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PubMed | Centro Hospitalar Of Vila Nova Of Gaia E Espinho and Centro Hospitalar do Medio Ave
Type: Journal Article | Journal: Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2015

Coronary spasm can cause myocardial ischemia and angina in both patients with and without obstructive coronary artery disease. However, provocation tests using intracoronary acetylcholine (ACh) have been rarely performed in the Western world.We report a case of a 75-year-old woman with a history of hypertension and a mechanical aortic prosthesis who presented in the emergency room with acute-onset chest pain, widespread ST-segment depression and severe left ventricular systolic dysfunction, with no signs of prosthesis dysfunction. Emergent coronary angiography excluded obstructive coronary artery disease. Pain relief and normalization of ST segment and systolic function occurred within six hours. The patient was treated for a possible thromboembolic myocardial infarction and was discharged home asymptomatic. Two weeks later, cardiac magnetic resonance was performed showing inferoseptal transmural infarct scar, inferior and inferolateral subendocardial infarct and mid-basal ischemia in the anterior and anterolateral walls. She was readmitted with recurrence of chest pain and it was decided to perform a provocation test with ACh. After injection of ACh into the left anterior descending artery, chest pain, ST-segment depression, blood flow impairment (TIMI 1) and transient grade 3 atrioventricular (AV) block occurred. Intracoronary administration of nitrates reversed the coronary spasm and AV conduction disturbances. Twenty minutes later, chest pain and ischemic ST changes recurred; there was no response to vasodilators and the patient developed cardiac arrest with pulseless electrical activity. Advanced life support was maintained for 32 minutes without return of spontaneous circulation.Provocation tests have a high sensitivity and specificity for the diagnosis of vasospastic angina. Although it is rare, these tests have the potential risk of irreversible spasm leading to arrhythmia and death.


Ruano L.,Hospital Of Sao Sebastiao | Melo C.,Centro Hospitalar Do Medio Ave | Silva M.C.,Abel Salazar Biomedical Sciences Institute | Coutinho P.,University of Porto
Neuroepidemiology | Year: 2014

Background: Hereditary cerebellar ataxias (HCA) and hereditary spastic paraplegias (HSP) are two groups of neurodegenerative disorders that usually present with progressive gait impairment, often leading to permanent disability. Advances in genetic research in the last decades have improved their diagnosis and brought new possibilities for prevention and future treatments. Still, there is great uncertainty regarding their global epidemiology. Summary: Our objective was to assess the global distribution and prevalence of HCA and HSP by a systematic review and meta-analysis of prevalence studies. The MEDLINE, ISI Web of Science and Scopus databases were searched (1983-2013) for studies performed in well-defined populations and geographical regions. Two independent reviewers assessed the studies and extracted data and predefined methodological parameters. Overall, 22 studies were included, reporting on 14,539 patients from 16 countries. Multisource population-based studies yielded higher prevalence values than studies based primarily on hospitals or genetic centres. The prevalence range of dominant HCA was 0.0-5.6/105, with an average of 2.7/105 (1.5-4.0/105). Spinocerebellar ataxia type 3 (SCA3)/Machado-Joseph disease was the most common dominant ataxia, followed by SCA2 and SCA6. The autosomal recessive (AR) HCA (AR-HCA) prevalence range was 0.0-7.2/105, the average being 3.3/105 (1.8-4.9/10 5). Friedreich ataxia was the most frequent AR-HCA, followed by ataxia with oculomotor apraxia or ataxia-telangiectasia. The prevalence of autosomal dominant (AD) HSP (AD-HSP) ranged from 0.5 to 5.5/105 and that of AR-HSP from 0.0 to 5.3/105, with pooled averages of 1.8/105 (95% CI: 1.0-2.7/105) and 1.8/105 (95% CI: 1.0-2.6/105), respectively. The most common AD-HSP form in every population was spastic paraplegia, autosomal dominant, type 4 (SPG4), followed by SPG3A, while SPG11 was the most frequent AR-HSP, followed by SPG15. In population-based studies, the number of families without genetic diagnosis after systematic testing ranged from 33 to 92% in the AD-HCA group, and was 40-46% in the AR-HCA, 45-67% in the AD-HSP and 71-82% in the AR-HSP groups. Key Messages: Highly variable prevalence values for HCA and HSP are reported across the world. This variation reflects the different genetic make-up of the populations, but also methodological heterogeneity. Large areas of the world remain without prevalence studies. From the available data, we estimated that around 1:10,000 people are affected by HCA or HSP. In spite of advances in genetic research, most families in population-based series remain without identified genetic mutation after extensive testing. © 2014 S. Karger AG, Basel.


Diniz R.P.H.,Centro Hospitalar Do Medio Ave | Nascimento J.C.,University of Minho
2015 10th Iberian Conference on Information Systems and Technologies, CISTI 2015 | Year: 2015

ICT management is traditionally a complex area in the health sector. Significant investments have been made but related results are normally hard to find. In this context, the present research aims to study the process of implementation of Picture Archiving and Communication System (PACS) at Centro Hospitalar do Médio Ave, in order to understand the process of technology adoption in a hospital context and the analyze the related impacts. This study is based in an interpretative approach, supported by a qualitative research process in order to obtain and analyze relevant information that was gained from a qualified panel of experts, including both health and ITC professionals. © 2015 AISTI.


Rocha A.,Centro Hospitalar do Porto | Castro R.,Centro Hospitalar do Medio Ave | Santos J.,Centro Hospitalar do Porto
International Journal of Artificial Organs | Year: 2015

Introduction: Patients undergoing chronic hemodialysis using tunneled cuffed catheters (TCCs) are at increased risk of metastatic infections, namely endocarditis and spondydodiscitis, and mortality is high in this group. The aim of this study was to determine the clinical features, causative organisms, its susceptibility and outcomes in patients hospitalized with these infections from a single center. Methods: All consecutive patients with TCC and endocarditis and/or spondylodiscitis treated at the authors’ institution between 2005 and 2011 were selected retrospectively. Results: A total of 7 cases of endocarditis and 7 cases of spondylodiscitis were diagnosed. Concurrent infection was present in 1 patient. The mean age was 63.4 years, 53.8% were male, 23% had diabetes and 31% had previous immunosuppression. The average time on hemodialysis was 24 months. Those patients with endocarditis presented with fever, and 43% had previous valvular disease; mitral valve involvement was the most common. Early surgery was performed in 2 patients. Concerning spondylodiscitis, the median time from first symptom to diagnosis was 48 days. The first manifestation was back pain in 86% percent of patients, and 71% had an epidural or paraspinous abscess demonstrated by neuroimaging. One patient underwent surgical drainage of the abscess. Regarding both infections, staphylococcus aureus was the most common causative agent with a lower rate of negative blood cultures. All patients received intravenous antibiotics for a mean duration of six weeks. The mortality rate was 46%. Conclusions: A high index of suspicion is critical in the early recognition and management of both of these infections. © 2015 Wichtig Publishing.


Marques A.M.,Centro Hospitalar Do Medio Ave | Turner A.,University of Otago | De Mello R.A.,Portuguese Oncology Institute IPO PORTO | De Mello R.A.,University of Algarve
World Journal of Gastroenterology | Year: 2014

Metastatic colorectal cancer (mCRC) is still one of the tumor types with the highest incidence and mortality. In 2012, colorectal cancer was the second most prevalence cancer among males (9%) and the third among females (8%). In this disease, early diagnosis is important to improve treatment outcomes. However, at the time of diagnosis, about one quarter of patients already have metastases, and overall survival of these patients at 5-years survival is very low. Because of these poor statistics, the development of new drugs against specific targets, including the pathway of angiogenesis, has witnessed a remarkable increase. So, targets therapies through epidermal growth factor and its receptor and also KRAS pathways modulation acquired a main role whether in association with standard chemotherapy and radiotherapy. With the current knowledge in the field of molecular biology, including genetic mutations and polymorphisms, we know better why patients respond so differently to the same treatments. So, in the future we can develop increasingly personalized treatments to the patient and not the disease. This review aims to summarize some molecular pathways and their relation to tumor growth, as well as novel targeted developing drugs and recently approved for mCRC. © 2014 Baishideng Publishing Group Inc. All rights reserved.


Antunes H.,Braga Hospital | Antunes H.,University of Minho | Rodrigues H.,Unidade Local de Saude do Alto Minho | Silva N.,Braga Hospital | And 5 more authors.
Journal of Clinical Virology | Year: 2010

Background: In 2006, bronchiolitis due to adenovirus nosocomial infections resulted in the closure of a pediatric department in northern Portugal. Objectives: To determine the etiology of bronchiolitis in northern Portugal. Study design: It was a prospective multicenter study on the etiology of bronchiolitis during the respiratory syncytial virus (RSV) season (November-April). Children ≤24 months of age admitted for a first wheezing episode were included. Nasopharyngeal specimens were analyzed by an indirect immunofluorescent-antibody assay (IFA) for RSV, adenovirus (HAdV), parainfluenza (PIV) 1-3 and influenza (IV) A and B and by polymerase chain reaction (PCR) or reverse transcription-PCR for the same viruses and for human metapneumovirus (hMPV), bocavirus (HBoV), rhinovirus (HRV), coronaviruses (229/E; NL63; OC43; HKU1) and enterovirus. Results: During this period, 253 children were included, 249 IFA analyses and 207 PCRs were performed. IFA detected RSV in 58.1%; PCR increased it to 66.7%. IFA detected HAdV in 3.2%, PCR 10.0%. PCR detected IV A in 5; IV B in 2; PIV 1 in 6, PIV 2 in 4 and PIV 3 in 11 cases. HBoV, as single agent in 2 cases, and HRV were positive in 8 samples and hMPV in 11. With this virus panel, 19.7% remained without etiology. Conclusions: The most frequent agent was RSV, followed by HAdV. PCR can be cost-effective and more accurate than IFA, which is crucial for HAdV that may be associated with significant mortality (IFA alone did not detect 2/3 of the cases). © 2010 Elsevier B.V. All rights reserved.


Marques V.M.,Centro Hospitalar do Medio Ave
Revista brasileira de reumatologia | Year: 2011

The authors report the case of a 10-year-old girl with Graves' disease (GD), treated with propylthiouracil, who developed uveitis and polyarticular arthritis, and whose mother also had GD and discoid lupus. The differential diagnosis of inflammatory arthritis that appears in a child with autoimmune thyroid disease managed with antithyroid drugs is discussed.


Rolanda C.,Domain Surgical | Rolanda C.,Hospital Of Braga | Silva D.,Domain Surgical | Silva D.,Centro Hospitalar Do Medio Ave | And 5 more authors.
Endoscopy | Year: 2011

Background and study aims: A transesophageal natural orifice transluminal endoscopic surgery (NOTES) approach has been proposed for thoracic and mediastinal access. Similarly to transgastric surgery, serious limitations remain related to creating an esophagotomy and its safe closure. A hybrid approach in thoracic NOTES could work as an intermediate step before pure transesophageal NOTES. We assessed the benefit of hybrid thoracic NOTES for peroral segmental esophagectomy and subsequent complete esophageal anastomosis with a single transthoracic port. Methods: Two protocols were used to attempt esophago-esophageal anastomosis: ex vivo using a phantom model (n = 5), and in vivo after esophageal mobilization, and segmental esophagectomy achieved using either a gastroscope (flexible) (n = 5) or thoracoscope (rigid) instruments (n = 5). A forward-viewing double-channel endoscope and a transthoracic operative thoracoscope with a working channel were coordinated in order to create a complete single-layer, end-to-end esophageal anastomosis ex vivo as well as in vivo. Feasibility and anastomosis quality were evaluated by inside and outside assessment of: patency, the incorporation of mucosa in all stitches, and a leak test. Results: Anastomosis was achieved in all ex vivo experiments and thoracoscopically-led in vivo procedures. All anastomoses were patent, allowing distal passage of the endoscope, with mucosa incorporation. In in vivo experiments, a leak was detected in three animals and corrected with additional stitching. Conclusions: Peroral esophageal anastomosis with a single transthoracic trocar is feasible, which may represent a step forward in thoracic NOTES. © 2011 Georg Thieme Verlag KG Stuttgart. New York.


PubMed | Centro Hospitalar Vila Nova Of Gaia Espinho, Unidade de Saude Familiar Ribeirao and Centro Hospitalar do Medio Ave
Type: | Journal: Revista brasileira de reumatologia | Year: 2015

Lyme disease, a pathology secondary to infection by bacteria of the genus Borrelia, can present with erythema migrans and monoarticular or oligoarticular arthritis. The relationship between infection with this agent and Juvenile Idiopathic Arthritis has been already mentioned.In this paper, the case of a 6-year-old female child, seen at our outpatient clinic because of symptoms compatible with Lyme disease confirmed by a serological work-up, is described. Erythema migrans lesions disappeared with the appropriate antibiotic treatment. The resolution of joint symptoms was only transitory; chronic anti-inflammatory and immunosuppressant treatment was needed.In this case, the resolution of cutaneous symptoms and the persistence of chronic arthritis suggest that the strong likelihood of infection by has triggered Juvenile Idiopathic Arthritis.


PubMed | Centro Hospitalar do Medio Ave
Type: Journal Article | Journal: Revista portuguesa de pneumologia | Year: 2016

The PAQ questionnaire (Physical Activity Questionnaire - Kowalski, Crocker, Donen) is a self-administered 7-day recall validated questionnaire that measures physical activity levels in young people. A final activity score is obtained (1 indicates low and 5 indicates high physical activity level). Our aim was to determine whether there was any difference between the level of physical activity of children with controlled allergic disease and healthy children.We used the PAQ questionnaire with a group of asthmatic children attending hospital outpatient clinic and a group of healthy children matched for age.155 children with allergic disease (median age of 11 years; 63% males) and 158 healthy controls (median age of 10 years; 46% males) answered the questionnaire. There were no differences in the overall level of physical activity, estimated by PAQ score, between allergic and healthy children (2,400,7 vs 2,480,62; p=0,32). Performance in physical education classes and after school sports activity was found to be different between the study groups; healthy children were more active (p=0,011) and did more sports between 6 and 10 pm (p=0,036). No other statistically significant differences were found between the study groups.Despite the fact that a majority of the parents of allergic children stated that their childs disease was a barrier to physical activity, in our study there seems to be no difference between the level of physical activity of controlled asthmatic children and their healthy peers.

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