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No description available.

Introdução: A infeção pelo Vírus da Hepatite C (HCV) é uma das principais causas de doença hepática crónica no mundo. Com elevado risco de cirrose e carcinoma hepatocelular. A terapêutica antivírica direta (DAA) estendeu o alcance terapêutico a praticamente todos os indivíduos infetados, com resposta virológica sustentada (SVR) em mais de 90% dos tratados, proporcionando melhoria da sobrevida e da fibrose hepática. Métodos: Neste estudo retrospetivo foram incluídos 64 doentes monoinfetados com HCV e com fibrose avançada que alcançaram SVR após tratamento com DAA iniciada entre janeiro de 2015 e junho de 2016. Antes do inicio do tratamento e 24 semanas pós-tratamento foram testadas a sensibilidade e especificidade dos scores ALT/AST ratio (AAR), Aspartate aminotransferase to platelet ratio index (APRI) e FIB-4, comparando com o FibroScan. Resultados: Na comparação antes do tratamento, os scores tiveram desempenhos semelhantes: FIB-4 com AUC 0.784, 79% sensibilidade e 82 % especificidade. Na comparação pós-tratamento: FIB-4 com AUC 0.809, 82% sensibilidade e 70% especificidade; APRI com AUC 0.841, 64% sensibilidade e 90% especificidade; AAR não apresentou resultados estatisticamente significativos. Discussão: No inicio, todos os scores mostraram boa capacidade diagnóstica para cirrose, especialmente o FIB-4. No pós-tratamento, principal objetivo do estudo, o FIB-4 e o APRI apresentaram bom desempenho, comparativamente com o FibroScan, na avaliação das alterações na extensão da fibrose hepática. O AAR falhou, possivelmente devido a confundidores. Conclusão: O FIB-4 e o APRI demonstraram ser boas alternativas ao FibroScan na avaliação das alterações na extensão da fibrose hepática. Apesar de serem necessários estudos maiores para confirmação desta hipótese. / Backround: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. With elevated risk for development of cirrhosis and Hepatocellular carcinoma. The Direct Acting Antiviral (DAA) therapy extended the treatment reach to practically every patient, achieving Sustained Virological Responses (SVR) in over 90% of patients, providing improvement of clinical outcomes and liver fibrosis. Methods: In this retrospective cohort study were enrolled 64 monoinfected HCV patients with advanced fibrosis who achieved SVR after treatment with DAA therapy beginning from January 2015 to June 2016. At baseline and 24 weeks post-treatment were tested the sensibility and specificity of the ALT/AST ratio (AAR), Aspartate aminotransferase to platelet ratio index (APRI) and the FIB-4 score against TE (FibroScan). Results: At the baseline checkpoint, all scores were similar, with FIB-4 accomplishing AUC 0.784, 79% sensitivity and 82 % specificity. At the post-treatment checkpoint: FIB-4 had AUC 0.809, 82% sensitivity and 70% specificity; APRI had AUC 0.841, 64% sensitivity and 90% specificity; AAR did not show statistically significative results. Discussion: At baseline, all scores had a good diagnostic accuracy for cirrhosis, specially FIB-4. At the post-treatment, the main endpoint, the FIB-4 and APRI scores performed well compared with FibroScan to evaluate the changes in the extension of liver fibrosis. The AAR failed possible due to confounding. Conclusion: The FIB-4 and APRI scores proved to be acceptable alternatives for the FibroScan to evaluate the changes in the extension of liver fibrosis. Though bigger studies are needed for confirming this hypothesis.

No description available.

No description available.

Introdução Ensaios clínicos randomizados foram realizados para analisar a eficácia e segurança da oclusão do apêndice auricular esquerdo na fibrilação auricular não-valvular versus terapia médica. Esta técnica foi desenvolvida para doentes com contraindicação para anticoagulação, contudo esses pacientes continuavam a ser hipocoagulados por um período de tempo, o que alça problemas relativos à sua segurança. Na nossa revisão sistemática pretendemos avaliar a viabilidade desta intervenção com terapia antiplaquetária após intervenção. Métodos Uma pesquisa pela MedLine e ISI Web of Knowledge foi conduzida com base em critérios pré-definidos. Nós incluímos estudos observacionais não-comparativos com pelo menos 15 pacientes e por um período mínimo de 6 meses de seguimento. Resultados Foram selecionados 21 estudos com 3974 pacientes na globalidade. A taxa de incidência ajustada de eventos tromboembólicos corresponde a 1.99/ 100 pessoa-ano (95% CI: 1.66-2.38/100 pessoa-ano) e a taxa de incidência de eventos hemorrágicos major foi de 2.07/100 pessoa-ano (95% CI: 1.40-3.06/100 pessoa-ano). Os resultados foram similares, se não melhores, que os dados clínicos dos ensaios clínicos realizados. A taxa de incidência de mortalidade corresponde a 6.13 per 100 pessoa-ano (95% CI: 5.18-7.27 pessoa-ano), com a proporção mais elevada associada a causas não-cardiovasculares. Uma pequena porção de pacientes mudaram a sua terapia inicial para anticoagulantes orais com uma taxa de incidência de 1.62/100 pessoa-ano (95% CI: 0.92-2.84 pessoa-ano). Conclusão A nossa revisão sustém a viabilidade desta técnica em pacientes submetidos a terapia antiplaquetária após intervenção, na prevenção de eventos tromboembólicos e hemorrágicos, comparando com a terapia anticoagulante selecionada nos ensaios clínicos. / Background Randomized clinical trials have been performed to analyzed the efficacy and safety of left atrial appendage closure in nonvalvular atrial fibrillation versus medical management. This technique had emerged for patients with contraindication to anticoagulation therapy; nonetheless, those patients were still medicated with anticoagulation strategies for a period of time, which gave rise to safety concerns. Our systematic review aims to evaluate the feasibility of this intervention in patients with contraindication to anticoagulation and post-operative antiplatelet therapy. Methods A comprehensive search of the Medline and ISI Web of Knowledge databases was conducted using pre-defined criteria. We included non-comparative cohort studies with at least 15 patients and a follow-up time longer than 6 months. Results We selected 21 eligible studies enrolling 3974 patients. The adjusted pooled incidence rate of thromboembolic events was 1.99/100 person-years (95% CI: 1.66 to 2.38/100 person-years) and the incidence rate of major bleeding corresponded to 2.07/100 person-years (95% CI: 1.40 to 3.06/100 person-years). These results were similar, if not better, that the outcomes of the clinical trials made so far. The incidence rate of all-cause mortality was 6.13 per 100 person-years (95% CI: 5.18 to 7.27 person-years), with a higher proportion of mortality associated to non-cardiovascular causes. Among patients that changed from antiplatelet therapy to anticoagulation, the incidence rate was 1.62/100 person-years (95% CI: 0.92 to 2.84 person-years). Conclusions Our review sustains the feasibility of this technique in patients submitted to antiplatelet therapy, on the prevention of thromboembolic and bleeding events, in comparison to anticoagulation after procedure.

Objetivo: O objetivo deste estudo passa por comparar as expectativas dos pacientes antes da cirurgia a patologia degenerativa da coluna com a sua perceção dos resultados e identificar os principais fatores que se correlacionam com expectativas superiores e o seu cumprimento. A questão do nosso estudo baseia-se na possibilidade de as expectativas pré-cirúrgicas dos pacientes poderem predizer os resultados reais da cirurgia. Métodos: Para a nossa análise foram considerados doentes consecutivos submetidos a cirurgia espinhal por patologia degenerativa no nosso centro hospitalar entre Agosto de 2018 e Maio de 2019. As expectativas expressas pelos pacientes foram registadas usando o questionário de expectativas para cirurgia espinhal cervical ou lombar e foram comparadas com o mesmo instrumento três meses após a cirurgia. Os resultados relatados pelo paciente foram avaliados usando o questionário COMI antes e após a cirurgia. Resultados: Foram analisados 120 pacientes. A média do score de expectativas relatadas pelos pacientes foi de 82.87%±14.57% e o score pós-operatório foi significativamente mais baixo, com uma média de 60.5±20.6% (p<0.001). Na análise multivariada, apenas Cirurgia prévia e Duração dos sintomas mantiveram a sua relação com as expectativas pré-operatórias e apenas Tipo de cirurgia se correlacionou com o Rácio de expectativas. Melhoria no score COMI após a cirurgia foi observada em 85% dos pacientes, mas somente em 14% é que as expectativas foram igualadas ou superadas. Conclusão: As expectativas pré-operatórias foram significativamente mais altas, mas os resultados pós-cirúrgicos foram menos otimistas. Expectativas mais baixas e uma perceção de sucesso menor após a cirurgia podem ser antecipadas em alguns pacientes tendo em conta características pré-operatórias. Apesar de 85% dos pacientes melhorarem após a cirurgia, as suas expectativas não foram cumpridas na maioria dos casos. / Purpose: The aim of this study is to compare patient's expectations before surgery for degenerative spine disease to postoperative perceived outcomes and identify main factors that correlate with higher expectations and their fulfillment. The study question is whether patient's pre-surgical expectations can predict actual outcomes. Methods: Consecutive patients submitted to degenerative spine surgery between August 2018 and May 2019 in our spine center were enrolled. Patient's expressed expectations were recorded using the Lumbar/Cervical Spine Surgery Expectations Survey and compared to the same instrument, three months after surgery. Patient reported outcomes were evaluated using the COMI questionnaire before and after surgery. Results: A total of 120 patients were analyzed. The mean score of expectations reported by patients was 82.87%±14.57% and post-surgical score was significantly lower, 60.5±20.6% (p<0.001). In a multivariate analysis, only a history of spine surgery and a longer duration of symptoms were associated with low pre-surgical expectations. Lumbar surgery was associated to a lower ratio between postoperative and preoperative Expectations Survey scores. An improvement on the COMI score after surgery was achieved in 85% of the patients, but only 14% reported that their expectations were matched or exceeded. Conclusion: The pre-surgical expectations were significatively high, but the post-surgical results were less optimistic. Lower expectations and lower perceived success after surgery can be anticipated on some patients based on preoperative features. Although 85% of patients improved after surgery, their expectations weren't met in most cases.

Objetivos: Rever a literatura sobre a decisão de terminar o rastreio do Cancro do Cólon e Reto (CCR), tendo em conta os riscos e benefícios e as opiniões dos utentes e profissionais de saúde. Fontes de dados: Pesquisa nas bases de dados PubMed, Scopus e The Cochrane Library através da query: [screening AND cancer AND colorectal AND stop]. Métodos de revisão: Foi realizada uma revisão sistemática, sem metanálise, com inclusão de todos os artigos originais de investigação e estudos em modelos de microssimulação, disponíveis em Inglês ou Português, sem restrições de ano de publicação, cujo conteúdo abordasse a decisão de terminar o rastreio do CCR. A avaliação da qualidade dos estudos foi realizada com base na ferramenta ROBINS-I para estudos observacionais e transversais e na STRESS checklist para estudos baseados em modelos de microssimulação. Resultados: Obtiveram-se 231 resultados e, desses, foram selecionados seis artigos, aos quais se adicionaram três obtidos em pesquisa adicional, totalizando nove artigos: seis sobre a relação risco-benefício do rastreio; dois sobre a opinião dos utentes e um sobre a opinião dos profissionais de saúde. Conclui-se que o rastreio após os 75 anos de idade apenas tem benefício em indivíduos sem comorbilidades significativas ou com risco acrescido de CCR; que há benefício se a decisão for individualizada; e que os utentes concordam com uma decisão individualizada e partilhada com os profissionais de saúde. Quanto à opinião dos profissionais de saúde, a evidência é vaga e pouco fundamentada. Conclusões: Sendo a evidência escassa quando se trata da população idosa, são precisos dados mais concretos sobre a relação risco-benefício do rastreio nesta faixa etária, estratificados por idade, comorbilidades e risco prévio de CCR, bem como a integração da preferência dos utentes e da opinião dos profissionais de saúde nesta equação. Palavras-chave: Cancro do Cólon e Reto, Rastreio, Idosos / Objectives: To review the literature about the decision to stop Colorectal Cancer (CRC) screening, concerning risks, benefits and patients and health care providers' opinions. Source of data: Search in the databases PubMed, Scopus and The Cochrane Library using the query: [screening AND cancer AND colorectal AND stop]. Methods: In order to do a systematic review without metanalysis, we included all original articles and studies based on microsimulation models about the decision to stop CRC screening. We included all results written in English or Portuguese, without publication year restrictions. To evaluate the quality of the articles, we used the ROBINS-I tool for observational and cross-sectional studies and the STRESS checklist for studies based on microsimulation models. Results: 231 results were identified, from which we selected six. We gathered three more articles obtained through additional search. Nine studies were included: six were related to the risks and benefits of screening; two were related to the patients' opinions; and one about health care providers' opinions. Our results showed that screening patients with more than 75 years old is only beneficial in two cases: when the patient have increased risk of CRC or when he is in good health status. This decision should be individualized. Furthermore, patients agree with an individualized decision and they appear to be more comfortable if this decision is shared with their health care provider. Concerning health care providers' opinions, the evidence is quite unclear and limited. Conclusions: There is very low evidence related to elderly patients and more studies are needed concerning the risk-benefit of CRC screening in these patients, stratified by age, comorbidities and CRC risk. We also need consolidation of the patients and health care providers' opinions in the decision. Key-words: Colorectal cancer, Screening, Elderly

Troponin elevation after vascular surgery (MINS) is a frequent event, ranging between 12 - 20%, even more common after revascularization in patients with peripheral artery disease (PAD). Myocardial injury is strongly associated with higher mortality in short and long-term periods with a ten-fold and two-fold increased risk, respectively. Still, there is lack of data regarding myocardial injury after aorto-iliac TASC-D revascularization and this study aims to evatuate the prognostic impact of MINS and its perioperative determinants. From a tertiary referral hospital, patients with TASC-D lesions were consecutively retrieved from a prospective database. Study population was submitted to revascularization either by open surgery or percutaneous artery stenting according to the surgeons' discretion. Cardiac troponins were routinely measured in the postoperative period. Myocardial infarction (MI), acute heart failure (AHF), stroke, major adverse cardiovascular events (MACE), major adverse limb events (MALE) and all-cause mortality were assessed both post-operativelly and at follow-up. / Background: Troponin elevation after vascular surgery (MINS) is a frequent event, ranging between 12 - 20%, even more common after revascularization in patients with peripheral artery disease (PAD). Myocardial injury is strongly associated with higher mortality in short and long-term periods with a ten-fold and two-fold increased risk, respectively. Still, there is lack of data regarding myocardial injury after aorto-iliac TASC-D revascularization and this study aims to evatuate the prognostic impact of MINS and its perioperative determinants. Material and methods: From a tertiary referral hospital, patients with TASC-D lesions were consecutively retrieved from a prospective database. Study population was submitted to revascularization either by open surgery or percutaneous artery stenting according to the surgeons' discretion. Cardiac troponins were routinely measured in the postoperative period. Myocardial infarction (MI), acute heart failure (AHF), stroke, major adverse cardiovascular events (MACE), major adverse limb events (MALE) and all-cause mortality were assessed both post-operativelly and at follow-up. Results: The incidence of MINS was 25.8%. Multivariate analysis has confirmed chronic heart failure as a significant risk-factor for MINS with Hazard ratio (HR) = 21.3 (95% Confidence interval (CI) 1.696 - 268.0, P = 0.018). At 12 months after revascularization, troponin elevation was found to be significantly associated with further MI, stroke, AHF, MALE, MACE and all-cause death. Conclusion: MINS plays a role as a predictor of significant cardiovascular comorbidities and mortality during follow-up. Moreover, the presence of Chronic heart failure was associated with higher incidence of myocardial lesions after aortoiliac TASC-D revascularization. In light of current evidence, pre-emptive strategies should be adopted to detect and treat these patients together with the opportunity to initiate secondary prophylactic measures and surveillance.