Browsing by Author "Figueiredo, A"
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- Adenite do bacilo Calmette-Guérin: protocolo diagnóstico e terapêuticoPublication . Constant, F; Figueiredo, A; Brito, MJA linfadenite regional da BCG, designada por BCGite, é uma complicação esporádica da vacinação, sem gravidade na maior parte dos casos e que apenas em situações excepcionais pode orientar para uma imunodeficiência. Descrevemos seis casos de BCGite internados no nosso serviço (2005-7) para tratamento cirúrgico, com BCG administrada no período neonatal, cinco do sexo masculino e com mediana de idade na apresentação clínica de 5,5 meses. Três crianças apresentaram supuração espontânea, uma com envolvimento axilar e supraclavicular. Cinco necessitaram de drenagem por supuração ou persistência da adenopatia. A criança com envolvimento ganglionar múltiplo realizou antibacilares por suspeita de imunodeficiência primária. O estudo imunológico não revelou alterações em nenhum dos casos. O tempo médio de seguimento foi 15 meses. A abordagem terapêutica da linfadenite supurativa e a decisão de investigar uma imunodeficiência subjacente não é consensual. Na ausência de doença disseminada os autores defendem uma atitude expectante.
- Apresentação atípica de estenose hipertrófica do piloroPublication . Moniz, M; Figueiredo, A; Torre, MLA estenose hipertrófica do piloro (EHP), no pequeno lactente, é uma causa conhecida de vómitos não biliosos que se apresenta habitualmente entre a terceira e sexta semana de vida. Com o desenvolvimento dos métodos de imagem a apresenta- ção clássica tornou-se rara. É apresentado o caso de um lactente de quatro meses internado por má progressão ponderal e vómitos intermitentes, não biliosos desde a segunda semana de vida. Apresentava alcalose metabólica hipoclorémica e excreção urinária de potássio elevada, o que levou a considerar outros diagnósticos, para além de EHP excluída aos dois meses por ecografia abdominal normal. Este caso relembra que embora rara, a EHP deve ser considerada em lactentes com mais de seis semanas de vida.
- Chronic hepatitis C treated with peginterferon alfa plus ribavirin in clinical practicePublication . Velosa, J; Serejo, F; Bana, T; Redondo, I; Simão, A; Vale, A; Pires, S; Macedo, G; Marinho, R; Peixe, P; Sarmento, J; Matos, L; Calinas, F; Carvalho, A; Figueiredo, ABACKGROUND/AIMS: The role of genotype and viremia were retrospectively evaluated on sustained virological response (SVR) rates in routine clinical practice. METHODOLOGY: From 1907 patients with chronic hepatitis C proposed for treatment, we analysed 1380 (1124 naive and 256 treatment-experienced) with complete follow-up. Genotype and HCV RNA quantification were assayed by commercial tests. Viremia was considered high if >800,000IU/mL, and low if <400,000IU/mL. Liver fibrosis was staged in 614 patients. RESULTS: Genotype 1 was the most frequent (60%), followed by 3 (25%), 4 (9%) and 2 (2%); 3.2% had other or unclassified genotype. Genotype 1 was more prevalent in central Portugal and genotype 4 in the south. Viremia was =800,000IU/mL in 54.6% and <400,000IU/mL in 34.6% of the patients, particularly in genotype 2 (p<0.03) and 4 (p<0.001). Genotype non-1 had a significantly lower viral load (p=0.004). Mild or moderate fibrosis was present in 71.7% and bridging fibrosis or cirrhosis in 28.3%, with no differences among genotypes. Treatment was discontinued in 19.8%. SVR was achieved in 55.3% of naive and 36.3% of re-treated patients. CONCLUSIONS: Standard treatment of chronic hepatitis C in real-life achieves similar results obtained in clinical trials, despite differences of demographic and viral parameters.
- Dieulafoy’s lesion in Treitz’s anglePublication . Alberto, S; Oro, I; Pires, E; Alves, N; Godinho, A; Figueiredo, A; Deus, JR
- Familial haemophagocytic lymphohistiocytosis: two case reportsPublication . Ferreira, M; Martins, J; Silvestre, C; Abadesso, C; Matias, E; Loureiro, H; Figueiredo, A; Dias, A; Almeida, HIHaemophagocytic lymphohistiocytosis (HLH) is a life threatening inflammatory syndrome, which presents a highly stimulated but ineffective immune response with severe hypercytokinaemia. HLH, primary or secondary, is characterised by prolonged fever and hepatosplenomegaly associated with pancytopenia, hypertriglyceridaemia and hypofibrinogenaemia. However, the hallmark of HLH is impaired or absent function of natural killer cells and cytotoxic T lymphocytes. HLH presents major diagnostic difficulties, since it may have an incomplete and/or late onset and with many conditions leading to the same clinical picture. When untreated, it is fatal in all primary cases and in a high percentage of acquired cases. Awareness of the clinical picture and diagnostic criteria is thus important to start life saving treatment. We describe two cases of primary HLH, with significant differences in their clinical presentation and evolution.
- Hemophagocytic lymphohistiocytosis, Leishmania and Epstein-Barr infection: an uncommon associationPublication . Costa, F; Miranda, A; Figueiredo, A; Correia, PIntroduction: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of abnormal excessive immune activation, with signs and symptoms of excessive inflammation. Case report: 18-months-old girl admitted for persistent fever for the past two months. No other symptoms associated. History of a trip to the north of Portugal with contact with dogs. On examination: ill-appearance, pale and hepatosplenomegaly. Laboratory findings revealed pancytopenia progressively worst, associated with elevated ferritin (828ng/mL), hypertriglyceridemia (490 mg/dL), elevated soluble interleukin-2-receptor (11045 U/mL), which lead to the diagnosis of HLH. Etiologic investigation: IgM VCA-EBV positive (99U/mL), IgG VCA-EBV negative (<20U/mL), IgG EBNA negative (<3U/mL) and PCR for EBV negative; immunofluorescence and immunoblot serologies for Leishmania spp. were positive. Bone marrow examination did not reveal hemophagocytosis and PCR for Leishmania and EBV was negative. Treatment was initiated with lipossomic amphotericin with progressive improvement of the clinical condition. Discussion: Although serology for Leishmania is not the gold standard for diagnosis, it’s positivity in this case and the epidemiologic history lead to a favourable outcome.
- Insuficiência hepática agudaPublication . Alberto, S; Pires, S; Figueiredo, A; Deus, JRIntrodução: Define-se como insuficiência hepática aguda o desenvolvimento rápido de falência hepática em indivíduos sem doença hepática prévia ou com doença hepática crónica compensada. Etiologia: É variada e é o principal indicador do prognóstico, pelo que a sua rápida identificação é vital. Avaliação inicial e diagnóstico: Atendendo a uma possível progressão para falência multiorgânica é necessário o internamento destes doentes numa Unidade de Cuidados Intensivos. A primeira abordagem terapêutica inclui medidas intensivas de suporte até determinar a etiologia exacta, para um tratamento dirigido. Para além da encefalopatia porto-sistémica podem ocorrer um conjunto de complicações sistémicas responsáveis pela alta morbilidade e mortalidade desta entidade e que exigem uma vigilância e terapêutica rigorosas. Os sistemas artificiais de suporte hepático são alternativas de tratamento ainda em estudo e sem influência comprovada a longo prazo, sendo o transplante hepático a terapêutica final. Atendendo às limitações inerentes a este procedimento, a sua decisão depende de um prognóstico correcto baseado em vários modelos estatísticos de previsão.
- Prevalence of hepatitis E virus antibody in an non endemic population: prospective studyPublication . Alberto, S; Pires, S; Félix, J; Figueiredo, A; Silva, L; Franco, M; Sousa, JG; Deus, JR
- Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC).Publication . Figueiredo, A; Almeida, MA; Almodovar, MT; Alves, P; Araújo, A; Araújo, D, et al.OBJECTIVE: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. METHODS: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). RESULTS: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. CONCLUSIONS: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.
- Rectal ulcer as a complication of Longo’s haemorrhoidopexyPublication . Alberto, S; Oro, I; Sanchez, P; Godinho, A; Garcia, H; Figueiredo, A; Deus, JR