients with RS presented at least one symptom for disease diagnosis (p<0.001). Conclusions: Half the patients (50%) with RS had already been submitted to, at least, one medical exam. Same relevant difference between RS diagnostic and treatment guidelines and the current practice in Primary Health Care Centres were found.
- Cytomorphological features of blastic plasmacytoid dendritic cell neoplasm on FNA and cerebrospinal fluid cytology: a review of 6 cases.Publication . Ferreira, J; Gasparinho, MG; Fonseca, RBACKGROUND: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematopoietic tumor that was once believed to be derived from natural killer cells and is now recognized as originating from precursors of plasmacytoid dendritic cells. It generally involves the skin and has an aggressive clinical course. Due to its highly malignant behavior, a fast and accurate diagnosis of this condition is of the utmost importance. METHODS: Six cytology specimens from 5 patients diagnosed with BPDCN were reviewed as well as their clinical records. Findings were compared with 3 previously published cases. RESULTS: Two exfoliative cytology specimens (cerebrospinal fluid) and 4 fine-needle aspiration specimens (3 lymph node specimens and 1 cutaneous specimen) were reviewed. The cytomorphological aspects were similar in all cases. The smears were hypercellular with a monotonous population of intermediate-sized cells, dispersed singly or arranged in loose aggregates. The cells had round to oval nuclei, with fine chromatin and prominent nucleoli; the cytoplasm was generally scant, without visible granules. Intracytoplasmic microvacuoles were found in the majority of cases. Four cases were also characterized by flow cytometry, which revealed expression of CD 123, CD56 and/or CD4. Fine-needle aspiration was used in 1 case for primary diagnosis. Histological confirmation was available in all cases. CONCLUSIONS: BPDCN is a highly malignant neoplasm with a poor outcome. Cytology, in association with flow cytometry immunophenotyping and clinical history, is a reliable method with which to establish the diagnosis.
- Diagnosis of stroke by the nonneurologist: a validation study.Publication . Ferro, J; Pinto, A; Falcão, I; Rodrigues, G; Ferreira, J; Falcão, F; Azevedo, E; Canhão, P; Melo, T; Rosas, MJ; Oliveira, V; Salgado, AVBACKGROUND AND PURPOSE: The first medical contact of an acute stroke victim is often a nonneurologist. Validation of stroke diagnosis made by these medical doctors is poorly known. The present study seeks to validate the stroke diagnoses made by general practitioners (GPs) and hospital emergency service physicians (ESPs). METHODS: Validation through direct interview and examination by a neurologist was performed for diagnoses of stroke made by GPs in patients under their care and doctors working at the emergency departments of 3 hospitals. RESULTS: Validation of the GP diagnosis was confirmed in 44 cases (85%); 3 patients (6%) had transient ischemic attacks and 5 (9%) suffered from noncerebrovascular disorders. Validation of the ESP diagnosis was confirmed in 169 patients (91%); 16 (9%) had a noncerebrovascular diagnosis. Overall, the most frequent conditions misdiagnosed as stroke were neurological in nature (cerebral tumor, 3; subdural hematoma, 1; seizure, 1; benign paroxysmal postural vertigo, 1; peripheral facial palsy, 2; psychiatric condition, 6; and other medical disorders, 7). CONCLUSIONS: In the majority of cases, nonneurologists (either GPs or ESPs) can make a correct diagnosis of acute stroke. Treatment of acute stroke with drugs that do not cause serious side effects can be started before evaluation by a neurologist and CT scan.
- Effectiveness and safety of levosimendan in clinical practicePublication . Silva-Cardoso, J; Ferreira, J; Oliveira-Soares, A; Martins-de-Campos, J; Fonseca, C; Lousada, N; Ilídio-Moreira, J; Rabaçal, C; Damasceno, A; Amorim, S; Seabra-Gomes, R; Ferreira, R; Abreu-Lima, CBACKGROUND: In previous randomized studies levosimendan improved hemodynamics and clinical course, with a still unclear effect on prognosis. There are, however, few data regarding its effects when used in daily practice. AIMS: We evaluated the clinical effectiveness and safety of levosimendan in the treatment of acute systolic heart failure (SHF) in daily practice conditions. METHODS: In this prospective, multicenter, nonrandomized trial, a continuous infusion of levosimendan (0.05 microg/kg/min-0.2 microg/kg/min) was administered for 24 hours. An optional loading dose of 12 microg/kg over 10 minutes was used. The primary combined endpoint of clinical effectiveness (as defined by a eight-variable clinical score) and safety (defined by the absence of serious adverse events) was assessed at 24 hours after the beginning of treatment; a second similar primary combined endpoint was assessed at 5 days. RESULTS: One hundred and twenty-nine consecutive patients requiring inotropes despite optimal oral background heart failure therapy were recruited. The primary endpoint was reached in 80.6% at 24 hours and in 79.7% at 5 days. During the six months before levosimendan the number of patient days of hospitalization for heart failure was 14.9 +/- 14.6 versus 3.1 +/- 7.6 during the six months following levosimendan (p < 0.001). CONCLUSIONS: In daily practice, levosimendan was clinically effective and safe in 80.6% and 79.7% of patients with acute SHF at 24 hours and 5 days respectively after the beginning of treatment. A marked reduction in the number of days of hospitalization for heart failure was also seen during the subsequent six months.
- Fatores implicados no fenómeno de bullying em contexto escolar: revisão integrada da literaturaPublication . Lopez, R; Amaral, AF; Ferreira, J; Barroso, TAs evidências científicas sugerem que o bullying é um fenómeno cada vez mais frequente no contexto escolar, ao qual está inerente um vasto número de consequências para a saúde, pelo que, a sua prevenção deve constituir uma área prioritária. Com o objetivo de identificar os fatores implicados no fenómeno do bullying em contexto escolar, efetuou-se uma revisão da literatura de forma sistematizada na Biblioteca do Conhecimento Online (b-on) com as seguintes palavras-chave: “bullying/ bullying school context”, considerando os seguintes critérios de inclusão: participantes (estudantes do 2º e 3º ciclo); variáveis em estudo (fatores implicados no fenómeno do bullying), sem restrições relativas ao desenho dos estudos. Foram identificados 351 artigos, dos quais não foi possível aceder a 132. Considerando os critérios de inclusão, foram eliminados 203 artigos, os restantes 16 foram analisados. Da análise dos resultados dos estudos que integram esta revisão da literatura, emergem quatro tipologias de fatores, os fatores relacionados com as variáveis sociodemográficas, os fatores relacionados com as variáveis pessoais, os relativos à dimensão familiar e ainda os relacionados com as variáveis escolares. Em função destas tipologias, identificaram-se diversos fatores protetores e fatores de risco implicados no fenómeno de bullying.
- Persistent radiologic thoracic hypotransparency: A case report and review of the literature.Publication . Miranda, A; Marques, J; Ferreira, J; Cunha, F; Ribeiro, M; Ruivo, RA thymolipoma is a slow-growing, anterior mediastinal tumor, rare in childhood. The authors present a report of a 4-year-old girl with persistent right thoracic hypotransparency on the chest radiograph. Computed tomography and magnetic resonance imaging revealed an anterior, well-limited, mediastinal mass of heterogeneous density, with lipomatous and soft tissue density areas. The tumor was totally excised and the histopathologic findings revealed a thymolipoma. A year and a half after surgery, the child remains well. This report enhances the relevance of differential diagnosis in the presence of persistent radiologic thoracic hypotransparency.
- REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in PortugalPublication . Batista, S; Nunes, C; Cerqueira, J; Silva, A; Sá, J; Ferreira, J; Mendonça, M; Pinheiro, J; Salgado, V, et al.Background: Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). Objectives: To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. Methods: Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. Results: Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. Conclusions: Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported.
- Risco Cardiovascular Associadoà Interrupção dos Antiagregantes Plaquetares e Anticoagulantes OraisPublication . Ferreira, J; Gil, VMDiversas situações clínicas estão associadas a risco aterotrombótico (por exemplo endopróteses coronárias) ou tromboembólico (por exemplo próteses valvulares mecânicas). Inúmeros doentes fazem terapêutica regular com antiagregantes ou anticoagulantes, cujo risco hemorrágico associado coloca problemas delicados quando o doente tem que ser submetido a um procedimento cirúrgico. Por outro lado, a suspensão da medicação antitrombótica repõe o risco da situação de base e vulnerabiliza o doente. Os autores reveêm a literatura recente sobre este tema e propõem esquemas práticos de actuação em diversas situações.
- Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroupPublication . Santos, AR; Freitas, P; Ferreira, J; Faria, D, et al.BACKGROUND: Patients with acute pulmonary embolism are at intermediate-high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate-high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction. METHODS: We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40). RESULTS: Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P<0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P<0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P<0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3-10.3; P=0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5-5.2; P=0.001) as independent predictors of events. In the intermediate-high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8-6.2; P=0.003). CONCLUSIONS: Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate-high risk subgroup.