Browsing by Author "Nunes, A"
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- Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? – A literature reviewPublication . Alpuim Costa, D; Amaro, CE; Nunes, A; Cardoso, JS; Daniel, PM; Rosa, I; Branco, JVRadiotherapy (RT) is the backbone of multimodality treatment of more than half of cancer cases. Despite new modern RT techniques, late complications may occur such as radiation proctitis (RP). The natural history of RP is unpredictable. Minor symptoms may resolve spontaneously or require conservative treatment. On the other hand, for similar and uncomplicated clinical contexts, symptoms may persist and can even be refractory to the progressive increase in treatment measures. Over the last decades, an enormous therapeutic armamentarium has been considered in RP, including hyperbaric oxygen therapy (HBOT). Currently, the evidence regarding the impact of HBOT on RP and its benefits is conflicting. Additional prospective and randomised studies are necessary to validate HBOT's effectiveness in the 'real world' clinical practice. This article reviewed the relevant literature on pathophysiology, clinical presentation, different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.
- Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? – A literature reviewPublication . Alpuim Costa, D; Amaro, CE; Nunes, A; Cardoso, JS; Daniel, PM; Rosa, I; Branco, JVRadiotherapy (RT) is the backbone of multimodality treatment of more than half of cancer cases. Despite new modern RT techniques, late complications may occur such as radiation proctitis (RP). The natural history of RP is unpredictable. Minor symptoms may resolve spontaneously or require conservative treatment. On the other hand, for similar and uncomplicated clinical contexts, symptoms may persist and can even be refractory to the progressive increase in treatment measures. Over the last decades, an enormous therapeutic armamentarium has been considered in RP, including hyperbaric oxygen therapy (HBOT). Currently, the evidence regarding the impact of HBOT on RP and its benefits is conflicting. Additional prospective and randomised studies are necessary to validate HBOT's effectiveness in the 'real world' clinical practice. This article reviewed the relevant literature on pathophysiology, clinical presentation, different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.
- A large outbreak of Legionnaires’ Disease in an industrial town in PortugalPublication . George, F; Shivaji, T; Pinto, CS; Serra, LA; Valente, J; Albuquerque, MJ; Vicêncio, PC; San-Bento, A; Diegues, P; Nogueira, PJ; Marques, T; Rebelo, H; Costa, F; Rodrigues, R; Nunes, A; Borges, V; Gomes, JP; Sampaio, D; Barreiro, P; Duarte, S; Carpinteiro, D; Mendonça, J; Silva, C; Vieira, L; Simões, MJ; Gonçalves, P; Nunes, B; Dias, C; Machado, J; Almeida, F; Goncalves, EA; Carvalho, L; Viterbo, P; Jardim, D; Lacasta, N; Boavida, F; Perez, A; Santana, I; Matias, P; Banza, N; Rabacal, CBackground We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak's attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
- Ventilação Mecânica próximo dos Grandes Centros: Experiência de uma Unidade de Apoio PeriNatalPublication . Vale, P; Guerreiro, R; Luiz, P; Gonçalves, G; Areias, F; Nunes, A; Mocho, A; Garcia, P; Berdeja, A; Avelar, CA retrospective study of the newborns who were submitted to mechanical ventilation at the Neonatal Intermediate Care Unit was made between July 1991 and June 1994. Mechanical ventilation in such a unit should be transitory and not exceed 24 hours. Information concerning pregnancy, labour, neonates, type of ventilation and its problems was gathered. Forty seven neonates were ventilated. The average ventilation time was six hours (1-20 hours). The main cause of ventilation was hyaline membrane disease which occurred in 24% of all cases. Mortality observed was 16.6% and some sequellae were registered which were related not only to ventilation but also to the basic pathology in 26% of cases.