Centro Hospitalar Tondela Viseu

Viseu, Portugal

Centro Hospitalar Tondela Viseu

Viseu, Portugal

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Gumus K.,Erciyes University | Guerra M.G.,Centro Hospitalar Tondela Viseu | De Melo Marques S.H.,Centro Hospitalar Tondela Viseu | Karakucuk S.,Anadolu Medical Center | Barritault D.,University Paris Est Creteil
Journal of Refractive Surgery | Year: 2017

PURPOSE: To investigate the hypothesis that a new matrix therapy agent (ReGeneraTing Agent, [RGTA]) would speed up the corneal reepithelialization, improve stromal healing, and reduce ocular symptoms after epi-off corneal cross-linking (CXL). METHODS: Sixty eyes of60 patients with progressive keratoconus were enrolled in the study. Epi-off accelerated CXL was performed in all patients. Sixty eyes were randomized into two groups according to use of RGTA eye drops prior to contact lens fitting at the end. Identical medical agents were started postoperatively for the two groups. All participants were monitored on 3 consecutive days after the CXL. Ocular pain, burning, stinging, tearing, photophobia, conjunctival hyperemia, and corneal healing status were evaluated. RESULTS: By day 2, 25 eyes (83.3%) with RGTA revealed complete healing compared to 4 eyes (13.3%) that revealed complete healing in the control group (P <.001). All eyes had complete corneal epithelial defect closure by day 3 in both groups. Ocular pain scores were lower in the RGTA group on days 0, 1, and 2 (all P <.05). Burning scores were lower on days 1 and 2; stinging scores on days 2 and 3; tearing scores on days 2 and 3; and photophobia on days 1 and 2 (P <.05) in the RGTA group compared to the control group. CONCLUSIONS: RGTA ophthalmic solution facilitates corneal healing by reconstructing the extracellular matrix in the wound area, leading to an earlier relief ofsymptoms for patients.


Magro F.,University of Porto | Magro F.,Hospital Of Sao Joao | Magro F.,Institute for Molecular and Cell Biology | Sousa P.,Centro Hospitalar Tondela Viseu | Ministro P.,Centro Hospitalar Tondela Viseu
Expert Review of Gastroenterology and Hepatology | Year: 2014

C-reactive protein (CRP) is an important acute-phase marker, produced mainly in the liver. Its production by mesenteric adipocytes has been recently stressed in Crohn's disease (CD). There are many factors affecting CRP levels, both environmental and genetics. The short-life of this biomarker makes it of pertinent use in the assessment of inflammation. There are inconsistent results concerning the association of clinical activity indices, mucosal healing, histological activity and CRP. This review summarizes the role of CRP in CD, namely its importance in the differential diagnosis of CD; its relationship with clinical activity indices, other markers of inflammation and endoscopic and radiological cross sectional imaging; prediction of response to anti-TNF treatment and prediction of outcome. © Informa UK, Ltd.


PubMed | University of Lisbon, Hospital Of Vila Franca Of Xira, Centro Hospitalar Tondela Viseu and University of Coimbra
Type: Journal Article | Journal: Revista portuguesa de pneumologia | Year: 2016

Current guidelines differ slightly on the recommendations for treatment of Chronic Obstructive Pulmonary Disease (COPD) patients, and although there are some undisputed recommendations, there is still debate regarding the management of COPD. One of the hindrances to deciding which therapeutic approach to choose is late diagnosis or misdiagnosis of COPD. After a proper diagnosis is achieved and severity assessed, the choice between a stepwise or hit hard approach has to be made. For GOLD A patients the stepwise approach is recommended, whilst for B, C and D patients this remains debatable. Moreover, in patients for whom inhaled corticosteroids (ICS) are recommended, a step-up or hit hard approach with triple therapy will depend on the patients characteristics and, for patients who are being over-treated with ICS, ICS withdrawal should be performed, in order to optimize therapy and reduce excessive medications. This paper discusses and proposes stepwise, hit hard, step-up and ICS withdrawal therapeutic approaches for COPD patients based on their GOLD group. We conclude that all approaches have benefits, and only a careful patient selection will determine which approach is better, and which patients will benefit the most from each approach.


PubMed | Ghent University, University of Porto, Hospital Beatriz Angelo, Hospital da Senhora da Oliveira and 13 more.
Type: | Journal: Journal of Crohn's & colitis | Year: 2016

Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients.This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers.Macroscopic lesions [i.e. endoscopic Mayo score 1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 g/g for faecal calprotectin and 12 g/g for neutrophil gelatinase B-associated lipocalin were proposed.Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.


Franco D.G.,University of Beira Interior | Franco D.G.,Centro Hospitalar Tondela Viseu | Cardoso J.,Instituto Superior Of Ciencias Da Saude Egas Moniz | Neto I.,University of Beira Interior
Sexuality and Disability | Year: 2012

The acceptance of sexuality and its manifestations has changed in recent decades to being considered a normal feature of the identity of each individual. However, the person with intellectual disability have not benefited from this change in attitude. Their sexuality remains shrouded in myths and prejudices. The study population consisted of 454 students from the University of Beira Interior, from the Medicine, Psychology and Architecture majors. The data was collected using a questionnaire specifically drafted for this research. Most surveyed students consider sexuality an important part of life for every human being. From the responses to the questionnaire, psychology students were those with a more positive attitude towards sexuality and affectivity of the individual with intellectual disability, but the variability of the distribution of student responses from the three majors did not differ significantly. A positive attitude is characteristic of those who have acquired sufficient knowledge, females and of those who have frequent contact with individuals with intellectual disability. © Springer Science+Business Media, LLC 2012.


Freitas F.,University of Porto | Freitas F.,Fernando Pessoa University | Freitas F.,Centro Hospitalar Tondela Viseu | Machado E.,University of Porto | And 5 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014

We investigated the occurrence, diversity and molecular epidemiology of genes coding for acquired AmpC β-lactamases (qAmpC) among clinical isolates of Enterobacteriaceae lacking inducible chromosomal AmpCs in Portugal. A total of 675 isolates non-susceptible to broad-spectrum cephalosporins obtained from four hospitals and three community laboratories during a 7-year period (2002-2008) were analysed. The presence of genes coding for qAmpC was investigated by phenotypic criteria, polymerase chain reaction (PCR) and sequencing. Bacterial identification, antibiotic susceptibility testing, conjugation assays and clonal analysis were performed by standard procedures. The presence of bla qAmpC genes was detected in 50 % (50/100; 41 Klebsiella pneumoniae, 5 Escherichia coli, 4 Klebsiella oxytoca) of the presumptive qAmpC producers. DHA-1, detected in those species, was the most prevalent qAmpC (94 %, 47/50), being identified since 2003 and throughout the studied period in different institutions. Despite the high clonal diversity observed, three DHA-1-producing Klebsiella spp. clones were more frequently identified. CMY-2 (6 %, 3/50) was observed in B1-E. coli clones. Conjugative transfer was only observed in one (2 %) CMY-2-producing isolate. Most qAmpC producers (94 %, 47/50) co-expressed SHV-type and/or OXA-1 or CTX-M-32 extended-spectrum β-lactamases (ESBLs). To the authors' knowledge, this is the first description of the molecular epidemiology and the long-term dissemination of qAmpC-producing Enterobacteriaceae in Portuguese clinical settings, highlighting an evolution towards a more complex epidemiological situation regarding cephalosporin resistance in Portugal. © 2013 Springer-Verlag.


Porto L.,Centro Hospitalar Tondela Viseu
BMJ case reports | Year: 2013

Paraneoplastic syndromes are indirect manifestations of cancer due to functional peptides/hormones produced by a tumour, or due to cross reactivity between tumour and host antigens. Here the case of a 58-year-old woman presenting with ataxia, paraesthesia and subacute and progressive loss of vision is reported. The patient exhibited strong serum positivity for anti-Hu and anti-CV2 antibodies, and a chest CT scan showed a hypodense nodule in proximity of the right upper lobe bronchus and an enlarged ipsilateral paratracheal lymph node that was not visible on a lung x-ray. Histopathological examination of a biopsy specimen from this lymph node showed that small cell carcinoma of the lung was present. The patient's deficits were subsequently diagnosed as three coexisting paraneoplastic neurological syndromes (PNSs): subacute cerebellar ataxia, sensory neuropathy and retinopathy, respectively. Although rare, PNSs can be the first manifestations of cancer, and their rapid recognition facilitates an early treatment.


Carvalho R.,Centro Hospitalar Tondela Viseu | Segura E.,Centro Hospitalar Tondela Viseu | Loureiro M.D.C.,Centro Hospitalar Tondela Viseu | Assuncao J.P.,Centro Hospitalar Tondela Viseu
Revista Brasileira de Anestesiologia | Year: 2014

Background and objectives: The quadratus lumborum block was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascial block guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient; 61 years old; 83. kg; with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25. mL) and depot methylprednisolone (20. mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable. © 2014 Sociedade Brasileira de Anestesiologia.


Porto L.,Centro Hospitalar Tondela Viseu
BMJ case reports | Year: 2013

A 51-year-old man presented with a 3 month history of progressive right visual loss. On examination, the only abnormal findings were a right visual acuity of 4/10 and a swollen right optic disc. The patient had previously undergone MRI that had been reported as being normal and a trial of corticosteroids under the care of the referring ophthalmologist. An extensive battery of blood tests was normal apart from a rapid plasmatic reagin titre of 1:64. ELISA revealed elevated levels of total and immunoglobulin M antibodies against Treponema pallidum. Cerebrospinal fluid analysis revealed a mild leucocytosis and mildly elevated protein content. The patient was treated with a 5 week course of penicillin. Three months after starting treatment, his right visual acuity had improved to 8/10 and his right optic disc swelling had resolved.


PubMed | Centro Hospitalar Tondela Viseu
Type: Journal Article | Journal: Bulletin of emergency and trauma | Year: 2016

The article reports a clinical case of a 39-year-old male patient who was admitted in the emergency room in shock. The clinical exams and additional tests identified a right massive hemothorax, without apparent etiological factors. He was submitted to an emergency right thoracotomy. A bulky varicose formation in the diaphragmatic surface, with evident laceration and haemorrhage was identified. The article describes this case due to its rarity. The varicose formation was simply ligated and the evolution, as well as the outcome of this clinical case was uneventful.

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