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- Adrenal failure as an antiphospholipid syndrome manifestationPublication . Santos, Mariana; Gama, C.; Marques, B.; Saldanha, T.; Tremoceiro, J.; Lourenço, M. H.; Gonçalves, Maria João; Costa, M.; Sepriano, Alexandre; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de ReumatologiaAdrenal involvement in antiphospholipid syndrome (APS) is rare but potentially life-threatening. Early recognition reduces morbidity and mortality. We report a 56-year-old male with chronic thrombocytopenia and prolonged activated partial thromboplastin time who developed fatigue, anorexia, and weight loss. On admission, he presented with hypotension, hyperkalemia, thrombocytopenia, anemia, and elevated inflammatory markers. After hospitalization, he underwent an extensive workup study. PET-CT revealed bilateral adrenal uptake, and hormonal tests confirmed primary adrenal insufficiency (PAI). Autoimmune studies showed persistently positive lupus anticoagulant, and high-titer antinuclear and anti-double-stranded DNA antibodies, establishing systemic lupus erythematosus and APS with secondary PAI. Treatment with mineralocorticoids, hydroxychloroquine, anticoagulation, and subsequently high-dose glucocorticoids led to clinical and laboratory improvement. Review of published cases shows that, although APS is more frequent in women, adrenal involvement occurs predominantly in men and usually presents acutely with abdominal pain, hypotension, and electrolyte imbalance. Our patient’s atypical presentation delayed diagnosis. Awareness of such variable presentation is crucial, as early recognition and treatment significantly improve outcomes. Clinicians should consider APS in new-onset adrenal failure and systematically evaluate adrenal involvement in APS patients with compatible symptoms.
- Initial experience with the extravascular implantable cardioverter-defibrillatorPublication . Lousinha, Ana; Kahlbau, Hagen; Coelho, Sara; Jacinto, Sofia; Sousa, Rodrigo; Paulo, Margarida; Covas, Susana; Domingues, Abel; Trindade, Ana; Aguiar Rosa, Sílvia; Cardim, Nuno; Cruz Ferreira, Rui; Oliveira, Mário; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierIntroduction and objectives: Implantable cardioverter-defibrillators (ICDs) are among the most effective interventions for the prevention of sudden cardiac death. However, traditional transvenous systems are associated with venous access and intracardiac lead complications. Subcutaneous ICDs (S-ICD), which were developed to overcome these complications, are unable to provide anti-tachycardia pacing (ATP) or pause prevention pacing. The extravascular ICD (EV-ICD) is a recent technological innovation designed to mitigate these limitations by enabling cardioversion, defibrillation and pacing without entering the central venous system. Our aim was to assess the initial experience with the new EV-ICD system, as a valid alternative to transvenous ICD and S-ICDs, including patient selection, implantation technique, procedure feasibility and safety, functional parameters, and immediate clinical outcomes. Methods: We conducted an observational study of all patients who underwent EV-ICD implantation between November 2024 and June 2025 at two centers. Demographic, clinical, imaging, pharmacologic and procedural data were analyzed. Results: A total of 11 patients were included, with a mean age of 36.3 years (range 19–59); 27% were female. Main diagnoses included hypertrophic cardiomyopathy (n=3), left ventricular non-dilated cardiomyopathy (n=3), dilated cardiomyopathy (n=2), Brugada syndrome (n=1), polymorphic ventricular tachycardia (n=1) and arrhythmogenic right ventricular cardiomyopathy (n=1). There were no procedural or peri-procedural complications. The mean procedure duration (“skin-to-skin”) was 68.2 minutes (range 60–78). Median fluoroscopy time was 3.9 minutes (range 2.5–6.2). Defibrillation threshold (DFT) testing was successful in all cases. During the follow-up, two patients received an inappropriate shock, one due to sinus tachycardia and the other due to oversensing of myopotentials. Conclusions: Our initial experience with the EV-ICD confirms the feasibility and safety of the procedure. This novel system may offer an effective alternative for selected populations, especially young patients with extended life expectancy and high cumulative device exposure. The rate of inappropriate shocks remains a concern and improvements are required to reduce these events.
- Cardio-oncology meets pharmacoeconomicsPublication . Toste, Júlia Cristina; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | Elsevier
- Corticosteroids and community-acquired pneumoniaPublication . Sweeney, Daniel A.; Póvoa, Pedro; Kalil, Andre C.; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); BioMed Central (BMC)
- Interstitial lung disease in Sjögren’s diseasePublication . Duarte, Ana Catarina; Matias, Susana; Bargado, Carolina; Bandeira, Matilde; Romão, Vasco C.; Marques Gomes, Carlos; Bernardes, Miguel; Correia Natal, Miguel; Moniz, Ana Catarina; Gonçalves, Maria João; Emília Santos, Mariana; Canhão André, Filipa; Cadório, Maria João; Alves Costa, Sara; Vieira, Ana Rita; Mendonça, Beatriz; Barcelos, Filipe; Cunha, Anita; Pontes Ferreira, Maria; Barcelos, Anabela; Pinto Oliveira, Cláudia; Fonseca, Rita; Silva, Catarina; Brites, Luísa; Almeida, Inês; Augusto, Duarte; Belchior Raimundo, Diana; Santos, Maria José; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de ReumatologiaIntroduction: Apart from exocrine glands involvement with sicca symptoms, several extra-glandular manifestations can occur in Sjögren’s disease (SjD) such as pulmonary manifestations. Interstitial lung disease (ILD) is the most common lung manifestation in SjD. We aim to evaluate the presence of ILD in a national cohort of patients with SjD, identify variables associated with its development and progression, as well as describe the treatment used for SjD-ILD and its effectiveness and tolerability. Methods: We conducted an observational multicenter study of SjD-ILD patients prospectively followed in Reuma. pt. Demographic and clinical data were collected. We compared patient characteristics between groups using Chi-square or Fisher’s exact test, Mann–Whitney or independent samples t-test, as appropriate. Logistic regression analysis was used to identify predictors of SjD-ILD. A linear mixed model with random intercept was used to compare results from pulmonary function tests (PFTs) before and after immunosuppression initiation. Results: Of the 1532 patients enrolled in the Reuma.pt-SjD protocol, 1333 (87%) had information on the presence of pulmonary manifestations. Among these, 127 (9.5%) had documented lung involvement, with ILD being the most common manifestation (74%). Ever smoking (OR=2.175; [95%CI:1.214-3.899]; p=0.009) and older age at SjD diagnosis (OR=1.047 per year; [95%CI:1.025-1.069]; p<0.001) were predictors of ILD. Nonspecific interstitial pneumonia was the most frequent ILD pattern (45.7%). Immunosuppression was used in 62 (66%) SjD-ILD patients and antifibrotics in eight patients (in seven of them in association with immunosuppression). Among the 26 patients with serial PFTs available, 10 (38.5%) showed ILD progression. Progressors had a higher forced vital capacity (FVC 96.8 ± 22.1 vs. 71.1 ± 21.4%; p=0.007) and diffusion capacity for carbon monoxide (DLCO 75.5 ± 12.1 vs. 50.2 ± 16.6%; p=0.002) at baseline and tended to have hypergammaglobulinemia more often (80% vs. 43.8%; p=0.069). Nevertheless, immunosuppression interrupted the decline of FVC (absolute value) and DLCO (percent predicted). Conclusion: This work demonstrated that a substantial proportion of SjD-ILD patients present with progressive fibrosis. Immunosuppression seems to delay the progression of lung disease. Therefore, identifying predictors for ILD development and progression is essential for recognizing which patients will require closer monitoring and intervention.
- An Implementation Roadmap to Accelerate Academic Clinical Cancer Research in PortugalPublication . Ana, Ana Sofia; Cardoso Borges, Fábio; Cardoso, Maria João; Oliveira, Júlio; Pais Silva, José; Carvalho, Sónia; Costa, Luís; Fernandes, Isabel; Gomes, Dora; Gomes, Mónica; Milagre, Tamara; Rego, Sónia; Soares, Marta; Sottomayor, Carlos; Joaquim, Ana; Sousa, Nuno; Passos Coelho, José Luís; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOM
- Post-implantation syndrome after EVARPublication . Soares Ferreira, Rita; Bastos Gonçalves, Frederico; Abreu, Rodolfo; Camacho, Nelson; Catarino, Joana; Correia, Ricardo; Ferreira, Maria Emília; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Angiologia e Cirurgia VascularIntroduction: Post-implantation syndrome (PIS) is characterized by fever, flu-like symptoms, leukocytosis and elevation of reactive C protein in the postoperative period of EVAR. The authors aim to estimate the incidence of PIS after EVAR in their institution, identify risk factors and determine the association with clinical events
- Planning, EVAR and followup without contrast in chronic kidney diseasePublication . Soares Ferreira, Rita; Bastos Gonçalves, Frederico; Quintas, Anita; Abreu, Rodolfo; Camacho, Nelson; Ferreira, Maria Emília; Albuquerque e Castro, João; Mota Capitão, Luís; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Angiologia e Cirurgia Vascular
- Unidades de Cuidados Saúde Primários UniversitáriasPublication . Correia, Gil; Pereira, António; Bulhões, Cláudia; Outeirinho, Conceição; Prazeres, Filipe; Rosendo, Inês; Antunes, José Pedro; Monteiro, Luís; Jacinto, Nuno; Broeiro-Gonçalves, Paula; Santos, Paulo; Simões, Pedro; Resendes Martins, Raquel; Correia, Rubina; Maricoto, Tiago; Santiago, Luiz Miguel; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOM
- Vacinação de Adultos Mais Velhos em PortugalPublication . Sousa Almeida, Paulo Ricardo; Sarmento, Gonçalo; Gruner, Heidi; Veríssimo, Rafaela; Duque, Sofia; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOMOlder persons are more susceptible to infections and have a higher risk of serious complications, with a worse functional and vital prognosis. Vaccination is an effective strategy with a favorable safety profile for preventing infections and promoting healthy aging. In view of the clinical evidence and the vaccines available in Portugal in the first half of 2025, the Geriatrics Study Group of the Portuguese Society of Internal Medicine presents a proposal for vaccination of adults aged 65 years or older. The experts also point out the need to create a national lifelong vaccination program that includes older people to increase vaccination coverage and reduce the impact of infections in this population. Although the document focuses on people aged 65 years or older, vaccination against some diseases should start earlier. This article outlines five main recommendations: 1) Annual influenza and COVID-19 vaccination for all adults aged 50 years or older, with those aged 65 years or older receiving the high-dose trivalent influenza vaccine; 2) Respiratory syncytial virus vaccination for all adults aged 60 years or older and adults aged 18 - 59 years with risk factors, prioritizing people aged 75 years or older and those aged 50 years or older with risk factors; 3) Pneumococcal vaccination with the 20-valent or 21-valent pneumococcal conjugate vaccine for all adults aged 50 years or older and adults aged 18 - 49 years with risk factors; 4) Herpes zoster vaccination with the recombinant vaccine for all adults aged 50 years or older and adults aged 18 - 49 years at high risk of herpes zoster; 5) From the age of 65 years, booster vaccination against tetanus, diphtheria and pertussis every 10 years.