Salvador, Brazil
Salvador, Brazil

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Couto C.A.,Federal University of Minas Gerais | Bittencourt P.L.,Portuguese Hospital | Porta G.,University of Sao Paulo | Abrantes-Lemos C.P.,University of Sao Paulo | And 3 more authors.
Hepatology | Year: 2014

Reactivity and titers of autoantibodies vary during the course of autoimmune hepatitis (AIH), and some autoantibodies have been associated with disease activity and adverse outcomes after treatment. The aim of this study was to assess the autoantibody behavior in AIH and its significance as predictors of biochemical and histological remission. A total of 117 patients with AIH (mean age 18.6 [4-69] years) were evaluated and tested for autoantibodies at disease onset and successively (mean 3.2 [2-6] times) after a mean follow-up evaluation of 70 [20-185] months. Antismooth muscle (ASMA), antiliver kidney microsome type 1 (anti-LKM1), antiliver cytosol type 1 (anti-LC1), antimitochondrial, antinuclear (ANA), and antiactin antibodies (AAA) were determined at disease onset and 379 other times during the follow-up evaluation through indirect immunofluorescence in rodent tissues, HEp-2 cells, and human fibroblasts. Anti-SLA/LP were assessed 45 times in the follow-up evaluation of 19 patients using enzyme-linked immunosorbent assay (ELISA). Upon admission, AIH types 1 and 2 were observed in 95 and 17 patients, respectively. Five subjects had AIH with anti-SLA/LP as the sole markers. Patients initially negative for AAA did not develop these antibodies thereafter. ANA were detected de novo in six and three subjects with AIH types 1 and 2, respectively. After treatment, only ASMA (>1:80) and AAA (>1:40) were significantly associated with biochemical (76.9% and 79.8%) and histological features (100% and 100%) of disease activity (P<0.001). Conclusion: With the exception of ANA, the autoantibody profile does not markedly vary in the course of AIH. The persistence of high titers of ASMA and/or AAA in patients with AIH is associated with disease activity. © 2013 by the American Association for the Study of Liver Diseases.


Dantas J.F.C.,Portuguese Hospital | Neto J.N.N.,State University of Paraíba | De Carvalho S.H.G.,State University of Paraíba | Martins I.M.C.L.D.,Federal University of Paraiba | And 2 more authors.
International Journal of Oral and Maxillofacial Surgery | Year: 2015

The aim of this study was to compare the satisfaction of skeletal class III patients following treatment with three different methods of orthognathic surgery. Eighty-two patients were divided into three groups according to the surgical procedure performed to correct their class III dentofacial deformity, and answered a questionnaire designed to determine the patient's opinion of the aesthetic and functional treatment outcomes. Differences in the patterns of responses to questions in the questionnaire related to satisfaction between the three clinical groups were evaluated by χ2 and Fisher's exact tests (α = 5%). Eighty patients (97.6%) reported being satisfied with the treatment received. There was no significant difference in response patterns among clinical groups when assessing the improvement in facial appearance, chewing, speech, and socialization. Maxillary advancement led to higher levels of improvement in breathing (P < 0.0003). Class III patients treated by orthognathic surgery had high levels of satisfaction with the aesthetic and functional outcomes of their treatment. © 2014 International Association of Oral and Maxillofacial Surgeons.


Bittencourt P.L.,Portuguese Hospital | Evangelista M.A.,Portuguese Hospital | Lins R.,Federal University of Bahia | Codes L.,Portuguese Hospital | And 3 more authors.
Transplantation Proceedings | Year: 2011

Background: Infections are a frequent cause of morbidity and mortality among postoperative liver transplant (OLT) patients and a leading cause of decompensated chronic liver disease (CLD) among patients awaiting the procedure. Oral lesions that are frequently observed in subjects with CLD may represent foci for systemic infections before and after OLT. Aims: To evaluate the oral health profile of patients with CLD awaiting OLT. Methods: One hundred thirty one patients including 100 males of overall mean age 49.5 ± 10.8 years with CLD were listed for OLT and examined for oral health status according to a established protocol. Results: One hundred thirty (99%) patients were partially edentulous; 66 (51%) had chewing difficulties; and 63 (48%) experienced reduced salivary flow. With respect to periodontal disease and oral infections, 68 (25%) had periodontitis, 63 (48%) had periapical lesion, 64 (49%) had abscesses, and 59 (45%) had root fragments. Loss of follow-up was observed in 21 subjects. Among the 110 other patients, 63 (57%) underwent dental treatments with complications in only two cases. Interestingly, mortality was significantly lower among treated (31%) versus nontreated patient (79%; P < .001). Conclusions: Poor oral health status observed in most CLD patients may represent a source of systemic infections before and after OLT. Treatment of such lesions was feasible in the majority of the patients and seemed to be associated with a reduction in mortality. © 2011 by Elsevier Inc. All rights reserved.


Bittencourt P.L.,Portuguese Hospital | Couto C.A.,Federal University of Minas Gerais | Ribeiro D.D.,Federal University of Minas Gerais
Hematology/Oncology Clinics of North America | Year: 2011

Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management. © 2011 Elsevier Inc.


Correia L.C.L.,San Rafael Hospital | Rabelo M.M.N.,San Rafael Hospital | Esteves J.P.,Portuguese Hospital
Sleep | Year: 2012

Study Objective: We aimed to test the hypothesis that clinically suspected obstructive sleep apnea (OSA) independently predicts worse in-hospital outcome in patients with non-ST elevation acute coronary syndromes. Design: At admission, individuals were evaluated for clinical probability of OSA by the Berlin Questionnaire. Primary cardiovascular endpoint was defined as the composite of death, nonfatal myocardial infarction, or refractory angina during hospitalization. Setting: Coronary care unit. Patients: There were 168 consecutive patients admitted with unstable angina or non-ST elevation acute myocardial infarction. Measurements and Results: During a median hospitalization of 8 days, the incidence of cardiovascular events was 13% (12 deaths, 4 nonfatal myocardial infarctions, and 6 refractory anginas.) Incidence of the primary endpoint was 18% in individuals with high probability of OSA, compared with no events in individuals with low probability (P = 0.002). After logistic regression adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score, anatomic severity of coronary disease, and hospital treatment, probability of OSA remained an independent predictor of events (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 1.3 - 9.0; P = 0.015). Prognostic discrimination of the GRACE score, measured by a C-statistic of 0.72 (95% CI = 0.59-0.85), was significantly improved to 0.82 (95% CI = 0.73-0.92) after inclusion of OSA probability in the predictive model (P = 0.03). Conclusion: Considering the independent prognostic and incremental value of suspected OSA, this condition may represent an aggravating factor for patients with non-ST elevation acute coronary syndrome.


Andrade W.L.,Royal Spanish Hospital | Andrade W.L.,Portuguese Hospital | Andrade W.L.,Cardio Pulmonar Institute | Amoretti J.R.,Royal Spanish Hospital | And 2 more authors.
Heart Surgery Forum | Year: 2010

Background: Minimal-access valve repair was introduced in the 1990s and is becoming an accepted option for patients undergoing valve surgery. Minimally invasive surgical valve repair reduces the degree of surgical insult, produces less postoperative pain, uses less blood, and is associated with better cosmetic results. Methods: Between July 2008 and February 2009, 17 cardiac surgical patients were treated with minimally invasive valve repair at 3 different institutions (Royal Spanish Hospital, Portuguese Hospital, and Cardio Pulmonar Institute, Salvador, Brazil). The heart was accessed via an incision between the ribs in the second or third intercostal space. A retrospective analysis was performed on the outcomes in the first 24 postoperative hours in the intensive care unit and on the fourth postoperative day before the patient's discharge from the hospital. Results: Of the 17 patients who underwent minimally invasive valve repair and were evaluated, 8 patients (47.05%) underwent aortic surgery, 4 patients (23.52%) underwent mitral valve surgery, 4 patients (23.52%) underwent surgery for a congenital heart defect, and 1 patient (5.88%) underwent endocarditis treatment. The duration of cardiopulmonary bypass (CPB) was <120 minutes in all cases (median interval between lowest and highest CPB times, 90 minutes), and all cross-clamp times were <100 minutes (median interval between lowest and highest cross-clamp times, 70 minutes). There were no cases of reoperation for bleeding, incision infection, or myocardial infarction. The median hospital stay was 5 days; the operative mortality rate was 5.8%. Conclusion: We conclude that by avoiding full sternotomy, the approach of minimal surgical access contributes to an improved postoperative stability of the chest and less surgical pain. On the other hand, the limited exposure of the heart is a disadvantage of minimally invasive valve repair. Minimally invasive surgical valve repair is safe and feasible with excellent outcomes and is well tolerated in the elderly. Care must be taken to follow the learning curve for operation duration and to treat surgical complications. © 2010 Forum Multimedia Publishing, LLC.


Correia L.C.L.,Portuguese Hospital | Andrade B.B.,Oswaldo Cruz Foundation | Borges V.M.,Oswaldo Cruz Foundation | Clarencio J.,Oswaldo Cruz Foundation | And 7 more authors.
Clinica Chimica Acta | Year: 2010

Background: Increased cytokine and chemokine levels are associated with cardiovascular events in patients with non-ST-elevation acute coronary syndromes (ACS), but the incremental prognostic value of these inflammatory markers is not known. We determined if cytokine and chemokine assessment adds prognostic information to the GRACE Score in patients with ACS. Methods: Five cytokines (interleukin (IL)-1β, IL-6, IL-10, IL-12p70, and tumor necrosis factor (TNF)-β soluble receptor I), five chemokines (IL-8, CCL5, CXCL9, CCL2, and CXCL10) and C-reactive protein (CRP) were measured at admission of 87 patients admitted with ACS. Results: During hospitalization, the incidence of cardiovascular events was 13% (7 deaths, 1 nonfatal acute myocardial infarction, and 3 refractory unstable angina). Individuals who developed events had significantly greater levels of CRP, IL-1β, IL-12, TNF-β, IL-8, CXCL9 and CCL2, compared with those free of events. Thus, these markers were used to build an Inflammatory Score, by the input of one point for each of these variables above the 75th percentile. After adjustment for the GRACE Score, the Inflammatory Score independently predicted events (OR=1.80; 95% CI=1.12-1.88). Incorporation of the Inflammatory Score into the GRACE Score promoted a C-statistics improvement from 0.77 (95% CI=0.58-0.96) to 0.85 (95% CI=0.71-1.0). Net reclassification improvement obtained with GRACE-Inflammatory Score was 13% (P=0.007), indicating a significant reclassification. When only CRP was incorporated into GRACE, the increase on C-statistics was not relevant (from 0.77 to 0.80). Conclusion: Cytokines and chemokines measured at admission add prognostic information to the GRACE Score in patients admitted with ACS. © 2010 Elsevier B.V.


Moreira L.,Federal University of Bahia | Schinzel A.,University of Zürich | Baumer A.,University of Zürich | Pinto P.,Salvador University | And 4 more authors.
American Journal of Medical Genetics, Part A | Year: 2010

Rieger syndrome (RS; OMIM 180500) is a rare autosomal dominant disorder of morphogenesis, with ocular and systemic abnormalities and variability in phenotypic expression. Some patients with RS presented with a deletion of the band 4q25 to which the homeobox gene PITX2(former RIEG) wasmapped. To study the natural history and perform a genotype-phenotype correlation, we followed a girl with RS from the age of 1 year to puberty. The study included physical examination, clinical and psychological evaluation, and cytogenetic analysis withGTG -banded karyotype and array CGH. Additionally, molecular analysis using microsatellite markers for chromosome 4 (D4S427, D4S194 and D4S1615) was performed. Conventional chromosome analysis showed a 4q deletion, and aCGH con-firmed the determination of the breakpoints at 4q25 and 4q31. With the exception of the typical features of RS is the patient, the clinicalmanifestations were relatively mild, despite the relatively large size of the deleted chromosome segment. The patient was periodically re-evaluated for several years. The teeth are still abnormal, and she is still under orthodontic treatment. The facial features were attenuated with age. Currently, she is under constant monitoring of eye pressure. She benefited from early intervention program, and her tonus is normal. She attends a normal school with minor learning difficulties. In conclusion, this study offers a comprehensive phenotypic delineation of RS through almost two decades and may contribute to a more accurate genetic counseling in cases of this syndrome. © 2010 Wiley-Liss, Inc.


PubMed | Portuguese Hospital
Type: Journal Article | Journal: World journal of hepatology | Year: 2015

Acute renal failure, now termed acute kidney injury (AKI), is frequently found in patients with cirrhosis. The occurrence of AKI, irrespective of the underlying cause, is associated with reduced in-hospital, 3-mo and 1-year survival. Hepatorenal syndrome is associated with the worst outcome among AKI patients with cirrhosis. Several definitions for AKI that have been proposed are outlined and evaluated in this paper. Among these, the International Club for Ascites-AKI criteria substantially strengthen the quality of early diagnosis and intervention according to underlying cause of AKI.


PubMed | Portuguese Hospital
Type: Journal Article | Journal: Hematology/oncology clinics of North America | Year: 2011

Venous thrombosis results from the convergence of vessel wall injury and/or venous stasis, known as local triggering factors, and the occurrence of acquired and/or inherited thrombophilia, also known as systemic prothrombotic risk factors. Portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS) are caused by thrombosis and/or obstruction of the extrahepatic portal veins and the hepatic venous outflow tract, respectively. Several divergent prothrombotic disorders may underlie these distinct forms of large vessel thrombosis. While cirrhotic PVT is relatively common, especially in advanced liver disease, noncirrhotic and nontumoral PVT is rare and BCS is of intermediate incidence. In this article, we review pathogenic mechanisms and current concepts of patient management.

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