Guimarães, Portugal
Guimarães, Portugal

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Curdia Goncalves T.,Centro Hospitalar Do Alto Ave | Dias De Castro F.,Centro Hospitalar Do Alto Ave | Moreira M.J.,Centro Hospitalar Do Alto Ave | Rosa B.,Centro Hospitalar Do Alto Ave | And 3 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2014

BACKGROUND/AIM: Small bowel capsule endoscopy (SBCE) is currently a fundamental tool in the etiological study of obscure gastrointestinal bleeding (OGIB). However, the impact of a negative exam and the risk of rebleeding are not entirely known. The aim of this study was to evaluate the outcomes of patients with OGIB and a negative SBCE examination in terms of follow-up duration, additional diagnostic studies, and achievement of a diagnosis as well as to assess the incidence of rebleeding and possible associated factors. MATERIALS AND METHODS: We retrospectively analyzed 256 patients who consecutively underwent an SBCE examination for the study of OGIB between April 2006 and December 2011, and then selected the 79 whose results excluded potentially bleeding lesions. Eleven patients were lost to follow-up and the remaining 68 were eligible for a nested case-control analysis. Pre-SBCE and post-SBCE information was collected, including follow-up interval and incidence of rebleeding, defined as admission to the hospital for symptomatic anemia, need for blood transfusion, decrease in hemoglobin value of greater than 2g/dl, or evidence of melena or hematochezia. Univariate analysis included age, sex, OGIB presentation (occult or visible), hemoglobin levels at presentation, and comorbidities. RESULTS: In the 68 patients analyzed, the mean age was 52±18 years and 61.8% were women. The OGIB was occult in 54 patients (79.4%) and overt in 14 patients (20.6%). Patients were followed up for an average of 32 months. Thirty-nine patients (57.4%) underwent further diagnostic investigations during the period of follow-up and a cause for the gastrointestinal bleeding was found in five of them. Rebleeding was documented in 16 (23.5%) patients, occurring on average 15±13.8 months after the SBCE. Male sex was associated significantly with higher incidence of rebleeding (P=0.004). CONCLUSION: Approximately one quarter of patients with OGIB and negative SBCE examination will experience rebleeding, with higher incidence among men; thus, a negative SBCE in this setting is not reassuring. As the vast majority of rebleeding episodes seem to occur within the following 2 years after SBCE, the maintenance of regular medical surveillance during the above-mentioned period of time after a negative SBCE seems advisable. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Pereira V.H.,University of Minho | Pereira V.H.,PT Government Associate Laboratory | Pereira V.H.,Centro Hospitalar Do Alto Ave | Cerqueira J.J.,University of Minho | And 5 more authors.
International Journal of Cardiology | Year: 2013

Cardiovascular diseases are traditionally related to well known risk factors like dyslipidemia, smoking, diabetes and hypertension. More recently, stress, anxiety and depression have been proposed as risk factors for cardiovascular diseases including heart failure, ischemic disease, hypertension and arrhythmias. Interestingly, this association has been established largely on the basis of epidemiological data, due to insufficient knowledge on the underlying pathophysiologic mechanisms. This review will revisit evidence on the interaction between the cardiovascular and nervous systems, highlighting the perspective on how the central nervous system is involved in the pathogenesis of cardiovascular diseases. Such knowledge is likely to be of relevance for the development of better strategies to treat patients in a holistic perspective. © 2012 Elsevier Ireland Ltd.


Ferreira M.,Centro Hospitalar do Alto Ave | Santos P.,Escola Superior de Saude e Tecnologia do Porto
Acta Medica Portuguesa | Year: 2011

Background: Stress urinary incontinence (SUI) is involuntary leakage from effort or exertion or from sneezing or coughing and it is usually related to increased urethral mobility and/or poor intrinsic sphincter function. Pelvic floor muscle training (PFMT) has principally been recommended in the management of SUI. The aims of PFMT are to improve pelvic organ support (bladder, bladder neck, and urethra) and increase intraurethral pressure during exertion. The PFMT programmes are prescribed to increase strength, endurance and coordination muscle. Objectives: To determine the effects of pelvic floor muscle training in the management of female stress urinary incontinence. The following hypothesis was tested: • What is the evidence for PFMT, either alone or in combination with adjunctive therapies? • What is the evidence for different types of PFMT? • What is the length of treatment and number of PFMT? Material e Methods: Types of studies: randomised controlled trials and quasirandomised studies were included. Searches of MEDLINE, PUBMED, COCHRANE, PEDro e SCOPUS review articles published between 1999-2009. Types of participants: all women with stress urinary incontinence and diagnosed on the basis of symptoms, signs, or urodinamic evaluation. Other forms of controlled clinical trial were excluded, for example whose symptoms might be due to significant factors outside the urinary tract (neurological disorders, cognitive impairments, lack of independent mobility). Types of interventions: PFMT was defined as a programme of repeated voluntary pelvic floor muscle contraction and with or without supervised by health care professional. All studies were eligible for inclusion if there was at least one arm with a PFMT protocol, alone or together with other adjunctive therapies (biofeedback, electrical stimulation or vaginal weights) compared with or without control group. Types of outcome measures: The outcomes of interest were symptomatic cure and cure/improvement; symptom and condition specific quality of life assessment, quantification of leakage episodes; measures of pelvic floor muscle contraction. Results: Nineteen studies met the inclusion criteria. The review found consistent evidence from of high quality randomised controlled trials, that PFMT alone and in combination with adjunctive therapies (biofeedback and electrical stimulation) was effective treatment for women with SUI with of «cure» and «cure/improvement» up to 70% and 97% respectively. Conclusions: Based on the few data available there is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further studies are needed to evaluate the optimal training protocol and length of treatment. © 2011 CELOM.


Cotter J.,Centro Hospitalar Do Alto Ave | Cotter J.,University of Minho | Cotter J.,Life and Health science Research Institute 3Bs | Dias De Castro F.,Centro Hospitalar Do Alto Ave | And 3 more authors.
Endoscopy | Year: 2015

Background and study aims: The Lewis score was developed to measure mucosal inflammatory activity as detected by small-bowel capsule endoscopy (SBCE). The aim of the current study was to validate the Lewis score by assessing interobserver correlation and level of agreement in a clinical setting. Patients and methods: This was a retrospective, single-center, double-blind study including patients with isolated small-bowel Crohn's disease who underwent SBCE. The Lewis score was calculated using a software application, based on the characteristics of villous edema, ulcers, and stenoses. The Lewis score was independently calculated by one of three investigators and by a central reader (gold standard). Interobserver agreement was assessed using intraclass correlation (ICC) coefficient and Bland-Altman plots. Results: A total of 70 patients were consecutively included (mean age 33.9±11.7 years). The mean Lewis score was 1265 and 1320 for investigators and the central reader, respectively. There was a high correlation, both for scores obtained for each tertile (first tertile r=0.659-0.950, second tertile r=0.756-0.906, third tertile r=0.750-0.939), and for the global score (r=0.745-0.928) (P<0.0001). Interobserver agreement was almost perfect between the investigators and the central reader (first tertile ICC=0.788-0.971, second tertile ICC=0.824-0.943, third tertile ICC=0.857-0.968, global score ICC=0.852-0.960; P<0.0001). The inflammatory activity was classified as normal (score<135) in 2.9% vs. 2.9%, mild (score≥135-<790) in 51.4% vs. 55.7%, and moderate to severe (score≥790) in 45.8% vs. 41.4% of patients, respectively (P<0.001). Conclusion: A strong interobserver agreement was demonstrated for the determination of the Lewis score in a practical clinical setting, validating this score for the reporting of small-bowel inflammatory activity. The Lewis score might be used for diagnosing, staging, follow-up, and therapeutic assessment of patients with isolated small-bowel Crohn's disease.


Cotter J.,Centro Hospitalar do Alto Ave | Cotter J.,University of Minho | Cotter J.,PT Government Associate Laboratory | Dias de Castro F.,Centro Hospitalar do Alto Ave | And 2 more authors.
Journal of Crohn's and Colitis | Year: 2014

Background and aims: Small bowel capsule endoscopy (SBCE) may detect proximal small bowel lesions that have been previously missed by ileocolonoscopy and small bowel imaging in patients with known ileal and/or colonic Crohn's disease (CD). We aimed to evaluate whether the therapeutic management is influenced by SBCE findings. Methods: Retrospective single center study. Inclusion of consecutive patients with known non-stricturing and non-penetrating ileal and/or colonic CD, submitted to SBCE to evaluate disease extension and activity, with ≥ 1. year follow-up. Lesions were classified with the Lewis score (LS) as non-significant (LS. <. 135), mild (135. ≤. LS. ≤. 790), or moderate-to-severe (LS. >. 790). Therapeutic changes were assessed three months after SBCE. Results: Fifty consecutive patients (35. ±. 13. years, 52% females) were included. At ileocolonoscopy, disease location was ileal (L1) in 60%, colonic (L2) in 10% and ileocolonic (L3) in 30% of the patients. In 33 patients (66%) SBCE detected significant proximal lesions previously missed by other modalities. The proportion of patients on thiopurines and/or biologics before SBCE was 2/50 (4%); this was significantly higher three months after SBCE, 15/50 (30%), p. = 0.023. Treatment with thiopurines and/or biologics was started more often in patients with proximal small bowel lesions [13/33 (39%) vs. 1/17 (6%), p. = 0.011, relative risk (RR) 6.5], particularly when severe (6%, 36% and 45% of patients with non-significant, mild and moderate-to-severe inflammation, respectively). Conclusions: SBCE diagnoses previously undetected lesions and it influences therapeutic management of CD, triggering an earlier introduction of immunomodulators and/or biological therapy. © 2014 European Crohn's and Colitis Organisation.


Pereira C.,University of Minho | Goncalves L.,Centro Hospitalar Do Alto Ave | Ferreira M.,University of Minho
Medical and Biological Engineering and Computing | Year: 2013

Diabetic retinopathy has been revealed as the most common cause of blindness among people of working age in developed countries. However, loss of vision could be prevented by an early detection of the disease and, therefore, by a regular screening program to detect retinopathy. Due to its characteristics, the digital color fundus photographs have been the easiest way to analyze the eye fundus. An important prerequisite for automation is the segmentation of the main anatomical features in the image, particularly the optic disc. Currently, there are many works reported in the literature with the purpose of detecting and segmenting this anatomical structure. Though, none of them performs as needed, especially when dealing with images presenting pathologies and a great variability. Ant colony optimization (ACO) is an optimization algorithm inspired by the foraging behavior of some ant species that has been applied in image processing with different purposes. In this paper, this algorithm preceded by anisotropic diffusion is used for optic disc detection in color fundus images. Experimental results demonstrate the good performance of the proposed approach as the optic disc was detected in most of all the images used, even in the images with great variability. © 2012 International Federation for Medical and Biological Engineering.


Pereira C.S.,University of Porto | Azevedo O.,Centro Hospitalar do Alto Ave | Maia M.L.,University of Porto | Dias A.F.,University of Porto | And 3 more authors.
Molecular Genetics and Metabolism | Year: 2013

Fabry disease is a lysosomal storage disease belonging to the group of sphingolipidoses.In Fabry disease there is accumulation of mainly globotriaosylceramide due to deficiency of the lysosomal enzyme α-galactosidase A. The lysosome is an important compartment for the activity of invariant natural killer T (iNKT) cells. iNKT cells are lipid-specific T cells that were shown to be important in infection, autoimmunity and tumor surveillance. In several mouse models of lysosomal storage disorders there is a decrease in iNKT cell numbers. Furthermore, alterations on iNKT cell subsets have been recently described in the Fabry disease mouse model. Herein, we analyzed iNKT cells and their subsets in Fabry disease patients. Although there were no differences in the percentage of iNKT cells between Fabry disease patients and control subjects, Fabry disease patients presented a reduction in the iNKT CD4+ cells accompanied by an increase in the iNKT DN cells. Since iNKT cell subsets produce different quantities of pro-inflammatory and anti-inflammatory cytokines, we analyzed IFN-γ and IL-4 production by iNKT cells of Fabry disease patients and mice.We found a significant reduction in the production of IL-4 by mice splenic iNKT cells and human iNKT cell subsets, but no significant alterations in the production of IFN-γ. Altogether, our results suggest a bias towards a pro-inflammatory phenotype in Fabry disease iNKT cells. © 2013 Elsevier Inc.


Dias J.,Centro Hospitalar Do Alto Ave | Lages N.,Centro Hospitalar Do Alto Ave | Marinho A.,Centro Hospitalar Do Alto Ave | Maria L.,Centro Hospitalar Do Alto Ave | And 3 more authors.
Anaesthesia | Year: 2014

We describe the management of a 62-year-old man who developed severe pain, cramps, paraplegia and pulmonary oedema after the accidental administration of potassium chloride into the subarachnoid space. In addition to supportive treatment, we performed cerebrospinal fluid lavage with saline 0.9%. The patient recovered well without any permanent injury. © 2013 The Association of Anaesthetists of Great Britain and Ireland.


Boal Carvalho P.,Centro Hospitalar Do Alto Ave | Rosa B.,Centro Hospitalar Do Alto Ave | Moreira M.J.,Centro Hospitalar Do Alto Ave | Cotter J.,Centro Hospitalar Do Alto Ave
Gastroenterology Research and Practice | Year: 2014

Objectives. Small bowel capsule endoscopy (SBCE) plays a decisive role in the obscure gastrointestinal bleeding (OGIB) diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential), P1 (uncertain bleeding potential: erosions), and P2 (high bleeding potential: angioectasias, ulcers, and tumors). We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4%) were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P=0.026). We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions. © 2014 Pedro Boal Carvalho et al.


Rebelo A.,Centro Hospitalar do Alto Ave | Leite S.,Centro Hospitalar do Alto Ave | Cotter J.,Centro Hospitalar do Alto Ave
BioDrugs | Year: 2010

In patients with inflammatory bowel disease (IBD) the prevalence of ankylosing spondylitis is 4-10%, and approximately 5-10% of ankylosing spondylitis patients have concomitant IBD. The correct recognition of spondyloarthritides is essential in order to identify common therapeutic strategies, especially in the era of new biological therapies such as infliximab. This paper reports a case of a patient with a severe presentation of ankylosing spondylitis and Crohn's disease successfully treated with infliximab. Two important points concerning this case are discussed: one is the true value of non-steroidal anti-inflammatory drug-induced IBD exacerbation and the other is the role of anti-tumor necrosis factor agents (especially infliximab) in the treatment of patients with concomitant diseases. © 2010 Adis Data Information BV. All rights reserved.

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