João Moreira

Universidade Federal de Juiz de Fora

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Maria João Centeno

Hospital Garcia de Orta

Isabel Ribeiro

Hospital de Santo António

Patrícia O’Neill

SUNY Downstate Health Sciences University

Filipa Duarte

Hospital Beatriz Ângelo

Catarina Santos Carvalho

Hospital Garcia de Orta

Filipa Resende

IPO Porto

Camila de Aguiar Lima

Universidade Federal de Minas Gerais

Sofia Ferraz

INESC TEC

Leonor Mendes

Hospital de São João

F. Abelha

Hospital de São João

Cooperative Institutions

Universidade de São Paulo

Universidade Federal de Juiz de Fora

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Universidade do Porto

Hospital de São João

Hospital Garcia de Orta

Instituto de Medicina Tropical

Universidade Federal de Minas Gerais

Universidade Brasil

Instituto Adolfo Lutz

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Infarto agudo do miocárdio na 31ª semana de gravidez: relato de caso

Brazilian Journal of Anesthesiology (2011)

Filipa Duarte Patrícia O’Neill Maria João Centeno Isabel Ribeiro João Moreira

JUSTIFICATIVA E OBJETIVOS: A ocorrência de infarto agudo do miocárdio (IAM) durante a gravidez é rara. Os autores descrevem o caso de IAM numa grávida de 31 semanas e a importância da existência de uma equipe multidisciplinar para sua abordagem. RELATO DO CASO: Grávida de 31 semanas, com antecedentes de tabagismo, alcoolismo e hipertensão, internada após um episódio de síncope. Na admissão, encontrava-se consciente e assintomática, embora hipotensa. O eletrocardiograma evidenciou marcada elevação do segmento ST em DI, AVL, V1-V6. Pesquisa de enzimas cardíacas foi positiva. O ecocardiograma transtorácico demonstrou redução da contratilidade ventricular esquerda e septal e uma fração de ejeção de 30%. A angiografia revelou oclusão proximal da artéria descendente anterior. Por insucesso da angioplastia por balão, foi colocado um stent metálico. A paciente iniciou terapêutica com b-bloqueadores, aspirina e clopidogrel. Em relação ao parto, optou-se por realizar cesariana eletiva, quatro semanas após o IAM. Suspendeu-se o clopidogrel sete dias antes do parto. A função cardíaca pré-operatória foi otimizada com infusão de levosimendana iniciada no dia anterior. A cesariana decorreu sob bloqueio peridural. O período intraoperatório decorreu sem complicações, à exceção de moderada hipotensão facilmente corrigida com fenilefrina. O índice de Apgar do recém-nascido foi de 9/10. CONCLUSÕES: Este é um dos poucos casos de infarto agudo do miocárdio e angioplastia descritos durante a gravidez. Os autores discutem as decisões tomadas pela equipe multidisciplinar, constituída por anestesiologistas, obstetras, cardiologistas e neonatologistas, notadamente no que se refere à dupla antiagregação plaquetária, ao tipo de parto e à anestesia.

10.1590/s0034-70942011000200012

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Citations (2)

Molecular genotyping reveals inter-regional relatedness among antimicrobial resistant Salmonella Minnesota strains isolated from poultry farm and humans, Brazil

Brazilian Journal of Microbiology (2022)

João Moreira Daniel F. M. Monte Camila de Aguiar Lima Celso José Bruno de Oliveira Nélson Rodrigo da Silva Martins

Flock

10.1007/s42770-021-00666-1

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Citations (4)

Incidence, predictors and validation of risk scores to predict postoperative mortality after noncardiac vascular surgery, a prospective cohort study

International Journal of Surgery (2019)

Pedro Reis Ana Isabel Lopes Diana Leite João Moreira Leonor Mendes

Vascular surgery

10.1016/j.ijsu.2019.12.010

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Citations (19)

Interferon production in primary macrophages during Junín virus infection

João Moreira Jennifer M. Hayashi Melaine Ott

Primary (astronomy)

10.13140/rg.2.2.28926.84809

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Ropivacaine Continuous Wound Infusion Versus Epidural Morphine for Postoperative Analgesia After Cesarean Delivery

Obstetrical & Gynecological Survey (2012)

Patrícia O’Neill Filipa Duarte Isabel Ribeiro Maria João Centeno João Moreira

The gold standard for postcesarean delivery analgesia is opioid-based regimens. However, neuraxial opioids have a ceiling effect, and their use is associated with a number of adverse reactions. Wound infiltration with local anesthetics has been widely used in the multimodal management of postoperative pain. Previous studies have shown that continuous wound infusion with a local anesthetic through a multiorifice catheter reduces consumption of opioids and opioid-related side effects. This assessor-blinded randomized study tested the hypothesis that continuous wound infusion with ropivacaine after cesarean delivery would provide better pain control than epidural morphine analgesia, with fewer side effects. Healthy, term women scheduled for elective cesarean delivery were randomly assigned to receive continuous wound infusion with 5 mL/hour ropivacaine 2 mg/mL (n = 29) or an epidural bolus of morphine 2 mg every 12 hours (n = 29). Both regimens were continued for 48 hours. The verbal rating scale for pain (VRSP) (0–10) was used to compare the efficacy of the regimens. At 2, 6, 24, and 48 hours after cesarean delivery, an observer blinded to group allocation assessed pain intensity, rescue analgesia consumption, and side effects. Three months after discharge, patients were interviewed by telephone by an investigator blinded to group assignment to assess residual pain, surgical wound healing, and satisfaction with analgesic technique. The median rest VRSP score was significantly lower at 24 hours in the continuous infusion group (median 0, interquartile range: 0–0) compared with the epidural morphine group (median 3, interquartile range: 2–3); 95% confidence interval of difference: 1–3 units (P < 0.001). The VRSP scores at rest at 2, 6, and 48 hours were also lower in the continuous wound infusion group (P < 0.001), and at 2 and 6 hours with movement (P < 0.001 for both comparisons). Compared with epidural morphine, wound analgesia was associated with a significantly lower incidence of nausea or vomiting, pruritus, and urinary retention, as well as a higher percentage of women with return of gastrointestinal function at 48 hours (P < 0.001–0.007). Significantly fewer nursing visits exclusively for issues related to analgesia during the 48-hour follow-up evaluation were required with wound analgesia; the median number of visits was 1 (interquartile range: 1–2) with continuous infusion and 8 (interquartile range: 7–10) with epidural morphine (95% confidence interval of difference: 6–8 visits; P < 0.001). Moreover, more patients who received wound analgesia were ready for discharge at 24 hours (25 vs. 0; P < 0.001). These findings show that continuous wound infusion for 48 hours after cesarean delivery with ropivicaine provides better analgesia with a lower incidence of side effects than epidural morphine analgesia and is associated with fewer nursing visits and shorter hospital stay.

Ropivacaine

Interquartile range

Bolus (digestion)

10.1097/ogx.0b013e3182562cb6

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Maternal expectations and experiences of labour pain and analgesia: a multicentre study of nulliparous women

International Journal of Obstetric Anesthesia (1996)

Giorgio Capogna S. Alahuhtat D. Celleno H. De Vlieger João Moreira

Labor pain

10.1016/s0959-289x(96)80042-2

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Citations (54)

Avaliação da qualidade da recuperação e do estado de saúde no pós‐operatório de cirurgias eletivas

Brazilian Journal of Anesthesiology (2018)

Sofia Ferraz João Moreira Leonor Mendes Tânia Amaral Ana Rachel Oliveira de Andrade

Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery.This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale.Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months.Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

10.1016/j.bjan.2018.06.002

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Citations (12)

Soft tissue injuries after direct laryngoscopy

Journal of Clinical Anesthesia (2015)

Joana Mourão João Moreira Joselina Barbosa J. Carvalho João Tavares

10.1016/j.jclinane.2015.07.009

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Citations (22)

Evaluation of real-time PCR assay to detect Schistosoma mansoni infections in a low endemic setting

BMC Infectious Diseases (2014)

Maria Cristina Carvalho do Espírito Santo Mónica V Alvarado-Mora Emmanuel Dias‐Neto Lívia Souza Botelho-Lima João Moreira

Schistosomiasis constitutes a major public health problem, and 200 million people are estimated to be infected with schistosomiasis worldwide. In Brazil, schistosomiasis has been reported in 19 states, showing areas of high and medium endemicity and a wide range of areas of low endemicity (ALE). Barra Mansa in Rio de Janeiro state has an estimated prevalence of 1%. ALE represent a new challenge for the helminth control because about 75% of infected individuals are asymptomatic and infections occur with a low parasite load (<100 eggs per gram of feces), causing a decrease in sensitivity of stool parasitological techniques, which are a reference for the laboratory diagnosis of this helminth. The objective of this study was to evaluate the performance of a TaqMan quantitative polymerase chain reaction (qPCR) technique in serum and feces DNA samples using the techniques of Kato-Katz (KK), Hoffman, Pons and Janer (HH) as references, during an epidemiological survey using fecal samples and sera from randomized residents from an ALE. A cross-sectional study conducted from April to December 2011 using a probabilistic sampling that collected 572 fecal and serum samples. The laboratory diagnostic techniques used were: KK, HH and qPCR (feces and serum). We obtained the following results using the different diagnostic techniques: KK and HH, 0.9% (n =5); qPCR-feces, 9.6% (n =55); and qPCR-serum, 1.4% (n =8). The qPCR-feces presented the highest positivity, whereas the techniques of HH and KK were the least sensitive to detect infections (0.8%). Compared to HH and KK, qPCR-feces showed a statistically significant difference in positivity (p <0.05), although with poor agreement. The positivity rate presented by the qPCR approach was far higher than that obtained by parasitological techniques. The lack of adequate surveillance in ALE of schistosomiasis indicates a high possibility of these areas being actually of medium and high endemicity. This study presents a control perspective, pointing to the possibility of using combined laboratory tools in the diagnosis of schistosomiasis in ALE.

Medical microbiology

Parasitology

Tropical Medicine

Schistosoma

10.1186/s12879-014-0558-4

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Citations (44)

Caracterização das mutações da região core do vírus da hepatite C associadas ao carcinoma hepatocelular

João Moreira

10.11606/d.5.2016.tde-24022016-153617

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