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Med Clin (Barc) ; 153(12): 446-453, 2019 Dec 27.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31320135


BACKGROUND AND OBJECTIVE: Hip fracture is a common injury among elderly patients. The main goal of our study was to assess the effectiveness of a multidisciplinary educational intervention aimed at hip fracture patients to promote home discharges and reduce in-hospital complications. MATERIAL AND METHOD: A quasi-experimental study was performed by taking repeated measurements at hospital admission, at hospital discharge, and at both 30days and one year of discharge. Patients aged ≥65years with hip fracture who were admitted to the Orthogeriatric Service between February 2016 and January 2017 were included in the study. The educational intervention consisted in two coordinated actions: patient education administered during their hospitalization and multimodal support provided during their discharge home. RESULTS: A total of 67 patients were included in the study (77.6% of whom were women; 84.19±7,78 years old). Of these, 70.1% were discharged home, which doubles the figures recorded in the 2014-2015 period. The rate of readmission at 30days and one year of the discharge was 8.5%. At the one-year follow-up, the patient's dependence to perform basic activities of daily living was nearer to the pre-fracture level (Barthel: 86.67±19.31; 94.33±14.66), their mobility had improved in comparison with the time of discharge (Parker: 4.73±1.84; 6.73±2.76; Timed Up and Go Test: 38.29±21.27; 21.91±10.97), and their cognitive function had not worsened significantly. The patient education measures improved the patients' autonomy as perceived by the patients, the caregivers, and the healthcare providers. Satisfaction with the healthcare received was high. CONCLUSIONS: As a novelty to the already described benefits in orthogeriatric care models, this study would contribute by proving an increase of the number of patients discharged home in a safe condition.

Eur J Nucl Med Mol Imaging ; 46(8): 1626-1632, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31081519


PURPOSE: To analyse the risk of ischaemic events in patients with newly diagnosed giant cell arteritis (GCA) according to PET/CT findings. METHODS: PET/CT was performed during the first 10 days of steroid therapy. Clinical manifestations at diagnosis, and physical examination and PET/CT findings were recorded and compared according to the presence or absence of ischaemic symptoms at disease onset. Analysed territories included the ascending aorta, aortic arch, descending aorta, abdominal aorta, carotid arteries, brachiocephalic trunk, vertebral arteries, subclavian arteries and axillary arteries. RESULTS: The study group comprised 30 patients with a median age of 80.8 years. Of these patients, 21 (70%) reported ischaemic symptoms at diagnosis, and 13 (43.3%) had permanent visual loss. Of the 30 patients, 77.8% showed large vessel vasculitis (including aortic and vertebral artery involvement) on PET/CT, and 60% had isolated involvement of the vertebral territory. Vertebral arteries were more frequently involved in patients with ischaemic symptoms (OR 5.0, 95% CI 0.99-24.86, p = 0.051). The presence of vertebral artery involvement in the absence of aortic involvement was associated with the presence of ischaemic manifestations (Fisher's exact test, p = 0.001). The presence of aortitis was found to protect against the development of permanent visual loss (OR 19.0, 95% CI 2.79-127.97, p = 0.001). CONCLUSION: Our findings suggest an association between the vascular pattern on PET/CT at the time of GCA diagnosis and the risk of ischaemic events.

Amyloid ; 25(2): 109-114, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29706127


Amyloidosis comprises a group of heterogeneous conditions. To ascertain the burden of disease is important because it can determine the treatment as well as the evolution of the disease. Recent reports have shown good results in diagnosing cardiac amyloidosis using 18F-florbetapir. We hypothesize that combining whole body PET/CT with 18F-Florbetapir can be useful to characterize the burden of the disease. We included 25 patients, 13 of them with different types of amyloidosis, and 12 with Alzheimer's disease as controls. Target-to-background ratio was computed for multiple organ using maximum standardized uptake values. Organ involvement was described (standardized techniques versus PET) according to different kinds of amyloidosis showing promising results in AA and AL types. Heart involvement showed poorer results when compared to tongue, lung or thyroid gland. Multiple organ involvement in patients previously labelled as having negative organ affectation could be identified. This is the first study to evaluate the utility of 18F-florbetapir in the assessment of the global extension of disease. Our results show that this technique is useful for its diagnosis.

Amiloidose/diagnóstico por imagem , Compostos de Anilina/análise , Etilenoglicóis/análise , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Amiloidose Familiar/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Immunol Lett ; 174: 19-22, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27091480


Complement factor I (CFI) deficiency is typically associated to recurrent infections with encapsulated microorganisms and, less commonly, to autoimmunity. We report a 53-years old male who, in a routine control for non-alcoholic fatty liver disease, presented a flat beta-2 fraction at the capillary protein electropherogram. Patient's clinical records included multiple oropharyngeal infections since infancy and an episode of invasive meningococcal infection. Complement studies revealed reduced C3, low classical pathway activation and undetectable Factor I. CFI gene sequencing showed a novel inherited homozygous deletion of 5 nucleotides in exon 12, causing a frameshift leading to a truncated protein. This study points out that capillary protein electrophoresis can alert of possible states of low C3, which, once confirmed and common causes ruled out, can lead to CFI and other complement deficiency diagnosis. This is important since they constitute a still underestimated risk of invasive meningococcemia that can be greatly reduced by vaccination.

Complemento C3/deficiência , Eletroforese Capilar , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/diagnóstico , Doenças Genéticas Inatas/genética , Homozigoto , Mutação , Biomarcadores , Complemento C3/genética , Complemento C4 , Fator I do Complemento/genética , Análise Mutacional de DNA , Eletroforese Capilar/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem