Browsing by Author "Gaspar, A"
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- A 2018 overview of diuretic resistance in heart failurePublication . Jardim, S; Ramos dos Santos, L; Araújo, I; Marques, F; Branco, P; Gaspar, A; Fonseca, CAbstract Heart failure is a disease with high direct and indirect costs. Current treatment includes drugs that alter disease progression and drugs that to improve symptoms. Loop diuretics are the cornerstone of congestion relief for acute management, as well as for chronic stabilization. In heart failure patients, maximal diuretic response is reduced by many individual factors. Diuretic resistance is defined as failure to achieve effective congestion relief despite appropriate or escalating diuretic doses. Its causes include impaired delivery of the diuretic to its luminal site of action, neurohormonal activation, tubular compensatory adaptation and drug interactions. Several strategies can be employed to aid decongestion of patients with impaired diuretic response. These include salt restriction, a higher effective single dose or higher dose frequency of loop diuretics, continuous infusion of diuretics and/or sequential nephron blockade through a synergistic combination of two or more diuretics from different classes. Ultrafiltration has also been found to be another effective and safe therapeutic option and should be considered in patients with refractory diuretic resistance. Overall, there is a lack of high-quality clinical data to guide the choice of treatment strategy and therapy should be tailored on a case-by-case basis.
- After an acute coronary syndrome: oral tolerance test for all patients?Publication . Ribeiro, S; Azevedo, P; Gaspar, A; Vieira, C; Ramos, V; Nabais, S; Basto, L; Pereira, MA; Correia, A
- Anaphylaxis to clavulanic acid: seven-year surveyPublication . Silveira, AM; Gaspar, A; Benito-Garcia, F; Couto, S; Matias, J; Chambel, M; Morais-Almeida, M
- Aneurisma trombosado do seio de valsalva esquerdoPublication . Brandão, A; Nabais, S; Salomé, N; Gaspar, A; Simões, A; Costeira, A; Correia, AThe authors present the case of a 57-year-old asymptomatic woman, in whom a large left coronary sinus of Valsalva aneurysm was incidentally diagnosed on a routine echocardiogram in 1998. The case was initially presented to cardiac surgery consultants, and since there were no signs of rupture and the patient was asymptomatic, it was decided to keep her in close clinical and echocardiographic follow-up. Eight years later, and with no clinical manifestation in the meantime, a transesophageal echocardiogram (TEE) showed that the aneurysm was filled with swirling spontaneous echo contrast ("smoke") overlying a thrombus, which was not detected by transthoracic echocardiography. The patient then underwent surgical treatment with aortic root and aortic valve replacement and coronary reimplantation, with an excellent result. Although the need for early surgical intervention in patients with ruptured sinus of Valsalva aneurysms is well established, the optimal management of an asymptomatic, unruptured aneurysm is less clear, due to the absence of a precise natural history. The follow-up of our patient clearly demonstrated that it is mandatory to assess unruptured sinus of Valsalva aneurysms by TEE, particularly to exclude thrombotic complications. Such complications are one of the possible paths of the natural history of unruptured sinus of Valsalva aneurysms, and support the indication for early surgical treatment to avoid future complications.
- Aspirin desensitization in a woman with inherited thrombophilia and recurrent miscarriage.Publication . Santos, N; Gaspar, A; Livramento, S; Sampaio, G; Morais-Almeida, MWomen with inherited thrombophilia and recurrent miscarriage might benefit from preconceptional antiagreggation with low-dose acetylsalicylic acid (ASA), but concerns about severe adverse reactions may prevent physicians from performing this treatment in patients with ASA hypersensitivity. We report the first known case of ASA desensitization in a 41-year-old woman with inherited thrombophilia, who had homozygosity (4G/4G polymorphism) of the plasminogen activator inhibitor-1 (PAI-1) gene and first trimester recurrent miscarriage, and had previously presented with anaphylaxis to ASA. Desensitization was completed despite one self-limited adverse reaction, and the patient has maintained a daily ASA intake of 100 mg with good tolerance.
- Associação entre o índice de anisocitose (RDW) e a ocorrência de morte ou enfarte aos seis meses em doentes com síndrome coronária agudaPublication . Nabais, S; Losa, N; Gaspar, A; Rocha, N; Costa, J; Azevedo, P; Basto, L; Pereira, MA; Correia, ABACKGROUND: Higher values of red ceildistribution width (RDW) may be associated with adverse outcomes in patients with heart failure and in those with stable coronary artery disease. We assessed the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS). METHODS: We studied 1796 patients with ACS admitted to a coronary care unit. We analyzed clinical and laboratory characteristics, management, and outcomes of patients according to tertiles of baseline RDW. The primary outcome was death or myocardial infarction (MI) during six-month follow-up. RESULTS: Patients with higher RDW values tended to be older, were more likely to be female and have a history of MI, and more often had renal dysfunction, anemia, and Killip class >I on admission (p < 0.05). Higher RDW values were associated with increased 6-month mortality (tertile 1: 8.2%; tertile 2: 10.9%; tertile 3: 15.5%; p = 0.001 for trend) and increased 6-month death/MI rates (tertile 1, 13.0%; tertile 2, 17.2%; tertile 3, 22.9%; p < 0.0001 for trend). An association between higher RDW and increased 6-month death/MI rates was found in patients with non-ST-elevation ACS (10.5% vs. 15.3% vs. 22.7%; p < 0.001 for trend), with a tendency in patients admitted with ST-elevation MI (15.1% vs. 19.1% vs. 23.1%; p = 0.053 for trend). After adjustment for baseline characteristics and treatment, higher RDW values remained independently associated with the study's primary composite outcome but not with all-cause death. Using the first tertile of RDW as reference, the adjusted odds ratio (OR) for 6-month death/MI among patients in the highest RDW tertile was 1.43 (95% confidence interval [CI], 1.00-2.05; p = 0.049). Using RDW as a continuous variable, the adjusted OR for 6-month death/MI was 1.16 (95% CI, 1.03-1.30; p = 0.017) per 1% increase in RDW.
- Cam deformity and the omega angle, a novel quantitative measurement of femoral head-neck morphology: a 3D CT gender analysis in asymptomatic subjectsPublication . Mascarenhas, VV; Rego, P; Dantas, P; Gaspar, A; Soldado, F; Consciência, JGOBJECTIVE: Our objectives were to use 3D computed tomography (CT) to define head-neck morphologic gender-specific and normative parameters in asymptomatic individuals and use the omega angle (Ω°) to provide quantification data on the location and radial extension of a cam deformity. METHODS: We prospectively included 350 individuals and evaluated 188 asymptomatic hips that underwent semiautomated CT analysis. Different thresholds of alpha angle (α°) were considered in order to analyze cam morphology and determine Ω°. We calculated overall and gender-specific parameters for imaging signs of cam morphology (Ω° and circumferential α°). RESULTS: The 95 % reference interval limits were beyond abnormal thresholds found in the literature for cam morphology. Specifically, α° at 3/1 o´clock were 46.9°/60.8° overall, 51.8°/65.4° for men and 45.7°/55.3° for women. Cam prevalence, magnitude, location, and epicenter were significantly gender different. Increasing α° correlated with higher Ω°, meaning that higher angles correspond to larger cam deformities. CONCLUSION: Hip morphometry measurements in this cohort of asymptomatic individuals extended beyond current thresholds used for the clinical diagnosis of cam deformity, and α° was found to vary both by gender and measurement location. These results suggest that α° measurement is insufficient for the diagnosis of cam deformity. Enhanced morphometric evaluation, including 3D imaging and Ω°, may enable a more accurate diagnosis. KEY POINTS: • 95% reference interval limits of cam morphotype were beyond currently defined thresholds. • Current morphometric definitions for cam-type morphotype should be applied with care. • Cam prevalence, magnitude, location, and epicenter are significantly gender different. • Cam and alpha angle thresholds should be defined according to sex/location. • Quantitative 3D morphometric assessment allows thorough and reproducible FAI diagnosis and monitoring.
- Cistatina C e valor prognóstico nas síndromes coronárias agudasPublication . Vieira, C; Nabais, S; Ramos, V; Ribeiro, S; Gaspar, A; Braga, CG; Salomé, N; Rocha, S; Azevedo, P; Álvares-Pereira, M; Correia, A
- Desensitization to Cyanocobalamin: Rush ProtocolPublication . Alves-Correia, M; Gaspar, A; Borrego, L M; Mota, I; Morais-Almeida, M
- Drug-Induced Anaphylaxis Survey in Portuguese Allergy DepartmentsPublication . Faria, E; Rodrigues-Cernadas, J; Gaspar, A; Botelho, C; Castro, E; Morais-Almeida, M; Portuguese Society of Allergology and Clinical Immunology; Drug Allergy Interest Group.; et alBACKGROUND AND OBJECTIVE: Drug-induced anaphylaxis is an unpredictable and potentially fatal adverse drug reaction. The aim of this study was to identify the causes of drug-induced anaphylaxis in Portugal. METHODS: During a 4-year period a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 313 patients with drug anaphylaxis were received and reviewed. Statistical analysis included distribution tests and multiple logistic regression analysis to investigate significance, regression coefficients, and marginal effects. RESULTS: The mean (SD) age of the patients was 43.8 (17.4) years, and 8.3% were younger than 18 years. The female to male ratio was 2:1.The main culprits were nonsteroidal anti-inflammatory drugs (NSAIDs) (47.9% of cases), antibiotics (35.5%), and anesthetic agents (6.1%). There was a predominance of mucocutaneous symptoms (92.2%), followed by respiratory symptoms (80.4%) and cardiovascular symptoms (49.0%). Patients with NSAID-induced anaphylaxis showed a tendency towards respiratory and mucocutaneous manifestations. We found no significant associations between age, sex, or atopy and type of drug. Anaphylaxis recurrence was observed in 25.6% of cases, and the risk was higher when NSAIDs were involved. CONCLUSIONS: NSAIDs were the most common cause of anaphylaxis in this study and were also associated with a higher rate of recurrence. We stress the need for better therapeutic management and prevention of recurring episodes of drug-induced anaphylaxis.
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