Browsing by Author "Domingues, Tiago Dias"
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- 1 ªs Jornadas de Estatística Médica:Programa e ResumosPublication . Diamantino, Fernanda; Sousa, Lisete; Pereira, Miguel; São João, Ricardo; Caldeira, Sílvia; Pereira, Soraia; Domingues, Tiago DiasO Centro de Estatística e Aplicações (CEAUL) organiza a 1.a edição das Jornadas de Estatística Médica que se realizam nos dias 12 e 13 de fevereiro de 2020. Este encontro destina-se a todos os interessados em aplicações da Estatística nas áreas de Medicina, Enfermagem e Indústria Farmacêutica.
- Análise Automática vs Análise Manual no diagnóstico da síndrome de apneia obstrutiva do sonoPublication . Cardoso, Andreia; Silva, Vânia; Fradinho, Marta; Santos, Laura; São João, Ricardo; Domingues, Tiago Dias; Feliciano, AméliaA Síndrome Apneia Obstrutiva do Sono (SAOS) caracteriza-se por períodos de diminuição ou ausência total do fluxo respiratório resultantes do colapso da via aérea superior durante o sono, que podem estar associados a fragmentação deste e alteração das trocas gasosas. Estas alterações do sono são avaliadas através da realização de exames, polissonografia ou estudo cardiorrespiratório e a sua presença permite fazer o diagnóstico de SAOS. A gravidade da SAOS é determinada através do índice de apneia-hipopneia (IAH), sendo considerada de gravidade ligeira entre 5 e 14,9; moderada de 15 a 29,9; e grave igual ou superior a 30 eventos respiratórios/hora. Para um diagnóstico válido é importante uma correta análise dos parâmetros respiratórios. Com o presente estudo pretende-se realizar a comparação entre a análise automática e a análise manual em exames de sono cardiorrespiratórios no que respeita ao diagnóstico da SAOS, no sentido verificar a existência de “misdiagnosis” quando utilizada a análise automática e a sua expressividade em termos de gravidade. Foram avaliados 2980 exames de doentes com suspeita de SAOS, realizados entre 2011 e 2019 sendo utilizado o software de análise Remlogic e seguidas as diretrizes da American Academy of Sleep Medicine mais atuais. No resultado do IAH automático versus manual verifica-se que com base na análise automática, 1240 estudos foram negativospara diagnóstico de SAOS, dos quais comparados com a análise manual 238 (19,2%) mantinham o diagnóstico negativo; 575 (46,4%) passam para SAOS de grau ligeiro; 269 (21,7%) passam para SAOS de grau moderado e 158 (12,7%) passam para SAOS de grau grave, existindo 80,8% de “misdiagnosis”. De acordo com os resultados obtidos, conclui-se que a análise automática destes exames pode levar a um incorreto diagnóstico da SAOS assim como da sua gravidade, sendo importante que o diagnóstico desta patologia seja baseado numa análise manual de todos os parâmetros.
- Analysis of cervical node metastasis in oral cavity squamous cell carcinoma patients retrospective study and literature comparisonPublication . Silva, Leonor Cruz; Coutinho, José Cunha; São João, Ricardo; Domingues, Tiago Dias; Coutinho, Gonçalo Cunha; Caldas, Cecília; Palmela, Paulo; Nobre, Miguel; Salvado, FranciscoBackground/Objective: Oral Cavity Cancer is a frequent type of Head and Neck Cancer, associated with high mortality rates worldwide. One of the main prognostic factors for the disease is regional lymph node metastasis that is associated with survival rate reduction by 50%. Reported tumour sites more frequently associated with regional node metastasis vary throughout literature. Therefore, we aimed to conduct a retrospective study that would allow us to identify the relationship between patient and SCC tumour factors with the rate of neck metastasis and compare our data with the conclusions from similar studies. Methods: A retrospective study was conducted in the Oral Medicine and Oncology Consultation of the Stomatology Department from Centro Hospitalar Universitário Lisboa Norte, comprehending patients diagnosed with Squamous Cell Carcinoma between January 2015 and April 2021. As eligibility criteria we considered patients which had clinical charts with complete information including sociodemographic variables, tumour site and disease staging at diagnosis. We excluded tumour sites with only two diagnosed cases, considering bias risk. Three groups were defined according to a clinical/pathological reason. The current research was approved by an independent ethics committee. Results: The sample includes 151 cases, the majority of which were males (≈59%) and with average age at diagnosis (± standard deviation) of 65 ± 13 years-old. Oral tumour sites with highest percentage of cases with clinical positive lymph nodes (cN+) by the time of diagnosis were inferior gingiva (72.7%, n=16), mouth floor (66.7%, n=22), oropharynx (64.7%, n=11), retromolar trigone (58%, n=11) and ventral tongue (57%, n=16). Sites with fewer cases of cN+ were inferior lip (31%, n=4) and superior lip (n=0). Similar results were found in our sample when operated tumors (pN+) were considered: floor of the mouth (65%, n=13), retromolar trigone (63.6%, n=7), inferior gingiva (46.2%, n=6) and ventral tongue (45%, n=9). Tumour sites with fewer pN+ cases were hard palate (25%, n=1), superior gingiva (16.7%, n=1) and inferior lip (0 out of 7 cases). According to Fisher’s exact test there is no statistically significant association (p-value=0.1506) between primary tumour site and cervical node disease (either cN+ or, whenever available, pN+). Conclusions: Our data seem to indicate an association between primary tumour site and N+, being cervical metastasis more frequent when tumour site was posterior and caudally located. Lower lip had the fewer positive lymph nodes, probably correlated with the inclusion in the same group of oral mucosa and skin cancers. Despite these findings, the association was not statistically significant.
- Doentes oncológicos críticos admitidos em Unidade de Cuidados Intensivos - preditores de mortalidadePublication . Domingues, Tiago Dias; Pissarra, Ana João; São João, RicardoO objectivo principal deste estudo consiste em identificar potenciais factores preditivos de mortalidade nos doentes oncológicos críticos admitidos em UCI. Pretende-se ainda avaliar a mortalidade na UCI, hospitalar e 30-dias após a alta; os índices de gravidade à admissão; as causas de admissão; as características da doença oncológica e o subgrupo de doentes admitidos por causa médica.
- Estatística aplicada à GestãoPublication . Domingues, Tiago Dias
- Observational and comparative study between automatic and manual analysis of sleep studiesPublication . São João, Ricardo; Cardoso, Andreia; Domingues, Tiago Dias; Silva, Vânia; Fradinho, Marta; Santos, Laura; Feliciano, AméliaObstructive sleep apnea syndrome (OSAS) is a sleep-disordered breathing disorder. It consists of a set of symptoms and signs that result from recurrent episodes of intermittent upper airway obstruction. It is estimated that this syndrome is very common; however, its true prevalence is unknown, as it is underdiagnosed. OSAS is considered a systemic disease with several associated consequences, including cardiovascular and metabolic diseases, making it a public health problem. Polysomnography is the sleep study of choice for the diagnosis of OSAS, but the fact that it is a time-consuming test contributes to the underdiagnosis of this pathology. For this reason, one can opt for the Cardiorespiratory Sleep Study which, despite being a simpler test, allows for the diagnosis of this syndrome. The manual reading of these tests is one of the aspects that most contributes to their slowness, as well as the inter-observer variability in their reading. From a simplistic perspective, some studies have focused on the automatic analysis of these exams. However, there have been discrepancies between the two analyses, which can be significant in terms of final diagnosis and consequent therapeutic orientation. The Sleep Unit of the Hospital da Luz Setúbal, based on a sample of 3297 scans performed in 2011-2019, concluded that the automatic analysis may lead to an incorrect diagnosis of OSAS as well as its severity, being important that the diagnosis of this pathology be based on a manual analysis.
- Pancreatic câncer associatedCachexia:role of the modified Glasgow prognostic score in outcome predictionPublication . Cardoso, Debora; Matos, Leonor Vasconcelos; Fernandes, Leonor; Domingues, Tiago Dias; São João, Ricardo; Mirra, Renata Medeiros; Miranda, Helena; Martins, AnaCancer-associated-cachexia (CAC) is a ubiquitous characteristic of pancreatic cancer (PC) and 1/3 of patients die from its complications. Systemic inflammation is key in CAC and the modified Glasgow Prognostic Score (mGPS) is a reliable inflammation-based prognostic tool. We aimed to evaluate the prognostic value of consensus-based cachexia classification and mGPS, their agreement and to analyze relevant clinical predictors of cachexia. This unicentric, retrospective, cohort study included patients with advanced PC treated over a 5-year period. Cachexia was classified according to weight loss, body mass index and mGPS. Fisher’s test was used to test correlation between classifications and logistic regression models were performed to test their association with other variables. Survival was analyzed with cox regression and Kaplan-Meier curves. 88 eligible patients (mean age 72, 56% female) were reviewed. At baseline, cachectic patients (CP) (77%), when compared with pre-CP, had worse performance status (p=0.016), more NLR>3,5 (p<0.01) and hypoalbuminemia (p 0.01). Of 77% (n=68) categorized as cachectic, only 16% (n=8) had a positive mGPS. No association was found between classifications (p=0.187). In multivariate analysis, NLR>3.5 was a significant predictor of both cachexia (p<0.001) and positive mGPS (p<0.01). Median overall survival (OS) for pre-CP was 19.1 months vs. 4.9 months in the CP (HR 1.94 95% CI 1.10-3.43 p=0.02). A positive mGPS at baseline was an independent predictor of worst OS (HR 2.73, 95% CI 1.126.66, p=0.027). CAC leads to worst survival and a better understanding of this syndrome in PC may improve outcomes for these patients. Our study suggests a baseline predominant fat-only loss phenotype, that patients with positive mGPS are at higher risk of worst outcomes and that NLR is a potential predictor of CAC. A prompt identification of prognostic markers may lead to a better standardized management of CA.
- A retrospective study on obstructive sleep apneaPublication . São João, Ricardo; Cardoso, Andreia; Domingues, Tiago Dias; Fradinho, Marta; Silva, Vânia; Feliciano, AméliaObstructive sleep apnea (OSA) is a sleep-related breathing disorder with worldwide increasing prevalence. Polysomnography is the traditional gold standard for the diagnosis of OSA, but the fact that it is a complex, time-consuming, and expensive test contributes to the underdiagnosis of this pathology. For this reason, one usually opts for the simpler, less labor-intensive, and cheaper cardiorespiratory sleep test for the diagnosis of this syndrome. The manual analysis of these tests, which usually involves two or more qualified observers, is one of the aspects that most contributes to the amount of time spent in the analysis and, consequently, to diagnostic delay. Automatic analysis emerges as a faster alternative to the manual analysis. Based on a sample of 2559 patients monitored by the Pulmonology Department—Sleep Unit of the Hospital da Luz Setúbal during the period 2011–2019, this research concludes that there is no agreement between the manual and automatic readings of two popular OSA classification indexes.