Browsing by Author "Rocha, S"
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- Admission glycemia: a predictor of death after acute coronary syndrome in non-diabetic patients?Publication . Rocha, S; Nabais, S; Magalhães, S; Salgado, A; Azevedo, P; Marques, J; Torres, M; Pereira, MA; Correia, ABACKGROUND: Previous studies have demonstrated that acute phase hyperglycemia is associated with increased in-hospital mortality in diabetic patients admitted with acute coronary syndrome (ACS), but this has not been clearly demonstrated in non-diabetic patients. The present study was designed to determine whether admission hyperglycemia (AG) is an independent predictor of in-hospital and six-month mortality after ACS in non-diabetic patients. METHODS: This was a retrospective cohort study of 426 non-diabetic patients consecutively admitted with ACS. The patients were stratified into quartile groups according to AG, which was also analyzed as a continuous variable. Vital status was obtained at six-month follow-up in 96.8% of the patients surviving hospitalization. Logistic regression analysis was used to identify independent predictors of in-hospital and six-month death. RESULTS: Of the 426 patients included in the study (age 62.6 years+/-13.1, 77% male), 22 (5.4%) patients died during hospitalization and 20 (5.2% of the patients surviving hospitalization) within six months of ACS. Mean AG was 134.89 mg/dl+/-51.95. The higher the AG, the more probable was presentation with ST-segment elevation ACS (STEMI), anterior STEMI, higher heart rate, Killip class higher than one (KK >1), higher serum creatinine and greater risk of in-hospital and six-month death. In multivariate analysis, only age (OR=1.10; 95% CI 1.04-1.17), STEMI (OR=3.02; 95% CI 1.07-8.50), AG (OR=1.073; 95% CI 1.004-1.146), serum creatinine (OR=1.10; 95% CI 1.009-1.204) and KK >1 on admission (OR=4.65; 95% CI 1.59-13.52) were independently associated with in-hospital death. Age (OR=1.07; 95% CI 1.03-1.12), serum creatinine (OR=1.09; 95% CI 1.01-1.18) and in-hospital development of heart failure (OR=2.34; 95% CI 1.07-5.10) were independently associated with higher risk of death within six months of ACS. CONCLUSIONS: AG is an independent predictive factor of in-hospital death after ACS in non-diabetic patients. Although it did not show an independent association with higher risk of six-month death, AG appears to contribute to it, since the risk is greater the higher the AG. Its predictive value may have been blunted by the insufficient power of the sample and/or by the time interval between acquisition of AG and the evaluated endpoint.
- Uma causa rara de paralisia facial periférica recorrentePublication . Pinho, J; Rocha, S; Machado, A; Lourenço, ERecurrent peripheral facial palsy (PFP) is not uncommon and it is reported in 3 to 15% of idiopathic PFPs. Other etiologies include intracranial compressive tumors, parotid gland tumors or inflammation, recurrent otitis media, head trauma, multiple sclerosis, sarcoidosis, tuberculosis, Lyme disease, HIV, and the rare Melkersson-Rosenthal Syndrome (MRS). The MRS is a non-necrotizing granulomatous disease characterized by PFP, lingua plicata and orofacial edema, even though the classic triad is reported in only from 20 to 30% of the patients1. We describe a patient with recurrent alternating PFP with MRS.
- 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
- Deep cerebral venous thrombosis: a challenging diagnosisPublication . Pires, A; Rocha, S; Rodrigues, M; Machado, A; Lourenço, E; Ferreira, C
- Deep cerebral venous thrombosis: a challenging diagnosis.Publication . Pires, A; Rocha, S; Rodrigues, M; Machado, A; Lourenço, E; Ferreira, C
- Epilepsia Mioclónica Progressiva: à procura do diagnóstico genéticoPublication . Pinho, J; Rocha, S; Maré, R; Lourenço, E
- G2P[4] the most prevalent rotavirus genotype in 2007 winter season in an European non-vaccinated populationPublication . Antunes, H; Afonso, A; Iturriza, M; Martinho, I; Ribeiro, C; Rocha, S; Magalhães, C; Carvalho, L; Branca, F; Gray, JBACKGROUND: Recently, a high prevalence of G2P[4] rotavirus (RV) infection was reported from Brazil, and linked with the universal RV vaccination programme that used the G1P[8] live oral RV vaccine. OBJECTIVE: To determine the genotypes of RV co-circulating in a non-vaccinated population, in northern Portugal in the winter season of 2007. STUDY DESIGN: Prospective multicenter study of the genotypes circulating in the northwest region of Portugal during January to March 2007. Children with acute gastroenteritis, who attended the Pediatric Emergency Services of five Hospitals, were included in the study. The parents of the children completed a clinical and epidemiological data questionnaire and stool samples were collected. Stool samples positive in a RV enzyme immunoassay (EIA) were genotyped by reverse transcriptase-polymerase chain reaction. RESULTS: Stool samples were collected from 424 children. Two hundred and thirty-four (55.2%) stool samples were RV-positive. G2P[4] was the predominant RV type (68.6%), followed by G9P[8] (14.0%). CONCLUSIONS: Because our population was naïve for RV vaccine, the G2P[4] predominance cannot be explained by vaccination. Rather, this high prevalence of G2P[4] may be within the normal fluctuation of RV genotypes. RV strain surveillance programmes are important for informing RV vaccination programmes.
- Heart failure after acute coronary syndrome: identify to treat better!Publication . Rocha, S; Nabais, S; Magalhães, S; Azevedo, A; Torres, M; Marques, J; Pereira, MA; Correia, AINTRODUCTION: The development of heart failure (HF) following acute coronary syndromes (ACS) significantly worsens short- and long-term prognosis. The present study aimed to identify clinical characteristics, detectable at admission for ACS, that could predict HF development during hospitalization, and to evaluate its impact on in-hospital mortality. METHODS: This was a retrospective cohort study that included 601 patients consecutively admitted with ACS. Demographic, clinical and laboratory data at admission were collected and HF was defined as maximum Killip class II or III. Logistic regression analysis was performed to identify independent predictors of HF and, additionally, in-hospital death. RESULTS: 29.3% of the population developed HF, mostly older patients (69.52+/-11.9 years vs. 61.81+/-12.4 years, p<0.0001), women, hypertensive, diabetic and non-smokers. On admission, this subgroup of patients presented with higher heart rate and glycemia, and lower glomerular filtration rate (eGFR) and hemoglobin. The percentage of patients with left ventricular systolic dysfunction (LVSD) was significantly higher in the group of patients with HF (74.4% versus 48.7%, p<0.0001); however, no significant differences were found in the type of ACS or its location. In the present study, we found that patients with HF were stratified less invasively (less likely to undergo cardiac catheterization or percutaneous coronary intervention). The development of HF was associated with longer hospitalization and higher in-hospital mortality (7.4% versus 2.1%, p=0.004) on univariate analysis, but not on multivariate analysis. On multivariate analysis, only age (OR=1.04; 95% CI 1.02-1.06), diabetes mellitus (OR=1.77; 95% CI 1.05-2.96), glycemia (OR=1.05; 95% CI 1.01-1.08), eGFR <60 ml/min/1.73m2 (OR=2.90, 95% CI 1.73- 4.84), heart rate (OR=1.03, 95% CI 1.02-1.04) and LVSD (OR=2.48, 95% CI 1.59-3.85) were independent predictors of HF. CONCLUSIONS: HF is a frequent complication in ACS and is associated with higher in-hospital mortality. Identifying risk of HF development on admission, through easily acquired clinical characteristics (older age, diabetes and/or elevated glycemia, renal failure and higher heart rate), will certainly influence immediate therapeutic choices and permit an individualized approach to each patient.
- Impacto da fibrilhação auricular nas síndromes coronárias agudasPublication . Torres, M; Rocha, S; Marques, J; Nabais, S; Rebelo, A; Álvares-Pereira, M; Azevedo, P; Correia, AINTRODUCTION: Atrial fibrillation (AF) is a relatively common arrhythmia in the context of acute coronary syndromes (ACS). However, the impact of AF on these patients' survival is not well established. The present study aimed to estimate the prevalence of AF in ACS patients and to evaluate its impact on in-hospital and six-month post-event mortality, from any cause. METHODS: This was a retrospective cohort study that included 1183 patients admitted consecutively to a Coronary Care Unit with ACS. Demographic and clinical data and information from various complementary exams were collected and occurrence of AF during the first 48 hours of hospitalization was analyzed. Six-month follow-up was achieved in 95.9% of the patients. Logistic regression statistical analysis was used to identify independent predictors of in-hospital and six-month post-event mortality. RESULTS: AF was diagnosed in 140 patients (11.8%); these patients were older (73.89 +/- 8.69 vs. 63.20 +/- 12.73 years; p<0.0001) and less likely to be male (60.0% vs. 74.1%; p=0.001), and had a lower prevalence of dyslipidemia (32.9% vs. 44.1%; p=0.001) and smoking (10.0% vs. 25.9%; p<0.0001). Fewer patients with AF underwent reperfusion therapy (19.3% vs. 29.7%; p=0.006), beta-blocker therapy (72.1% vs. 85.7%; p<0.0001), and cardiac catheterization (48.2% vs. 62.9%; p=0.001) or percutaneous coronary intervention (14.3% vs. 23.4%; p=0.01). These patients more frequently developed heart failure (54.3% vs. 28.5%; p<0.0001) and more often presented left ventricular dysfunction (69.3% vs. 57.2%; p=0.002). In patients presenting AF, there were significant increases in in-hospital (12.1% vs. 4.2%; p<0.0001) and six-month mortality (27.2% vs. 8.2%. p<0.0001). In multivariate analysis, AF remained an independent marker of in-hospital (OR 1.95; 95% CI 1.03-3.69; p=0.03) and six-month mortality (OR 2.89; 95% CI 1.67-5.00; p=0.0001), as was age >75 years, severe left ventricular dysfunction and heart failure. The performance of coronary angiography correlated with improved prognosis. CONCLUSIONS: AF in the context of ACS is an independent predictor of increased in-hospital and six-month mortality. These findings should be taken into consideration in the management and treatment of such patients.
- Impacto prognóstico da insuficiência mitral isquémica no EAM sem supraSTPublication . Ramos, V; Vieira, C; Galvão, C; Martins, J; Ribeiro, S; Rocha, S; Gaspar, A; Marques, J; Azevedo, P; Álvares-Pereira, M; Correia, A
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