Browsing by Author "Reis, J"
Now showing 1 - 10 of 42
Results Per Page
Sort Options
- Abordagem clínica da cirrose hepática: protocolos de atuaçãoPublication . Reis, J; Alves, N; Martins, A; Horta, D; Alberto, S; Santos, L; Carvalho, R; Rodrigues, C; Oliveira, A; Costa, M; Lourenço, L; Branco, J; Cardoso, M; Anapaz, V; Alexandrino, G; Figueiredo, L; Rafael, M
- Actinomycosis Causing Recurrent Perianal FistulaePublication . Cardoso, M; Carneiro, C; Lourenço, L; Rodrigues, C; Alberto, S; João, A; Rocha, R; Geraldes, V; Costa, A; Reis, J; Nunes, VActinomycosis is a rare but easily curable infection that should be considered in the differential diagnosis of perianal fistulizing disease. We present the case of a 26-year-old woman with complex perianal fistulae, including trans-sphincteric and suprasphincteric fistulous tracts and a rectovaginal fistula, requiring multiple abscess drainages, seton placement, and antibiotic courses, with little improvement. After extensive investigation, Actinomyces spp. was identified in anal cytology. The patient underwent a 6-week course of intravenous penicillin followed by oral amoxicillin, with remarkable improvement. This case illustrates the importance of pursuing less common diagnoses in refractory complex perianal disease, such as actinomycosis.
- Acute Hepatitis in the DRESS SyndromePublication . Oliveira, AM; Carvalho, R; Martins, A; Reis, JDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, idiosyncratic reaction characterized by diffuse maculopapular rash, facial edema, lym- phadenopathy, fever, eosinophilia and/or other leukocyte abnormalities, and involvement of internal organs as liver, kidney, heart and lung. Diagnosing this entity is specifically complicated due to the multiplicity of organs involved. DRESS syndrome must be recognized promptly and the causative drug withdrawn in order to improve patient outcomes. Indeed, it is a potentially life-threatening condition, with a reported mortality between 5 and 20%. We describe a case of a 22-year old woman admitted to our hospital with acute diffuse, pruritic rash associated with crampy abdominal pain, vomiting, diarrhea and fever three weeks after starting sulfasalazine therapy. Initially, laboratory parameters revealed normal white blood cell count and normal liver enzymes, but during hospitalization, eosinophilia developed and liver enzymes, including transaminases and cholestatic parameters, dramatically increased. The diagnostic of DRESS syn- drome was made and sulfasalazine was withdrawn and as there were signs of disease severity, systemic corticotherapy was initiated, with gradually improvement of the rash and symptoms resolution. The patient was discharged home after thirty days of hospitalization.
- An exceptional cause of drug-induced colitis: cholestyramine.Publication . Branco, J; Alexandrino, G; Alves, A; Reis, J
- Avaliação do impacto do timing da endoscopia na abordagem da hemorragia digestiva altaPublication . Alexandrino, G; Carvalho, R; Costa, M; Reis, JIntrodução e Objetivos A hemorragia digestiva alta (HDA) é uma das urgências mais frequentes em Gastrenterologia. Os autores apresentam um estudo que tem como objetivo avaliar o impacto do timing da endoscopia digestiva alta (EDA) em doentes com HDA. Material Estudo retrospetivo que incluíu os doentes consecutivos admitidos por HDA (presença de hematemeses, vómitos tipo borra de café ou melenas) entre Janeiro e Outubro de 2015. Definiu-se o timing da EDA relativamente ao momento de admissão hospitalar em "very early" (<12 horas), "early" (<24 horas) e "late" (>24 horas). Consideraram-se como endpoints os achados diagnósticos na endoscopia, a realização de terapêutica endoscópica, recidiva hemorrágica aos 7 dias e a mortalidade aos 7 e 30 dias. Análises estatística realizada no SPSS Versão 24 através da AUROC com IC de 95%. Sumário dos Resultados Foram incluídos 102 doentes, a maioria (75%) do sexo masculino, com média de idades de 67 anos. O tempo médio até à realização de EDA foi 15.8h. Os principais achados foram doença ulcerosa péptica (37%), hemorragia varicosa (24%) e doença erosiva (16%). 6% tinham EDA sem alterações. A taxa global de recidiva hemorrágica aos 7 dias foi de 8% e a mortalidade aos 30 dias de 7%. 49% dos doentes realizaram EDA em <12h (Grupo 1), 27% entre 12-24h (Grupo 2) e 24% >24h (Grupo 3). Achados na EDA Terapêutica endoscópica Recidiva Grupo1 96% 70% 12% Grupo2 93% 39% 7% Grupo3 92% 21% 0% A AUROC relativamente ao efeito do timing da EDA na recivida até 7 dias, mortalidade até 7 dias e mortalidade até 30 dias, foi, respetivamente, 0.328, 0.531 e 0.482. Conclusões Nesta série, os doentes que realizaram EDA mais cedo realizaram mais terapêutica endoscópica. No entanto, não houve qualquer impacto do timing da EDA no número de achados na EDA, na taxa de recidiva hemorrágica nem na taxa de mortalidade.
- Avaliação e comparação dos scores de estratificação de risco na abordagem da hemorragia digestiva alta varicosa e não varicosaPublication . Alexandrino, G; Branco, J; Carvalho, R; Costa, M; Reis, JIntrodução e Objetivos Existem vários scores validados para estratificar o risco na hemorragia digestiva alta (HDA). Permanece controverso qual utilizar. O nosso objetivo foi comparar a eficácia de 4 scores à admissão de doentes com HDA: Glasgow Blatchford score (GBS), Rockall à admissão (RA), AIMS65 e Rockall completo (RC) e calcular os cut-offs que melhor classificam os doentes em risco. Material Estudo retrospetivo em doentes com HDA de Janeiro-Outubro/2015. Endpoints considerados: terapêutica endoscópica, recidiva hemorrágica aos 7 dias e mortalidade aos 30 dias. Considerou-se ainda um endpoint composto que avaliou a necessidade de qualquer intervenção (transfusão, cirurgia, tratamento endoscópico, admissão em UCI). Análise estatística no SPSS versão 24 (AUROC com IC 95%). Sumário dos Resultados 102 doentes (75% homens, idade média: 67 anos), 24% com HDA varicosa. Características dos doentes especificadas na Tabela 1. Em relação à etiologia da hemorragia, as AUROC do GBS, RA e AIMS65 para predizer intervenção foram, respetivamente, 0,833 (cut- off >9), 0,623 e 0,636 na HDA não varicosa Vs. 0,370, 0,283 e 0,380 na HDA varicosa. Nenhum score foi eficaz a predizer a necessidade de terapêutica endoscópica nem a recidiva, independentemente da causa da HDA. Quanto à mortalidade, as AUROC do RC, AIMS65, GBS e RA foram, respetivamente, 0.864 (cut-off >5), 0.822, 0.807 e 0.761 na HDA não varicosa 0.783, 0.826 (cut-off >1), 0.793 e 0.717 na HDA varicosa. Conclusões O GBS foi o único score eficaz a predizer a necessidade de intervenção, somente nos doentes com HDA de causa não varicosa (cut- off >9). Nenhum score teve capacidade de predizer necessidade de terapêutica endoscópica ou recidiva hemorrágica. Os scores Rockall completo (cut-off>5 para HDA não varicosa) e AIMS65 (cut-off >1 para HDA varicosa) parecerem vantajosos relativamente ao GBS a predizer o risco de mortalidade. Estes dados mostram a utilidade dos scores, sendo necessária cautela na sua aplicação, sobretudo em doentes com hemorragia varicosa.
- Can red cell distribution width be used as a marker of Crohn's disease activity?Publication . Oliveira, AM; Cardoso, F; Rodrigues, C; Santos, L; Martins, A; Deus, JR; Reis, JIntroduction: Recently, it has been suggested an association between red cell distribution width (RDW) and Crohn’s disease activity index (CDAI), but its use is not yet performed in daily clinical practice. Objectives: To determine whether RDW can be used as a marker of Crohn’s disease (CD) activity. Methods: This was a cross-sectional study including patients with CD, observed consecutively in an outpatient setting between January 1st and September 30th 2013. Blood cell indices, erythrocyte sedimentation rate (ESR), and C-reactive protein were measured. CD activity was determined by CDAI (active disease if CDAI ≥ 150). Associations were analyzed using logistic regression (SPSS version 20). Results: 119 patients (56% female) were included in the study with a mean age of 47 years (SD 15.2). Twenty patients (17%) had active disease. The median RDW was 14.0 (13---15). There was an association between RDW and disease activity (p = 0.044). After adjustment for age and gender, this association remained consistent (OR 1.20, 95% CI 1.03---1.39, p = 0.016). It was also found that the association between RDW and disease activity was independent of hemoglobin and ESR (OR 1.36, 95% CI 1.08---1.72, p = 0.01) and of biologic therapy (OR 1.19, 95% CI 1.03---1.37, p = 0.017). A RDW cutoff of 16% had a specificity and negative predictive value for CDAI ≥ 150 of 88% and 86%, respectively. Conclusion: In this study, RDW proved to be an independent and relatively specific marker of CD activity. These results may contribute to the implementation of this simple parameter, in clinical practice, aiming to help therapeutic decisions.
- Comparison of the AIMS65 Score with Other Risk Stratification Scores in Upper Variceal and Nonvariceal Gastrointestinal Bleeding.Publication . Alexandrino, G; Carvalho, R; Reis, J
- A Complex Case of Cholestasis in a Patient with ABCB4 and ABCB11 MutationsPublication . Cardoso, M; Branco, J; Anapaz, V; Rodrigues, C; Carvalho, R; Horta, D; Martins, A; Reis, JThe low-phospholipid-associated cholelithiasis (LPAC) syndrome is a form of symptomatic cholelithiasis occurring in young adults, characterized by recurrence of symptoms after cholecystectomy and presence of hepatolithiasis. The case refers to a healthy 39-year-old Caucasian male who presented with abdominal pain and jaundice. His blood tests showed conjugated hyperbilirubinemia and elevated liver enzymes (total bilirubin 6.65 mg/dL, γ-glutamyltransferase 699 IU/L) and abdominal computed tomography revealed dilation of common bile duct and left intrahepatic ducts. Magnetic resonance cholangiopancreatography identified choledocholithiasis, retrieved by endoscopic retrograde cholangiopancreatography, after which there was a worsening of jaundice (total bilirubin 23 mg/dL), which persisted for several weeks, possibly due to ciprofloxacin toxicity. After an extensive workup including liver biopsy, the identification of two foci of hepatolithiasis on reevaluation abdominal ultrasound raised the hypothesis of LPAC syndrome and the patient was started on ursodeoxycholic acid, with remarkable improvement. Genetic testing identified the mutation c.1954A>G (p.Arg652Gly) in ABCB4 gene (homozygous) and c.1331T>C (p.Val444Ala) in ABCB11 gene (heterozygous). In conclusion, we describe the unique case of an adult male with choledocholithiasis, hepatolithiasis, and persistent conjugated hyperbilirubinemia after retrieval of stones, fulfilling the criteria for LPAC syndrome and with possible superimposed drug-induced liver injury, in whom ABCB4 and ABCB11 mutations were found, both of which had not been previously described in association with LPAC.
- Correction: Pancreatoscopy-guided laser lithotripsy in a patient with difficult ductal stonePublication . Alexandrino, G; Lourenço, L; Horta, D; Reis, J; Canena, J; Rodrigues, C