Percorrer por autor "Brito, Marta"
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- Home parenteral support in chronic intestinal failure : first results from a pioneer Portuguese intestinal failure centerPublication . Mendes, Ivo; Vara-Luiz, Francisco; Palma, Carolina; Nunes, Gonçalo; Lima, Maria João; Oliveira, Cátia; Brito, Marta; Santos, Ana Paula; Santos, Carla Adriana; Fonseca, JorgeBackground/Objectives: Home parenteral support (HPS) is the core of chronic intestinal failure (IF) treatment. For legal reasons, HPS in Portugal lags behind other European countries, and only a few patients were taken care of at home by nurses. Now, the legislation has changed, allowing patient self-care. The authors report their pioneer experience as the largest Portuguese IF center, evaluating the underlying conditions leading to IF, HPS nutritional impact, HPS-related complications and survival. Methods: This is a retrospective study including IF patients who underwent HPS in a Portuguese IF center. The data included demographics, underlying conditions, IF types, HPS duration, BMI at the beginning and end of HPS/follow-up, complications, microbiological agents of infectious complications and current status (deceased or alive with/without HPS). Survival was calculated until death or September 2024. Results: A total of 23 patients (52.2% female, mean age 57.3 years), all with type III IF, were included. Short bowel syndrome (SBS) was the most common cause of IF (69.6%). Of the included patients, 78.3% received home parenteral nutrition; the others received home parenteral hydration. The mean BMI increased significantly, from 19.1 kg/m2 to 22.5 kg/m2 (p < 0.001). Two patients received Teduglutide. The most common complication was catheter-related bloodstream infection (2.5/1000 catheter days). The complications did not increase with patient self-care. At the end of follow-up, 21.7% of patients remained on HPS, 34.8% were alive without HPS, and 43.5% died. The average survival was 43.4 months. One death (4.35%) was attributable to HPS-related complications. Conclusions: The conditions underlying IF varied, with SBS being the most frequent condition. HPS improved the BMI, allowing considerable survival. Despite the complications and one attributable death, HPS was safe, even when relying on patient self-care.
- Long-term endoscopic gastrostomy enteral feeding of neurosurgical patients : a reference center experiencePublication . Palma, Carolina; Santos, Carla Adriana; Mendes, Ivo; Vara-Luiz, Francisco; Nunes, Gonçalo; Mocanu, Irina; Oliveira, Cátia; Meira, Tânia; Brito, Marta; Santos, Ana Paula; Gonçalves, Ana Sofia; Casimiro, Carlos; Sá, Manuel Cunha e; Fonseca, JorgeBackground/Objectives: Nutritional support in neurosurgical patients is challenging due to severe brain injury, neurological disease, or post-surgical complications. This study aimed to assess outcomes of long-term enteral nutrition via endoscopic gastrostomy (PEG) in these patients over a 22-year period. Methods: A single-center retrospective (2001–2023) study was conducted on patients referred for PEG. Included patients presented severe traumatic brain injury (TBI), stroke, brain tumor, or other neurosurgical conditions. Demographic, anthropometric, and clinical data were collected. Results: A total of 196 patients were included (105 men); 57% were under 65 years. The main diagnoses were stroke (41.8%), TBI (35.2%), and brain tumors (19.9%). The median time from diagnosis to PEG was 94 days. At the time of PEG, only 38.5% were underweight. Outcomes: A total of 132 deaths (75.4%) occurred, while 21 patients resumed oral feeding (10.7%), 22 patients remained PEG-fed (12.6%), and 21 patients were lost to follow-up (10.7%). Most surviving PEG-fed patients had experienced stroke (77%). Median post-PEG survival was 11.5 months and 88% survived >1 month. Higher albumin, transferrin, and cholesterol levels at the time of PEG were associated with longer survival. Albumin (p < 0.001) and transferrin (p < 0.01) were significantly associated with reduced short-term mortality. Conclusions: Despite limited overall survival, reflecting the clinical severity of the diseases, most patients were adequate survivors, and PEG-feeding proved to be appropriate and useful for neurosurgical patients. While most patients had normal-to-high BMI, low serum biomarkers reflected acute illness. Higher serum albumin level was associated with better outcomes, supporting its potential prognostic value.
- Long-term intestinal failure and home parenteral nutrition: a single center experiencePublication . Padinha, Mafalda; Oliveira, Cátia; Carlos, Sandra; Santos, Ana Paula; Brito, Marta; Santos, Carla Adriana; Fonseca, JorgeIntestinal failure is the reduction in gut function below the minimum necessary for the absorption of macronutrients and/or water electrolytes. The based treatment for type II and III intestinal failure patients is home parenteral nutrition (HPN) and hydration (HPH). This is a case-series study of HPN/HPH patients of the Hospital Garcia de Orta, Portugal, where thirteen patients present different underlying disorders and various IVS needs of nutrition and/or hydration. Most presented type III failure and most of them survived a long period under HPN and/or HNH.
- Percutaneous endoscopic gastrostomy in the 21st Century : an overview of 1415 consecutive dysphagic adult patientsPublication . Mendes, Ivo; Vara-Luiz, Francisco; Palma, Carolina; Nunes, Gonçalo; Lima, Maria João; Oliveira, Cátia; Brito, Marta; Santos, Ana Paula; Santos, Carla Adriana; Meira, Tânia; Mascarenhas, Paulo; Fonseca, JorgeBackground/Objectives: Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition in dysphagic patients. This study aims to characterize conditions motivating PEG, assess nutritional status on the gastrostomy day, evaluate survival and search for survival predictors. Methods: Retrospective study of adult patients who underwent PEG in a tertiary hospital from 2001 to 2023. Data collected included demographics, underlying disorders, nutritional status (anthropometry/laboratory evaluation) on the day of PEG and survival recorded until death or December 2023. Multivariable analysis was performed with Cox regression to search for survival predictors. Results: A total of 1415 patients were included (61.8% males, mean age 66.9 years); 66.4% presented a neurological disorder and 31.3% head and neck or esophageal cancers (HNC/EC). The mean BMI was 20.9 kg/m2, with 49.8% underweight. Albumin, transferrin and total cholesterol were low at 43.2%, 62.2% and 50%, respectively. Median overall survival was 11.1 months; 14.1% of deaths occurred within 4 weeks. HNC/EC patients showed lower survival than neurological patients. Potentially regressive neurological conditions presented longer survival than progressive ones. Predictors of increased survival included female gender, younger age, higher albumin and higher BMI. The protective effect of BMI and albumin was more pronounced in males than in females. Conclusions: Neurological disorders were the most frequent underlying conditions. Nearly half of the patients displayed malnutrition before PEG feeding. Although PEG-fed patients displayed a considerable median survival time, some died early without benefit from PEG. Patients with potentially regressive neurological conditions presented better outcomes. Female gender, younger age, higher albumin and higher BMI were associated with longer survival.