Browsing by Author "Sousa, L"
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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.
- Neuromyelitis optica spectrum disorders: A nationwide Portuguese clinical epidemiological studyPublication . Santos, E; Rocha, AL; Oliveira, V; Ferro, D; Samões, R; Sousa, P; Figueiroa, S; Mendonça, T; Abreu, P; Guimarães, J; Sousa, R; Melo, C; Correia, I; Durães, J; Sousa, L; Ferreira, J; de Sá, J; Sousa, F; Sequeira, M; Correia, AS; André, AL; Basílio, C; Arenga, M; Mendes, I; Marques, IB; Perdigão, S; Felgueiras, H; Alves, I; Correia, F; Barroso, C; Morganho, A; Carmona, C; Palavra, F; Santos, M; Salgado, V; Palos, A; Nzwalo, H; Timóteo, A; Guerreiro, R; Isidoro, L; Boleixa, D; Carneiro, P; Neves, E; Silva, AM; Gonçalves, G; Leite, MI; Sá, MJIntroduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits. Objective: To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics. Methods: This was a nationwide multicenter study. Twenty-four Portuguese adult and 3 neuropediatric centers following NMOSD patients were included. Results: A total of 180 patients met the 2015 Wingerchuk NMOSD criteria, 77 were AQP4-antibody positive (Abs+), 67 MOG-Abs+, and 36 seronegative. Point prevalence on December 31, 2018 was 1.71/100,000 for NMOSD, 0.71/100,000 for AQP4-Abs+, 0.65/100,000 for MOG-Abs+, and 0.35/100,000 for seronegative NMOSD. A total of 44 new NMOSD cases were identified during the two-year study period (11 AQP4-Abs+, 27 MOG-Abs+, and 6 seronegative). The annual incidence rate in that period was 0.21/100,000 person-years for NMOSD, 0.05/100,000 for AQP4-Abs+, 0.13/100,000 for MOG-Abs+, and 0.03/100,000 for seronegative NMOSD. AQP4-Abs+ predominated in females and was associated with autoimmune disorders. Frequently presented with myelitis. Area postrema syndrome was exclusive of this subtype, and associated with higher morbidity/mortality than other forms of NMOSD. MOG-Ab+ more often presented with optic neuritis, required less immunosuppression, and had better outcome. Conclusion: Epidemiological/clinical NMOSD profiles in the Portuguese population are similar to other European countries.
- Neuromyelitis optica spectrum disorders: A nationwide Portuguese clinical epidemiological studyPublication . Santos, E; Rocha, AL; Oliveira, V; Ferro, D; Samões, R; Sousa, AP; Figueiroa, S; Mendonça, T; Abreu, P; Guimarães, J; Sousa, R; Melo, C; Correia, I; Durães, J; Sousa, L; Ferreira, J; de Sá, J; Sousa, F; Sequeira, M; Correia, AS; André, AL; Basílio, C; Arenga, M; Mendes, I; Marques, IB; Perdigão, S; Felgueiras, H; Alves, I; Correia, F; Barroso, C; Morganho, A; Carmona, C; Palavra, F; Santos, M; Salgado, V; Palos, A; Nzwalo, H; Timóteo, A; Guerreiro, R; Isidoro, L; Boleixa, D; Carneiro, P; Neves, E; Silva, AM; Gonçalves, G; Leite, MI; Sá, MJIntroduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits. Objective: To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics. Methods: This was a nationwide multicenter study. Twenty-four Portuguese adult and 3 neuropediatric centers following NMOSD patients were included. Results: A total of 180 patients met the 2015 Wingerchuk NMOSD criteria, 77 were AQP4-antibody positive (Abs+), 67 MOG-Abs+, and 36 seronegative. Point prevalence on December 31, 2018 was 1.71/100,000 for NMOSD, 0.71/100,000 for AQP4-Abs+, 0.65/100,000 for MOG-Abs+, and 0.35/100,000 for seronegative NMOSD. A total of 44 new NMOSD cases were identified during the two-year study period (11 AQP4-Abs+, 27 MOG-Abs+, and 6 seronegative). The annual incidence rate in that period was 0.21/100,000 person-years for NMOSD, 0.05/100,000 for AQP4-Abs+, 0.13/100,000 for MOG-Abs+, and 0.03/100,000 for seronegative NMOSD. AQP4-Abs+ predominated in females and was associated with autoimmune disorders. Frequently presented with myelitis. Area postrema syndrome was exclusive of this subtype, and associated with higher morbidity/mortality than other forms of NMOSD. MOG-Ab+ more often presented with optic neuritis, required less immunosuppression, and had better outcome. Conclusion: Epidemiological/clinical NMOSD profiles in the Portuguese population are similar to other European countries
- Patent foramen ovale: Seeing through the mist.Publication . Sousa, L
- Single puncture approach guided by transesophageal echocardiography for atrial fibrillation ablation in a patient with prior percutaneous septal closure: case reportPublication . Oliveira, M; Sousa, L; Trindade, A; da Silva, NBackground: Atrial septal defect (ASD) is associated with a risk of developing atrial fibrillation (AF) higher than in the general population, even after percutaneous or surgical septal closure. Catheter ablation is an effective treatment strategy for preventing recurrences and reducing the AF burden. However, electrophysiologists are faced with technical difficulties and the risk of complications with the left atrium access in patients with prior ASD percutaneous closure. Case summary: We report a case of a patient with highly symptomatic paroxysmal AF, with an ASD, closed percutaneously many years before, who underwent a successful catheter AF ablation, using a single transeptal (TSP) approach guided by transesophageal echocardiography (TEE). Discussion: In patients with ASD and an occluder device implanted, there is a potential risk for septal tear during the TSP passage, device dislodgement, or thrombus formation on the device. Atrial fibrillation ablation in this subset of patients has often been protracted and scarcely reported. TEE and intra-cardiac echocardiography have been increasingly used for interventional procedure guidance during AF ablation. As described here, AF ablation using a simplified single TSP guided by TEE is feasible, safe, and effective after device ASD closure.
- Titration with automatic continuous positive airway pressure in obstructive sleep apneaPublication . Dias, C; Sousa, L; Batata, L; Reis, R; Teixeira, F; Moita, J; Moutinho Dos Santos, JBackground and objective Autotitrating positive airway pressure (APAP) is an accepted titration method to determine the optimal positive airway pressure (PAP), for the treatment of obstructive sleep apnea (OSA). The required duration of APAP monitoring to determine a fixed continuous positive airway pressure level still remains to be established. We aimed to evaluate the variation in PAP level, delivered by APAP devices, at different periods of treatment, to determine the APAP treatment duration required to reach an effective and stable PAP level. Methods A cross-sectional study of 62 patients newly diagnosed with OSA were evaluated after 3 months of APAP therapy. APAP data corresponding to the first day (D1), first week (W1), seventh week (W7) and twelfth week (W12) under APAP therapy was collected. For the analysis of the pressure behaviour, the difference of P95th pressure level between W12 and W7 (P W12–W7), W12 and W1 (P W12–W1) and W12 and D1 (P W12–D1) was calculated. Results There was a high correlation in P95th pressure level between D1 and W12 (r = 0.771; p > 0.0001), W1 and W12 (r = 0.817; p > 0.0001), and W7 and W12 (r = 0.926; p > 0.0001). This correlation progressively increased with APAP use. A significance difference was found in concordance between P W12–W7 and P W12–D1 (p = 0.046) within the pressure range ±2 cmH2O. However there was no significant difference in concordance between P W12–W7 and P W12–W1. Conclusions One week of APAP therapy seems sufficient to determine an effective and stable PAP level, within the pressure range ±2 cmH2O.
- Tumor neuroendocrino primario del riñónPublication . Cabral-Ribeiro, J; Sousa, L; Ribeiro-Santos, A