Browsing by Author "Silva, A"
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- 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.
- Cistadenoma multiquístico da próstata: caso clínicoPublication . Furtado, A; Féria, R; Silva, A; Kronenberg, P; Alves, C; Cardoso, POs cistadenomas prostáticos são tumores raros e como tal pouco reportados na literatura. Descreve-se o caso clínico de um indíviduo do sexo masculino, com 48 anos de idade, assintomático e sem antecedentes pessoais do foro urológico, referenciado à consulta por PSA elevado e achado ecográfico de volumosa massa pélvica. A cistoscopia apresentava, estritamente, um abaulamento extrínseco da parede vesical póstero-inferior. Levou-se a cabo a excisão cirúrgica da massa tumoral e a sua análise anátomo-patológica caracterizou-a como cistadenoma multiquístico da próstata.
- Controlo de qualidade: a cereja no topo do boloPublication . Lopes, A; Lourenço, A; Rodrigues, A; Silva, A; Ribeiro, C; Lourenço, H; Matos, R; Marques, SIntrodução: As metodologias de controlo interno de qualidade são uma exigência dos sistemas de certificação e acreditação de laboratórios. A discussão/divulgação deste tipo de ferramentas no contexto da anatomia patológica facilitaria a sua implementação na rotina laboratorial, constituindo um desafio para todos os profissionais. Objectivos: Elaborar uma ferramenta de controlo interno de qualidade técnico (CIQT) diário, transversal à Macroscopia, Histologia, Citologia, Histoquímica, Imunohistoquímica e Microscopia Electrónica, de forma a detectar precocemente falhas e proceder, se possível, à sua correcção imediata. Material e Métodos: Em cada área laboratorial estabeleceram-se etapas de verificação (ex. microtomia) onde são identificados e registados os desvios observados (ex. dobras/pregas). Na etapa final, aplica-se uma escala de classificação transversal a amostras, lâminas e/ou grelhas. Esta é aplicada de acordo com parâmetros específicos de cada área e com o potencial impacto na interpretação dos desvios registados. Resultados: Obteve-se uma escala de avaliação qualitativa/quantitativa que permite classificar as diferentes unidades de trabalho de “Não satisfaz/1” (“presença de desvios que podem influenciar ou impedir a interpretação”) a “Muito Bom/5” (“ausência de desvios”). Na presença de desvios, estes são registados com base numa listagem codificada. Conclusão: A utilização desta metodologia de CIQT de forma constante e contínua possibilita a identificação de potenciais desvios e a sua eventual correcção imediata. A classificação das várias unidades de trabalho permitirá a obtenção de valores de referência, cuja monitorização e controlo poderão contribuir para a adopção de procedimentos de melhoria, individuais e/ou colectivos, promovendo o envolvimento de todos os profissionais. Referências Bibliográficas: 1. CHKS – Insight for better healthcare, Programa de acreditação internacional para organizações de saúde, Normas para a acreditação. 3ª edição, Versão 1. CHKS, 2010. 2. Estratégia de controlo de qualidade interno técnico em histologia [em linha]. Amadora: Repositório do Hospital Prof. Doutor Fernando Fonseca, 2011. Disponível na http://hdl.handle.net/10400.10/337. [Trabalho apresentado no Congresso Técnico de Anatomia Patológica, XII, Espinho, 2011] 3. FURNESS, Peter – An overview of quality control. In BANCROFT, John; GAMBLE, Marilyn – Theory and practice of histological techniques. 5th edition. Churchill Livingstone. 2002. ISBN 0443064350. P. 33-42. 4. HLADIK, Christa; WHITE, Charles – Immunohistochemistry quality control. In BANCROFT, John; GAMBLE, Marilyn – Theory and practice of histological techniques. 6th edition. Churchill Livingstone Elsevier. 2008. ISBN 978-0-443-10279-0. p. 473-492. 5. Imunohistoquímica: um exercício de gestão e qualidade [em linha]. Amadora: Repositório do Hospital Prof. Doutor Fernando Fonseca, 2011. Disponível na http://hdl.handle.net/10400.10/338. [Trabalho apresentado no Congresso Técnico de Anatomia Patológica, XII, Espinho, 2011] 6. NP EN ISO 15189. 2006, Laboratórios clínicos – Requisitos particulares da qualidade e competência (ISO 15189:2003). Caparica: IPQ. 55p. 7. RHODES, Anthony; MILLER, Keith – Internal quality control and external quality assessment of immunocytochemistry. In BANCROFT, John; GAMBLE, Marilyn – Theory and practice of histological techniques. 5th edition. Churchill Livingstone. 2002. ISBN 0443064350. P. 465-498. 8. SILVA, Ana; APARÍCIO, Samuel – Microscopia Electrónica de transmissão: Diagnosticar com Controlo de Qualidade. Congresso Técnico de Anatomia Patológica, XIII, Figueira da Foz, 2011 [Comunicação Oral]. 9. STIRLING, J. W.; CURRY, A. – Quality Standards for Diagnostic Electron Microscopy; Ultrastructural Pathology. 31, 5 (2007), 365-367. 10. UKNEQAS for Cellular Pathology Technique – Quality Manual. 6th edition. UKNEQAS, 2012. 11. UKNEQAS for Immunocytochemistry and In Situ Hybridisation – Participants Manual. london. UKNEQAS, 2001
- Disfunções sexuais iatrogénicasPublication . Silva, A; Cebola, A; Ramos, S; Cardoso, P
- Human plasma derived prothrombin complex concentrate (OCTAPLEX), the HFF, EPE: Blood Department experience.Publication . Barra, A; Barradas, A; Cardoso, E; Costa, C; Gil, A; Rodrigues, T; Silva, A; Simões, A; Venâncio, BBackground: The HPDPCC was introduced in our clinical practice in 2005, and it has some specific clinical recommendations . We use Octaplex mostly to recert coagulation parameters in patients whose status require their quick conversion, mainly to reverse oral anticoagulation. We initially started using Octaplex in lower doses than the recommended by the drug leaflet, trying to find an optimal dose, aiming to avoid side effects. Aims: Our goals are to share our experience using Octaplex in clinical practice, demonstrating that we can obtain rapid results with minimal dose, without adverse events. Methods: We only included in this study patients who have done Octaplex (1unit – 20ml) and have results of measurement of their International Normalized Ratio (INR) before and after the infusion of prothrombin complex concentrate. The INR was determined using the fully automated hemostasis analyser BCS XP System (Siemens) and the reagent Innovin (Dade Behring). The period of the study was, 2005-2010, and included 87 patients with different diseases. The INR results upper than 10 were counted like 10 because the laboratory doesn’t quantify values higher than this. Results: The patients were 64 men and 23 women, with ages ranged between 18 and 85-years-old, average 66,5-years-old 53 were under treatment with oral anticoagulants (OAC), 22 with liver impairment (1.1), and 12 with other pathologies (OP). The INR before treatment varied from 10 (maximal value) to 1.4 (minimal value), the average values were 6.72 to the patients under OAC, 2.15 to the patients with LI and 3.39 to the patients with OP. After treatment the average values were 2.0 to the OAC 1.84 to the LI and 1.76 to the OP. After treatment the maximal value of the INR was 6.9 and the minimal 0.9. The average number of units used to revert the patients clinical status were for OAC 1.62 (in an average of 1.4 number of intakes), for LI 2 units (1 intake) and for OP 2.75 units (1.42 intakes). We didn’t find any adverse post-administration events. Summary/Conclusions: We found better results in the administration of Octaplex in patients doing OAC, where the 1.62 units (in 1.04 intakes) lowered the INR average from 6.72 to 2.0. The dose used to resolve our clinical cases were much lower than the recommended in the drug leaflet. We didn’t find any adverse events in this dose. The clinical practice feedback suggests a quicker INR conversion comparing to fresh frozen plasma.
- Microscopia electrónica de transmissão: diagnosticar com controlo de qualidadePublication . Silva, A; Aparício, SINTRODUÇÃO: A Microscopia Electrónica de Transmissão, como meio complementar de diagnóstico, necessita de estabelecer métodos de controlo de qualidade para cumprir exigências dos processos de certificação e/ou acreditação dos Serviços de Anatomia Patológica, contribuindo para a melhoria contínua dos procedimentos. OBJECTIVOS: Apresentar um método de controlo de qualidade em Microscopia Electrónica em meio hospitalar, através da definição de critérios de avaliação aplicados ao processamento, corte e coloração/contraste de semi-finos e ultra-finos. MATERIAL E MÉTODOS: O controlo de qualidade foi aplicado por médicos e técnicos a 35 casos (Abril-Dezembro de 2011). Atribuíram-se valores de 1-3 que qualitativamente corresponderam a avaliações de “Não Satisfaz” a “Muito Bom”. As classificações obtiveram-se partindo do valor máximo (3) descontando sucessivamente valores definidos atribuídos a artefactos segundo o impacto que estes apresentavam no estudo dos casos. RESULTADOS: Observaram-se artefactos de processamento em 14,3% das amostras, sendo o critério mais registado a “extracção de componentes tecidulares” (83,3%). Os cortes semi-finos obtiveram classificação “Muito Bom” em 91,4% dos casos. Dos artefactos registados, 52,4% relacionaram-se com a coloração. Os cortes ultra-finos registaram 90,0% de classificação “Muito Bom”. Do total de artefactos identificados, 67,8% corresponderam a estrias e artefactos de contraste. CONCLUSÕES: Através da detecção/registo dos artefactos mais frequentes foram implementadas alterações e desenvolvidos novos protocolos, justificando também a aquisição de novos materiais e equipamentos.O controlo de qualidade desenvolvido foi usado como indicador de qualidade da área de Microscopia Electrónica cumprindo os requisitos dos processos de certificação/acreditação.
- Morgagni hernia in incremental peritoneal dialysis: Is it possible to continue with the technique?Publication . Santos Alonso, C; Silva, A; Ossorio González, M; Del Peso Gilsanz, G; Maldonado Martín, M; Racionero González, P, et al.
- Nonsense mutation in TITF1 in a Portuguese family with benign hereditary choreaPublication . Costa, MC; Costa, C; Silva, A; Evangelista, P; Santos, L; Ferro, A; Sequeiros, J; Maciel, PBenign hereditary chorea (BHC) is an autosomaldominant disorder of early onset characterized by a slowly progressing or nonprogressing chorea, without cognitive decline or other progressive neurologic dysfunction, but also by the existence of heterogeneity of the clinical presentation within and among families. The genetic cause of BHC is the presence of either point mutations or deletions in the thyroid transcription factor 1 gene (TITF1). We studied a Portuguese BHC family composed of two probands: a mother and her only son. The patients were identified in a neurology out-patient clinic showing mainly involuntary choreiform movements since childhood, myoclonic jerks, falls, and dysarthria. We performed magnetic resonance imaging (MRI), electroencephalogram (EEG), nerve conduction studies, thyroid ultrasound scan, biochemical thyroid tests, and electrocardiogram (ECG). We excluded Huntington disease by appropriate genetic testing and sequenced the entire TITF1 gene for both patients. The patients showed MRI alterations: (1) in the mother, abnormal hyperintense pallida and cortical cerebral/cerebellar atrophy; and (2) in the son, small hyperintense foci in the cerebellum and subtle enlargement of the fourth ventricle. Sequence analysis of the TITF1 gene in these patients revealed the presence of a heterozygous C > T substitution at nucleotide 745, leading to the replacement of a glutamine at position 249 for a premature stop codon. A previously undescribed nonsense mutation in the TITF1 gene was identified as being the genetic cause of BHC in this family.
- One year of Lamivudine therapy for portuguese patients with chronic hepatitis B.Publication . Areias, J; Calinas, F; Porto, A; Carvalho, A; Freitas, D; Macedo, G; Noronha, R; Cotter, J; Meliço-Silvestre, A; Peixe, R; Pratas, J; Barrote, D; Teixeira, R; Augusto, F; Carrilho, I; Campante, F; Velosa, J; Carvalho, L; Duarte, M; Guerreiro, H; Pires, C; Silva, A; Cotrim, I; Guedes, F; Tomé, L; Marcelino, M; Gonçalves, C; Ferreira, E; Matos, L; Peixe, P; Esteves, J; Valente, T; Simões, C; Marinho, C; Jasmins, L; Vieira, M; Marinho, R; Matos, P; Estevans, J; Carrasquinho, J; Salsedo, G; Parada, P; Teixeira, COBJECTIVE: To further verify the efficacy and safety of locally manufactured lamivudine on patients with chronic hepatitis B (CHB). METHODS: 2200 patients with CHB were recruited and received lamivudine orally 100 mg once daily for 12 months. The efficacy assessments included virologic response rate (defined by the absence of serum HBV DNA, HBeAg loss and HBeAg/HBeAb seroconversion), percentage of patients with normalization of alanine aminotransferase (ALT). Meanwhile improvement of quality of life (QOL) measured by mos SF-36 QOL questionnaire and liver histology evaluation were conducted in some patients. The safety assessments included adverse events, serious adverse events and laboratory abnormalities. All 2200 patients received at least one dose of medication and were all included in the safety population. RESULTS: Ninety seven percent of patients (2137/2200) recruited were HBV DNA positive by dot blot (sensitivity GRT or equal to 1.0 pg/ml) at baseline. At the end of 12 months treatment, HBV DNA was undetectable in 80% patients (1538/1920) with HBV DNA positive before treatment. Among the 79%(1744/2200) of the patients recruited had positive HBV DNA accompanied abnormal ALT levels at baseline, 72% patients became ALT normal. And among the 84% (1843/2200) of the patients recruited were HBV DNA and HBeAg positive, anti-HBe negative, 16% (269/1650) patients achieved HBeAg/HBeAb seroconversion after 12 months of lamivudine treatment. The HBeAg/HBeAb seroconversion rate was positive correlation to the ALT level before treatment. A total of 304 patients completed the health-related QOL questionnaire. After 12 months treatment, lamivudine improved both their physical and mental health, especially for their mental health. 133 evaluable, paired liver biopsies were obtained for histological assessment, among whom 115 patients had abnormal ALT levels at baseline. Compared with pre-treatment most of their liver injury got alleviated (51.9%) or no further deterioration (36%), only 12% worsening. During the 12 months treatment, 9% patients withdrew from the study and 17% patients showed at least one adverse event, mild or moderate. There were no obvious difference between this study and the previously reported lamivudine Phase II or III study with regard to the kinds, incidence and severity of adverse events. CONCLUSION: The efficacy and safety profile of the locally manufactured lamivudine 100 mg tablets are similar with those of the previously reported available lamivudine tablets imported in treating Chinese chronic hepatitis B patients.
- Programa educativo pré-alta: impacto de um programa educativo para doentes após AVC e cuidadores informais no momento da alta hospitalar: estudo exploratórioPublication . Damião, L; Baptista, F; Pereira, C; Alves, A; Silva, A; Carvalho, A; Vera-Cruz, C; Patinha, B; Pires, F; Prates, L; Ferreira, M; Silva, V