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Curdia Goncalves T.,Centro Hospitalar Do Alto Ave | Dias De Castro F.,Centro Hospitalar Do Alto Ave | Moreira M.J.,Centro Hospitalar Do Alto Ave | Rosa B.,Centro Hospitalar Do Alto Ave | And 3 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2014

BACKGROUND/AIM: Small bowel capsule endoscopy (SBCE) is currently a fundamental tool in the etiological study of obscure gastrointestinal bleeding (OGIB). However, the impact of a negative exam and the risk of rebleeding are not entirely known. The aim of this study was to evaluate the outcomes of patients with OGIB and a negative SBCE examination in terms of follow-up duration, additional diagnostic studies, and achievement of a diagnosis as well as to assess the incidence of rebleeding and possible associated factors. MATERIALS AND METHODS: We retrospectively analyzed 256 patients who consecutively underwent an SBCE examination for the study of OGIB between April 2006 and December 2011, and then selected the 79 whose results excluded potentially bleeding lesions. Eleven patients were lost to follow-up and the remaining 68 were eligible for a nested case-control analysis. Pre-SBCE and post-SBCE information was collected, including follow-up interval and incidence of rebleeding, defined as admission to the hospital for symptomatic anemia, need for blood transfusion, decrease in hemoglobin value of greater than 2g/dl, or evidence of melena or hematochezia. Univariate analysis included age, sex, OGIB presentation (occult or visible), hemoglobin levels at presentation, and comorbidities. RESULTS: In the 68 patients analyzed, the mean age was 52±18 years and 61.8% were women. The OGIB was occult in 54 patients (79.4%) and overt in 14 patients (20.6%). Patients were followed up for an average of 32 months. Thirty-nine patients (57.4%) underwent further diagnostic investigations during the period of follow-up and a cause for the gastrointestinal bleeding was found in five of them. Rebleeding was documented in 16 (23.5%) patients, occurring on average 15±13.8 months after the SBCE. Male sex was associated significantly with higher incidence of rebleeding (P=0.004). CONCLUSION: Approximately one quarter of patients with OGIB and negative SBCE examination will experience rebleeding, with higher incidence among men; thus, a negative SBCE in this setting is not reassuring. As the vast majority of rebleeding episodes seem to occur within the following 2 years after SBCE, the maintenance of regular medical surveillance during the above-mentioned period of time after a negative SBCE seems advisable. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Monteiro N.,European Institute of Excellence on Tissue Engineering and Regenerative Medicine | Monteiro N.,Pt Government Assoc Laboratory | Martins A.,European Institute of Excellence on Tissue Engineering and Regenerative Medicine | Martins A.,Pt Government Assoc Laboratory | And 9 more authors.
Biomaterials Science | Year: 2014

Electrospun nanofiber meshes (NFM), due to their morphology and fibrous structure, are extensively proposed as biomedical devices, for tissue engineering on scaffolds and also as drug delivery systems. Liposomes are nanoparticles prepared from a biologically derived material (phospholipid), which are already in clinical use as a drug release device. Liposomes may be combined with biomaterial scaffolds to promote a local and sustained delivery of loaded bioactive agents. The main objective of the present study is to evaluate the efficacy of dexamethasone (Dex)-loaded liposomes immobilized on the surface of electrospun polycaprolactone (PCL) NFM for promoting the osteogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs). The in vitro release profile demonstrates a sustained release of Dex over 21 days, after an initial burst release over 12 h. Biological assays show that Dex-loaded liposomes immobilized on the surface of electrospun PCL NFMs do not exhibit any cytotoxic effect, being able to successfully promote the osteogenic differentiation of hBMSCs. We herein validate the concept of using liposomes immobilized on the surface of a nanostructured fibrous system to be used as an advanced cell carrier device with autonomous release of growth/differentiation factors relevant for tissue engineering and regenerative medicine strategies. This journal is © the Partner Organisations 2014. Source


Monteiro S.,Alto Ave Hospital Center | Boal Carvalho P.,Alto Ave Hospital Center | Dias De Castro F.,Alto Ave Hospital Center | Magalhaes J.,Alto Ave Hospital Center | And 6 more authors.
Inflammatory Bowel Diseases | Year: 2015

Background: The Lewis Score (LS) aims to standardize the method of quantification of small bowel inflammatory activity detected by the small bowel capsule endoscopy (SBCE). The aim of this study was to evaluate the diagnostic accuracy of the LS in patients with suspected CD undergoing SBCE. Methods: We performed a retrospective study including patients who underwent SBCE for suspected CD between September 2006 and February 2013. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy for the definition of suspected CD. Inflammatory activity on SBCE was objectively assessed by determining the LS. Results: Ninety-five patients were included. Group 1: 37 patients not fulfilling International Conference on Capsule Endoscopy criteria; Group 2: 58 patients with ≥2 International Conference on Capsule Endoscopy criteria. The diagnosis of CD was established in 38 patients (40%): 8 (21.6%) from group 1 and 30 from group 2 (51.7%) (P 0.003). Among those patients, 34 had LS ≥135 (73.9%) and 4 had LS <135 (8.2%) at SBCE (P < 0.001). The LS ≥135 had an overall diagnostic accuracy of 83.2% with a sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of CD of 89.5%, 78.9%, 73.9%, and 91.8%, respectively. Conclusions: The application of LS ≥135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing SBCE for suspected CD may be useful to establish the diagnosis of CD. In patients with LS <135, the probability of having CD confirmed on follow-up is low. © 2015 Crohn's & Colitis Foundation of America, Inc. Source


Nebenzahl-Guimaraes H.,National Institute for Public Health and the Environment RIVM | Nebenzahl-Guimaraes H.,University of Minho | Nebenzahl-Guimaraes H.,Pt Government Assoc Laboratory | Verhagen L.M.,Wilhelmina Childrens Hospital Utrecht | And 4 more authors.
Journal of Clinical Microbiology | Year: 2015

The aim of this study was to determine if mycobacterial lineages affect infection risk, clustering, and disease progression among Mycobacterium tuberculosis cases in The Netherlands. Multivariate negative binomial regression models adjusted for patientrelated factors and stratified by patient ethnicity were used to determine the association between phylogenetic lineages and infectivity (mean number of positive contacts around each patient) and clustering (as defined by number of secondary cases within 2 years after diagnosis of an index case sharing the same fingerprint) indices. An estimate of progression to disease by each risk factor was calculated as a bootstrapped risk ratio of the clustering index by the infectivity index. Compared to the Euro-American reference, Mycobacterium africanum showed significantly lower infectivity and clustering indices in the foreign-born population, while Mycobacterium bovis showed significantly lower infectivity and clustering indices in the native population. Significantly lower infectivity was also observed for the East African Indian lineage in the foreign-born population. Smear positivity was a significant risk factor for increased infectivity and increased clustering. Estimates of progression to disease were significantly associated with age, sputum-smear status, and behavioral risk factors, such as alcohol and intravenous drug abuse, but not with phylogenetic lineages. In conclusion, we found evidence of a bacteriological factor influencing indicators of a strain's transmissibility, namely, a decreased ability to infect and a lower clustering index in ancient phylogenetic lineages compared to their modern counterparts. Confirmation of these findings via follow-up studies using tuberculin skin test conversion data should have important implications on M. tuberculosis control efforts. Copyright © 2015, American Society for Microbiology. All Rights Reserved. Source


Cardoso L.,University of Minho | Marins F.,University of Minho | Magalhaes R.,University of Minho | Magalhaes R.,Pt Government Assoc Laboratory | And 6 more authors.
Scientific World Journal | Year: 2015

Schizophrenia stands for a long-lasting state of mental uncertainty that may bring to an end the relation among behavior, thought, and emotion; that is, it may lead to unreliable perception, not suitable actions and feelings, and a sense of mental fragmentation. Indeed, its diagnosis is done over a large period of time; continuos signs of the disturbance persist for at least 6 (six) months. Once detected, the psychiatrist diagnosis is made through the clinical interview and a series of psychic tests, addressed mainly to avoid the diagnosis of other mental states or diseases. Undeniably, the main problem with identifying schizophrenia is the difficulty to distinguish its symptoms from those associated to different untidiness or roles. Therefore, this work will focus on the development of a diagnostic support system, in terms of its knowledge representation and reasoning procedures, based on a blended of Logic Programming and Artificial Neural Networks approaches to computing, taking advantage of a novel approach to knowledge representation and reasoning, which aims to solve the problems associated in the handling (i.e., to stand for and reason) of defective information. © 2015 L. Cardoso et al. Source

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