Centro Hospitalar iversitario Of Coimbra

Coimbra, Portugal

Centro Hospitalar iversitario Of Coimbra

Coimbra, Portugal

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Carvalhana S.,Hospital Santa Maria | Leitao J.,Centro Hospitalar iversitario Of Coimbra | Alves A.C.,Institute Nacional Of Saude Dr Ricardo Jorge | Bourbon M.,Institute Nacional Of Saude Dr Ricardo Jorge | Cortez-Pinto H.,Hospital Santa Maria
Liver International | Year: 2014

Background & Aims: Liver steatosis measurement by controlled attenuation parameter (CAP) is a non-invasive method for diagnosing steatosis, based on transient elastography. Its usefulness as screening procedure for hepatic steatosis in general population has not been previously evaluated. The aim of this study was to evaluate the diagnostic accuracy of CAP and fatty liver index (FLI) for detection and quantification of steatosis in general population. Methods: Recruitment was done from a prospective epidemiological study of the general adult population. Steatosis was evaluated using CAP, FLI and ultrasound (US). Steatosis scored according to Hamaguchi's US scoring, from 0 (S0) to 6 (S6) points. Hepatic steatosis defined by score ≥2 (S≥2) and moderate/severe steatosis by score ≥4 (S≥4). Performance of CAP and FLI for diagnosing steatosis compared with US was assessed using areas under receiver operating characteristic curves (AUROC). Results: From 219 consecutive individuals studied, 13 (5.9%) excluded because of failure/unreliable liver stiffness measurements. Steatosis prevalence: S≥2 38.4% and S≥4 12.1%. CAP significantly correlated with steatosis (ρ = 0.73, P < 0.0001), steatosis score (ρ = 0.76; P < 0.0001), FLI (ρ = 0.69), waist circumference (ρ = 0.62), body mass index (ρ = 0.55), triglyceride (ρ = 0.49), HOMA-IR (ρ = 0.26), alcohol consumption (ρ = 0.24) and cholesterol (ρ = 0.19), not with liver stiffness measurements. Using CAP and FLI, AUROC's were 0.94 (95% CI 0.91-0.97, P < 0.001) and 0.91 for S≥2; 0.95 (95% CI 0.90-0.99, P < 0.001) and 0.93 for S≥4 respectively. Optimal cut-off value of CAP and FLI were 243 dB/m and 48 for S≥2; 303.5 dB/m and 62 for S≥4 respectively. Conclusion: Controlled attenuation parameter and FLI seem promising tools for screening and steatosis quantification in the general population. Larger studies are needed for validation. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Coghill D.R.,University of Dundee | Seth S.,University of Dundee | Seth S.,National Health Service Tayside | Pedroso S.,Centro Hospitalar iversitario Of Coimbra | And 3 more authors.
Biological Psychiatry | Year: 2014

Background Attention-deficit/hyperactivity disorder (ADHD) is associated with a broad range of neuropsychological impairments. The relationship between these neuropsychological deficits and the defining symptoms of ADHD seems more complex than originally thought. Methylphenidate (MPH) is an effective treatment for ADHD symptoms, but its impact on cognition is less clearly understood. Methods With a common systematic search strategy and a rigorous coding and data extraction strategy across domains, we searched electronic databases to identify published placebo controlled trials that compared MPH and placebo on executive and nonexecutive memory, reaction time, reaction time variability and response inhibition in children and adolescents (5-18 years) with a formal diagnosis of ADHD. Results Sixty studies were included in the review, of which 36 contained sufficient data for meta-analysis. Methylphenidate was superior to placebo in all five meta-analyses: executive memory, standardized mean difference (SMD).26, 95% confidence interval (CI): -.39 to -.13; non-executive memory, SMD.60, 95% CI: -.79 to -.41; reaction time, SMD.24, 95% CI: -.33 to -.15; reaction time variability, SMD.62, 95% CI: -.90 to -.34; response inhibition, SMD.41, 95% CI: -.55 to -.27. Conclusions These data support the potentially important effects of MPH on various aspects of cognition known to be associated with ADHD. Consideration should be given to adding cognitive outcomes to the assessment of treatment outcome in ADHD, considering the complexity of the relationship between ADHD symptoms and cognition. © 2014 Society of Biological Psychiatry.


Vieira R.,Hospital da Luz | Costa G.,Centro Hospitalar iversitario Of Coimbra
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2013

Nuclear medicine in Portugal has been an autonomous speciality since 1984. In order to obtain the title of Nuclear Medicine Specialist, 5 years of training are necessary. The curriculum is very similar to the one approved under the auspices of the European Union of Medical Specialists, namely concerning the minimum recommended number of diagnostic and therapeutic procedures. There is a final assessment, and during the training the resident is in an approved continuing education programme. Departments are accredited by the Medical College in order to verify their capacity to host nuclear medicine residencies. © 2013 Springer-Verlag Berlin Heidelberg.


Vieira M.J.,University of Coimbra | Teixeira R.,University of Coimbra | Teixeira R.,Hospital Beatriz Angelo | Goncalves L.,University of Coimbra | And 2 more authors.
Journal of the American Society of Echocardiography | Year: 2014

The importance of the left atrium in cardiovascular performance has long been acknowledged. Quantitative assessment of left atrial (LA) function is laborious, requiring invasive pressure-volume loops and thus precluding its routine clinical use. In recent years, novel postprocessing imaging methodologies have emerged, providing a complementary approach for the assessment of the left atrium. Atrial strain and strain rate obtained using either Doppler tissue imaging or two-dimensional speckle-tracking echocardiography have proved to be feasible and reproducible techniques to evaluate LA mechanics. It is essential to fully understand the clinical applications, advantages, and limitations of LA strain and strain rate analysis. Furthermore, the technique's prognostic value and utility in therapeutic decisions also need further elucidation. The aim of this review is to provide a critical appraisal of LA mechanics. The authors describe the fundamental concepts and methodology of LA strain and strain rate analysis, the reference values reported with different imaging techniques, and the clinical implications. Copyright © 2014 by the American Society of Echocardiography.


Guedes M.,University of Coimbra | Canavarro M.C.,University of Coimbra | Canavarro M.C.,Centro Hospitalar iversitario Of Coimbra
Birth | Year: 2014

Background: Recent studies have reported that primiparous women of advanced maternal age (AMA) appear to constitute a heterogeneous group, emphasizing the need to revise stereotyped views. The aims of this study were the following: 1) to describe the sociodemographic and marital characteristics of Portuguese couples who experienced first childbirth at advanced maternal age (the AMA group) compared with their younger counterparts (the comparison group); 2) to compare the reproductive characteristics of both groups and identify distinct reproductive trajectories within the AMA group; and 3) to distinguish among different subgroups of couples within the AMA group, depending on distinct patterns of sociodemographic, marital, and reproductive characteristics. Methods: The sample consisted of 250 couples. Both partners completed sociodemographic, marital, and reproductive health forms during pregnancy. Results: Despite being more highly educated, having a higher socioeconomic status, and having been employed longer, the AMA group displayed diverse conjugal configurations and reproductive trajectories over time. Within the AMA group, two subgroups were distinguished: couples who experienced infertility problems and couples who did not. Conclusions: Couples who experience first childbirth at AMA constitute a heterogeneous group, which includes distinct subgroups with different psychosocial needs during the transition to parenthood. To revise stereotyped views of these couples, protective social policies should be improved, and health professionals should assume nonjudgmental attitudes and promote informed reproductive decisions. Psychoeducative programs concerning the transition to parenthood should take into account the distinct subgroups of couples who experience first childbirth at AMA. © 2014, Wiley Periodicals, Inc.


Ramos L.,Centro Hospitalar iversitario Of Coimbra | Cabral R.,Centro Hospitalar iversitario Of Coimbra | Goncalo M.,Centro Hospitalar iversitario Of Coimbra | Goncalo M.,University of Coimbra
Contact Dermatitis | Year: 2014

Backgound Allergic contact dermatitis (ACD) caused by (meth)acrylates is traditionally an occupational disease among dentists, printers, and fibreglass workers. With the use of artificial nails, cases have been reported both in nail technicians and in users. Objectives The aims of this study were to characterize ACD caused by (meth)acrylates, identify the responsible allergens, and assess the sensitivity of the patch test with 2-hydroxyethyl methacrylate (HEMA) for diagnosis. Methods An observational and retrospective study (January 2006-April 2013) was performed, evaluating and correlating epidemiological and clinical parameters and positive patch test results with (meth)acrylates. Results Among 2263 patch tested patients, 122 underwent aimed testing with an extended (meth)acrylate series, and 37 showed positive and relevant reactions. Twenty-five cases (67.6%) were occupational. Hand eczema with pulpitis was observed in 32 patients. Twenty-eight cases were related to artificial nails, 3 were related to dental materials, and 2 were industrial workers. Oral lesions associated with dental prostheses were observed in 4 patients. Thirty-one patients reacted to more than one (meth)acrylate. In our sample, beauty technicians working with artificial nails were the most affected group (80% of occupational cases). Conclusion HEMA detected 80.6% of our cases, and may be considered a good screening allergen. However, to perform an accurate diagnosis, it is safer to use a broader series of allergens. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Martins Rosa A.,Centro Hospitalar iversitario Of Coimbra
BioMed research international | Year: 2013

Neuroplasticity refers to the ability of the brain to reorganize the function and structure of its connections in response to changes in the environment. Adult human visual cortex shows several manifestations of plasticity, such as perceptual learning and adaptation, working under the top-down influence of attention. Plasticity results from the interplay of several mechanisms, including the GABAergic system, epigenetic factors, mitochondrial activity, and structural remodeling of synaptic connectivity. There is also a downside of plasticity, that is, maladaptive plasticity, in which there are behavioral losses resulting from plasticity changes in the human brain. Understanding plasticity mechanisms could have major implications in the diagnosis and treatment of ocular diseases, such as retinal disorders, cataract and refractive surgery, amblyopia, and in the evaluation of surgical materials and techniques. Furthermore, eliciting plasticity could open new perspectives in the development of strategies that trigger plasticity for better medical and surgical outcomes.


Alves J.L.,Centro Hospitalar iversitario Of Coimbra
American Journal of Forensic Medicine and Pathology | Year: 2016

ABSTRACT: Subdural hematomas are a frequent and highly heterogeneous traumatic disorder, with significant clinical and socioeconomic consequences. In clinical and medicolegal practice, subdural hematomas are classified according to its apparent age, which significantly influences its intrinsic pathogenic behavior, forensic implications, clinical management, and outcome. Although practical, this empirical classification is somewhat arbitrary and scarcely informative, considering the remarkable heterogeneity of this entity. The current research project aims at implementing a comprehensive multifactorial classification of subdural hematomas, allowing a more standardized and coherent assessment and management of this condition. This new method of classification of subdural hematomas takes into account its intrinsic and extrinsic features, using imaging data and histopathological elements, to provide an easily apprehensible and intuitive nomenclature. The proposed classification unifies and organizes all relevant details concerning subdural hematomas, hopefully improving surgical care and forensic systematization. © 2016 by Lippincott Williams & Wilkins.


Santiago T.,Centro Hospitalar iversitario Of Coimbra | Da Silva J.A.P.,Centro Hospitalar iversitario Of Coimbra
Annals of the New York Academy of Sciences | Year: 2014

Low- to medium-dose glucocorticoids have been shown to have not only anti-inflammatory but also disease-modifying properties in rheumatoid arthritis. The evidence for the benefit of its early use in combination with disease-modifying antirheumatic drugs underlines the need for a close evaluation of their risk-benefit ratio. Over time, numerous myths and fears about glucocorticoid toxicity in rheumatoid arthritis have arisen from observational studies, and many concerns have been unduly extrapolated from observations with higher-dose treatment. Furthermore, we cannot exclude the possibility of a powerful effect of bias by indication in these studies. Low- to medium-dose glucocorticoid regimens continued to be evaluated in randomized clinical trials, particularly in early disease, but these studies also have relevant methodological limitations in assessing safety, particularly due to small size and/or short duration. At present, the evidence on which to support clear recommendations about glucocorticoid toxicity remains remarkably weak. A large prospective pragmatic trial dedicated to the toxicity of low-dose glucocorticoids is dearly needed. Meanwhile, adherence to recommendations on standardized methodologies for registration and report of glucocorticoid adverse events is essential for improving our knowledge and competence in the best management of these important medications. © 2014 New York Academy of Sciences.


Campos S.,Centro Hospitalar iversitario Of Coimbra
European Journal of Gastroenterology and Hepatology | Year: 2016

BACKGROUND: Combination therapy, with anti-tumor necrosis factor-α agents and immunomodulators, is the most effective option to induce and maintain remission in inflammatory bowel disease (IBD). Infliximab, with its administration features, determines particular conditions of adherence; the same is not possible with thiopurines. Nevertheless, research on adherence to these treatments is scarce. Nonadherence worsens the prognosis of IBD. AIM: (a) Assess adherence to immunomodulators and (b) determine therapeutic nonadherence predictors. PATIENTS AND METHODS: We included all IBD outpatients consecutively evaluated over a 6-month period in our center. Participants completed a study-specific questionnaire on IBD, IBD therapeutic adherence (Morisky Medication Adherence Scale-8-item), Therapeutics Complexity questionnaire, Beliefs about Medication questionnaire, and Hospital Anxiety and Depression Scale. RESULTS: A total of 112 patients under azathioprine were considered; 49.1% were also under anti-tumor necrosis factor-α. Self-assessed questionnaire showed that 70.5% were adherent to immunosuppression. Similar adherence was found with and without infliximab (68.4%-monotherapy vs. 72.7%-combination therapy; P=0.61). Nonintentional nonadherence was documented in 57.6%; 42.4% reported voluntary nonadherence. Nonadherence was higher in male patients [odds ratio (OR): 3.79; 95% confidence interval (CI): 1.2–11.95; P=0.023], younger patients (OR: 0.93; 95% CI: 0.87–0.98; P=0.01), nonsmokers (OR: 4.90; 95% CI: 1.22–19.73; P=0.025), and those who had depression (OR: 2.22; 95% CI: 1.36–3.62; P=0.001). Most of the IBD patients believed in the necessity of maintaining immunosuppression (86.7%), but 36.6% reported concerns about drugs. CONCLUSION: Nonadherence to thiopurines plays a significant role in IBD. Nonetheless, it does not increase with association with biological agents. Involuntary nonadherence is higher. Male sex, younger age, nonsmoker, and presence of depression were independent predictors of nonadherence to immunomodulators. More than one-third of IBD patients had concerns about drugs. Optimizing the discussion on patients’ concerns to overcome perceptual barriers related to drugs may obviate the negative course of IBD related to nonadherence. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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