Percorrer por autor "Patita, Marta"
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- Endoscopic gastrostomy for nutritional support in post-stroke dysphagiaPublication . Patita, Marta; Nunes, Gonçalo; Grunho, Miguel; Santos, Carla Adriana; Fonseca, JorgeIntroduction: persistent dysphagia affects 15 % of stroke patients and contributes to malnutrition, aspiration, and death. This study aimed to characterize patients with post-stroke dysphagia who underwent percutaneous endoscopic gastrostomy (PEG), and to assess the impact of PEG feeding on nutritional status and outcome. Methods: an observational and retrospective study using records from patients with post-stroke dysphagia who underwent PEG. Body mass index (BMI), serum albumin, transferrin, and cholesterol were recorded at the time of PEG insertion (T0) and 3 months later (T3). The evolution of these parameters was analyzed and compared to survival. Results: we obtained data from 158 patients (53.2 % males) with a median age of 75 years. Most strokes were ischemic (n = 135, 85.4 %). Median time between stroke and PEG was 2 months. Median survival after gastrostomy was 16 months. At admission, 41.6 % of patients had low BMI, 62.3 % low albumin, 68.6 % low transferrin, and 59.6 % low cholesterol levels. The prevalence of low albumin and low transferrin was higher in the patients who underwent PEG more than 2 months after stroke. A significant increase in albumin and transferrin, and a normalization of cholesterol levels was observed after 3 months of PEG feeding. Mortality was 12.9 %, 27.7 %, and 40 % at 1, 3, and 12 months, respectively. Survival was lower in patients with low albumin, transferrin or total cholesterol at admission. Conclusions: the prevalence of malnutrition is high among patients with post-stroke dysphagia. PEG feeding improves albumin, transferrin, and cholesterol levels. Early post-PEG mortality is high and must be considered on an individual basis.
- Endoscopic treatment of bile duct stones after bariatric Roux-en-Y gastric bypass through endoscopic ultrasound-directed transgastric ERCPPublication . Vara-Luiz, Francisco; Nunes, Gonçalo; Pinto-Marques, Pedro; Oliveira, Carla; Mendes, Ivo; Patita, Marta; Fonseca, JorgeEndoscopic retrograde cholangiopancreatography (ERCP) is technically challenging after Roux-en-Y gastric bypass (RYGB) [1]. Standard approaches include enteroscopy-assisted and laparoscopy-assisted ERCP, which present difficult implementation in clinical practice [2]. The authors report endoscopic ultrasound-directed transgastric ERCP (EDGE) for the treatment of bile duct stones in RYGB patients ([Video 1]).
- Endoscopic ultrasound-guided cholecystoduodenostomy followed by stone clearance using electrohydraulic and mechanical lithotripsy in a frail patient with acute cholecystitisPublication . Vara-Luiz, Francisco; Mendes, Ivo; Nunes, Gonçalo; Palma, Carolina; Patita, Marta; Fonseca, Jorge; Pinto-Marques, Pedro
- First case report of pancreatic angiomyolipoma diagnosed by EUS-guided fine-needle biopsyPublication . Vara-Luiz, Francisco; Patita, Marta; Pinto-Marques, Pedro; Mendes, Ivo; Canastra, Ana Ramos
- Hypophosphatemia before endoscopic gastrostomy predicts higher mortality during the first week and first month post-gastrostomy: a risk marker of refeeding syndrome in gastrostomy-fed patientsPublication . Nunes, Gonçalo; Brito, Mariana; Patita, Marta; Santos, Carla Adriana; Fonseca, JorgeIntroduction: starvation is usual in patients referred for endoscopic gastrostomy (PEG). A high risk of refeeding syndrome (RS) may contribute to poor prognosis. Objectives: this study aims to: a) evaluate serum phosphorus and magnesium when patients underwent PEG; b) determine the mortality rate during the first week and first month of enteral nutrition; and c) assess if hypophosphatemia or hypomagnesemia are associated with early mortality. Material and methods: retrospective study with patients followed in the Artificial Nutrition Clinic and died under PEG feeding. General nutritional assessment included NRS 2002, anthropometry and serum proteins. Serum phosphorus and magnesium were measured immediately before gastrostomy. Survival was recorded and compared to electrolyte and nutritional status. Results: one hundred and ninety-seven patients (137 men/60 women) aged 26-100 years. Most underwent PEG due to neurologic disorders (60.9%) and were malnourished according to body mass index (BMI) and serum proteins. Low phosphorus and magnesium were found in 6.6% and 4.6%, respectively. Hypophosphatemia was associated with malnutrition (p < 0.05). Mean survival was 13.7 ± 15.4 months. Mortality was 4.6% in the first week and 13.2% in the first month post-gastrostomy. Overall survival was shorter in malnourished patients but malnutrition did not directly influence early mortality (p > 0.05). Hypophosphatemia was associated with mortality during the first week (p = 0.02) and the first month of PEG feeding (p = 0.02). Conclusions: hypophosphatemia was uncommon but predicted early mortality after PEG. Although RS may be less frequent than expected, hypophosphatemia may be used as a RS marker and RS is the probable cause of increase early mortality in hypophosphatemic PEG-fed patients.
- Inflammatory bowel disease, alpha-synuclein aggregates and Parkinson’s disease: the InflamaSPark protocolPublication . Grunho, Miguel; Godinho, Catarina; Patita, Marta; Mocanu, Irina; Vieira, Ana Isabel; De Matos, António; Carregosa, Ricardo; Marx, Frederico; Tomé, Morgane; Sousa-Catita, Diogo; Proença, Luís; Outeiro, Tiago; Fonseca, JorgeThe hallmark of Parkinson’s disease (PD) is the accumulation of alpha-synuclein (AS) aggregates. Prior to the central nervous system involvement, PD establishes itself in the gut as a result of the complex interplay between microbiota, the host’s immune/neural systems and increased intestinal permeability. Inflammatory Bowel Disease (IBD) patients present a higher number of AS aggregates in the intestinal wall and an increased risk of developing PD. By studying AS aggregates in gut biopsy specimens of IBD patients and controls, this project aims to further clarify the pathophysiology of PD and to explore the potential of gut a biopsy for AS aggregates as a biomarker for prodromal PD.
- Refeeding syndrome in a patient with an obstructive pancreatic cancer : an emerging complication of artificial nutrition in the gastroenterology wardPublication . Patita, Marta; Nunes, Gonçalo; Canhoto, Manuela; Fonseca, JorgeRefeeding syndrome (RS) is a life-threatening condition first described in severe malnourished prisoners of the Second World War1. This syndrome is defined as electrolyte and fluid shifts associated with metabolic abnormalities developed during nutritional support. RS hallmark is hypophosphatemia, but also includes hypomagnesemia, hypokalemia, vitamin deficiencies, abnormal glucose metabolism and fluid retention. Prolonged fasting is the most important risk factor and RS may be precipitated by oral, enteral or parenteral nutrition4,5. The authors describe a case of RS in the gastroenterology ward exemplifying the importance of recognizing this underreported condition in patients with digestive pathology under nutritional therapy.
- Solitary gastric extramedullary plasmacytoma EUS features : a case reportPublication . Vara-Luiz, Francisco; Patita, Marta; Pinto-Marques, Pedro; Ferro, Susana Mão de; Ilgenfritz, Raquel; Bernardo, Manuela
- SX-ELLA Danis-stent for refractory acute esophageal variceal bleedingPublication . Currais, Pedro; Nunes, Gonçalo; Patita, Marta; Coimbra, Élia; Fonseca, JorgeThe authors describe a 78-year-old male with alcoholic liver cirrhosis (Child-Pugh score 9 points, Meld-Na 16 points, without active drinking habits for several years). The patient had clinically significant portal hypertension manifested as refractory ascites managed with repeated large volume paracentesis and five bleeding episodes from esophageal varices. During these bleeding events the patient was treated with multiple sessions of band ligation and sclerotherapy. Two days after being discharged from the hospital due to the last bleeding episode he was readmitted due to hematemesis with hypotension and anemia. After clinical stabilization and blood transfusion to reach safe hemoglobin levels (hemoglobin at admission: Hb 6.7 g/dL), upper GI endoscopy was performed, showing in the distal third of the esophagus (37 cm from the incisors), an esophageal varix with cherry-red spots and a white nipple sign suggestive of a rupture point (Fig. 1a). Band ligation was initially tried, which was not successful due to marked fibrosis that prevented the cord to enter in the cap for banding. A massive variceal bleeding developed causing loss of endoscopic view and an SX-ELLA Danis-stent (25 × 135 mm, fully covered) was placed under guidewire with immediate technical and clinical success (Fig. 1b). The proximal limit of SX-ELLA Danis-stent was located at 29 cm of the incisors. The patient progressed favorably with no evidence of further blood loss and ICU admission was not needed. Given the several episodes of variceal bleeding despite endoscopic therapy and refractory ascites, 7 days after the index procedure a Transhepatic Portosystemic Shunt (TIPS) VIATORR® endoprosthesis with 7 mm was placed without complications reaching a hepatic venous pressure gradient of 11 mm Hg (from an initial 22 mm Hg) (Fig. 2). The Danis-stent was endoscopically removed using a foreign body forceps 11 days after its placement (Fig. 3). A marked reduction in the size of the esophageal varices and a whitish scarry area in the distal esophagus coincident with the previous rupture point were observed (Fig. 4). Clinical evolution was favorable with no further bleeding recurrence or hepatic encephalopathy and partial improvement of ascites. The patient was discharged and maintained follow-up on hepatology outpatient clinic.