Loading...
7 results
Search Results
Now showing 1 - 7 of 7
- Cardiovascular events reported in randomized controlled trials in restless legs syndromePublication . Duarte, Gonçalo Silva; Alves, Mariana; Silva, Maria A.; Câmara, Raquel; Caldeira, Daniel; Ferreira, Joaquim J.Objective: Evaluate the frequency of cardiovascular adverse events reported in randomized controlled trials (RCT) in Restless Leg Syndrome (RLS). Methods: Databases were searched up to October 2015. Randomized, double-blind, placebo-controlled trials of patients with RLS were included if quantitative data were extractable. The primary outcome was cardiovascular adverse events defined as cardiac diseases, blood pressure abnormalities, syncope, cerebrovascular diseases, thromboembolic events, and sudden death. The pooled estimated prevalence of cardiovascular (CV) adverse events (AE) and respective 95% confidence interval (CI) was determined by using a meta-analysis. Results: In sum, 28 RCT (2515 participants in the placebo arm and 4223 participants in the intervention arm) reported CV AE. The pooled estimated prevalence of CV AE was 0.61% (95% CI 0.31 to 0.91; I2 ¼ 0%) in the placebo arm and 0.68% (95%CI 0.40 to 0.96; I2 ¼ 18.25%) in the intervention arm. The frequency of major CV events (myocardial infarction, stroke and peripheral artery disease) was 0.49% (95%CI 0.22 to 0.77; I2 ¼ 0%) and 0.33% (95% CI 0.16 to 0.50; I2 ¼ 0%) in the placebo and intervention arm, respectively. Conclusions: The frequency of major cardiovascular events in the RLS trials is not negligible, particularly when considering the young age of these patients.
- Neurosyphilis prevalence at a Portuguese stroke unit carePublication . Pintado Maury, Ines; Alves, Mariana; Fonseca, TeresaIntroduction: Syphilis is a systemic human disease which is caused by infection with the spirochete Treponema pallidum. It is spread worldwide, and there has recently been an increase in its incidence. Neurosyphilis (NS) can have a variety of presentations; meningovascular NS is a specific affection of the Treponema which occurs in an early stage after the primary infection, causing an inflammatory arteriopathy which may result in an ischemic stroke. As a rare manifestation of syphilis, there are few prevalence and epidemiological studies, and data are almost non-existent. The objective of this study is to analyse the prevalence of meningovascular NS in a stroke unit in a tertiary hospital. Methods: A descriptive retrospective study was carried out over a period of 44 months in a stroke unit. All patients admitted had neurological symptoms compatible with a vascular event, and routine blood tests including infectious screening were performed. Those with positive test results for syphilis were identified and proceeded to lumbar puncture to CSF cytochemical analysis and VDRL. NS was categorized as confirmed or probable (using CDC criteria). Results: A total of 525 patients were admitted, and 62.53% were submitted to a routine screening for syphilis. A total of 309 patients (95.67%) revealed a negative screening; 12 patients (3.72%) had a positive syphilis serology. Among the 12 patients with positive screening, a single case of NS (0.31%) was identified. Conclusion: We observed a low prevalence of NS (0.31%), but this result was surprisingly higher than what was expected in an elderly population.
- Análise da revisão Cochrane : alta hospitalar precoce para hospitalização domiciliária : Cochrane Database Syst Rev. 2017;6:CD000356Publication . Alves, Mariana; Vieira, Miguel Bigotte; Costa, João; Carneiro, António VazHospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital in-patient care. However, the clinical bene t of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insuf cient objective evidence of economic bene t (through a reduction in hospital length of stay) or improved health outcomes.
- Does Parkinson's disease increase the risk of cardiovascular events? A systematic review and meta‐analysisPublication . Alves, Mariana; Caldeira, Daniel; Ferro, José; Ferreira, Joaquim J.Background and purpose: The impact of Parkinson’s disease (PD) on the risk of cardiovascular disease is poorly known. The aim was to systematically review observational studies evaluating the association between PD and cardiovascular events. Methods: MEDLINE through PubMed, the Web of Science and Cochrane Central Register of Controlled Trials with conference proceedings were searched from inception to 4 July 2019. Two reviewers independently selected studies comparing cardiovascular events between Parkinson’s disease and control groups. Ischaemic stroke, myocardial infarction and cardiovascular mortality were the outcomes of interest. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were derived by random effects meta-analysis. Heterogeneity was assessed using the I 2 test. The study protocol was registered at PROSPERO: CRD42017076527. Results: Eleven studies were included: nine cohort studies and two case–control studies. PD was associated with a significantly increased risk of stroke (nine studies: OR 1.66, 95% CI 1.19, 2.34; I 2 = 50%). No significant differences were detected regarding myocardial infarction risks (eight studies: OR 1.15, 95% CI 0.72, 1.83; I 2 = 76%) nor cardiovascular mortality risks (seven studies: OR 1.11, 95% CI 0.85, 1.45; I 2 = 47%) in PD patients. Conclusions: The best evidence available showed an association between PD and increased risk of stroke. The risk of myocardial infarction and cardiovascular mortality was not different in PD and non-PD individuals.
- Choosing Wisely Portugal : a visão dos médicos portuguesesPublication . Morgado, Mariana; Alves, Mariana; Reis-de-Carvalho, Catarina; Viegas Dias, Catarina; Sousa, David Cordeiro; Santos, Guilherme; Leal, Ines; Jorge, João Valente; Vieira, Miguel Bigotte; Fortunato, Paula; Baeta Baptista, Rute; Carneiro, António VazEm outubro de 2018 foi apresentado o conceito e modo de implementação do programa Choosing Wisely Portugal — Escolhas Criteriosas em Saúde. Este programa tem como objetivo promover escolhas em Saúde baseadas na melhor evidência cientifica, reduzindo o número de intervenções desnecessárias, sem eficácia comprovada e/ou com uma relação risco-benefício desfavorável.1,2 A colaboração dos médicos é essencial para combater a sobreprescrição de exames e procedimentos, contribuindo para a segurança do doente e a sustentabilidade do Sistema Nacional de Saúde.
- Análise da revisão Cochrane : antibióticos destinados ao tratamento da bacteriúria assintomática : Cochrane Database Syst Rev. 2015;4:CD009534Publication . Vieira, Miguel Bigotte; Alves, Mariana; Costa, João; Carneiro, António VazAsymptomatic bacteriuria is frequently detected in women aged up to 60 years, patients with diabetes and elderly patients. The benefit of antibiotic treatment for this condition is controversial. The objective of this Cochrane systematic review was to assess the effectiveness and safety of antibiotic treatment for symptomatic bacteriuria in adults. A systematic review of the literature up to 24 February 2015 was performed using the Cochrane Renal Group’s Specialised Register. Randomised controlled trials (RCTs) and quasirandomised controlled trials comparing antibiotics to placebo or no treatment for asymptomatic bacteriuria in adults were included. The outcomes of interest were the development of symptomatic urinary tract infection, complications, death, adverse events, development of antibiotic resistance, bacteriological cure, and decline in kidney function. Nine studies (1614 participants) were included in this review. The incidence of symptomatic urinary tract infection, complications or death was similar between groups. Antibiotic use was significantly associated with bacteriological cure and an increase in minor adverse events. No decline in kidney function was observed with any one of the treatments. According to the results of the studies included in this revision, authors have concluded that there is no clinical benefit in treating asymptomatic bacteriuria in adults.
- Nocebo response in Parkinson's disease : a systematic review and meta-analysisPublication . Leal Rato, Miguel; Duarte, Gonçalo Silva; Nunes-Ferreira, Afonso; Alves, Mariana; Mainoli, Beatrice; Teodoro, Tiago; Mestre, Tiago; Costa, João; Ferreira, Joaquim J.Objective: To estimate the magnitude of the nocebo response in Parkinson's disease and explore possible associations with study characteristics. Methods: Databases were searched up to February 2017. Placebo-controlled, parallel-group randomized controlled trials investigating pharmacological interventions in people with Parkinson's disease were included. Data were derived from the last measured within-group response in the placebo and intervention arms of randomized controlled trials, after independent extraction. A random-effects model was used to pool study data. The main outcome was the nocebo response, measured as the proportion of placebo-treated participants experiencing any adverse events (AEs). We also measured the proportion of patients with serious AEs (SAEs), and the rates of study dropouts (including due to AEs) and death. PROSPERO registration number is CRD42017070471. Results: We included 236 randomized controlled trials, with a combined population of 17,381 participants allocated to placebo. The nocebo response was 56.0% (95% CI, 51.7%-60.4%; 148 trials; I2 = 98%). SAEs were reported in 4.0% (95% CI, 3.4%-4.6%, 157 trials; I2 = 73%) of placebo-treated patients, dropouts in 14.0% (95% CI, 12.5%-15.5%, 225 trials; I2 = 91%), dropouts due to AEs in 5.7% (95% CI, 5.1%-6.4%, 219 trials; I2 = 73%). Deaths occurred in 0.6% (95% CI, 0.5%-0.7%, 227 trials; I2 = 0%). Similar proportions were identified in patients in intervention arms. Conclusions: The magnitude of the nocebo response in parallel-designed randomized controlled trials in Parkinson's disease is substantial and should be considered in the interpretation of safety results and in the design and interpretation of future clinical trials.