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Barahona-Correa B.,New University of Lisbon | Barahona-Correa B.,Centro Hospitalar Of Lisbon Ocidental | Bugalho P.,Hospital Egas Moniz | Guimaraes J.,British Hospital | Xavier M.,New University of Lisbon
Movement Disorders | Year: 2011

Primary focal dystonia is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology probably involves the basal ganglia and cortical-basal pathways. Primary dystonia appears to be associated with significant obsessive-compulsive symptoms, but evidence remains scarce and contradictory. We addressed the following research questions: (1) Do primary dystonia patients have high obsessive-compulsive symptom scores? (2) Are these symptoms more severe in dystonia than in controls with equivalent peripheral neurological disorders? and (3) Is psychopathology different in botulinum toxin-treated and -untreated dystonia patients? This work was a cross-sectional, descriptive, controlled study comprising 45 consecutive patients with primary focal dystonia (i.e., blepharospasm, spasmodic torticollis, or writer's cramp) 46 consecutive patients with hemifacial spasm, cervical spondylarthropathy, or carpal tunnel syndrome, and 30 healthy volunteers. Assessment included the DSM-IV based psychiatric interview, Symptom Checklist 90R, Yale-Brown Obsessive-Compulsive Scale and Checklist, and the Unified Dystonia Rating Scale. Dystonia patients had higher Yale-Brown Obsessive-Compulsive Symptom scores than both control groups. Dystonia patients with obsessive-compulsive symptom scores above cut-off for clinical significance predominantly developed hygiene-related symptoms. Major depression and generalized anxiety disorder were the most frequent psychiatric diagnoses in primary focal dystonia. Obsessive-compulsive disorder frequency was 6.7%. Primary focal dystonia patients have higher obsessive-compulsive symptom scores than individuals with similar functional disabilities resulting from other neurological disorders, suggesting that obsessive-compulsive symptoms in dystonia are not reactive to chronic disability. Dystonic muscle contractions and obsessive-compulsive symptoms may share a common neurobiological basis related to cortical-basal dysfunction. Psychopathology, especially obsessive-compulsive symptoms, should be actively explored and treated in primary focal dystonia. © 2011 Movement Disorder Society.


Aldir I.,Centro Hospitalar Of Lisbon Ocidental | Horta A.,Centro Hospitalar do Porto | Serrado M.,Centro Hospitalar Of Lisbon Norte
Current Medical Research and Opinion | Year: 2014

Objectives: Review of the available data on the currently available single-tablet regimens (STRs), from the analysis of efficacy and safety to the key points of value in terms of adherence, quality of life and pharmacoeconomic evaluation. Methods: For this narrative review, literature searches have been performed in PubMed, IndexRevMed and Cochrane, using the search terms HIV, single-tablet, one-pill, single dose, fixed-dose, and STR. These have been reviewed and complemented with the most recent publications of interest. Results: Fixed-dose combinations are a significant advance in antiretroviral treatment simplification, contributing to an increase in compliance with complex chronic therapies, thus improving patients' quality of life. Reducing the number of pills and daily doses is associated with higher adherence and better quality of life. As a fixed-dose combination tablet given once daily, EFV/FTC/TDF was the first available STR combining efficacy, tolerability and convenience, with the simplest dosing schedule and smallest numbers of pills of any ART combination therapy. The RPV/FTC/TDF is a next-generation NNRTI-based STR, a once daily complete ART regimen for the treatment of HIV-1 infection. Recently the combination of EVG/COBI/FTC/TDF was also approved by the European Commission, and is the first integrase inhibitor-based STR. Receiving antiretroviral therapy as once daily STR is associated with both clinical and economic benefits, which confirms previous research. Conclusions: The associated benefits of STRs provide a valid strategy for the treatment of HIV-infected patients. © 2014 Informa UK Ltd.


Madeira C.,University of Lisbon | Santhagunam A.,University of Lisbon | Salgueiro J.B.,Centro Hospitalar Of Lisbon Ocidental | Cabral J.M.S.,University of Lisbon
Trends in Biotechnology | Year: 2015

Advanced cell-based therapies are promising approaches for stimulating full regeneration of cartilage lesions. In addition to a few commercially available medicinal products, several clinical and preclinical studies are ongoing worldwide. In preclinical settings, high-quality cartilage tissue has been produced using combination strategies involving stem or progenitor cells, biomaterials, and biomolecules to generate a construct for implantation at the lesion site. Cell numbers and mechanical stimulation of the constructs are not commonly considered, but are important parameters to be evaluated in forthcoming clinical studies. We review current clinical and preclinical studies for advanced therapy cartilage regeneration and evaluate the progress of the field. © 2014 Elsevier Ltd.


Parreira R.,New University of Lisbon | Centeno-Lima S.,New University of Lisbon | Lopes A.,New University of Lisbon | Portugal-Calisto D.,Unidade de Clinica Tropical IHMT UNL | And 4 more authors.
Eurosurveillance | Year: 2014

A concurrent dengue virus serotype 4 and chikungunya virus infection was detected in a woman in her early 50s returning to Portugal from Luanda, Angola, in January 2014. The clinical, laboratory and molecular findings, involving phylogenetic analyses of partial viral genomic sequences amplified by RT-PCR, are described. Although the circulation of both dengue and chikungunya viruses in Angola has been previously reported, to our knowledge this is the first time coinfection with both viruses has been detected there.


Walss-Bass C.,University of Texas Health Science Center at San Antonio | Fernandes J.M.,Centro Hospitalar Of Lisbon Ocidental | Roberts D.L.,University of Texas Health Science Center at San Antonio | Service H.,University of Helsinki | Velligan D.,University of Texas Health Science Center at San Antonio
Schizophrenia Research | Year: 2013

Social cognitive impairment is related to poor social functioning in schizophrenia. This impairment includes both deficits in emotion perception and theory of mind (ToM), and cognitive biases including attributional bias and jumping to conclusions. Oxytocin (OXT) is a hormone that has been implicated in human social behavior, and that has also been associated with regulation of inflammation. In a cross-sectional study involving 60 patients with schizophrenia and 20 healthy controls, we examined associations between OXT and social cognitive capacity and bias. Secondary analyses examined associations between OXT and inflammation. We found significant correlations between OXT and social cognitive bias in the control group and in patients with delusions, but not in patients without delusions. Social cognitive capacity only correlated significantly with OXT in patients with delusions. A correlation between OXT and inflammation was observed only in patients without delusions. Findings suggest that OXT may be implicated in social cognition both in controls and in patients with delusions, but that this association may be blunted in patients without delusions. Inflammation appears to be related to OXT rather independently of social cognition. Future longitudinal and intervention studies with OXT are needed to clarify causality in the identified associations. © 2013 Elsevier B.V.


Camacho R.J.,New University of Lisbon | Camacho R.J.,Centro Hospitalar Of Lisbon Ocidental
Intervirology | Year: 2012

HIV-2 is responsible for a limited epidemic in West Africa. Around 20% of all infected patients will progress to AIDS, and will need antiretroviral therapy. Unfortunately, antiretrovirals were developed to suppress HIV-1 replication; not all of them are active against HIV-2, e.g. all nonnucleoside reverse transcriptase inhibitors or fusion inhibitors. Moreover, only three protease inhibitors have the same activity in HIV-1 and HIV-2: lopinavir, saquinavir and darunavir. Even if all nucleoside and nucleotide reverse transcriptase inhibitors appear to be equally efficient against HIV-2, different resistance pathways and an increased facility of resistance selection make their use much more difficult than in HIV-1. Integrase inhibitors have a potent inhibitory effect on HIV-2 replication, but questions about the best timing for their use remain unanswered, as well as those regarding the use of entry inhibitors in this setting. The lack of reliable monitoring tools adds to the difficulty of treating HIV-2-infected patients, mostly because the viral load is not as useful as it is in HIV-1, and the incomplete knowledge about resistance pathways limits the clinical usefulness of resistance testing. With all these limitations, HIV-2 treatment remains a challenge. Further research is urgently needed, since antiretroviral therapy is now becoming available in countries where the HIV-2 prevalence is significant. The need for appropriate guidelines for HIV-2 treatment has become an emergency. Copyright © 2012 S. Karger AG, Basel.


Neto N.,Centro Hospitalar Of Lisbon Ocidental | Nunnes P.,Hospital da Lapa
Insights into Imaging | Year: 2016

Ganglion and synovial cysts occur mainly, but not necessarily, in association with osteoarthritis. Presentation varies widely, ranging from small, incidentally detected, asymptomatic lesions to giant ones that might be the source of symptoms, either due to their compressive effect on adjacent structures or due to complications, such as rupture. On magnetic resonance imaging they are typically presented as smooth, well-circumscribed, thin-walled, unilocular, and homogeneously T2-hyperintense lesions. An identifiable thin stalk communicating to the joint space is not infrequent. Nevertheless, depending on their age, anatomic location, and eventual complication, they might have many distinct appearances, including septae and internal debris, which the radiologist must be familiar with in order to accurately differentiate them from worrisome cystic-like lesions. With regard to this diversity, some illustrative cases are presented. © 2016, The Author(s).


Mourao A.F.,Centro Hospitalar Of Lisbon Ocidental | Mourao A.F.,New University of Lisbon | Blyth F.M.,University of Sydney | Branco J.C.,Centro Hospitalar Of Lisbon Ocidental
Best Practice and Research: Clinical Rheumatology | Year: 2010

The study of the descriptive epidemiology of chronic widespread pain (CWP) in several countries is of interest, as the occurrence of this condition varies among different populations. However, reports of pain prevalence are not consensual: it is clear that chronic musculoskeletal pain is frequent all over the world, varying from 4.2% to 13.3%. The reasons for the prevalence differences in CWP might include genetic and/or environmental factors. Multifactorial aetiopathogenesis of CWP and fibromyalgia syndrome (FMS) certainly includes genetic susceptibility and environmental influences. The risk factors for the occurrence and maintenance of CWP/FMS include female gender, increasing age, family history of chronic pain, several causes of distress, obesity and poorest mental and/or physical status. On the other hand, risk factors that negatively influence the outcome of CWP/FMS are: high levels of psychological distress, presence of somatisation, presence of fatigue, poor sleep, higher number of painful sites and pain intensity, poorest mental status and functional capacity, presence of co-morbid conditions and highest number of primary-care consultations. Mild alcohol consumption and individualised social support seem to have a protective effect on the outcome of CWP/FMS. © 2010 Elsevier Ltd. All rights reserved.


Valles J.,Consorci Hospitalari Universitari Parc Tauli | Peredo R.,Consorci Hospitalari Universitari Parc Tauli | Burgueno M.J.,Consorci Hospitalari Universitari Parc Tauli | Rodrigues De Freitas A.P.,Centro Hospitalar Of Lisbon Ocidental | And 6 more authors.
Chest | Year: 2013

Background: Comatose patients present a high risk of early-onset ventilator-associated pneumonia (EO-VAP) for which antibiotic prophylaxis has been proposed. Comatose patients were studied to evaluate the efficacy of a single-dose of antibiotic prophylaxis at intubation against EO-VAP. Methods: A prospective cohort of comatose patients (Glasgow Coma Score ≤8) who were admitted in 2009-2010 and administered a single-dose of antibiotic within 4 h of intubation was compared with comatose patients (admitted ≥4 h after intubation in 2009-2010 or admitted in 2007-2008) who did not receive antibiotic prophylaxis. We analyzed the incidence of EO-VAP, late-onset VAP, and ventilator-associated tracheobronchitis in both groups. Propensity scores for receiving antibiotic prophylaxis were derived on the basis of patients' characteristics (eg, age and severity) to assess its impact on EO-VAP development. Results: We included 129 patients (71 in the prophylaxis group and 58 in the control group). The global incidence of VAP and incidence of EO-VAP were lower in the prophylaxis group:10.8 vs 28.4 episodes/1,000 days on mechanical ventilation (P = .015) and 4.4 vs 23.1 episodes/1,000 days on mechanical ventilation (P = .02), respectively. The incidence of late-onset VAP did not differ. The prophylaxis group tended toward lower incidence of ventilator-associated tracheobronchitis (15.5% vs 25.9%, P = .14). No differences in mortality were found between groups. The propensity- score regression analysis confirmed that a single dose of antibiotic prophylaxis was independently associated with lower incidence of EO-VAP (OR, 0.11;95% CI, 0.02-0.58;P = .009). Conclusions: A single dose of antibiotic prophylaxis at intubation might lower the incidence of EO-VAP. However, a randomized clinical trial should be conducted to confirm our findings. © 2013 American College of Chest Physicians.


Lopes F.A.,Centro Hospitalar Of Lisbon Ocidental
BMJ case reports | Year: 2013

We present a case of a 67-year-old patient with a history of augmentation ileocystoplasty 31 years ago following genitourinary tuberculosis. Radiological investigations performed due to asymptomatic microscopic haematuria revealed three contrast-enhancing polyps within the neobladder. The patient had enterocystoprostatectomy and histopathological examination of the neobladder revealed mucinous adenocarcinoma in all three polyps, together with a prostatic adenocarcinoma Gleason 7 (3+4). After adjuvant chemotherapy and 1 year of follow-up, he had no sign of clinical or radiological recurrence. Taking into consideration this rare case, we discuss the development of malignant tumours after the incorporation of intestinal segments in a urinary tract reconstruction, showing what relationship exists between secondary neoplastic growth, the primary disease and the type of urinary diversion utilised.

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