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Mesquita-Bastos J.,University of Aveiro | Mesquita-Bastos J.,Hospital Infante D Pedro | Bertoquini S.,Faculdade Psicologia e Ciencias da Educacao | Polonia J.,University of Aveiro | Polonia J.,Hospital Pedro Hispano
Blood Pressure Monitoring | Year: 2010

Aim: We investigated the cardiovascular (CV) prognostic value of 24-h ambulatory blood pressure (ABP) and blood pressure (BP) during the six 4-h periods of the 24-h ABP length in a cohort of 1200 Portuguese hypertensive patients (aged 51±12 years) without earlier CV events. Method: The presence of CV events were followed for 9.833 patient years and analyzed using a cox hazard model. RESULTS: During the 15.2 (mean 8.2) years follow-up, there were 152 CV events (11% fatal) including 79 strokes and 52 coronary events. After adjustment for risk factors and office BP (OBP), a 1-standard deviation increment of 24-h, daytime and night-time systolic BP (SBP) significantly predicted any CV event with hazard ratios (HR) 1.41, 1.33 and 1.57, respectively, and stroke with HR 1.67, 1.58, 1.67, respectively (all P<0.01), but not coronary events. Prognostic significance of these SBP values and of night-time ABP persisted after adjustment for diastolic BP and daytime ABP, respectively, whereas the opposite did not occur. SBP night-time fall (%) inversely predicted total CV events after adjustment for diastolic BP night-time fall. Among all six 4-h periods of 24-h, increment of SBP during the first 4h of night-time was the most powerful predictor of any CV event (HR 1.64) and stroke (HR 2.02) (both P<0.01) even after adjustment for daytime and 24-h BP. Conclusion: In predicting CV events and stroke, ABP is superior to office BP, ABP systolic is superior to ABP diastolic, and night-time BP is superior to daytime BP particularly during the first 4h of sleep. Copyright © 2010 Lippincott Williams & Wilkins.


Xavier J.M.,University of Lisbon | Xavier J.M.,Instituto Gulbenkian Of Ciencia | Shahram F.,Tehran University of Medical Sciences | Davatchi F.,Tehran University of Medical Sciences | And 11 more authors.
Arthritis and Rheumatism | Year: 2012

Objective Independent replication of the findings from genome-wide association studies (GWAS) remains the gold standard for results validation. Our aim was to test the association of Behçet's disease (BD) with the interleukin-10 gene (IL10) and the IL-23 receptor-IL-12 receptor β2 (IL23R-IL12RB2) locus, each of which has been previously identified as a risk factor for BD in 2 different GWAS. Methods Six haplotype-tagging single-nucleotide polymorphisms (SNPs) in IL10 and 42 in IL23R-IL12RB2 were genotyped in 973 Iranian patients with BD and 637 non-BD controls. Population stratification was assessed using a panel of 86 ancestry-informative markers. Results Subtle evidence of population stratification was found in our data set. In IL10, rs1518111 was nominally associated with BD before and after adjustment for population stratification (odds ratio [OR] for T allele 1.20, 95% confidence interval [95% CI] 1.02-1.40, unadjusted P [Punadj] = 2.53 × 10-2; adjusted P [Padj] = 1.43 × 10-2), and rs1554286 demonstrated a trend toward association (Punadj = 6.14 × 10-2; Padj = 3.21 × 10-2). Six SNPs in IL23R-IL12RB2 were found to be associated with BD after Bonferroni correction for multiple testing, the most significant of which were rs17375018 (OR for G allele 1.51, 95% CI 1.27-1.78, Punadj = 1.93 × 10-6), rs7517847 (OR for T allele 1.48, 95% CI 1.26-1.74, P unadj = 1.23 × 10-6), and rs924080 (OR for T allele 1.29, 95% CI 1.20-1.39, P = 1.78 × 10-5). SNPs rs10489629, rs1343151, and rs1495965 were also significantly associated with BD in all tests performed. Results of meta-analyses of our data combined with data from other populations further confirmed the role of rs1518111, rs17375018, rs7517847, and rs924080 in the risk of BD, but no epistatic interactions between IL10 and IL23R-IL12RB2 were detected. Results of imputation analysis highlighted the importance of IL23R regulatory regions in the susceptibility to BD. Conclusion These findings independently confirm, extend, and refine the association of BD with IL10 and IL23R-IL12RB2. These associations warrant further validation and investigation in patients with BD, as they may have implications for the development of novel therapies (e.g., immunosuppressive therapy targeted at IL-23p19). Copyright © 2012 by the American College of Rheumatology.


PubMed | Hospital Of Sao Joao, Hospital Garcia Of Orta, Hospital Of Santa Maria, Hospital Infante D Pedro and Centro Hospitalar iversitario Of Coimbra
Type: | Journal: Acta reumatologica portuguesa | Year: 2017

Children and adolescents with systemic rheumatic diseases have an increased risk of infections. Although some infections are vaccine-preventable, immunization among patients with juvenile rheumatic diseases is suboptimal, partly due to some doubts that still persist regarding its efficacy and safety in this patient population.To review the available evidence regarding the immunological response and the safety of vaccination in children and adolescents with systemic inflammatory rheumatic diseases (SIRD).A systematic review of the current literature until December 2014 using MEDLINE, EMBASE and abstracts from the American College of Rheumatology and European League Against Rheumatism congresses (2011-2014), complemented by hand search was performed. Eligible studies were identified and efficacy (seroprotection and/or seroconversion) and safety (reactions to vaccine and relapse of rheumatic disease) outcomes were extracted and summarized according to the type of vaccine.Twenty-eight articles concerning vaccination in pediatric patients with SIRDs were found, that included almost 2100 children and adolescents, comprising nearly all standard vaccinations of the recommended immunization schedule. Children with SIRDs generally achieved seroprotection and seroconversion; nevertheless, the antibody levels were often lower when compared with healthy children. Glucocorticoids and conventional disease-modifying anti-rheumatic drugs do not seem to significantly hamper the immune responses, whereas TNF inhibitors may reduce antibody production, particularly in response to pneumococcal conjugate, influenza, meningococcal C and hepatitis A vaccine. There were no serious adverse events, nor evidence of a relevant worsening of the underlying rheumatic disease. Concerning live attenuated vaccines, the evidence is scarce, but no episodes of overt disease were reported, even in patients under biological therapy.Existing literature demonstrates that vaccines are generally well tolerated and effective in stable SIRD patients, yet antibody titers are frequently lower than in healthy controls. There is some evidence that biological therapy could hamper the immune response. Data on safety of live attenuated vaccines is limited. Although the available literature covers most vaccines included in the national immunization plan, there is a need for more information regarding new vaccines and new anti-rheumatic therapies.


Pedrosa C.,University of Porto | Pedrosa C.,Hospital Infante D Pedro | Oliveira B.M.P.M.,University of Porto | Albuquerque I.,Hospital Infante D Pedro | And 4 more authors.
European Journal of Pediatrics | Year: 2011

The aim of this study was to evaluate the effect of a lifestyle intervention programme (nutrition and exercise counselling) on metabolic syndrome (MS) components, adipokines (leptin, adiponectin) and ghrelin levels in overweight children. A total of 61 overweight children aged 7-9 years (≥85th body mass index (BMI) percentile; 27 boys/34 girls) were randomly assigned and completed a 1-year individual (IT) or group-based treatment (GT). Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. Twenty-two normal weight children (<85th BMI percentile; 7-9 yearsold; 13 boys/nine girls) were also evaluated at baseline. Insulin resistance (IR) was determined by the homeostasis model assessment of IR (HOMA-IR). Overweight children presented significantly higher blood pressure, triglycerides, apolipoprotein B, insulin, HOMA-IR, leptin, C-reactive protein and homocysteine levels, while apolipoprotein A-I was significantly lower. At baseline, MS was present in ten overweight children, of which only five maintained it at 1 year. Leptin and ghrelin levels were associated with IR and MS components. MS was predicted by apolipoprotein A-I, insulin and pre-puberty. The lifestyle intervention led to a significant improvement in standard deviation score of BMI, waist circumference/height ratio and lipid profile. Changes in insulin, HOMA-IR, leptin and adiponectin were not significant. Ghrelin behaved differently between IT and GT. The GT intervention seems to be more successful, with a decrease in BMI Z-score and an improvement of metabolic parameters. In conclusion, overweight children have multiple risk factors associated with MS. A lifestyle intervention programme seems to be an effective mean for reducing obesity and MS components and improving adipokines concentrations. © 2010 Springer-Verlag.


Lousada M.,University of Aveiro | Jesus L.M.T.,University of Aveiro | Capelas S.,Agrupamento de Escolas de ilhavo | Margaca C.,Hospital Infante D Pedro | And 4 more authors.
International Journal of Language and Communication Disorders | Year: 2013

Background In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives. Aims To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0-6.7 years, with a phonologically based SSD. Methods & Procedures The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included. Outcomes & Results Both treatments were effective in improving the participants' speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children's speech. Conclusions & Implications The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD. © 2012 Royal College of Speech and Language Therapists.


Tiago S.,Hospital Infante D Pedro | Nuno M.,University of Coimbra | Joao A.,Hospital Infante D Pedro | Carla V.,Hospital Infante D Pedro | And 2 more authors.
Clinical Practice and Epidemiology in Mental Health | Year: 2012

Objective: Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. The authors present a clinical case of trichobezoar and discuss the most relevant aspects concerning this entity. Methods: Presentation of psychiatric and surgical data concerning the case report. Previously reported cases are also mentioned. Results: Report of a 27-year-old female patient with a trichobezoar submitted to surgical removal, with a prior intervention 4 years before also due to trichobezoar, and with unknown psychiatric antecedents or follow-up. Conclusions: A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. The discrepancies between the prevalence of trichotillomania and trichobezoars due to trichophagia may be due to issues related to self-selection of patients and symptom severity. Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders. © Tiago et al.; Licensee Bentham Open.


Santiago I.,Hospital Infante D Pedro | Loureiro R.,Hospital Destrital do Funchal | Curvo-Semedo L.,University of Coimbra | Marques C.,University of Coimbra | And 3 more authors.
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The purpose of this essay is to illustrate the imaging findings of congenital cystic lesions of the biliary tract. CONCLUSION. Congenital cystic lesions of the biliary tract include ductal plate malformations and choledochal cysts and can be recognized with characteristic imaging findings and basic knowledge of the embryologic development of the biliary tree. © American Roentgen Ray Society.


Santiago F.,University of Coimbra | Goncalo M.,University of Coimbra | Vieira R.,University of Coimbra | Coelho S.,Hospital Infante D Pedro | Figueiredo A.,University of Coimbra
Contact Dermatitis | Year: 2010

Background: In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients. Objective: The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS. Patients/Methods: Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%). Results: A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug. Conclusions: In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism. © 2010 John Wiley & Sons A/S.


Santos G.,Hospital Infante D Pedro | Sousa L.,University of Aveiro
Revista Portuguesa de Saude Publica | Year: 2015

Hospitalization is an event of high anxiety mainly for older persons, due to its association with health status deterioration and decrease of the quality of life. This study examines older person's quality of life at admission, considering the influence of socio-demographic, pathology and hospitalization duration variables. The sample comprises 250 participants (≥ 65 years old), 50.4% females. The Elderly Assessment System (EasyCare) was administered. Main findings show that: 27.6% of the participants are dependent in ADL and IDLA; 38.5% are dependent in IADL and independent in ADL; 39.6% are independent. The dependent tend to be older, with lower income, having lower education levels, being widowed, institutionalized, feeling more depressed and less satisfied with their residence; the independent tend to be less older, more satisfied with their housing conditions, able to manage their finances, with higher educational levels, married or divorced; and dependent moderates have intermediate values. Results suggest that the quality of life is influenced by life styles, what should be addressed during the hospitalization. © 2014 The Authors. Published by Elsevier España, S.L.U. on behalf of Escola Nacional de Saúde Pública.


Peralta L.,Hospital Infante D Pedro | Morais P.,University of Porto
Journal of Dermatological Case Reports | Year: 2012

Trichotillomania (TTM) is an impulse-control disorder, in which patients chronically pull hair from the scalp and/or other sites. We herein report a 8-year-old male patient who developed TTM in the classical tonsure pattern ("Friar Tuck" sign). The diagnosis was confirmed by trichoscopy, which showed decreased hair density, broken hairs with different shaft lengths, black dots, signs of hemorrhage, and an absence of exclamation mark hairs.

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