Browsing by Author "Fernandes, M"
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- Acute Pancreatitis in the Context of Abdominal Attack of Hereditary AngioedemaPublication . Lourenço, T; Fernandes, M; Lopes, A; Pereira Barbosa, M
- Determinants associated with uncontrolled asthma in Portugal: A national population-based studyPublication . Camarinha, C; Fernandes, M; Alarcão, V; Franco, J; Manaças, M E; Bárbara, C; Nicola, P JIntroduction and objectives: Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. Materials and methods: Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test™ (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. Results: 35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01-1.03), female sex (OR 1.87; 95% CI: 1.15-3.04), educational level (OR 0.5; 95% CI: 0.28-0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12-11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35-4.65 if being retired), income (OR 0.23; 95% CI: 0.07-0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03-1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56-7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24-0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. Conclusions: Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.
- Evaluating Residual Activity in 18F-FDG administrationPublication . Santos, A; Geão, A; Dias, L; Mota, A; Fernandes, MThe Positron Emission Tomography (PET) is an imaging technique, based on functional, biochemical and molecular information. It is also a useful tool in oncological examination. 18F-FluoroDeoxyGlucose (FDG) is a radiopharmaceutical widely used in nuclear medicine departments with PET facilities. FDG’s corrects administration is very important in order to achieve good images and correct Standard Uptake Values (SUV). The aim of this study was to evaluate the residual activity, according to the method used in our department. Materials & Methods: Residual activities of the syringes used to administer FDG to 125 patients were measured and recorded, during one month. The intravenous administration was always performed by the same four nuclear medicine technologists. These technologists are trained in this procedure, according with the developed technique, based on the procedure guidelines for PET imaging. This technique consists in administering FDG in a catheter with a triple channel system (standard system with three-way tap to enable saline flush); the syringe is always filled to its maximum capacity (5cc) and rinsed once, including needle rinsing. Registered time in every procedure was calibrated, in order not to include bias. Results: according to the analysis of the registered data, less than 1% of the activity calculated and measured for each patient remained on the syringe. Conclusions: regarding the search for the best administration procedure, we conclude that the technique used in our department results in a very low residual activity, meaning that it is an accurate technique that leads to reliable SUV values.
- Limited Antineutrophil Cytoplasmic Antibodies (ANCA)-Negative Granulomatosis With Polyangiitis: Successful Response to RituximabPublication . Andrade, MM; Fernandes, M; Freire, S; Cruz, DGranulomatosis with polyangiitis (GPA), a systemic vasculitis, is commonly characterized by the presence of antineutrophil cytoplasmic antibodies (ANCA). However, a subset of patients with limited disease may exhibit ANCA negativity. In this article, we report the case of a 40-year-old female diagnosed with GPA with intolerance to methotrexate titration and glucocorticoid therapy, leading to the initiation of rituximab treatment. Subsequently, the patient exhibited sustained clinical, laboratory, and radiological improvement. The identification of limited GPA has important therapeutic implications as the effectiveness of the medical treatment in ANCA-negative GPA may differ. Rituximab has emerged as an optimal treatment, irrespective of ANCA status, offering prolonged responses and a favorable tolerance profile in these patients.
- Subcutaneous immunotherapy with aeroallergens-evaluation of adherence in real lifePublication . Lourenço, T; Fernandes, M; Coutinho, C; Lopes, A; Spinola Santos, A; Neto, M; Pereira Barbosa, MIntroduction. Adherence in allergen immunotherapy is crucial for its efficacy. At least 3 years of treatment are recommended for achieving a long-term modifying effect. Objectives. To assess patient’s adherence and to identify determinant factors for allergen subcutaneous immunotherapy (SCIT) suspension in patients with respiratory allergy. Methods. Retrospective analysis of the medical record of patients submitted to SCIT between January 2013 and December 2016 in our Department. Results. 323 patients were included: 52% female; mean age 30 ± 13 years; average treatment time 19 ± 13 months. 52 patients (16%) stopped SCIT: 54% female; mean age 30 ± 9 years; average treatment time 12 ± 6 months; 67% dropped the treatment during the 1st year, 27% in the 2nd and 6% during the 3rd year of treatment. Adherence rate determined was 77%. The most frequent reasons for withdrawal were due to economic reasons (47.9%), followed by patients’ perception of no clinical improvement (23%) and change to sublingual immunotherapy (11.6%). Conclusions. Adherence rate in our study was 77%. Economic reasons were the main cause of abandonment in the first year, while the perception of non-improvement was the main reason for abandonment in subsequent years. Adequate information on SCIT prescribing and rigorous monitoring of patients during the treatment can improve adherence.