Browsing by Author "Costa, P"
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- Contraceção e risco de tromboembolismo venoso: um estudo caso-controloPublication . Guimarães, AC; Costa, P; Rocha, A; Queirós, F; Barbosa, AP; Nogueira-Silva, CObjetivos: Comparar o risco de tromboembolismo venoso (TEV) entre a 4ª geração e as gerações anteriores de contracetivos orais combinados (COC); analisar a correlação existente entre a idade, índice de massa corporal (IMC) e duração da toma do COC e o risco de TEV. Tipo de estudo: Estudo caso-controlo. Local: Centro Hospitalar doAlto-Ave, Hospital de Braga e Unidade Local de Saúde doAlto Minho. População: Foram estudadas no total 257 mulheres, das quais 122 tinham diagnóstico prévio de TEV e 135 não tinham história de TEV. Métodos: Reviram-se os registos clínicos de mulheres em seguimento por TEV, ocorrido entre 2010 e 2013. As mulheres a tomar COC aquando do evento tromboembólico eram os casos.Os controlosforam as mulheresseguidas em consulta de planeamento familiar,a tomar COC e sem antecedentes de TEV. Resultados: Os COC de 4ª geração não aumentam o risco de TEV comparativamente com as gerações anteriores (OR = 1,77; IC95 0,93-3,38; p = 0,083). Não se observou correlação entre o IMC e o risco de TEV (OR = 1,53; IC95 0,76-3,06; p = 0,234). Por outro lado, a idade (OR = 1,5; IC95 1,02-1,09; p = 0,001) e a duração da toma do COC (OR = 2,41; IC95 1,19-4,87; p = 0,014) estiveram associados a risco de TEV. Conclusões: O risco de TEV depende da idade e duração do uso do COC.Tendo em consideração as limitações do estudo, a interpretação dos resultados deve ser cautelosa, quanto à segurança dos COC de 4ª geração
- Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?Publication . Fernandes, S; Carvalho, AF; Rodrigues, AJ; Costa, P; Sanz, M; Goulart, A; Rios, H; Leão, PBACKGROUND: Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease. METHODS: A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00-7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue. RESULTS: A total of 330 patients were included, with 214 (64.8%) in the daytime group and 116 (35.2%) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100% of surgeons reported that they are less proficient during nighttime. CONCLUSIONS: Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital.
- Effector memory CD4(+) T cells are associated with cognitive performance in a senior populationPublication . Serre-Miranda, C; Roque, S; Santos, NC; Portugal-Nunes, C; Costa, P; Palha, JA; Sousa, N; Correia-Neves, MOBJECTIVE: Immunosenescence and cognitive decline are common markers of the aging process. Taking into consideration the heterogeneity observed in aging processes and the recently described link between lymphocytes and cognition, we herein explored the possibility of an association between alterations in lymphocytic populations and cognitive performance. METHODS: In a cohort of cognitively healthy adults (n = 114), previously characterized by diverse neurocognitive/psychological performance patterns, detailed peripheral blood immunophenotyping of both the innate and adaptive immune systems was performed by flow cytometry. RESULTS: Better cognitive performance was associated with lower numbers of effector memory CD4(+) T cells and higher numbers of naive CD8(+) T cells and B cells. Furthermore, effector memory CD4(+) T cells were found to be predictors of general and executive function and memory, even when factors known to influence cognitive performance in older individuals (e.g., age, sex, education, and mood) were taken into account. CONCLUSIONS: This is the first study in humans associating specific phenotypes of the immune system with distinct cognitive performance in healthy aging.
- Endocardite de válvula protésica – registo de 15 anosPublication . Arantes, C; Vieira, C; Costa, P; Martins, J; Abreu, G; Quina-Rodrigues, C; Galvão-Braga, C; Costeira, A; Salomé, N; Salgado, A; Rocha, S; Marques, J
- Fração Exalada de Óxido Nítrico no Controlo e Abordagem Terapêutica da AsmaPublication . Melo, B; Costa, P; Afonso, A; Machado, V; Moreira, C; Gonçalves, A; Gonçalves, JPINTRODUCTION: Asthma is a chronic respiratory disease characterized by hyper-responsiveness and bronchial inflammation. The bronchial inflammation in these patients can be monitored by measuring the fractional exhaled nitric oxide. This study aims to determine fractional exhaled nitric oxide association with peak expiratory flow and with asthma control inferred by the Global Initiative for Asthma. MATERIAL AND METHODS: Observational, analytical and cross-sectional study of children with asthma, 6-12 years-old, followed in the Outpatient Respiratory Pathology of Braga Hospital. Sociodemographic and clinical information were collected through a questionnaire. fractional exhaled nitric oxide and peak expiratory flow were determined by portable analyzer Niox Mino® and flow meter, respectively. RESULTS: The sample is constituted by 101 asthmatic children, 63 (62.4%) of males and 38 (37.6%) females. The mean age of participants in the sample is 9.18 (1.99) years. The logistic regression performed with the cutoff value obtained by ROC curve, revealed that fractional exhaled nitric oxide (b(FENO classes) = 0.85; χ(2)Wald (1) = 8.71; OR = 2.33; p = 0.003) has a statistical significant effect on the probability of changing level of asthma control. The odds ratio of going from "controlled" to "partly controlled/uncontrolled" is 2.33 per each level of fractional exhaled nitric oxide. DISCUSSION: The probability of an asthmatic children change their level of asthma control, from 'controlled' to 'partly controlled/uncontrolled', taking into account a change in their fractional exhaled nitric oxide level, increases 133%.
- Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphomaPublication . Oliveira, LC; Fardilha, C; Louro, M; Pinheiro, C; Sousa, A; Marques, H; Costa, PINTRODUCTION AND AIMS: Splenic marginal zone lymphoma, an uncommon subtype of non-Hodgkin lymphoma (NHL), is usually present with symptomatic splenomegaly. Although splenectomy has long been considered the first-line therapy in symptomatic or cytopenic patients, it can lead to significant morbidity and mortality. Splenic irradiation is an option for patients who have a poor response to systemic therapy and/or are not surgical candidates. In this paper, we present a case report of a patient who received splenic radiotherapy for symptomatic splenomegaly. METHODS: An 85-year-old Caucasian man with a 4 year history of low-grade NHL presented with progressive pancytopenia, significant weight loss and symptomatic splenomegaly (abdominal discomfort, sense of fullness and limitation of mobility due to spleen size). The patient refused splenectomy and, in December 2017, was referred to palliative splenic radiotherapy. He was initially treated with five fractions of one Grey (Gy) in order to evaluate clinical and haematology response. After that, 1.5 Gy daily, 5 days a week for 3 weeks. 3D conformal radiotherapy, multiple fields and mixed energy (6 and 15 Mv) were used. RESULTS: Radiotherapy allowed significant splenic reduction to almost half the size, resolving abdominal discomfort and improving quality of life. There was no decline of haemoglobin, leukocytes and platelet counts; in fact, there was a marginal increase. CONCLUSION: Palliative splenic irradiation was well tolerated confirming that it is a safe treatment option for palliation of symptomatic splenomegaly. Thereby, splenic irradiation should be strongly considered in the management of symptomatic splenomegaly, for selected patients who are refractory to or unsuitable for other options or when the patient refuses other treatments.
- Prognostic value of MGMT promoter methylation in glioblastoma patients treated with temozolomide-based chemoradiation: a Portuguese multicentre studyPublication . Costa, BM; Caeiro, C; Guimarães, I; Martinho, O; Jaraquemada, T; Augusto, I; Castro, l; Osório, L; Linhares, P; Honavar, M; Resende, M; Nabiço, R; Almeida, R; Alegria, C; Pires, M; Pinheiro, C; Carvalho, E; Lopes, JM; Costa, P; Damasceno, M; Reis, RMGlioblastoma (GBM) is the most common and aggressive primary brain tumor. The identification of novel molecular prognostic markers of GBM has recently been an area of great interest in neuro-oncology. The methylation status of the MGMT gene promoter is currently a promising molecular prognostic marker, but some controversial data have precluded its clinical use. We analyzed MGMT methylation by methylation-specific PCR in 90 GBM patients from four Portuguese hospitals, uniformly treated with radiotherapy combined with concomitant and adjuvant temozolomide (Stupp protocol). The Kaplan-Meier method was used to construct survival curves, and the log-rank test and a Cox-regression model were used to analyze patient survival. The methylation status of MGMT was successfully determined in 89% (80/90) of the tumors. The frequency of tumoral MGMT promoter methylation was 47.5%. The median overall survivals (OSs) were 16 months (95% CI 12.2-19.8) and 13 months (95% CI 13.3-18.7) for patients whose tumors had a methylated or unmethylated MGMT, respectively. Univariate and multivariate analyses did not show any statistically significant association between MGMT methylation status and patient OS (P=0.583 by the log-rank test; P=0.617 by the Cox-regression test) or progression-free survival (P=0.775 by the log-rank test; P=0.691 by the Cox-regression test). None of the patient clinical features were significantly correlated with survival. This is the first study to report the frequency of MGMT methylation among Portuguese GBM patients. Our data did not show statistically significant associations between MGMT promoter methylation and the outcome of GBM patients treated with temozolomide. Additional robust prospective studies are warranted to clarify whether the MGMT status should be used in clinical decisions.
- Should tumbling E go out of date in amblyopia screening? Evidence from a population-based sample normative in children aged 3-4 yearsPublication . Guimarães, S; Fernandes, T; Costa, P; Silva, EAIMS: To determine a normative of tumbling E optotype and its feasibility for visual acuity (VA) assessment in children aged 3-4 years. METHODS: A cross-sectional study of 1756 children who were invited to participate in a comprehensive non-invasive eye exam. Uncorrected monocular VA with crowded tumbling E with a comprehensive ophthalmological examination were assessed. Testability rates of the whole population and VA of the healthy children for different age subgroups, gender, school type and the order of testing in which the ophthalmological examination was performed were evaluated. RESULTS: The overall testability rate was 95% (92% and 98% for children aged 3 and 4 years, respectively). The mean VA of the first-day assessment (first-VA) and best-VA over 2 days' assessments was 0.14 logMAR (95% CI 0.14 to 0.15) (decimal=0.72, 95% CI 0.71 to 0.73) and 0.13 logMAR (95% CI 0.13 to 0.14) (decimal=0.74, 95% CI 0.73 to 0.74). Analysis with age showed differences between groups in first-VA (F(3,1146)=10.0; p<0.001; η2=0.026) and best-VA (F(3,1155)=8.8; p<0.001; η2=0.022). Our normative was very highly correlated with previous reported HOTV-Amblyopia-Treatment-Study (HOTV-ATS) (first-VA, r=0.97; best-VA, r=0.99), with 0.8 to 0.7 lines consistent overestimation for HOTV-ATS as described in literature. Overall false-positive referral was 1.3%, being specially low regarding anisometropias of ≥2 logMAR lines (0.17%). Interocular difference ≥1 line VA logMAR was not associated with age (p=0.195). CONCLUSIONS: This is the first normative for European Caucasian children with single crowded tumbling E in healthy eyes and the largest study comparing 3 and 4 years old testability. Testability rates are higher than found in literature with other optotypes, especially in children aged 3 years, where we found 5%-11% better testability rates.
- Sleeve Gástrico : Resultados e Fatores Preditores de Perda de PesoPublication . Goulart, A; Branco, C; Maia da Costa, J; Manso, F; Pereira, M; Fernandes, A; Costa, P; Leão, P
- Trait determinants of impulsive behavior: a comprehensive analysis of 188 ratsPublication . Soares, AR; Esteves, M; Moreira, PS; Cunha, AM; Guimarães, MR; Carvalho, MM; Raposo-Lima, C; Morgado, P; Carvalho, AF; Coimbra, B; Melo, A; Rodrigues, AJ; Salgado, AJ; Pêgo, JM; Cerqueira, JJ; Costa, P; Sousa, N; Almeida, A; Leite-Almeida, HImpulsivity is a naturally occurring behavior that, when accentuated, can be found in a variety of neuropsychiatric disorders. The expression of trait impulsivity has been shown to change with a variety of factors, such as age and sex, but the existing literature does not reflect widespread consensus regarding the influence of modulating effects. We designed the present study to investigate, in a cohort of significant size (188 rats), the impact of four specific parameters, namely sex, age, strain and phase of estrous cycle, using the variable delay-to-signal (VDS) task. This cohort included (i) control animals from previous experiments; (ii) animals specifically raised for this study; and (iii) animals previously used for breeding purposes. Aging was associated with a general decrease in action impulsivity and an increase in delay tolerance. Females generally performed more impulsive actions than males but no differences were observed regarding delay intolerance. In terms of estrous cycle, no differences in impulsive behavior were observed and regarding strain, Wistar Han animals were, in general, more impulsive than Sprague-Dawley. In addition to further confirming, in a substantial study cohort, the decrease in impulsivity with age, we have demonstrated that both the strain and sex influences modulate different aspects of impulsive behavior manifestations.