Browsing by Issue Date, starting with "2010"
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- Miosite OssificantePublication . Fonseca, F
- BioRePortAP, an electronic clinical record coupled with a database: an example of its use in a single centrePublication . Campanilho-Marques, R; Polido-Pereira, J; Rodrigues, A; Ramos, F; Saavedra, MJ; Costa, M; Martins, F; Pereira da Silva, JA; Canhão, H; Fonseca, JEAIMS: To evaluate the efficacy and safety of the treatment of psoriatic arthritis (PsA) patients with tumor necrosis factor (TNF) antagonists in the Rheumatology Department of Hospital de Santa Maria using the BioRePortAP. METHODS: The Portuguese Society of Rheumatology (SPR) developed an electronic medical chart coupled with a database for the follow up of PsA patients, the BioRePortAP, which was launched in May 2009. This evaluation was based on all the PsA patients that were on active treatment with TNF antagonists in September 2009 and were registered in the BioRePortAP. All the previous data on these patients were introduced in BioRePortAP using the prospective paper based follow up protocol that this Department was using since 1999. Only patients with more than 9 months of treatment were analyzed. RESULTS: Forty-two patients with PsA, actively treated with anti-TNF agents in September 2009, for at least 9 months, were analyzed in BioRePortAP. Twenty-three patients were male (55%) and nineteen were female (45%). The average age of these patients was 49.8+/-10.9 years old, the average disease duration was of 10.7+/-5.6 years and the mean duration of biological therapy was of 37.8+/-27.8 months. For the 81% of patients with peripheral joint disease there was a mean reduction of more than 80% in the swollen and tender joint counts, and almost 50% in the health assessment questionnaire (HAQ) value. In the 19% of the patients with axial involvement the reduction of BASDAI and BASFI was not statistically significative. On top of that, PASI score suffered a reduction of 64%. Fourteen patients (33.3%) had to switch their TNF antagonist treatment. 58.8% of the switches were due to adverse effects and 41.2% due to therapy failure. Regarding the 56 adverse reactions registered, only one was a severe reaction. The remaining adverse reactions were not severe and 67% of them were due to infections. DISCUSSION: The results of this first report of the use of the BioRePortAP in clinical practice confirm the efficacy and safety of TNF antagonist treatment in PsA. The results shown here elucidate the potential applications of BioRePortAP as a tool for efficacy and safety assessment of PsA patients treated with biotechnological drugs.
- Management of gallbladder polypsPublication . Matos, AS; Baptista, HN; Pinheiro, C; Martinho, FOBJECTIVE: Appropriate treatment and timing hinge on whether the lesion is benign or malignant. Study: A five years retrospective descriptive analysis was performed. Location : Department of General Surgery in Hospitals of the University of Coimbra. Patients: We present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007. METHODS: An analysis was performed using clinical and radiological files of patients electively treated for gallbladder polyp. Ninety-three consecutive patients were evaluated, treated and followed in a Department of General Surgery in a Central Hospital in that period. Biographic, clinical and radiological data were compiled. RESULTS: In 91 patients a benign lesion was found. Two (2.16%) patients had adenocarcinoma. Among benign polyps, 73 (78,5%) were cholesterol polyps, 14 (15%) were hyper-plastic and 2 (2.19%) were premalignant adenomas. Mean diameter of benign polyps, excluding adenomas, was 6 mm. In 40 (43%) patients, multiple lesions were found. The mean diameter in the subset of malignant and premalignant polyps was 18.8 mm, in all instances these were found to be single lesions; and mean age at presentation was 57,7 years. CONCLUSION: Cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. Patients benefitting from surgery are those who are symptomatic, whose polyps exceed 10 mm in diameter and , have shown to be enlarging, to be sessile or broad-based, to have long pedicles;and also have . infundibular polyps, coexisting gallstones or changes on the gallbladder wall appearance at ultrasonography
- Health-related quality of life in portuguese SLE patients: an outcome measure independent of disease activity and cumulative damagePublication . Duarte, C; Abreu, P; Couto, M; Vaz, C; Malcata, A; Inês, LPURPOSE: To evaluate quality of life in Portuguese patients with Systemic Lupus Erithematosus (SLE) and its correlation with disease activity and cumulative damage. METHODS: We included consecutive SLE patients, fulfilling the 1997 ACR Classification Criteria for SLE and followed at the Rheumatology Department of the University Hospital of Coimbra, Portugal at time of visit to the outpatient clinic. Quality of life was evaluated using the patient self-assessment questionnaire Medical Outcomes Survey Short Form-36 (SF-36) (validated Portuguese version). The consulting rheumatologist fulfilled the SLE associated indexes for cumulative damage (Systemic Lupus International Collaborating Clinics- Damage Index: SLICC/ACR-DI) and disease activity (Systemic Lupus Erythematosus Disease Activity Index: SLEDAI 2000). Correlation between SLEDAI and SLICC and SF-36 was tested with the Spearman Coefficient. Significant level considered was 0.05. RESULTS: The study included 133 SLE patients (90.2% female, mean age - 40.7 years, mean disease duration - 8.7 years). Most patients presented low disease activity (mean SLEDAI = 4.23) and limited cumulative damage (mean SLICC = 0.76). Despite that, SF-36 mean scores were below 70% in all eight domains of the index. Physical function domains showed lower scores than mental function domains. The QoL in this group of patients is significantly impaired when compared with the reference Portuguese population (p<0.05 in all domains). There was no correlation between clinical activity or cumulative damage and quality of life. CONCLUSION: QoL is significantly compromised in this group of SLE patients, but not related with disease activity or damage. These findings suggest that disease activity, cumulative damage and QoL are independent outcome measures and should all be used to assess the full impact of disease in SLE patients.
- Ulcerative colitis in northern Portugal and Galicia in SpainPublication . Barreiro-da-Costa, M; Magro, F; Carpio, D; Lago, P; Echarri, A; Cotter, J; Pereira, S; Gonçalves, R; Lorenzo, A; Carvalho, L; Castro, J; Barros, L; Dias, JA; Rodrigues, S; Portela, F; Dias, C; Costa-Pereira, ABACKGROUND: Clinical and therapeutic patterns of ulcerative colitis (UC) are variable in different world regions. The purpose of this study was to examine two close independent southern European UC populations from 2 bordering countries and observe how demographic and clinical characteristics of patients can influence the severity of UC. METHODS: A cross-sectional study was conducted during a 15-month period (September 2005 to December 2006) based on data of 2 Web registries of UC patients. Patients were stratified according to the Montreal Classification and disease severity was defined by the type of treatment taken. RESULTS: A total of 1549 UC patients were included, 1008 (65%) from northern Portugal and 541 (35%) from Galicia (northwest Spain). A female predominance (57%) was observed in Portuguese patients (P < 0.001). The median age at diagnosis was 35 years and median years of disease was 7. The majority of patients (53%) were treated only with mesalamine, while 15% had taken immunosuppressant drugs, and 3% biologic treatment. Most patients in both groups were not at risk for aggressive therapy. Extensive colitis was a predictive risk factor for immunosuppression in northern Portugal and Galicia (odds ratio [OR] 2.737, 95% confidence interval [CI]: 1.846-4.058; OR 5.799, 95% CI: 3.433-9.795, respectively) and biologic treatment in Galicia (OR 6.329, 95% CI: 2.641-15.166). Younger patients presented a severe course at onset with more frequent use of immunosuppressors in both countries. CONCLUSIONS: In a large population of UC patients from two independent southern European countries, most patients did not require aggressive therapy, but extensive colitis was a clear risk factor for more severe disease
- Avaliação da sensibilidade médica para o risco de gravidez não planeadaPublication . Nobre-Ramos, V; Rodrigues, A; Sousa, S; Bombas, T; Moura, PABSTRACT: In Portugal, about 94% of sexually active women who don`t want to become pregnant, use a contraceptive method. From these, oral hormonal contraceptives are the most used. Despite this, unplanned pregnancies are a reality. The current study aimed to evaluate physicians’ sensibility to contraceptive counselling on the introduction of new therapies in women with underlying medical conditions and in polymedicated ones. It was a survey study with ten closed-ended questions. Physicians who care for women of reproductive age in a tertiary referral centre (n= 181). It was conducted an opinion survey among physicians who care for women of childbearing age. The differences in medical opinion considering age, sex, medical / surgical specialties and years of clinical practice were analyzed. In the introduction of new therapies, asked about the contraceptive method in use: always 16,6% (n=30) of respondents, nearly always 28,7% (n=52) and sometimes 44,8% (n=81). From these, 62% (n=101) neither provided complete information nor remitted to family planning appointments. When pregnancy was contraindicated 38,7% (n=70) informed about a safe method. About 89,5% (n=162) of the respondents didn't attended updates on contraception in the last year. Even though 64,6% (n= 117) considered it useful taking into account clinical practise. The respondents had poor knowledge about the resources in family planning, 79% (n=118). The female doctor showed a greater information about family planning topics (p=0,001). The younger physicians (<35 years old) and those with few years of clinical practise (<8 years) referred more constantly the importance of professional qualification on family planning (p=0,034; p=0,034). Despite the care of women in childbearing age the issues on drug interactions haven't been addressed constantly. There is evidence of a poor knowledge of the respondents of existing resources which limits an effective contraceptive counselling.
- A coupled convection-diffusion level set model for tracking epithelial cells in colonic cryptsPublication . Figueiredo, IN; Leal, C; Leonori, T; Romanazzi, G; Figueiredo, P; Donato, MMColorectal cancer is initiated in colonic crypts as a consequence of alterations leading to the disruption of the normal colonic cellular process. We propose a model, which couples a convection-diffusion type equation with a level set equation, for tracking the time evolution of an epithelial cell set, inside a colonic crypt, until it reaches the top of the crypt. The convection-diffusion equation describes the evolution of the density of the cells in the epithelial cell set. The parameters of this equation regulate the geometric and temporal cellular mechanism, and different parameter choices lead to distinct cell behavior. The level set equation tracks the location and shape of the epithelial cell set, inside the crypt, as well as its interface, separating the cell set from the others cells, which reside within the crypt. The interfacial velocity of the epithelial cell set is obtained from the convection-diffusion type equation. Some in silico experiments are described. They are performed in a relative small time, with respect to the real biological evolution.
- Estudo do perfil do envelhecimento da população portuguesaPublication . Oliveira, CR; Santos-Rosa, M; Mota-Pinto, A; Botelho, MA; Morais, A; Veríssimo, MT
- Clinical relevance of incidental colonic uptake 18F-FDG PET/CT. Correlation with colonoscopy and histopathologyPublication . Fernandes, H; Lapa, P; Costa, G; Correia, J; Pedroso de Lima, J
- High blood pressure in the pediatric age groupPublication . Andrade, H; António, N; Rodrigues, D; Marinho da Silva, A; Pego, M; Providência, LAThe definition of hypertension (HT) in the pediatric age group is based on the normal distribution of blood pressure (BP) in healthy children. Normal BP is defined as being below the 90th percentile for gender, age and height, and hypertension as equal to or higher than the 95th percentile on at least three separate occasions. If the values are above the 90th percentile but below the 95th percentile, the child should be considered prehypertensive. Ambulatory BP monitoring is useful in the assessment of BP levels in the young. P values in children and adolescents have creased in the last decade, in parallel with increases in body mass index, and HT now has a prevalence of 2-5%. Obesity in childhood and adolescence is one of the main predictors of HT in adulthood, but it is also associated with other cardiovascular risk factors such as dyslipidemia, abnormal glucose metabolism, insulin resistance, inflammation and impaired vascular function. Left ventricular hypertrophy is the most prominent evidence of target organ damage caused by hypertension in children and adolescents. The goal for antihypertensive treatment is to reduce BP below the 95th percentile. Weight control, with regular physical activity and dietary changes, is the primary therapy for obesity-related hypertension. Weight loss decreases not only BP but also other cardiovascular risk factors. The indications for use of antihypertensive drugs are: symptomatic hypertension, secondary hypertension, established hypertensive target organ damage, stage 2 hypertension and failure of nonpharmacologic measures.