Browsing by Author "Gonçalves, Miguel"
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- Echocardiography and cardiovascular risk:The relationship in the renal transplant recipientPublication . Neto, Micaela; Gonçalves, Miguel; Resende, Luis; Vieira, Pedro; Gomes, Susana; Durães, José; Rosa, Nuno; Teixeira, José Alves; Silva, GilIntroduction: Cardiovascular disease (CVD) is the major cause of death among renal transplant recipientes (RTR). It is not known whether echocardiographic abnormalities are useful to identify RTR at high risk of CVD. Methods: Retrospective review of RTR with functioning and stable graft and an echocardiography performed in the last year. Risk of major adverse cardiac events (MACE) and death using a risk calculator specific for RTR. Results: Among 107 patients (57.9% males, 50.4±13.9 years), 7-year risk of MACE was >10% in 30.9% of patients and 7-year risk of death >10% in 56.1%. Left ventricular hypertrophy (LVH) was found in 55.1%, diastolic dysfunction in 39.3%, dilated left atrium (LA) in 53.3%, high pulmonary artery systolic pressure (PASP) in 9.0%, valvular calcifications in 22.4% and moderate to severe mitral regurgitation (MR) in 3.7%. Mean Ejection fraction was 68.36±6.87%. Univariate analysis showed an increased risk of MACE and death in patients with LVH, diastolic dysfunction, dilated LA, high PASP, valvular calcifications and MR. Multivariate analysis identified an independente association between the risk of MACE >10% and valvular calcifications and high PASP. Risk of death>10% in multivariate analysis had an independent association with diastolic dysfunction and elevated PASP. Conclusion: Echocardiographic abnormalities identify RTR at increased risk of MACE and death. Valvular calcifications and high PASP are predictors of MACE whereas diastolic dysfunction and high PASP predict death.
- Jovens Solistas da MetropolitanaPublication . Ribeiro, José; Nogueira, Inês; Wakabayashi, Paul; Coelho, Inês; Manso, André; Matos, André; Duarte, Guilherme Elawar; Gonçalves, MiguelBrochura de sala do concerto realizado pelos Jovens Solistas da Metropolitana a 23 de Fevereiro de 2023 no ÂMBITO CULTURAL, PISO 6 do EL CORTE INGLÉS em Lisboa no âmbito da Temporada 2022/2023 da Metropolitana. O programa do concerto foi preenchido com obras de Schubert, Beethoven, Crespo e Telemann. Desenvolvendo uma ponte pedagógica inédita entre a prática e o ensino musical, a ANSO é a única escola do país que forma maestros, instrumentistas de orquestra e pianistas vocacionados para música de câmara. Ao longo dos seus quase 30 anos, mudou o panorama cultural em Portugal, sendo muitos os seus alunos a entrar nas mais exigentes instituições de ensino e formações internacionais. Mais premiada escola nacional desta área, as novas gerações de intérpretes e diretores musicais que lança são reconhecidas pela qualidade. A música de câmara é uma das vertentes fundamentais da Academia Nacional Superior de Orquestra, que todos os anos apresenta o ciclo Jovens Solistas da Metropolitana.
- Obesity, acute kidney injury and mortality in patients with sepsis: a cohort analysisPublication . Gameiro, Joana; Gonçalves, Miguel; Pereira, Marta; Rodrigues, Natacha; Godinho, Iolanda; Neves, Marta; Gouveia, João; Silva, Zélia Costa e; Jorge, Sofia; Lopes, José AntónioAlthough the prognostic effect of obesity has been studied in critically ill patients its impact on outcomes of septic patients and its role as a risk factor for acute kidney injury (AKI) is not consensual. We aimed to analyze the impact of obesity on the occurrence of AKI and on in-hospital mortality in a cohort of critically ill septic patients. This study is retrospective including 456 adult patients with sepsis admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Obesity was defined as a body mass index of 30 kg/m2 or higher. The Kidney Disease Improving Global Outcomes classification was used to diagnose and classify patients developing AKI. AKI occurred in 87.5% of patients (19.5% with stage 1, 22.6% with stage 2 and 45.4% with stage 3). Obese patients developed AKI more frequently than non-obese patients (92.8% versus 85.5%, p = .035; unadjusted OR 2.2 (95% CI: 1.04-4.6), p = .039; adjusted OR 2.31 (95% CI: 1.07-5.02), p = .034). The percentage of obese patients, however, did not differ between AKI stages (stage 1, 25.1%; stage 2, 28.6%; stage 3, 15.4%; p = .145). There was no association between obesity and mortality (p = .739). Of note, when comparing AKI patients with or without obesity in terms of in-hospital mortality there were also no significant differences between those groups (38.4% versus 38.4%, p = .998). Obesity was associated with the occurrence of AKI in critically ill patients with sepsis; however, it was not associated with in-hospital mortality.
- Plataforma DECIdE: Transforme dados em conhecimentoPublication . Ferreira, Bruno; Carriço, Nelson; Mendes, Ana; Baio, Miguel; Barreira, Raquel; Grueau, Cédric; Antunes, André; Gomes, João; Gonçalves, Miguel; Covas, Dídia; Ferreira, João; Fernandes, Sílvia; Santos, João; Brito, Isabel; Boga, CristinaAs Entidades Gestoras (EG) de sistemas de abastecimento de água são responsáveis por assegurar água em quantidade e qualidade para as populações que servem, conforme o 6º Objetivo de Desenvolvimento Sustentável da ONU [1] sem, no entanto, comprometerem a sua integridade económico-financeira. Estas EG são responsáveis pela gestão e operação destes sistemas, recorrendo regularmente a um numeroso conjunto de sistemas de informação (SI) para recolher, armazenar e gerir o vasto conjunto de dados gerados por esta atividade. No âmbito do projeto de investigação DECIdE - Plataforma de Apoio à Decisão em Infraestruturas Urbanas de Água – foi desenvolvida uma plataforma informática que integra dados provenientes de diferentes SI da EG, incluindo ainda algumas ferramentas para o apoio à tomada de decisão. A plataforma foi desenvolvida em colaboração com cinco EGs de pequena e média dimensão, com modelos de gestão (i.e., gestão direta e gestão delegada), maturidade digital e processos de gestão da informação diferentes. A integração de informação proveniente de diversos SI numa base de dados unificada é um processo complexo, em parte devido à disparidade de processos de gestão de informação e maturidade digital presentes nas EGs parceiras. Neste sentido, foi desenvolvido um modelo de dados abrangente, assim como um mecanismo de análise, mapeamento e indexação entre o conteúdo a importar e o modelo de danos unificado, permitindo assim que diferentes entidades utilizem a plataforma. A plataforma, de forma a apoiar o processo de apoio à tomada de decisão, incorpora um conjunto de indicadores de desempenho [2], selecionados pelas EGs parceiras, de forma a refletir as necessidades por estas sentidas. Adicionalmente, foram incorporados módulos de cálculo de balanços hídrico e energético. Estes balanços permitem a avaliação da eficiência hídrica [3] e energética [4] dos sistemas. A visualização gráfica deste conjunto de indicadores de desempenho pode tornar-se de alguma forma difícil, especialmente quando se pretende realizar análises ao nível setorial (i.e., subsistema ou Zona de Medição e Controlo). Neste sentido, e com o objetivo de facilitar o processo de apoio à tomada de decisão, foi desenvolvido um dashboard baseado em filtros customizados pelo utilizador (i.e., por área de análise, conjunto de dados e indicadores, e período temporal), incluindo ainda diferentes tipos de representação gráfica (e.g., gráfico de barras, linhas, circular). O presente artigo aborda o desenvolvimento das diversas funcionalidades, módulos e ferramentas da plataforma DECIdE.
- Rare aetiology of obstructive kidney injury: Bilateral ureteral endometriosisPublication . Correia, Maria Inês; Vieira, Pedro; Gonçalves, Miguel; Durães, José M; Santos, Dina; Rosa, Nuno G; Silva, GilEndometriosis is highly prevalent in women at the reproductive age, ranging from 6-10%, though ureteral involvement is rare, only seen in 0.1% of the cases, but may lead to urinary tract obstruction with potential renal function loss. As endometriosis has a non-specific symptomology, diagnosis may be elusive, though it must be considered in order to prevent irreversible kidney injury and resultant morbidity. Here we present a 29-year-old Caucasian female with a past medical history of infertility and dysmenorrhoea who presented with a stage II acute kidney injury. On initial diagnostic approach, moderate bilateral ureterohydronephrosis was detected by ultrasound, assuming extrinsic compression, but no specific cause was recognizable. In order to diagnose the obstruction’s aetiology, Magnetic Resonance Imaging was used. This did not reveal an objective cause. Given the circumstances, workup ended in an explorative laparotomy, revealing a “frozen pelvis” due to endometriosis, confirmed histologically. Due to difficult ressecability, a conservative approach was taken through hormonal reatment and bilateral ureteral pigtail placement, given the necessity to salvage renal function and decrease disease burden.
- Serum lactates and acute kidney injury in patientsPublication . Gonçalves, Miguel; Gameiro, Joana; Pereira, Marta; Rodrigues, NatachaAbstract:Granting the association of lactates with mortality has been largely ocumented in critically ill patients with sepsis, its association with the development of acute kidney injury (AKI) in this setting is not well established. We aimed to analyze the association of serum lactates at intensive care unit (ICU) admission with the occurrence AKI in a cohort of critically ill septic patients. Materials and methods: This study is retrospective including 457 adult patients with sepsis admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to diagnose and classify patients developing AKI within the first week of hospitalization. Logistic regression analysis was employed to determine factors associated with AKI development. Data were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was defined as a p-value < 0.05. Results: AKI occurred in 87.5% of patients with a maximum KDIGO category (19.5% with stage 1, 22.6% with stage 2 and 45.4% with stage 3). Serum lactates were higher among patients developing AKI as compared with non-AKI patients (mmol/L 29.9 ± 25.7 vs. 18.6 ± 9.3, p = 0.001; unadjusted OR 1.04 (95% CI 1.02–1.07), p = 0.001; adjusted OR 1.03 (95% CI 1.01–1.06), p = 0.024), and they were progressively higher in accordance with AKI severity (stage 1, 24.5 ± 18.7; stage 2, 25.5 ± 16.9; stage 3, 34.6 ± 30.7; p = 0.001). Conclusions: Serum lactates at ICU admission were independently associated with the occurrence of AKI in critically ill patients with sepsis.
- Towards an integrated platform for decision support in water utility managementPublication . Grueau, Cédric; Antunes, André; Ferreira, Bruno; Gonçalves, Miguel; Carriço, NelsonThe pressure on water supply systems is a real challenge for water utilities, which are entrusted with the responsibility to manage and operate those systems. Water utility engineers and managers make decisions based on data that are obtained from several information systems (IS), such as geographic information systems (GIS), billing, asset operation and maintenance or accounting. Most of the time, these IS result in data silos as a consequence of lack of machine communication protocols, common data formats or common meaning of exchanged content. On the other hand, the diversity of IS is a challenge to water utilities which struggle with data consistency and interoperability. In this context, water utility engineers and managers make decisions based on data which are often incomplete, inaccurate or out-of-date. In this paper, we present an IT platform that integrates data from different information systems, including tools to support decision-making on water supply systems (e.g., performance indicators, water, and energy balances). This platform, developed in collaboration with a representative set of Portuguese water utilities, allows water utilities to integrate their data and perform analysis of their systems. With this approach, we provide water utilities and water supervision agencies with the possibility to compute a unified set of metrics whatever the IS they use.