Centro Hospitalar Cova da Beira

Quinta do Anjo, Portugal

Centro Hospitalar Cova da Beira

Quinta do Anjo, Portugal
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Palmeira-de-Oliveira R.,University of Beira Interior | Palmeira-de-Oliveira R.,Centro Hospitalar Cova da Beira | Palmeira-de-Oliveira A.,University of Beira Interior | Palmeira-de-Oliveira A.,Centro Hospitalar Cova da Beira | And 2 more authors.
Advanced Drug Delivery Reviews | Year: 2015

Vaginal infections are extremely prevalent, particularly among women of reproductive age. Although they do not result in high mortality rates, these infections are associated with high levels of anxiety and reduction of quality of life. In most cases, topical treatment of vaginal infections has been shown to be at least as effective as oral treatment, resulting in higher local drug concentrations, with fewer drug interactions and adverse effects. Furthermore, the emergence of microbial resistance to chemotherapeutics and the difficulties in managing infection recurrences sustain the need for more effective local treatments. However, conventional dosage forms have been associated with low retention in the vagina and discomfort. Formulation strategies such as the development of bioadhesive, thermogelling systems and microtechnological or nanotechnological approaches have been proposed to improve delivery of traditional drugs, and other treatment modalities such as new drugs, plant extracts, and probiotics are being studied.This article reviews the recent strategies studied to improve the treatment and prevention of the commonest vaginal infections-namely, vaginal bacteriosis, aerobic vaginitis, vulvovaginal candidosis, and trichomoniasis-through the intravaginal route. © 2015 Elsevier B.V.


Cunha A.R.,University of Beira Interior | Machado R.M.,University of Beira Interior | Palmeira-de-Oliveira A.,University of Beira Interior | Martinez-de-Oliveira J.,University of Beira Interior | And 5 more authors.
Pharmaceutics | Year: 2014

Vaginal lubricants are widely used by women to help solve intercourse difficulties or as enhancers, but recent reports raise questions about their safety. Twelve commercially available gel products were tested for pH value, pH buffering capacity, osmolality and cytotoxicity relevant to vaginal delivery. Obtained data were analyzed in light of the recent Advisory Note by the World Health Organization (WHO) for personal lubricants to be concomitantly used with condoms. Results showed that most products do not comply with pH and osmolality recommended standards, thus posing a potential hazard. Four products presented values of osmolality around three-times higher than the maximum acceptable limit of 1200 mOsm/kg. In vitro cell testing further identified substantial cytotoxicity even at 1:100 dilutions for three products, contrasting with no significant effect of up to at least a 1:5 dilution of a Universal Placebo gel. However, no direct correlation between these last results and pH or osmolality was found, thus suggesting that the individual toxicity of specific formulation components plays an important role in the outcome of a particular product. Although further assessment is required, these results highlight potential safety issues related to the formulation of commercially available vaginal lubricants. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


Patricio J.P.H.,BIAL | Barbosa J.P.P.,Centro Hospitalar Of Lisbon Central | Ramos R.M.M.,Centro Hospitalar Cova da Beira | Antunes N.F.P.,Centro Hospitalar Do Porto Hospital Of Santo Antonio | De Melo P.C.S.,Instituto Portugues Of Oncologia Of Lisbon
Clinical Drug Investigation | Year: 2013

Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used in clinical practice, and are considered a first-line option for pain management. However, non-selective NSAIDs (nsNSAIDs) and new generation NSAIDs named cyclo-oxygenase-2 inhibitors (coxibs) are very different from one another and their cardiovascular and gastrointestinal safety profiles may influence prescribing. This article resulted from a search of MEDLINE/Pubmed, Cochrane Library, Bandolier, Medscape and Trip database, up to June 2011. Key words included non-steroidal anti-inflammatory, coxib and safety, with the purpose of reviewing the gastrointestinal and cardiovascular safety issues of NSAIDS and the main aspects that differentiate both classes. Selective coxibs are associated with a more favourable gastrointestinal safety profile than nsNSAIDs. In terms of the risk of cardiovascular events, there seems to be a class effect for all NSAIDs with the possible exception of naproxen. The proper usage guidelines for NSAIDs detail the importance of risk factors for each patient in addition to the differences between classes. Patients with high cardiovascular or gastrointestinal risk should avoid using NSAIDs. These medications should be used at the minimum effective dose and for the shortest time possible in all patients. © 2013 Springer International Publishing Switzerland.


Castro A.T.E.,University of Coimbra | Mendes M.,Centro Hospitalar Cova da Beira | Freitas S.,University of Coimbra
Revista Portuguesa de Pneumologia | Year: 2015

Introduction: Adverse drug reactions (ADR) to first-line antituberculosis drugs are frequent and have important implications that may affect the effectiveness of treatment and course of tuberculosis (TB). Material and methods: Retrospective data analysis of clinical records and national registration forms from patients with ADR to first line antituberculosis that occurred between 2004 and 2013 at a Portuguese Pulmonology Diagnostic Centre, and from a case-control population matched by sex, age and year of initiation of treatment. Results: Of the 764 patients treated with antituberculosis drugs, 55 (52.7% male, 92.7% European, mean age 50.8 ± 19.5 years) had at least one severe ADR and six had a second ADR, for a total of 61 events. The most frequent ADR were hepatotoxicity (86.9%), rash (8.2%) and others, such as ocular toxicity, gastrointestinal intolerance and angioedema (4.9%). Isoniazid, alone or in combination, was the antituberculosis drug most associated to toxicity. Due to ADR, treatment time changed an average of 1.0 ± 2.6 months (range -3.4 to 10.6). There was no correlation between age or gender and the overall incidence of ADR although we found a significant association between younger age and an increased risk of hepatotoxicity (P = 0.035). There was also a statistically significant relationship between ADR and diabetes mellitus (P = 0.042) but not for other comorbidities or multi-resistant TB risk factors. Conclusions: This study found a high frequency of ADR with strong impact on subsequent therapeutic orientation. What seems to be of particular interest is the relationship between ADR and diabetes mellitus and the increased frequency of hepatotoxicity in younger patients. © 2014 Sociedade Portuguesa de Pneumologia.


Grilo L.M.,Polytechnic Institute of Tomar | Henriques R.S.,University of Beira Interior | Correia P.C.,Centro Hospitalar Cova da Beira | Grilo H.L.,Polytechnic Institute of Tomar
AIP Conference Proceedings | Year: 2015

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders in school age children, with a high increase of its prevalence rate in the last decade. ADHD has much comorbidity affecting the child's life in every domain of their quotidian life with a negative influence in the prognosis of this condition. Psychomotor deficits are responsible for many of the learning disabilities of these children.A sample was submitted to a Psychomotor Battery, in order to characterize the population of children with the diagnosis of ADHD, followed at the Centro Hospitalar Cova da Beira (Portugal), under psychomotor therapy. To the data, collected at baseline and at the end of the intervention, we applied a nonparametric testand graphical techniquesbased on limits of (dis)agreement. The main result shows that the psychomotor profile has a statistical significant improvement after psychomotor therapy. © 2015 AIP Publishing LLC.


Ramalhinho A.C.,University of Beira Interior | Ramalhinho A.C.,Centro Hospitalar Cova da Beira | Fonseca-Moutinho J.A.,University of Beira Interior | Fonseca-Moutinho J.A.,Centro Hospitalar Cova da Beira | Breitenfeld L.,University of Beira Interior
Molecular and Cellular Biochemistry | Year: 2011

Glutathione S-transferases are a superfamily of multifunctional enzymes that play a key role in Phase II metabolism, detoxifying therapeutic drugs, and various carcinogens by conjugation with glutathione. We undertook a case-control study in Central-Eastern Portuguese population to evaluate the association of null genotype in GSTM1 and GSTT1 along with the polymorphism in GSTP1 (A/G) and susceptibility to breast cancer. The population sample consisted of 85 patients with histological diagnosis of breast cancer and 102 healthy women. Genomic DNA was extracted from blood samples, and genotyping analyses were performed by PCR-based methods. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by unconditional logistic regression. We found a increased breast cancer risk associated with GSTM1 null genotype (OR = 3.597; 95% CI = 1.849-6.999; P = 0.0001) and GSTT1 (OR = 2.592; 95% CI = 1.432-4.690; P = 0.002), but the presence of valine alleles compared to isoleucine alleles in codon 105 in GSTP1 did not increase the risk of breast cancer development. The two-way combination of GSTM1 and GTTT1 null genotypes resulted in 8-fold increase for breast cancer risk (OR = 8.287; 95% CI = 3.124-21.980; P = 0.0001) and the three-way combination of GSTP1 105AA/AG and null genotypes for both GSTM1 and GSTT1 resulted in 5-fold increase for breast cancer risk (OR = 5.040; 95% CI = 1.392-18.248; P = 0.016). Our results suggest that GSTM1 and GSTT1 null genotype alone, both combined or combined with GSTP1 valine alleles, are associated with higher susceptibility to breast cancer development. © 2011 Springer Science+Business Media, LLC.


Paixao P.,Chronic Diseases Research Center | Almeida S.,Centro Hospitalar Cova da Beira | Videira P.A.,Chronic Diseases Research Center | Ligeiro D.,Hospital Pulido Valente | And 2 more authors.
European Journal of Pediatrics | Year: 2012

Human cytomegalovirus (HCMV) is the most frequent cause of congenital infection. Despite the fact that 5-17% of asymptomatic infected babies will develop late sequelae and, therefore, should be closely followed, most of these children will remain undetected, as screening of all newborns by viral culture is too expensive and no valid alternative has been widely accepted. The aim of this work was to demonstrate that pool testing can be used to screen HCMV congenital infection in newborns. For this purpose, a real-time PCR technique was tested in urine pools. This pool method was applied to all urine specimens from children received in the virology laboratory of the Centro Hospitalar Cova da Beira for diagnosis of HCMV infection for a period of 14 months. Ten out of the 160 urine samples were tested positive by shell-vial culture and were also detected by this pool method. Additionally, 100 urine specimens, collected in 2004 and culture negative for HCMV were included to test the specificity of this methodology, all of which were negative. In conclusion, these results suggest that urine pools can be used to detect HCMV-positive urines in children, with similar sensitivity and specificity when compared with the standard method. Because of the very significant reduction both in terms of labour and cost of testing materials, this methodology may represent a valid option for screening the HCMV congenital infection in newborns. © 2011 Springer-Verlag.


Mendes M.S.,Centro Hospitalar Cova da Beira | dos Santos J.M.,Centro Hospitalar iversitario Of Coimbra
Revista Portuguesa de Pneumologia | Year: 2015

Introduction: Obstructive sleep apnea syndrome (OSAS) and insomnia often coexist, and it is estimated that nearly half of those who suffer from the former report symptoms of the latter. The fact that these patients have no other causes of insomnia indicates that it is a sign of OSAS. Objective: The aim of the study is to evaluate the effectiveness of nocturnal ventilatory support (NVS) in the treatment of insomnia secondary to OSAS. Materials and methods: In order to conduct the retrospective study, the authors reviewed the medical records of patients with insomnia and OSAS that had received NVS. Patients with psychiatric disorders, sleep movement disorders, psycho-physiological insomnia, circadian rhythm sleep disorders, inadequate sleep hygiene, use and abuse of hypnotic agents, stimulants, antidepressants, anxiolytics and alcohol, were excluded. For the selected patients, the effects of NVS in terms of clinical signs and symptoms of insomnia, apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and number of sleep hours were analyzed, before and after treatment with NVS. Results: After reviewing 1241 medical records, 56 patients were selected, with a mean age of 60.9 ± 10.0 years. Twenty-two (39.3%) suffered from intermediate insomnia, 19 (33.9%) had initial insomnia, eight (14.3%) had the mixed type, and seven patients (12.5%) had terminal insomnia. The majority of patients (n = 48; 85.7%) were treated with auto-titrating continuous positive airway pressure (APAP). Forty-four patients (78.6%) overcame insomnia; insomnia symptoms persisted in nine (16.1%), and three (5.4%) patients abandoned during the medical follow-up. There was an association between the type of insomnia and its resolution and, in percentage terms patients with the mixed type did not manage to overcome insomnia symptoms (75%).There was a statistically significant difference between patients that overcame insomnia and those who did not in terms of the average time which elapsed between the initiation of treatment with NVS and compliance with the adherence criteria: 161 ± 61 days for the former, and 225 ± 141 days for the latter (p = 0.003). Before and after the NVS treatment, patients slept an average of 5.29 ± 1.37 and 6.37 ± 1.55 h per night, respectively (p < 0.001). Among the patients who overcame insomnia, six did not meet the treatment adherence criteria: five adhered more than 4 h/night in less than 70% of all nights (60.6 ± 3.2%), and one patient adhered less than 4 h in all nights (3.5 h/night). Conclusion: NVS has proved effective in treating insomnia secondary to OSAS, and favorable results could be observed even in patients that did not meet the criteria of NVS adherence. Results suggest that all insomnia subtypes, except the mixed subtype, may derive from OSAS. © 2014 Sociedade Portuguesa de Pneumologia.


Marmelo F.C.,Escola Superior de Saude Dr. Lopes Dias | Mateus S.M.F.,Escola Superior de Saude Dr. Lopes Dias | Mateus S.M.F.,Hospital Do Espirito Santo Of Evora | Pereira A.J.M.,Escola Superior de Saude Dr. Lopes Dias | Pereira A.J.M.,Centro Hospitalar Cova da Beira
Arquivos Brasileiros de Cardiologia | Year: 2014

Background: Aortic valve sclerosis (AVS) is characterized by increased thickness, calcification and stiffness of the aortic leaflets without fusion of the commissures. Several studies show an association between AVS and presence of coronary artery disease.Objective: The aim of this study is to investigate the association between presence of AVS with occurrence of previous coronary artery disease and classical risk factors.Methods: The sample was composed of 2,493 individuals who underwent transthoracic echocardiography between August 2011 and December 2012. The mean age of the cohort was 67.5 ± 15.9 years, and 50.7% were female. Results: The most frequent clinical indication for Doppler echocardiography was the presence of stroke (28.8%), and the most common risk factor was hypertension (60.8%). The most prevalent pathological findings on Doppler echocardiography were mitral valve sclerosis (37.1%) and AVS (36.7%). There was a statistically significant association between AVS with hypertension (p < 0.001), myocardial infarction (p = 0.007), diabetes (p = 0.006) and compromised left ventricular systolic function (p < 0.001).Conclusion: Patients with AVS have higher prevalences of hypertension, stroke, hypercholesterolemia, myocardial infarction, diabetes and compromised left ventricular systolic function when compared with patients without AVS. We conclude that there is an association between presence of AVS with previous coronary artery disease and classical risk factors. ©, Arquivos Brasileiros de Cardiologia. All rights reserved.


PubMed | Centro Hospitalar Cova da Beira and Polytechnic Institute of Viseu
Type: Journal Article | Journal: Nursing children and young people | Year: 2016

Theme: Child protection and managing risk.Skin-to-skin contact in the first hour of life has benefits for the mother and the newborn, as well as a major role in establishing breastfeeding.Determine the prevalence of skin-to-skin contact and breastfeeding within the first hour of life.A systematic review of literature followed by a quantitative and simple descriptive cross-sectional study, according to a non-probability analyzing of 382 clinic records of postpartum mothers.Evidence that early skin-to-skin contact immediately after birth is a potential sensory stimulus, which covers the newborn warming, tactile and active stimulation, respiratory rates and level of blood glucose, reduces baby crying and promotes breastfeeding. In the sample, about 92.6% of the mothers put the baby to the breast in the first hour of life, but only 26.6% made skin-to-skin contact with the baby.Despite the scientific evidence of the benefits of skin-to-skin contact immediately after birth, this practice is still not widely used as, according to the study results, and is only applied to one in every four newborns.

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