Dacheux L.,Institute Pasteur Paris |
Bourhy H.,Institute Pasteur Paris |
Gouveia J.,Hospital Pulido Valente
Eurosurveillance | Year: 2012
We report on a case of imported human rabies in Portugal, in July 2011 in a woman who presented initially complaining of back pain, without relating exposure to animal bites. She had travelled from Portugal to Bissau, Guinea-Bissau, in April where she had been bitten by a dog on 1 May. She was diagnosed with rabies on 26 July and died two weeks later in spite of being treated following the Milwaukee protocol.
PubMed | Hospital Pulido Valente, University of Lisbon and New University of Lisbon
Type: Journal Article | Journal: Revista portuguesa de pneumologia | Year: 2016
Coexistence between pulmonary cancer and chronic obstructive pulmonary disease (COPD) is frequent and is anticipated to be lead to high worldwide mortality in the next decades. The most powerful therapeutic approach for non-small cell lung carcinoma is lung surgical resection. However, in COPD patients, this approach bears a higher mortality and morbidity risk, thus requiring an accurate pre-operatory evaluation of the surgical risk comprising a clinical and functional assessment at rest, as well as a cardiopulmonary exercise test. In this observational study, factors associated with cardiopulmonary complications within 30 days after tumor resection surgery were investigated in a cohort of patients with COPD and lung cancer assigned to perform a cardiopulmonary exercise test. This study included 50 patients (46 men, 92.0%) with a mean age of 64.7 years old (standard deviation 7.9), forced expiratory volume in the first second (FEV1) of 61.8% (SD 19.0%) and carbon monoxide diffusing capacity (DLCO) of 46.0% (SD 14.8%). Complications were observed in eighteen patients (36.0%) including 2 deaths (4.0%). Peak oxygen uptake (VO2peak) expressed in percentage of the predicted value was the only parameter showing a statistically significant difference between the groups with and without complications (p=0.027). The best value of VO2peak to discriminate complications occurrence was 61.0%. This study highlights the relevance of the cardiopulmonary exercise test in the risk assessment of pulmonary resection surgery in patients with COPD. The VO2peak (percentage of predicted value) is shown to be associated with complications within 30 days after surgery.
Clave P.,Autonomous University of Barcelona |
Clave P.,Institute Salud Carlos III |
Acalovschi M.,Spitalul Clinic Adulti |
Triantafillidis J.K.,General Hospital of Nikea Agios Panteleimon |
And 4 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2011
Aliment Pharmacol Ther 2011; 34: 432-442 Summary Background Otilonium bromide (OB) is a spasmolytic agent that blocks L-Type Calcium channels in human colonic smooth muscle. Aim To study the efficacy of OB in symptom control in irritable bowel syndrome (IBS). Methods A total of 356 patients (46.16 ± 19 years, 71% female) with IBS participated in a double-blind, randomised, parallel placebo-controlled phase IV study. OB (40 mg t.d.s.) or placebo was administered for 15 weeks, and follow-up was extended 10 additional weeks. Results Otilonium bromide (n = 179) and placebo (n = 177) groups had comparable demographics, symptom severity and IBS subtype. Both OB and placebo reduced abdominal pain and IBS symptoms. The effect of OB was significantly greater than placebo in the reduction of weekly frequency of episodes of abdominal pain at the end of treatment period (primary endpoint, -0.90 ± 0.88 vs. -0.65 ± 0.91, P = 0.03), reduction of abdominal bloating (-1.2 ± 1.2 vs. -0.9 ± 1.1, P = 0.02) and global efficacy by patient assessment (1.3 ± 1.1 vs. 1.0 ± 1.1, P = 0.047). Intensity of abdominal pain, proportion of patient responders, safety and quality of life scores were similarly affected by OB and placebo. During follow-up, the therapeutic effect of OB remained greater than placebo in terms of withdrawal rate due to symptom relapse (10% vs. 27%, P = 0.009), global efficacy of treatment and relapse-free probability (P = 0.038). Conclusions This placebo-controlled double-blind study shows that otilonium bromide is safe, well tolerated and superior to placebo in reducing the frequency of abdominal pain, severity of abdominal bloating and protecting from symptom relapse in IBS. These results further confirm that patients with IBS can improve during and following treatment with otilonium bromide. © 2011 Blackwell Publishing Ltd.
Bugalho A.,Hospital Pulido Valente |
Bugalho A.,Hospital Beatriz Angelo |
Bugalho A.,New University of Lisbon |
Ferreira D.,Hospital Pulido Valente |
And 5 more authors.
BMC Cancer | Year: 2013
Background: Lung cancer diagnosis is usually achieved through a set of bronchoscopic techniques or computed tomography guided-transthoracic needle aspiration (CT-TTNA). However these procedures have a variable diagnostic yield and some patients remain without a definite diagnosis despite being submitted to an extensive workup. The aim of this study was to evaluate the efficacy and cost of linear endobronchial (EBUS) and endoscopic ultrasound (EUS) guided fine needle aspiration (FNA), performed with one echoendoscope, for the diagnosis of suspicious lung cancer lesions after failure of conventional procedures.Methods: One hundred and twenty three patients with an undiagnosed but suspected malignant lung lesion (paratracheal, parabronchial, paraesophageal) or with a peripheral lesion and positron emission tomography positive mediastinal lymph nodes who had undergone at least one diagnostic flexible bronchoscopy or CT-TTNA attempt were submitted to EBUS and EUS-FNA. Patients with endobronchial lesions were excluded.Results: Of the 123 patients, 88 had a pulmonary nodule/mass and 35 were selected based on mediastinal PET positive lymph nodes. Two patients were excluded because an endobronchial mass was detected at the time of the procedure. The target lesion could be visualized in 121 cases and FNA was performed in 118 cases. A definitive diagnosis was obtained in 106 cases (87.6%). Eighty-eight patients (72.7%) had non-small cell lung cancer, 15 (12.4%) had small cell lung cancer and metastatic disease was found in 3 patients (2.5%). The remaining 15 negative cases were subsequently diagnosed by surgical procedures. Twelve patients (9.9%) had a malignant tumor and in 3 (2.5%) a benign lesion was found. The overall sensitivity, specificity, positive and negative predictive values of EBUS and EUS-FNA to diagnose malignancy were 89.8%, 100%, 100% and 20.0% respectively. The diagnostic accuracy was 90.1% in a population with 97.5% prevalence of cancer. The ultrasonographic approach avoided expensive surgical procedures and significantly reduced costs (p < 0.001). Conclusions: Linear EBUS and EUS-FNA are able to improve the diagnostic yield of suspicious lung cancer lesions after non-diagnostic conventional techniques. These techniques, performed with one scope, can be offered to patients with accessible lesions as an intermediate step for diagnosis since they may avoid more invasive procedures and hence reduce costs. © 2013 Bugalho et al.; licensee BioMed Central Ltd.
Spencer J.A.,St James's Hospital |
Forstner R.,Universitatsinstitut For Radiodiagnostik |
Cunha T.M.,Hospital Pulido Valente |
Kinkel K.,University of Geneva
European Radiology | Year: 2010
A significant proportion of adnexal masses detected by sonography are indeterminate. Either their organ of origin is uncertain or it is unclear whether their nature is benign or malignant. MR imaging of the sonographically indeterminate adnexal mass can resolve most of these uncertainties. Most indeterminate masses result from common benign conditions and women with such masses can avoid unnecessary or inappropriate surgery. For the minority of women whose masses are malignant, use of MR imaging rather than a 'wait and watch' strategy of repeat ultrasound (US) results in a more timely diagnosis. There are simple diagnostic steps in the MR imaging assessment which direct an algorithmic and problem-solving approach based on signal characteristics and morphology. MR imaging should provide a more timely diagnosis and, thereby, guide the management of the patient with reduced costs of investigation and treatment. © 2009 European Society of Radiology.
Paixao P.,Chronic Diseases Research Center |
Almeida S.,Centro Hospitalar Cova da Beira |
Videira P.A.,Chronic Diseases Research Center |
Ligeiro D.,Hospital Pulido Valente |
And 2 more authors.
European Journal of Pediatrics | Year: 2012
Human cytomegalovirus (HCMV) is the most frequent cause of congenital infection. Despite the fact that 5-17% of asymptomatic infected babies will develop late sequelae and, therefore, should be closely followed, most of these children will remain undetected, as screening of all newborns by viral culture is too expensive and no valid alternative has been widely accepted. The aim of this work was to demonstrate that pool testing can be used to screen HCMV congenital infection in newborns. For this purpose, a real-time PCR technique was tested in urine pools. This pool method was applied to all urine specimens from children received in the virology laboratory of the Centro Hospitalar Cova da Beira for diagnosis of HCMV infection for a period of 14 months. Ten out of the 160 urine samples were tested positive by shell-vial culture and were also detected by this pool method. Additionally, 100 urine specimens, collected in 2004 and culture negative for HCMV were included to test the specificity of this methodology, all of which were negative. In conclusion, these results suggest that urine pools can be used to detect HCMV-positive urines in children, with similar sensitivity and specificity when compared with the standard method. Because of the very significant reduction both in terms of labour and cost of testing materials, this methodology may represent a valid option for screening the HCMV congenital infection in newborns. © 2011 Springer-Verlag.
Froes F.,Hospital Pulido Valente |
Froes F.,New University of Lisbon
Acta Medica Portuguesa | Year: 2013
Introduction and Objectives: Herpes zoster and post-herpetic neuralgia increasing incidence is related to ageing. These conditions can be very debilitating and have an important impact in patients' quality of life. In an ageing population like the Portuguese, is expected that the burden of herpes zoster and post-herpetic neuralgia rises, nevertheless, a specific surveillance system for zoster does not exist in the country, and data regarding the incidence of herpes zoster and the burden of the disease in Portugal in the last decades was not found. In Portugal, the vaccine is still not available. Scaling the burden of disease is important to support public health policies regarding zoster vaccination. Material and Methods: We carried out a retrospective analysis from encoded information from the Portuguese Ministery of Health database for hospital admissions which included all individuals with a primary diagnosis of Herpes Zoster (IDC-9-CM 053), who were discharged between 2000 and 2010. Results: In Portugal, between 2000 and 2010, 1 706 hospital admissions with primary diagnosis of herpes zoster occurred. The majority of the patients were elderly. Eleven percent of the patients had potentially severe immunocompromise. The predominant disease was uncomplicated herpes zoster, followed by nervous system and ophthalmic herpes zoster. Mean hospital stay length was 9.3 days, increasing with age. There was a 1% case fatality rate. Considering the 2000-2009 period and the adult population only, the average annual incidence rate of hospitalization with primary diagnosis of herpes zoster in Portugal was 1.9/100 000 inhabitants, increasing with age. Conclusion: This study confirms that, in Portugal, severe herpes zoster is related to ageing and associated with significant morbidity, mortality and health resources allocation. © Ordem dos Médicos 2013.
Carreiro A.,Hospital do Divino Espirito Santo |
Santos J.,Hospital Pulido Valente |
Rodrigues F.,Hospital Pulido Valente |
Rodrigues F.,New University of Lisbon
Revista Portuguesa de Pneumologia | Year: 2013
Background: Chronic Obstructive Pulmonary Disease (COPD) represents an increasing burden worldwide. COPD can no longer be considered a disease which only involves the lungs, its systemic consequences make it an important risk factor for other chronic comorbidities. Aim: To determine the frequency of comorbidities in patients with COPD undergoing a pulmonary rehabilitation program (PRP) and to evaluate the influence of baseline characteristics as well as comorbidities on the outcomes of PRP. Methods: The present study included all COPD patients that were admitted to a PRP in our unit. The response to PR was measured by the improvement in exercise tolerance (6. minute walk test), dyspnea (Mahler's Dyspnea Index) and health status (St. George's Respiratory Questionnaire). Results: 114 patients with COPD were included. Most patients (96,5%) had at least one comorbidity. Metabolic diseases (71.1%), cardiovascular diseases (67.5%), other respiratory conditions (57.9%) and anxiety/depression (21.1%) were the most prevalent ones. 64.9%, 64.9% and 51.1% of the patients improved in terms of exercise tolerance, quality of life and dyspnea, respectively.The overall results were similar in all levels of the disease and in all comorbid subgroups. Logistic regression analysis showed that respiratory failure and ischemic heart disease negatively influenced improvement in health status and anxiety/depression predicted lower improvement in dyspnea. Conclusion: PR was associated with improvements in all comorbid subgroups of patients, underlining the important role of exercise training in rehabilitation of those chronic diseases associated with COPD. On the other hand, the presence of comorbidities in COPD patients, if clinically controlled, should not preclude access to PR. © 2012 Sociedade Portuguesa de Pneumologia.
Alfarrobaa S.,Hospital Pulido Valente |
Videiraa W.,Hospital Pulido Valente |
Galvao-Lucasa C.,Hospital Pulido Valente |
Carvalhob F.,Hospital Pulido Valente |
Barbaraa C.,Hospital Pulido Valente
Revista Portuguesa de Pneumologia | Year: 2014
Background: It is widely recognized that asthma control is not always possible in patients with very severe asthma despite available treatment. The aim of this study was to evaluate the efficacy of Omalizumab on asthma control as an add-on therapy in patients from the «Severe Asthma Outpatient Clinic» of Pulido Valente Hospital in Lisbon, Portugal. Methods: A retrospective study was conducted to assess asthma control by the ACT score and by GINA classification, frequency and severity of exacerbations, medication use and pulmonary function in patients treated with Omalizumab. Clinical information was collected from medical records from the start of treatment and at 6, 12 and 24 month follow-up. Results: 26 patients started treatment with Omalizumab, all (100%) were classified by GINA with uncontrolled asthma prior to treatment. Mean ACT score was 11.5. All patients had treatment with fixed-dose ICS and LABA and 34.6% also had an anti-cholinergic inhaler. 42.3% of patients were also treated with oral glucocorticosteroids for control. Patients reported an average of 1.8 moderate and 3.1 severe exacerbations/year. Statistical differences were found at 6 month follow-up in most end-points: GINA score improved: 60.9% of patients with partially controlled asthma and only 39.1% with uncontrolled asthma (Wilcoxon 0.00); ACT score improved to 19.52 (Wilcoxon 0.00); mean FEV1 improved to 76.7% (Wilcoxon 0.025); the proportion of patients requiring oral glucocorticosteroid therapy reduced to 17.4% (Wilcoxon 0.014); and the number of moderate and severe exacerbations also decreased to 1.04 and 1.83 respectively (Wilcoxon 0.007; Wilcoxon 0.002 respectively). Conclusions: The current analysis shows evidence that omalizumab is successful in improving asthma control as an add-on therapy GINA step 5 treatment. © 2013 Sociedade Portuguesa de Pneumologia.
Marques I.,Hospital Pulido Valente |
Lagos A.,Hospital Pulido Valente |
Reis J.,Hospital Pulido Valente |
Pinto A.,Hospital Pulido Valente |
Neves B.,Hospital Pulido Valente
Journal of Crohn's and Colitis | Year: 2012
The tumour necrosis factor antagonists have demonstrated efficacy in the induction of remission and its maintenance in numerous chronic inflammatory conditions. These agents are generally well tolerated but with the increasing number of patients receiving anti-tumour necrosis factor-α (anti-TNFα) therapy, more adverse reactions are expected to occur. Cutaneous eruptions complicating treatment with anti-TNFα agents are common, occurring in around 20% of patients. Most reactions are mild-to-moderate and rarely warrant treatment withdrawal. We herein present a case of Henoch-Shönlein purpura (HSP) vasculitis following treatment with the monoclonal anti-TNFα antibody adalimumab for ileo-colic Crohn's disease. The reaction occurred after 18. months of adalimumab therapy and discontinuation of the anti-TNFα resulted in rapid improvement of the condition. The causal relationship has become even more likely when the purpura reappeared after restarting adalimumab. The patient started infliximab, with disease control and no cutaneous side effects. To the best of our knowledge, this is the second case report of HSP complicating adalimumab therapy. Although adalimumab is theoretically less related to immune-mediated reactions, clinicians must be aware that adverse side effects may still occur. This is the first case that shows that infliximab can be safely used in patients with adalimumab related HSP. We discuss the literature and potential causal mechanisms and propose possible approaches to its management. © 2012 European Crohn's and Colitis Organisation.