Vinhas J.,Centro Hospitalar Of Setubal |
Gardete-Correia L.,Portuguese Diabetes Association |
Boavida J.M.,General Directorate of Health |
Raposo J.F.,Portuguese Diabetes Association |
And 4 more authors.
Nephron - Clinical Practice | Year: 2011
Background/Aims: Chronic kidney disease (CKD) is a growing public health problem. However, data on risk factors and prevalence of CKD exist only in a small number of countries. Portugal has the highest incidence of end-stage renal disease (ESRD) among European countries, but there are huge disparities among countries. Whether these disparities reflect differences in risk factors, prevalence of CKD or other factors is currently unknown. Methods: We analyzed data from a nationally representative sample of 5,167 subjects, and estimated the prevalence of CKD and associated risk factors, and combined these prevalence estimates with available data on ESRD. Results: The prevalence of risk factors such as diabetes (11.7%), obesity (33.7%), and metabolic syndrome (41.5%) was similar to that in the US, but greater than in most European countries. The prevalence of CKD stages 3-5 was 6.1%, which is similar to that in other Western countries. The risk of ESRD was greater than in other European countries, but lower than in the US. Conclusion: The high incidence of ESRD among the Portuguese population is not due to a greater prevalence of CKD. A higher rate of progression associated with the high prevalence of risk factors may account for the high incidence of ESRD. The role of unmeasured factors needs to be evaluated in further studies. Copyright © 2011 S. Karger AG, Basel.
Cardoso C.,Centro Hospitalar Of Setubal |
Cremers I.,Centro Hospitalar Of Setubal |
Oliveira A.P.,Centro Hospitalar Of Setubal
Annals of Hepatology | Year: 2012
Spontaneous bacterial peritonitis (SBP) is a common and often serious complication of long standing asci-tes in the presence of advanced liver disease.1 We report a case of a 51-year-old man with alcoholic cirrhosis admitted to our department with jaundice, ascitis and lower limbs edema. A diagnosis of sponta-neous bacterial peritonitis was made and empiric therapy with cefotaxime was prescribed with no respon-se. Three days later Listeria monocytogenes was detected in peritoneal fluid culture and amoxicillin was initiated according to in vitro sensibility test. Despite adequate antibiotic therapy, the patient died one week later.
Cremers I.,Centro Hospitalar Of Setubal |
Ribeiro S.,Centro Hospitalar Of Setubal
Therapeutic Advances in Gastroenterology | Year: 2014
Acute upper gastrointestinal haemorrhage remains the most common medical emergency managed by gastroenterologists. Causes of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis can be grouped into two categories: the first includes lesions that arise by virtue of portal hypertension, namely gastroesophageal varices and portal hypertensive gastropathy; and the second includes lesions seen in the general population (peptic ulcer, erosive gastritis, reflux esophagitis, Mallory-Weiss syndrome, tumors, etc.).Emergency upper gastrointestinal endoscopy is the standard procedure recommended for both diagnosis and treatment of UGIB. The endoscopic treatment of choice for esophageal variceal bleeding is band ligation of varices. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the same time as endoscopy. Bleeding from portal hypertensive gastropathy is less frequent, usually chronic and treatment options include-blocker therapy, injection therapy and interventional radiology.The standard of care of UGIB in patients with cirrhosis includes careful resuscitation, preferably in an intensive care setting, medical and endoscopic therapy, early consideration for placement of transjugular intrahepatic portosystemic shunt and, sometimes, surgical therapy or hepatic transplant. © The Author(s), 2014.
Cardoso C.S.,Centro Hospitalar Of Setubal |
Vieira A.M.,Centro Hospitalar Of Setubal |
Oliveira A.P.,Centro Hospitalar Of Setubal
BMJ Case Reports | Year: 2011
DRESS syndrome (drug rash, eosinophilia and systemic symptoms) is an idiosyncratic drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. The authors report a case of this syndrome presenting with fever, generalised pruritus, macular rash and cholestatic hepatitis during allopurinol treatment. This case resolved with drug withdrawal, but the death rate in the setting of hepatic failure can reach 10%. Rapid diagnosis is crucial as prompt withdrawal of the offending drug is the key of the treatment, while the potential role of corticosteroids remains controversial. Copyright 2011 BMJ Publishing Group. All rights reserved.
Cardoso C.S.,Centro Hospitalar Of Setubal
BMJ case reports | Year: 2011
DRESS syndrome (drug rash, eosinophilia and systemic symptoms) is an idiosyncratic drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. The authors report a case of this syndrome presenting with fever, generalised pruritus, macular rash and cholestatic hepatitis during allopurinol treatment. This case resolved with drug withdrawal, but the death rate in the setting of hepatic failure can reach 10%. Rapid diagnosis is crucial as prompt withdrawal of the offending drug is the key of the treatment, while the potential role of corticosteroids remains controversial.
Amador P.,Centro Hospitalar Of Setubal |
Santos J.F.,Centro Hospitalar Of Setubal |
Goncalves S.,Centro Hospitalar Of Setubal |
Seixo F.,Centro Hospitalar Of Setubal |
Soares L.,Centro Hospitalar Of Setubal
Acute Cardiac Care | Year: 2011
Objectives: Compare the discriminatory performance of two validated ischemic risk scores and a bleeding risk score for in-hospital adverse events across the spectrum of non-ST elevation acute coronary syndromes (NSTE-ACS). Material and methods: Single center, 516 consecutive patients admitted with the diagnosis of NSTE-ACS. The following risk scores were calculated for each patient: TIMI, GRACE and CRUSADE. The following in-hospital endpoints were used: major bleeding (as defined by the CRUSADE criteria); recurrent ischemia (re-infarction or recurrent angina); and death. Discriminatory performance was measured by the c-statistic and compared. Results: There were 36 major bleeding events, 34 recurrent ischemic events and 10 deaths. TIMI RS, GRACE RS, and CRUSADE RS demonstrated fair discriminatory accuracy for major bleeding (c-statistic = 0.64, 0.58, and 0.61, respectively). GRACE and CRUSADE risk scores demonstrated a better performance than TIMI RS for predicting in-hospital death (c-statistic = 0.92 and 0.86, respectively versus c-statistic = 0.63, P < 0.001). For the combined endpoint of in-hospital death or recurrent ischemia there was no statistically significant difference between CRUSADE RS, GRACE RS, and TIMI RS (c-statistic = 0.58, 0.57, and 0.62, respectively). Conclusion: Both ischemic and bleeding risk scores are able to predict in-hospital bleeding, ischemic and fatal events. © 2011 Informa UK, Ltd.
Cardoso C.,Centro Hospitalar Of Setubal
BMJ case reports | Year: 2011
Sarcoidosis is a rare side effect of interferon therapy that has been reported over the last years. We present the case of a 43-year-old man presenting with systemic sarcoidosis during treatment with pegylated interferon and ribavirin. Skin lesions, which were found to be associated with asymptomatic bilateral hilar lymph nodes and pulmonary nodules, were the sole clinical manifestation of the disease. Stopping therapy resulted in clinical and radiological improvement.
Lobao B.,Centro Hospitalar Of Setubal
BMJ case reports | Year: 2012
Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare dermatological disease that causes serious morbidity and mortality. It is most commonly drug induced. The authors report the case of a 57-year-old woman who was admitted to our hospital with severe rash all over the body. She had been previously submitted to brain surgery for total resection of a large meningioma and medicated with phenytoin for seizures prophylaxis. During this treatment, erythematous lesions and blisters were observed first on her face and trunk and then spreading to the entire body. Detachment of the skin, as well as mucous involvement especially of mouth and conjunctiva, was also observed. TEN was diagnosed, and phenytoin was discontinued. Intravenous fluids, systemic steroids and tightened infection control measures were implemented. After 10 days, skin recovery and re-epithelialisation were established, temperature decreased and mucosal complications stabilised. The patient was discharged after 1 month of hospitalisation.
ST-segment elevation during general anesthesia for non-cardiac surgery: A case of takotsubo [Supradesnivelamento do segmento ST durante anestesia geral para cirurgia não cardíaca: Um caso de takotsubo]
Rodrigues L.B.-H.,Centro Hospitalar Of Setubal |
Batista A.,Centro Hospitalar Of Setubal |
Monteiro F.,Centro Hospitalar Of Setubal |
Duarte J.S.,Centro Hospitalar Of Setubal
Revista Brasileira de Anestesiologia | Year: 2015
Background and objectives: Takotsubo cardiomyopathy, also known as broken heart syndrome is a stress-induced cardiomyopathy, which can be interpreted as an acute coronary syndrome as it progresses with suggestive electrocardiographic changes. The purpose of this article is to show the importance of proper monitoring during surgery, as well as the presence of an interdisciplinary team to diagnose the syndrome. Case report: Male patient, 66 years old, with diagnosis of gastric carcinoma, scheduled for diagnostic laparoscopy and possible gastrectomy. In the intraoperative period during laparoscopy, the patient always remained hemodynamically stable, but after conversion to open surgery he presented with ST segment elevation in DII. ECG during surgery was performed and confirmed ST-segment elevation in the inferior wall. The cardiology team was contacted and indicated the emergency catheterization. As the surgery had not yet begun irreversible steps, we opted for the laparotomy closure, and the patient was immediately taken to the hemodynamic room where catheterization was performed showing no coronary injury. The patient was taken to the hospital room where an echocardiogram was performed and showed slight to moderate systolic dysfunction, with akinesia of the mid-apical segments, suggestive of apical ballooning of the left ventricle. Faced with such echocardiographic finding and in the absence of coronary injury, the patient was diagnosed with intraoperative Takotsubo syndrome. Conclusion: Because the patient was properly monitored, the early detection of ST-segment elevation was possible. The presence of an interdisciplinary team favored the syndrome early diagnosis, so the patient was again submitted to safely intervention, with the necessary security measures taken for an uneventful new surgical intervention. © 2015 Sociedade Brasileira de Anestesiologia.
PubMed | Centro Hospitalar Of Setubal
Type: | Journal: Urology case reports | Year: 2017
Paratesticular sarcomas are rare. Most cases reported in the literature are depending on retrospective analysis of case reports, small series, literature reviews, and expert opinion and they show different outcomes depending on several variables. The majority indicate that this may be an indolent tumor with a potential for cure if treated early. We present a case of a 58 year old man with a history of painless enlargement of the right testis. The ultrasound showed an extratesticular lesion and a right excisional of the mass was performed. The pathological examination revealed a leiomyosarcoma, and was then completed with a right radical inguinal orchiectomy. A review of the literature regarding paratesticular sarcomas presentation, diagnosis and treatment is presented in this article.