Quinta do Anjo, Portugal
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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.


PubMed | Centro Hospitalar Cova da Beira, Centro Hospitalar Vila Nova Of Gaia, Centro Hospitalar do Baixo Vouga, Exigo Consultores and 5 more.
Type: Journal Article | Journal: Advances in therapy | Year: 2016

Low-dose weekly methotrexate (MTX) is the mainstay in the therapy of rheumatoid arthritis (RA). It can be given via oral, intramuscular or subcutaneous (SC) route. This study sought to determine the real-world pattern of treatment with SC MTX in Portuguese adult patients with active RA.Utilization of Metoject() in Rheumatoid Arthritis (UMAR) was a non-interventional, cohort multicenter study with retrospective data collection. Eligible patients had active RA, at least 18 years of age, and started SC MTX treatment in 2009 or 2010 after failure or intolerance to oral MTX. Data were collected from patients clinical records. Both non-parametric and parametric survival methods were used to obtain a detailed understanding of SC MTX treatment duration.Fifty patients were included, of which only 9 discontinued SC MTX during the study follow-up period. The probability of discontinuation after 1, 2, and 3 years of treatment of SC MTX treatment is expected to be 6.10%, 8.50%, and 23.20%, respectively. The extrapolated median duration of SC MTX using an exponential model was 106.4 months/8.87 years. Mean dose of SC MTX was 18.36 mg. The reasons for treatment discontinuation were occurrence of adverse events in six patients and lack of efficacy in three.The long treatment duration of SC MTX highlights its excellent tolerability compared to oral MTX, especially concerning the frequent adverse gastrointestinal events of MTX. Furthermore, long MTX treatment duration provides the opportunity to postpone or even avoid expensive therapies with biologics. The results obtained from the UMAR study provide important information for the utilization and public financing of SC MTX in Portugal.


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.


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

Theme: Child protection and managing risk.On child abuse the protection of children requires cooperation between health and education professionals.To relate the sociodemographic and training context variables with the perception of teachers about child abuse.A descriptive-correlational and cross-sectional study. A sample of 172 teachers of the 1st cycle, selected by convenience. Questionnaire with sociodemographic characterization, training and perception about child abuse.Participants with an average age of 45 and average experience of 25.7 years (SD=6,83). Expertise in the related area-34,3% acquired in the training base and 16.3% in further training. Only 15.7% knew the guideline for education professionals in addressing mistreatment situations. The majority considered the training important (98%). Teachers with experience of more than 32 years considered it very important.The predictors of perceived mistreatment were: professional experience (p=.045), training and guidelines acknowledgement (p=.002). This indicates a need for training, from the health team to teachers seeking their empowerment.

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