Browsing by Author "Ricardo, L"
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- C-reactive protein at 24 hours after hospital admission may have relevant prognostic accuracy in acute pancreatitis: a retrospective cohort studyPublication . Cardoso, F; Ricardo, L; Oliveira, AM; Horta, D; Papoila, A; Deus, JR; Canena, JIntroduction: C-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis (BISAP) have been used in early risk assessment of patients with AP. Objectives: We evaluated prognostic accuracy of CRP at 24 hours after hospital admission (CRP24) for in-hospital mortality (IM) in AP individually and with BISAP. Materials and Methods: This retrospective cohort study included 134 patients with AP from a Portuguese hospital in 2009---2010. Prognostic accuracy assessment used area under receiver---operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: Thirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7% died during index hospital stay. AUCs for CRP24 and BISAP individually were 0.80 (95% confidence interval (CI) 0.65---0.95) and 0.77 (95% CI 0.59---0.95), respectively. No patients with CRP24 <60 mg/l died (P = 0.027; negative predictive value 100% (95% CI 92.3---100%)). AUC for BISAP plus CRP24 was 0.81 (95% CI 0.65---0.97). Change in NRI nonevents (42.4%; 95% CI, 24.9---59.9%) resulted in positive overall NRI (31.3%; 95% CI, − 36.4% to 98.9%), but IDI nonevents was negligible (0.004; 95% CI, − 0.007 to 0.014). Conclusions: CRP24 revealed good prognostic accuracy for IM in AP; its main role may be the selection of lowest risk patients.
- C-reactive protein may influence decisively the prescription of prophylactic antibiotics in acute pancreatitis: a population-based cohort studyPublication . Cardoso, F; Ricardo, L; Gondar, P; Deus, JR; Horta, DOBJECTIVES: Prescription of prophylactic antibiotics in acute pancreatitis (AP) is controversial. We aimed to identify the patients' characteristics that may prompt clinicians to prescribe prophylactic antibiotics in AP. METHODS: This single-center retrospective cohort study included 299 consecutive patients with AP from a Portuguese hospital in 2009 to 2010. Logistic regression was used to study the association of patients' characteristics with prescription of prophylactic antibiotics in AP. RESULTS: Persistent organ failure developed in 7% of patients (9/136). The median C-reactive protein at 48 hours after hospital admission was 154 mg/L (interquartile range, 55-271 mg/L). Bedside Index for Severity in AP score greater than or equal to 3 occurred in 14% of patients (42/299). Pancreatic necrosis was diagnosed in 21% of the patients (35/169). Computerized Tomography Severity Index score greater than 3 occurred in 23% of patients (38/169). In-hospital mortality rate was 4% (10/299). Prophylactic antibiotics were prescribed to 14% of patients (42/299). After adjusting for persistent organ failure and Computerized Tomography Severity Index score greater than 3, C-reactive protein at 48 hours after hospital admission greater than or equal to 150 mg/L was significantly associated with higher likelihood of receiving prophylactic antibiotics (odds ratio, 12.2). Prophylactic antibiotics did not improve in-hospital mortality rate (P = 0.637). CONCLUSIONS: C-reactive protein was the most influential in prescribing prophylactic antibiotics in AP. Clinicians may need better tools to support the decision to prescribe prophylactic antibiotics in AP.
- C-reactive protein prognostic accuracy in acute pancreatitis: timing of measurement and cutoff points.Publication . Cardoso, F; Ricardo, L; Oliveira, AM; Canena, J; Horta, D; Papoila, A; Deus, JRC-reactive protein (CRP) has been used widely in the early risk assessment of patients with acute pancreatitis. This study evaluated the prognostic accuracy of CRP for severe acute pancreatitis (SAP), pancreatic necrosis (PNec), and in-hospital mortality (IM) in terms of the best timing for CRP measurement and the optimal CRP cutoff points. MATERIALS AND METHODS: This was a single-center retrospective cohort study including 379 patients consecutively admitted with acute pancreatitis. CRP determinations at hospital admission, 24, 48, and 72 h after hospital admission were collected. Discriminative and predictive abilities of CRP for SAP, PNec, and IM were assessed by the area under the receiver-operating characteristic curve and the Hosmer-Lemeshow test, respectively. To determine the optimal CRP cutoff points for SAP, PNec, and IM, the minimum P-value approach was used. RESULTS: In total, 11% of patients had SAP, 20% developed PNec, and 4.2% died. The area under the receiver-operating characteristic curves of CRP at 48 h after hospital admission for SAP, PNec, and IM were 0.81 [95% confidence interval (CI) 0.72-0.90], 0.77 (95% CI 0.68-0.87), and 0.79 (95% CI 0.67-0.91), respectively. The Hosmer-Lemeshow test P-values of CRP at 48 h after hospital admission for SAP, PNec, and IM were 0.82, 0.47, and 0.24, respectively. The optimal CRP at 48 h after hospital admission cutoff points for SAP, PNec, and IM derived were 190, 190, and 170 mg/l, respectively. CONCLUSION: CRP at 48 h after hospital admission showed a good prognostic accuracy for SAP, PNec, and IM, better than CRP measured at any other timing. The optimal CRP at 48 h after hospital admission cutoff points for SAP, PNec, and IM varied from 170 to 190 mg/l.
- Caso invulgar de esofagite infecciosa em doente imunocompetentePublication . Santos, C; Proença, L; Ricardo, L; Godula, K; Santos, L; Santos, A; Louro, F
- Endoscopic bilio-duodenal bypass: outcomes of primary and revision efficacy of combined metallic stents in malignant duodenal and biliary obstructions.Publication . Canena, J; Coimbra, J; Carvalho, D; Rodrigues, C; Silva, M; Costa, M; Horta, D; Dias, A; Seves, I; Ramos, G; Ricardo, L; Coutinho, A; Romão, C; Veiga, PBACKGROUND: Self-expandable metal stents (SEMSs) can be used for palliation of combined malignant biliary and duodenal obstructions. However, the results of the concomitant stent placement for the duration of the patients' lives, as well as the need for and efficacy of endoscopic revision, are unclear. AIM: This study evaluated the clinical effectiveness of SEMS placement for combined biliary and duodenal obstructions throughout the patients' lives and the need for endoscopic revision. METHODS: This study is a retrospective multicenter study of 50 consecutive patients who underwent simultaneous or sequential SEMS placement for malignant biliary and duodenal obstructions. The data were collected to analyze the sustained relief of obstructive symptoms until the patients' death and the efficacy of endoscopic revision, as well as stent patency, adverse events, survival and prognostic factors for stent patency. RESULTS: Technical and immediate clinical success was achieved in all of the patients. Duodenal stricture occurred before the papilla in 35 patients (70 %), involved the papilla in 11 patients (22 %) and was observed distal to the papilla in four patients (8 %). Initial biliary stenting was performed endoscopically in 42 patients (84 %) and percutaneously in eight patients. After combined stenting, 30 patients (60 %) required no additional intervention until the time of their death. The remaining 20 patients were successfully treated using endoscopic stent reinsertion: nine patients needed biliary revision, three patients needed duodenal restenting and eight patients needed both biliary and duodenal reinsertion. The median duodenal stent patency and median biliary stent patency were 34 and 27 weeks, respectively. The median survival after combined stent placement was 18 weeks. A Cox multivariate analysis showed that duodenal stent obstruction after combined stenting was a risk factor for biliary stent obstruction (hazard ratio 6.85; 95 % confidence interval 1.43-198.98; P = 0.025). CONCLUSIONS: Endoscopic bilio-duodenal bypass is clinically effective, and the majority of the patients need no additional intervention until their death. Endoscopic revision is feasible and has a high success rate.
- Pancreatic panniculitis: a cutaneous manifestation of acute pancreatitisPublication . Laureano, A; Mestre, T; Ricardo, L; Rodrigues, AM; Cardoso, JPancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.
- Prevalência de hipertensão arterial em adolescentes portugueses da cidade de LisboaPublication . Silva, D; Matos, A; Magalhães, T; Martins, V; Ricardo, L; Almeida, HIObjetivo: Determinar a prevalência de pré-hipertensão arterial (pré-HTA) e hipertensão arterial (HTA) em adolescentes portugueses da cidade de Lisboa e averiguar a relac¸ão da pressão arterial (PA) com os fatores de risco: sexo, obesidade, tabagismo, alcoolismo, prática de exercício físico e história familiar de HTA. Metodologia: Estudo epidemiológico observacional, descritivo e transversal, numa amostra de conveniência de adolescentes de ambos os sexos, com idades compreendidas entre os 16 e 19 anos. A informac¸ão referente a hábitos comportamentais e história familiar de HTA foi obtida através de um questionário estruturado, autopreenchido. Resultados: Foram incluídos 234 adolescentes, com idade média de 16,4 ± 0,9 anos, 57% do sexo masculino. Registou-se uma prevalência de HTA de 34%, superior no sexo masculino (44 versus 21%, p = 0,001) e uma prevalência de pré-HTA de 12%, superior no sexo feminino (13 versus 10%, p = 0,001). O aumento do índice de massa corporal associou-se de forma significativa a maior prevalência de pré-HTA (categoria normoponderais: 9,40%; excesso de peso: 16,10%; obesidade: 22,70%) e HTA (normoponderais: 30,4%; excesso de peso: 45,2%; obesidade: 45,5%). Na presenc¸a de história familiar de HTA, a prevalência de HTA e de pré-HTA foi aproximadamente o dobro (41 versus 28% e 18 versus 9%, respetivamente). A prática regular de exercício físico, os hábitos tabágicos e o consumo alcoólico não revelaram associac¸ão estatisticamente significativa com os valores de pressão arterial. Conclusão: A prevalência de pré-HTA e HTA na amostra estudada foi elevada. Dos fatores de risco avaliados, apenas o sexo, a obesidade e a história familiar de HTA se associaram de forma significativa aos valores de PA.