Browsing by Author "Pereira, J"
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- Diversity in anti-N-methyl-D-aspartate receptor encephalitis: case-based evidencePublication . Pinho, J; Rocha, J; Rodrigues, M; Pereira, J; Maré, R; Ferreira, C; Lourenço, E; Beleza, PAntibodies against N-methyl-D-aspartate receptor (NMDAR) are identified in the form of immune-mediated encephalitis in which typical manifestations include neuropsychiatric symptoms, seizures, abnormal movements, dysautonomia and hypoventilation. The authors report two cases of anti-NMDAR encephalitis with different presentations and patterns of progression. The first patient presented with status epilepticus and later developed psychosis, pyramidal signs and diffuse encephalopathy. The second patient presented with acute psychosis followed a week later by seizures, dystonia, rigidity, oromandibular dyskinesias and dysautonomia. Possible mechanisms responsible for the clinical manifestations of this disease are discussed in light of recently described additional clinical and laboratory findings.
- Effect of occupational activity on ambulatory blood pressure behaviourPublication . Pereira, J; Teixeira, A; Pereira, TelmoHypertension (HBP) is a key risk factor for cardiovascular diseases, being strongly associated with behavioral and environmental aspects of living. Professional activities, amongst others that take place throughout the day, are responsible for important blood pressure (BP) variations and may increase it. Objective: This study aims at ascertaining the blood pressure profile and variation in teachers, during a typical teaching session. Methods: Ambulatory Blood Pressure Monitoring (ABPM) was performed in a cohort of 21 university teachers during a typical professional day, comprising the following periods: 24-hour period, day period, night period, morning period, 2 hours before class, during class, 2 hours after class, aerobic exercise period and 1 hour after exercise period. Results: Teachers demonstrated higher BP during the occupational activities (137.71 / 88.57 mmHg) compared to the period before (128.81 / 82.43 mmHg) and after the class (132,38 / 85, 19 mmHg) (p <0.05). It was found that systolic BP has the greatest variability across the considered activities and time periods. In a gender analysis, men had higher systolic BP compared to women (141.55 mmHg / 133.50 mmHg, respectively), and demonstrated greater variability across activities. Conclusions: The results clearly demonstrated the existence of important variations in BP due to different daily activities. The occupational period produced a significant increase in the different components of BP and heart rate. The long-term effects of repeated exposure to this increase in BP related with the occupational contexts remains to be demonstrated.
- Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures.Publication . Salvador, SF; Oliveira, J; Pereira, J; Barros, H; Vaz, RBACKGROUND: Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus, but the outcome is still controversial in terms of age and aetiology. METHODS: Between 1998 and 2011, 168 consecutive procedures were performed in 164 patients, primarily children (56%<18 years of age and 35%<2 years of age). The causes of obstructive hydrocephalus included tumoural pathology, Chiari malformation, congenital obstruction of the aqueduct, post-infectious and post-haemorrhagic membranes, and ventriculo-peritoneal shunt (VPS) malfunctions. Successful ETV was defined by the resolution of symptoms and the avoidance of a shunt. RESULTS: ETV was successful in 75.6% of patients, but 19% of the patients required VPS in the first month after ETV, and 5.4% required a VPS more than one month after ETV. Four patients were ultimately submitted for second ETVs. In this series, no major permanent morbidity or mortality was observed. CONCLUSIONS: ETV is a safe procedure and an effective treatment for obstructive hydrocephalus even following the dysfunction of previous VPSs and in children younger than two years.
- Neonatal Skull Depression: The Role of Cranial UltrasoundPublication . Assunção, A; Flor-de-Lima, F; Pereira, J; Pinto, DNontraumatic congenital neonatal skull depression is a rare condition resulting from external forces shaping the fetal skull. Typically, newborns are asymptomatic, and, usually, the condition resolves in a few months with no need for intervention. However, many newborns undergo a CT scan, an ionizing technique, to check for fractures or intracranial lesions. We report a case of congenital skull depression without neurological deficits, managed conservatively through clinical monitoring and ultrasound.
- Neonatal Skull Depression: The Role of Cranial UltrasoundPublication . Assunção, A; Flor-de-Lima, F; Pereira, J; Pinto, DNontraumatic congenital neonatal skull depression is a rare condition resulting from external forces shaping the fetal skull. Typically, newborns are asymptomatic, and, usually, the condition resolves in a few months with no need for intervention. However, many newborns undergo a CT scan, an ionizing technique, to check for fractures or intracranial lesions. We report a case of congenital skull depression without neurological deficits, managed conservatively through clinical monitoring and ultrasound.
- Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision CasesPublication . Ribeiro, R; Pouwels, S; Parmar, C; Pereira, J; Manaças, L; Guerra, AC; Borges, N; Ribeiro, J; Viveiros, OBackground: One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. Methods: A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. Results: The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. Conclusions: The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.
- Primary Central Nervous System Lymphoma Mimicking the Presentation of Pituitary Apoplexy: A Case ReportPublication . Meira Goncalves, J; Polónia, P; Pereira, J; Silva, PAPituitary lymphoma is one of the rare variants of primary central nervous system lymphoma (PCNSL), mostly arising due to the metastatic spread of systemic lymphoma. We report the case of a 69-year-old woman who initially presented to her family physician with a headache but without any other symptoms. The MRI scan revealed a sellar mass consistent with a pituitary macroadenoma. When the patient was referred to our hospital, two weeks later, the symptoms had progressed, comprising complete right-sided ophthalmoplegia and ptosis, with left-sided amaurosis. A repeat MRI revealed an increased size of the sellar mass, consistent with pituitary apoplexy. A right pterional craniotomy with partial resection of the mass was performed and an intraoperative frozen section biopsy was carried out. The final pathology revealed diffuse large B-cell lymphoma. A systemic follow-up including a whole-body CT, bone marrow aspiration, and cerebrospinal fluid studies ruled out any systemic manifestation, and the patient was HIV-negative. The patient underwent treatment with methotrexate, cytarabine, thiotepa, and rituximab for PCNSL. Although rare, PCNSL can mimic pituitary apoplexy, which needs to be considered if conservative therapy or surgery is to be offered to a patient with a radiological and clinical diagnosis of pituitary apoplexy.
- Probable acute disseminated encephalomyelitis due to Haemophilus influenzae meningitisPublication . Beleza, P; Ribeiro, M; Pereira, J; Jordão, MJ; Almeida, FWe report the case of a 17-year-old male on long-term steroid therapy for minimal lesion glomerulopathy who, after an upper respiratory infection, presented with Haemophilus influenzae type b meningitis. Twenty-four hours later he developed depression of consciousness which progressed to coma and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed multiple lesions (hyperintense on T2 and slightly hypointense on Tl) involving mainly white matter suggestive of inflammation. MRI features were compatible with acute disseminated encephalomyelitis (ADEM), although a differential diagnosis included cerebritis or vasculitis, secondary to bacterial meningitis. The patient was treated with high-dose steroids which resulted in a gradual improvement followed by complete clinical recovery. We propose a diagnosis of ADEM was the best diagnosis because of the radiological features and response to steroids. The occurrence of ADEM associated with acute meningitis, however rare, represents an important diagnostic challenge for the clinician.
- Randomized study of the effect of cocoa, on the blood pressure of healthy young individualsPublication . Coutinho, D; Pereira, J; Pereira, TelmoIntroduction: Since ancient times, chocolate is a food highly appreciated by people and, therefore, is present in varied eating patterns. When rich in cocoa, it has a higher concentration of flavonoids. The consumption of foods rich in flavanols has been associated with a reduction in some risk factors for cardiovascular diseases, such as hypertension. Objectives: To evaluate the effects of frequent consumption of a fixed dose of cocoa-rich chocolate on the blood pressure of healthy young individuals. Methods: Thirty healthy individuals of both sexes, aged between 18 and 35 years, were randomized, but only 28 people completed the intervention. A baseline blood pressure assessment was performed. After this the different types of chocolate were distributed by the control group (55% cocoa) and the intervention group (90% cocoa). The daily consumption of 20 grams of chocolate ran for thirty days. Two days after finishing the ingestion of the chocolate, the second evaluation was carried out. For the different evaluations, the oscillometric method was used. Results: In the different variables studied, there was a general improvement in both groups (control and intervention). However, there were only statistically significant differences in systolic blood pressure (p = 0.01) and pulse pressure (p = 0.001), in the control group. In the baseline assessment, it was found that there were no statistically significant differences between the two groups. Conclusions: This study showed that chocolate, with 55% cocoa, has beneficial effects on the blood pressure of healthy young individuals, when consumed frequently. Further research is needed with regard to the mechanisms associated with these effects, so that we can clarify the role of flavonoids.
- Takotsubo cardiomyopathy: a rare, but serious, complication of epileptic seizuresPublication . Rocha, J; Gonçalves, E; Vieira, C; Almeida, F; Pereira, J