Browsing by Author "Santos, A"
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- Acute segmental renal infarction due to factor V LeidenPublication . Cabral-Ribeiro, J; Sousa, L; Calaza, C; Santos, AOBJECTIVE: Renal infarction is rare and has variable clinical presentations causing diagnostic difficulties. Although most renal infarctions are caused by an obvious thromboembolic factor some are only explained by hereditary or acquired thrombophilia. The authors present a case of segmental renal infarction associated with factor V Leiden. METHODS/ RESULTS: A 48-year-old man presented with right flank pain that was unresponsive to analgesia for renal colic. CT scan was performed revealing a partial renal infarction. The etiologic study was only positive to factor V Leiden. In spite of the diagnosis and treatment it resulted in atrophy of the affected renal area. CONCLUSIONS: Renal infarction can be a presentation of thrombophilia that should be searched in the absence of an obvious embolic factor. Renal CT scan is the best way to a rapid diagnosis and treatment.
- Ceacum-ilio-cutaneous fistula. A rare complication of urinary tuberculosisPublication . Ribeiro, JC; Rolanda, C; Santos, A
- Comparação de dois tipos de colóides tecneciados na detecção de gânglio sentinelaPublication . Dias, L; Geão, A; Mota, A; Santos, A; Quaresma, P; Colarinha, PIntrodução: O gânglio sentinela define-se como o primeiro gânglio detectado numa via de drenagem linfática do tumor primário. O marcador ideal para pesquisa de gânglio sentinela deve apresentar: retenção persistente neste gânglio, reduzida acumulação de radiofármaco nos gânglios satélites e depuração rápida do local de injecção. Há dois tipos de colóides tecneciados que são frequentemente utilizados em linfocintigrafia – colóides de albumina humana e colóides de sulfureto de rénio. Objectivo: Comparar os dois radiofármacos tecneciados - colóides de albumina humana e colóides de sulfureto de rénio – quanto a: 1) tempo de migração e visualização do gânglio sentinela e 2) incidência de gânglios satélites, quando utilizados em linfocintigrafias para pesquisa de gânglio sentinela em doentes com carcinoma da mama. Material e Métodos: Analisaram-se os estudos de pesquisa de gânglio sentinela de 138 pacientes com carcinoma da mama. Em 63 doentes a linfocintigrafia foi realizada com colóides de albumina humana (Nanocoll®) e em 75 doentes o radiofármaco utilizado foi colóides de sulfureto de rénio (Nanocis®). Procedeu-se à aquisição de imagens iniciais após administração do radiofármaco e foram sendo adquiridas imagens seriadas aos 60min, 90min, 120min, 180min, 240min, 300min e 360min até aparecer o gânglio sentinela. Considerou-se como término do estudo o momento de visualização do gânglio sentinela. Em 5 pacientes não se visualizou gânglio sentinela; 3 correspondiam a colóides de albumina humana e 2 correspondiam a colóides de sulfureto de rénio. Estes 5 casos foram excluídos deste estudo. Resultados: Verificou-se que no grupo de doentes a quem foi administrado colóides de albumina humana, o intervalo de tempo para visualização do gânglio sentinela foi de; 130’ (média), 120’(mediana), com um tempo mínimo de 10’ e máximo de 330’. Neste grupo não foram visualizados gânglios satélites. No grupo de doentes a quem foi administrado colóides de sulfureto de rénio o intervalo de tempo para visualização do gânglio sentinela foi de; 145’(média) 150’(mediana), com 10’ de mínimo e 360’ de tempo máximo. Neste grupo de doentes foram observados gânglios satélites em 2 casos. Conclusão: Nesta amostra não foi observada diferença significativa entre os dois radiofármacos utilizados quanto a: taxa de detecção e tempo para visualização do gânglio sentinela, assim como quanto à incidência de visualização de gânglios satélite.
- Comparing two pharmacological stress tests: adenosine vs ATP infusion – patient’s tolerance and image qualityPublication . Santos, A; Geão, A; Mota, A; Pereira, E; Dias, L; Delgado, P; Figueiredo, S; Jerónimo, VAim: Adenosine and Adenosine Triphosphate (ATP) are vasodilator agents that are used for pharmacologic stress testing in Myocardial Perfusion Imaging (MPI). Both pharmaceuticals may cause side-effects that are similarly described in the literature. Although, the half-life of these molecules are slightly different and patient’s tolerance might be different. These molecules have also been associated to an increase in the sub diaphragmatic tracer uptake that may reduce image quality, interfering with image interpretation. The aim of this study was to compare pharmacologic stress tests induced by adenosine infusion and by ATP infusion in terms of side-effects referred by patients and the corresponding image quality. Materials & Methods: Two hundred and forty eight (248) patients that underwent MPI were divided in two groups: Group 1 – Adenosine infusion (n=157); Group 3 – ATP infusion (n=91). Each group was further divided according to the presence or absence of side effects, their number and the need to administer pharmacological therapy to control symptoms: A- No side-effects; B - One side-effect; C – Two side-effects; D – Three or more side-effects and/or pharmacologic therapy needed. Image quality was evaluated according to the requirement of a new stress acquisition due to extra-cardiac activity that interfered with image quality and interpretation. Microsoft ExcelTM and SPSSTM were used in this analysis. We also correlated the two populations (Adenosine and ATP) according to the risk factors for cardiac events and the MPI result (normal or pathologic), in order to ensure that uniformity between both groups. Results: The most common effects were facial flushing, abdominal/throat pressure and discomfort in the arms. (See Table 1). Conclusions: The group with the highest percentage of no side-effects and the smaller percentage of three or more side-effects was group 2. However, in spite of the higher percentage of one side effect for group 2 (group 2=38% vs group 1=34%), the difference between them is not statistically significant (p=0,065), so we can assume that both groups had the same percentage of only one side-effect. Additionally, this group had less acquisition repetition, if compared to group 1 (acquisitions repeated: group 1=19,9%, group 2= 9,9%, p= 0,001). So, the group that had better results in terms of patient’s tolerance and image quality was group 2 – ATP infusion.
- Effectiveness of the flipped classroom methodology In the performance of higher education students: systematic review with meta-analysisPublication . Santos, Hugo; Santos, A; Rodrigues, C; Valeriano, J; Lopes, L; Freitas, M J; Esteves, R; Silva, CIntroduction: The methodology Flipped Classroom (FC) consists in individual activities that the student has to do at home through the use of technologies which help the student to prepare for class, and during classes, activities are performed as more dynamic classes centered on the student. Through the years, the success has reached the maximum levels of performance and satisfaction in the teaching sessions in different areas of education compared to the classical methods, and there are no conclusive and considerable studies that compile and analyze this information succinctly. Objective: To analyze experimental and quasi-experimental studies that evaluate the methodology database in FC in performance and student satisfaction in comparison with the expository methodology. Methodology: This article is a systematic review that analyzes the randomized controlled trial (RCT) and Quasi-experimental studies selected with the methodology FC, which measures the efficacy through the results achieved in the realization and evaluation of the students. These articles were found in EBSCOhost and PubMed. Results: We selected 41 articles, that fulfilled all inclusion criteria established by the authors, for the accomplishment of this systematic review. Discussion: The results of our meta-analysis, both RCTs and quasi-experimental studies, point to a better effectiveness of the FC methodology compared to the expository methodology in academic performance. However, there is a heterogeneity in planned and developed activities during class, which means that our conclusions can’t be generalized. The poor methodological quality of the included studies, especially quasi-experimental studies, does not allow our conclusions about efficacy to be vigorous. Nevertheless, based on these first promising data, it seems to us that this methodology offers learning opportunities that aren’t possible in a classroom based on lectures and subject matter exposition. Conclusion: Although the articles selected have poor methodological quality, and it is necessary more rigorous investigations on this methodology, we believe that the FC methodology could revolutionize teaching methods and replace traditional teaching, which is so deeply rooted in today's society and doesn’t seems to favor the achievement of transversal competences.
- Effectiveness of the flipped classroom methodology in the performance of higher educationh students: systematic review with meta-analysisPublication . Santos, Hugo; Santos, A; Rodrigues, C; Valeriano, J; Lopes, L; Freitas, M J; Esteves, R; Silva, Cntroduction: The methodology Flipped Classroom (FC) consists in individual activities that the student has to do at home through the use of technologies which help the student to prepare for class, and during classes, activities are performed as more dynamic classes centered on the student. Through the years, the success has reached the maximum levels of performance and satisfaction in the teaching sessions in different areas of education compared to the classical methods, and there are no conclusive and considerable studies that compile and analyze this information succinctly. Objective: To analyze experimental and quasi-experimental studies that evaluate the methodology database in FC in performance and student satisfaction in comparison with the expository methodology. Methodology: This article is a systematic review that analyzes the RCT and Quasi - experimental studies selected with the methodology FC, which measures the efficacy through the results achieved in the realization and evaluation of the students. These articles were found in EBSCOhost and PubMed. Results: We selected 41 articles, that fulfilled all inclusion criteria established by the authors, for the accomplishment of this systematic review. The results of our meta-analysis, both RCTs and quasi experimental studies, point to a better effectiveness of the FC methodology compared to the expository methodology in academic performance. However, there is a heterogeneity in planned and developed activities during class, which means that our conclusions can’t be generalized. The poor methodological quality of the included studies, especially quasi-experimental studies, does not allow our conclusions about efficacy to be vigorous. Nevertheless, based on these first promising data, it seems to us that this methodology offers learning opportunities that aren’t possible in a classroom based on lectures and subject matter exposition. Conclusion: Although the articles selected have poor methodological quality, and is necessary more rigorous investigations on this methodology, we believe that the FC methodology could revolutionize teaching methods and replace traditional teaching, which is so deeply rooted in today's society and doesn’t seems to favor the achievement of transversal competences.
- Evaluating Residual Activity in 18F-FDG administrationPublication . Santos, A; Geão, A; Dias, L; Mota, A; Fernandes, MThe Positron Emission Tomography (PET) is an imaging technique, based on functional, biochemical and molecular information. It is also a useful tool in oncological examination. 18F-FluoroDeoxyGlucose (FDG) is a radiopharmaceutical widely used in nuclear medicine departments with PET facilities. FDG’s corrects administration is very important in order to achieve good images and correct Standard Uptake Values (SUV). The aim of this study was to evaluate the residual activity, according to the method used in our department. Materials & Methods: Residual activities of the syringes used to administer FDG to 125 patients were measured and recorded, during one month. The intravenous administration was always performed by the same four nuclear medicine technologists. These technologists are trained in this procedure, according with the developed technique, based on the procedure guidelines for PET imaging. This technique consists in administering FDG in a catheter with a triple channel system (standard system with three-way tap to enable saline flush); the syringe is always filled to its maximum capacity (5cc) and rinsed once, including needle rinsing. Registered time in every procedure was calibrated, in order not to include bias. Results: according to the analysis of the registered data, less than 1% of the activity calculated and measured for each patient remained on the syringe. Conclusions: regarding the search for the best administration procedure, we conclude that the technique used in our department results in a very low residual activity, meaning that it is an accurate technique that leads to reliable SUV values.
- Fatal case of imported human rabies in Amadora, Portugal, August 2011Publication . Santos, A; Calé, Etelvina; Dacheux, L; Bourhy, H; Gouveia, J; Vasconcelos, PaulaWe report on a case of imported human rabies in Portugal, in July 2011 in a woman who presented initially complaining of back pain, without relating exposure to animal bites. She had travelled from Portugal to Bissau, Guinea-Bissau, in April where she had been bitten by a dog on 1 May. She was diagnosed with rabies on 26 July and died two weeks later in spite of being treated following the Milwaukee protocol.
- Head-to-head comparison of two online nomograms for prostate biopsy outcome predictionPublication . Oliveira, M; Marques, V; Carvalho, AP; Santos, ALEVEL OF EVIDENCE: 2b. What's known on the subject? and What does the study add? In recent years, several nomograms were developed in an effort to decrease the number of unnecessary prostate biopsies. The European SWOP-PRI and the North American PCPT are among the most popular. However, evidence on the relative predictive accuracy is lacking. A head-to-head comparison on the diagnostic accuracy of two previously validated prostate cancer risk predictors on biopsy confirmed the superiority of these tools over PSA alone. Moreover, in the studied population, the European SWOP-PRI proved to be more accurate than the North American PCPT-CRC. OBJECTIVE: To compare the diagnostic accuracy of two previously validated prostate cancer risk predictors on biopsy. PATIENTS AND METHODS: In total, 390 consecutive patients submitted to 10-core systematic transrectal prostate biopsy at our institution were included in this retrospective study. External validation of a European (European Randomized Study of Screening for Prostate Cancer derived Prostate Risk Indicator; SWOP-PRI) and a North American (Prostate Cancer Prevention Trial Cancer Risk Calculator; PCPT-CRC) nomogram was performed. The predictive accuracy of these online available nomograms was calculated based on the area under the curve derived from receiver-operator characteristic curves and then compared using the DeLong method. RESULTS: Both tools were confirmed to be superior to prostate-specific antigen alone. Moreover, the SWOP-PRI (77.9%) displays a 7.96% increase in the predictive accuracy compared to the PCPT-CRC (69.9%) in a statistically significant fashion (P=0.002). CONCLUSIONS: The results obtained in the present study confirm the utility of nomograms with respect to biopsy outcome prediction in patients with suspicion of prostate cancer. In the current sample of patients, the European-based nomogram appears to be more accurate than the North American nonogram, which lacks information regarding prostate volume and prostatic ultrasonographic lesions. • To our knowledge, this is the first study to compare the accuracy of these popular risk calculators in a specific population.
- Hospital Resource Utilization and Treatment Cost of Skeletal-Related Events in Patients with Metastatic Breast or Prostate Cancer: Estimation for the Portuguese National Health SystemPublication . Félix, J; Andreozzi, V; Soares, M; Borrego, P; Gervásio, H; Moreira, A; Costa, L; Marcelo, F; Peralta, F; Furtado, I; Pina, F; Albuquerque, C; Santos, A; Passos-Coelho, JL; Portuguese Group for the Study of Bone MetastasesBACKGROUND: Skeletal-related events (SREs) occur frequently in patients with bone metastases as a result of breast (BC) and prostate (PC) cancers. They increase both morbidity and mortality and lead to extensive health-care resource utilization. METHODS: Health care resource utilization by BC/PC patients with at least one SRE during the preceding 12 months was assessed through retrospective chart review. SRE-treatment costs were estimated using the Portuguese Ministry of Health cost database and analyzed using generalized linear models. RESULTS: This study included 152 patients from nine hospitals. The mean (SD) annual SRE-treatment cost per patient was €5963 (€3646) and €5711 (€4347), for BC (n=121) and PC (n=31) patients, respectively. Mean cost per single episode ranged between €1485 (radiotherapy) and €13,203 (spinal cord compression). Early onset of bone metastasis (P = 0.03) and diagnosis of bone metastases at or after the occurrence of the first SRE (P < 0.001) were associated with higher SRE-treatment costs. CONCLUSION: These results reveal the high hospital SRE-treatment costs, highlighting the need for early diagnosis and treatment, and identify key factors determining the economic value of therapies for patients with skeletal metastases.