Aldir I.,Centro Hospitalar Of Lisbon Ocidental |
Horta A.,Centro Hospitalar do Porto |
Serrado M.,Centro Hospitalar Of Lisbon Norte
Current Medical Research and Opinion | Year: 2014
Objectives: Review of the available data on the currently available single-tablet regimens (STRs), from the analysis of efficacy and safety to the key points of value in terms of adherence, quality of life and pharmacoeconomic evaluation. Methods: For this narrative review, literature searches have been performed in PubMed, IndexRevMed and Cochrane, using the search terms HIV, single-tablet, one-pill, single dose, fixed-dose, and STR. These have been reviewed and complemented with the most recent publications of interest. Results: Fixed-dose combinations are a significant advance in antiretroviral treatment simplification, contributing to an increase in compliance with complex chronic therapies, thus improving patients' quality of life. Reducing the number of pills and daily doses is associated with higher adherence and better quality of life. As a fixed-dose combination tablet given once daily, EFV/FTC/TDF was the first available STR combining efficacy, tolerability and convenience, with the simplest dosing schedule and smallest numbers of pills of any ART combination therapy. The RPV/FTC/TDF is a next-generation NNRTI-based STR, a once daily complete ART regimen for the treatment of HIV-1 infection. Recently the combination of EVG/COBI/FTC/TDF was also approved by the European Commission, and is the first integrase inhibitor-based STR. Receiving antiretroviral therapy as once daily STR is associated with both clinical and economic benefits, which confirms previous research. Conclusions: The associated benefits of STRs provide a valid strategy for the treatment of HIV-infected patients. © 2014 Informa UK Ltd.
Cerqueira R.M.,Centro Hospitalar Entre Douro e Vouga |
Lago P.M.,Centro Hospitalar do Porto
European Journal of Gastroenterology and Hepatology | Year: 2013
Crohn's disease (CD) is a progressive disease that is subdivided into three phenotypes: inflammatory, stricturing and penetrating. At diagnosis, most CD patients have inflammatory disease. However, the natural history of CD is one of progression over time to structural complications of the gastrointestinal tract (strictures and fistulae) requiring hospitalizations and surgeries. There is now evidence that early treatment with immunosuppressants and biologics can halt the development of inflammatory damage/fibrosis because of their potential to induce complete mucosal healing. This change in the natural course of CD, mediated by mucosal healing, is associated with a reduction in the incidence of serious complications (those requiring hospitalization and surgeries). Nevertheless, the clinical course of CD varies considerably from one patient to another, and the exact point at which immunosuppressants and/or biologics should be used has not yet been established. Given the difficulty in predicting which individuals will progress to complications and the fact that these therapeutic agents are associated with certain risks (lymphomas and opportunistic infections), efforts are underway to identify the risk factors that will facilitate the classification of patients into high-risk and low-risk groups at the time of diagnosis and to tailor therapy accordingly. This paper is a review of the currently available evidence on the clinical risk factors predictive of CD complications and surgery. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Lima M.,Centro Hospitalar do Porto
Anais Brasileiros de Dermatologia | Year: 2015
Primary cutaneous B-cell lymphomas are a heterogeneous group of mature B-cells neoplasms with tropism for the skin, whose biology and clinical course differ significantly from the equivalent nodal lymphomas. The most indolent forms comprise the primary cutaneous marginal zone and follicle center B-cell lymphomas that despite the excellent prognosis have cutaneous recurrences very commonly. The most aggressive forms include the primary cutaneous large B-cell lymphomas, consisting in two major groups: the leg type, with poor prognosis, and others, the latter representing a heterogeneous group of lymphomas from which specific entities are supposed to be individualized over time, such as intravascular large B-cell lymphomas. Treatment may include surgical excision, radiotherapy, antibiotics, corticosteroids, interferon, monoclonal antibodies and chemotherapy, depending on the type of lymphoma and on the type and location of the skin lesions. In subtypes with good prognosis is contraindicated overtreatment and in those associated with a worse prognosis the recommended therapy relies on CHOP-like regimens associated with rituximab, assisted or not with local radiotherapy. We review the primary cutaneous B-cell lymphomas, remembering the diagnostic criteria, differential diagnosis, classification, and prognostic factors and presenting the available therapies. © 2015 by Anais Brasileiros de Dermatologia.
Cruz E.,Centro Hospitalar do Porto
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2012
There are several modalities to monitor oral anticoagulant therapy, namely: monitoring by a secondary care specialist in the hospital setting; monitoring by the general practitioner/ family doctor in the primary care setting; monitoring by private laboratories of clinical analysis; self-monitoring with point-of-care devices. In Portugal, the most frequent modality is still the hospital monitoring/anticoagulation clinics, although monitoring in the primary care/routine medical care setting has began to be implemented in some areas of the country since five years ago. Anticoagulation clinics are still actually the organizations that optimize better the clinical and laboratorial follow up of the patients anticoagulated with warfarin. In 2011, anticoagulation control quality was evaluated, in the setting of an anticoagulation clinic (Santo António Hospital, Porto Hospital Center) by determining the proportion of INRs within the therapeutic range. The evaluation focused ambulatory patients, during a period of two months, corresponding to 1067 controls from 687 patients (mean age: 69±13 years; 54%, n=567, female gender). 71% of controls (n=756) were within the therapeutic range. 27% of controls were outside the therapeutic range, after exclusion of patients with programmed surgery or invasive proceedings. 13.8% of controls were below the therapeutic range and 8.6% (n=92) of the latter had INR ≤ 1.5. Above therapeutic range were 13.2% (n=139), from which 4.4% (n=46) had an INR between 5-8 and 0.3% (n=4) an INR ≥ 8. The group of primary care Health Centers (Portuguese acronym ACES) of the Baixo Tâmega region conducted, also in 2011, an evaluation of the anticoagulant control quality, by determining the proportion of INRs within the therapeutic range. The results were similar to those found in the anticoagulation clinic of the Hospital de Santo António which shows that the quality of monitoring in the primary care setting can have the same quality of the anticoagulation clinics monitoring. The introduction of the new oral anticoagulants, that don't require laboratorial monitoring constitutes a challenge. In Portugal, there is no experience yet to respond to the question if, in this new context, the anticoagulation clinics will be fundamental for the registration of patients, the evaluation of the hemorrhagic risk, the clinical follow up or the evaluation of the adherence to therapy. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Lima M.,Centro Hospitalar do Porto
Pathology | Year: 2015
Mature natural killer (NK) cell neoplasms are classified by the World Health Organization into extranodal NK/T cell lymphoma, nasal type (ENKTL) and aggressive NK cell leukaemia (ANKL). In order to propose their normal NK cell counterparts, we reviewed the literature on the phenotype of the neoplastic NK cells from five series of patients with ENKTL (n = 411) and seven series of patients with ANKL (n = 114) and compared with that of the normal and activated mature CD56+ NK cell subsets. The tumour NK cells usually express brightly the CD56 adhesion molecule and CD94 lectin type killer receptor, and have an activation-related (cytoplasmic CD3ε+, CD7-/+dim, CD45RO+, HLA-DR+) phenotype; in contrast, CD16 and killer immunoglobulin-like receptors are frequently negative, and CD57 expression is almost never observed. These phenotypic features would suggest that ENKTL and ANKL cells do represent the neoplastic counterpart of the mature CD56+bright NK cells, which undergo activation and malignant transformation after Epstein-Barr virus infection. Copyright © 2015 Royal College of Pathologists of Australasia. All rights reserved.