Browsing by Author "Nogueira-Silva, C"
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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
- Diabetes gestacional: determinação de fatores de risco para diabetes mellitusPublication . Carvalho, AM; Nogueira-Silva, C; Melo-Rocha, G; Pereira, ML; Rocha, AObjetivos Identificar fatores preditivos do desenvolvimento de diabetes mellitus (DM) em mulheres com antecedentes de diabetes gestacional (DG). Tipo de estudo Estudo observacional, analítico, retrospetivo e de coorte. Local Hospital de Braga. População Amostra aleatória de 300 mulheres, nascidas antes de 1995, com diagnóstico de DG entre 1 de janeiro de 2001 e 31 de dezembro de 2010 e seguimento da gravidez no Hospital de Braga. Métodos Os dados foram obtidos através da consulta de processos clínicos. A lista de doentes com DM, referente ao ano de 2011, foi utilizada para verificação do desenvolvimento da doença no grupo selecionado. Foram analisados o perfil sociodemográfico, os antecedentes pessoais, familiares e obstétricos e outros fatores anteparto. Foi realizada uma análise descritiva univariada e bivariada. Seguidamente foi criado um modelo de regressão logística binária para identificar potenciais preditores de desenvolvimento de DM tipo 2. Resultados Trinta e dois vírgula sete por cento das mulheres desenvolveu DM. A probabilidade de desenvolvimento de DM após DG aumentou 8,2 vezes quando idade gestacional menor que 24 semanas no momento do diagnóstico (OR = 8,19; p < 0,001), 3,4 vezes se necessidade de insulinoterapia (OR = 3,36; p < 0,001) e 3,1 vezes se índice de massa corporal (IMC) prévio = 26,4 kg/m2 (OR = 3,07; p = 0,003). História familiar de DM tipo 2, 4 valores elevados na prova de tolerância oral à glicose, valor de glicemia em jejum, idade materna no momento do diagnóstico e IMC pós-parto, apesar de apresentarem associação com desenvolvimento de DM não se revelaram seus preditores. Não se verificou associação entre gravidez prévia ou diagnóstico prévio de DG com desenvolvimento de DM. Conclusões Em mulheres com DG, a idade gestacional menor que 24 semanas no momento do diagnóstico, a necessidade de insulinoterapia e o IMC prévio = 26,4 kg/m2 apresentaram-se como fatores de risco para desenvolvimento de DM. Aims: To identify predictive factors to diabetes mellitus (DM) development in women with history of gestational diabetes (GD). Study design: An observational, analytic, cohort retrospective study. Local: Hospital of Braga. Population: A random sample of 300 women, born before 1995, with GD diagnosed since January 1, 2001 to December 31, 2010 and pregnancy surveillance in a public Hospital of Braga. Methods: Data was collected by consultation of medical records. The DM patients’ list of 2011 was used to verification of the disease development in the selected group. Sociodemographic profile, personal, family and obstetric history, and other antepartum factors were analyzed. A univariate descriptive analysis and a bivariate analysis were performed. A binary logistic regression model was created to identify potential predictors of type 2 DM development. Results: 32.7% of women developed DM. The probability of DM development after GD was increased 8.2 times when gestational age at diagnosis was less than 24 weeks (OR = 8.19; p < 0.001), 3.4 times with the need of insulin therapy (OR = 3.36; p < 0.001) and 3.1 times with previous pregnancy body mass index (BMI) ≥ 26.4 kg/m2 (OR = 3.07; p = 0.003). Although family history of type 2 DM, maternal age at diagnosis, postpartum BMI, 4 abnormal values in the diagnostic oral glucose tolerance test and fasting glucose level had presented association with DM development, did not present as its predictors. It was not verified association between previous pregnancy or previous GD diagnosis and DM development. Conclusions: In women with GD, gestational age at diagnosis less than 24 weeks, need of insulin therapy and previous pregnancy BMI ≥ 26.4 kg/m2 were presented as risk factors to DM development.
- Episiotomy: early maternal and neonatal outcomes of selective versus routine usePublication . Coutada, RS; Nogueira-Silva, C; Rocha, AOverview and aims: Episiotomy is one of the most common procedures in Obstetrics, despite actual scientific evidence does not support its routine practice.The aim of this study was to determine the impact of selective and routine practice of episiotomy in early maternal and neonatal outcomes. Study design:An observational, transversal, descriptive and analytic study was conducted in two public Hospitals in northern Portugal, with different policies for the practice of episiotomy: selective practice (Hospital A) and routine practice (Hospital B). Population: A non-random sampling of convenience of the whole puerperal women whose deliveries was performed in these hospitals during months of July and August 2011 was utilized. A total of 397 women was analyzed, 200 in selective group and 197 in routine group. Methods: Data was collected by consultation of medical records of the puerperal women. Comparison between hospitals was performed with the chi-square test. Results: The groups were similar for the obstetric history, demographic, biometric, pregnancy and labor characteristics. However, gestational age, weight and head circumference of newborns as well as instrumentation rate were significantly higher in selective group. Episiotomy was performed in 72.5% cases of selective group and in 88.8% of routine group (p≤0.001).There wasless perinealsuturing (p=0.001) and a greater number of intact perineum in selective group (p≤0.001), without differences in lacerations type or degree. The routine group presented more frequent early perineal complications and higher pain levels in the first postpartum day (p≤0.001). No differences were found between groups in Apgar scores, neonatal trauma and Neonatal Intensive Care Unit admissions number. Conclusions: The selective use of episiotomy was associated with better early maternal outcomes, with no differences in neonatal morbidity. Thus, the routine practice of episiotomy showed no benefits
- Ghrelin and obestatin: Different role in fetal lung development?Publication . Nunes, S; Nogueira-Silva, C; Dias, E; Moura, RS; Correia-Pinto, JGhrelin and obestatin are two proteins that originate from post-translational processing of the preproghrelin peptide. Various authors claim an opposed role of ghrelin and obestatin in several systems. Preproghrelin mRNA is significantly expressed in airway epithelium throughout lung development, predominantly during the earliest stages. The aim of this study was to evaluate the role of ghrelin and obestatin in fetal lung development in vitro. Immunohistochemistry studies were performed at different gestational ages in order to clarify the expression pattern of ghrelin, GHS-R1a, obestatin and GPR39 during fetal lung development. Fetal rat lung explants were harvested at 13.5 days post-conception (dpc) and cultured during 4 days with increasing doses of total ghrelin, acylated ghrelin, desacyl-ghrelin, ghrelin antagonist (D-Lys(3)-GHRP-6) or obestatin. Immunohistochemistry studies demonstrated that ghrelin, GHS-R1a, obestatin and GPR39 proteins were expressed in primitive rat lung epithelium throughout all studied gestational ages. Total and acylated ghrelin supplementation significantly increased the total number of peripheral airway buds, whereas desacyl-ghrelin induced no effect. Moreover, GHS-R1a antagonist significantly decreased lung branching. Finally, obestatin supplementation induced no significant effect in the measured parameters. The present study showed that ghrelin has a positive effect in fetal lung development through its GHS-R1a receptor, whereas obestatin has no effect on lung branching.
- Leukemia inhibitory factor in rat fetal lung development: expression and functional studiesPublication . Nogueira-Silva, C; Piairo, P; Carvalho-Dias, E; Peixoto, FO; Moura, RS; Correia-Pinto, JBACKGROUND: Leukemia inhibitory factor (LIF) and interleukin-6 (IL-6) are members of the family of the glycoprotein 130 (gp130)-type cytokines. These cytokines share gp130 as a common signal transducer, which explains why they show some functional redundancy. Recently, it was demonstrated that IL-6 promotes fetal lung branching. Additionally, LIF has been implicated in developmental processes of some branching organs. Thus, in this study LIF expression pattern and its effects on fetal rat lung morphogenesis were assessed. METHODOLOGY/PRINCIPAL FINDINGS: LIF and its subunit receptor LIFRα expression levels were evaluated by immunohistochemistry and western blot in fetal rat lungs of different gestational ages, ranging from 13.5 to 21.5 days post-conception. Throughout all gestational ages studied, LIF was constitutively expressed in pulmonary epithelium, whereas LIFRα was first mainly expressed in the mesenchyme, but after pseudoglandular stage it was also observed in epithelial cells. These results point to a LIF epithelium-mesenchyme cross-talk, which is known to be important for lung branching process. Regarding functional studies, fetal lung explants were cultured with increasing doses of LIF or LIF neutralizing antibodies during 4 days. MAPK, AKT, and STAT3 phosphorylation in the treated lung explants was analyzed. LIF supplementation significantly inhibited lung growth in spite of an increase in p44/42 phosphorylation. On the other hand, LIF inhibition significantly stimulated lung growth via p38 and Akt pathways. CONCLUSIONS/SIGNIFICANCE: The present study describes that LIF and its subunit receptor LIFRα are constitutively expressed during fetal lung development and that they have an inhibitory physiological role on fetal lung
- Local Fetal Lung Renin-Angiotensin System as a Target to Treat Congenital Diaphragmatic HerniaPublication . Nogueira-Silva, C; Carvalho-Dias, E; Piairo, P; Nunes, S; Baptista, MJ; Moura, RS; Correia-Pinto, JAntenatal stimulation of lung growth is a reasonable approach to treat congenital diaphragmatic hernia (CDH), a disease characterized by pulmonary hypoplasia and hypertension. Several evidences from the literature demonstrated a possible involvement of renin-angiotensin system (RAS) during fetal lung development. Thus, the expression pattern of renin, angiotensin-converting enzyme, angiotensinogen, type 1 (AT(1)) and type 2 (AT(2)) receptors of angiotensin II (ANGII) was assessed by immunohistochemistry throughout gestation, whereas the function of RAS in the fetal lung was evaluated using fetal rat lung explants. These were morphometrically analyzed and intracellular pathway alterations assessed by Western blot. In nitrofen-induced CDH model, pregnant rats were treated with saline or PD-123319. In pups, lung growth, protein/DNA ratio, radial saccular count, epithelial differentiation and lung maturation, vascular morphometry, right ventricular hypertrophy and overload molecular markers, gasometry and survival time were evaluated. Results demonstrated that all RAS components were constitutively expressed in the lung during gestation and that ANGII had a stimulatory effect on lung branching, mediated by AT(1) receptor, through p44/42 and Akt phosphorylation. This stimulatory effect on lung growth was mimicked by AT(2)-antagonist (PD-123319) treatment. In vivo antenatal PD-123319 treatment increased lung growth, ameliorated indirect parameters of pulmonary hypertension, improved lung function and survival time in non-ventilated CDH pups, without maternal or fetal deleterious effects. Therefore, this study demonstrated a local and physiologically active RAS during lung morphogenesis. Moreover, selective inhibition of AT(2) receptor is presented as a putative antenatal therapy for CDH.
- Neuroendocrine factors regulate retinoic acid receptors in normal and hypoplastic lung developmentPublication . Pereira-Terra, P; Moura, RS; Nogueira-Silva, C; Correia-Pinto, JRetinoic acid (RA) and ghrelin levels are altered in human hypoplastic lungs when compared to healthy lungs. Although considerable data have been obtained about RA, ghrelin and bombesin in the congenital diaphragmatic hernia (CDH) rat model, neuroendocrine factors have never been associated with the RA signalling pathway in this animal model. In this study, the interaction between neuroendocrine factors and RA was explored in the CDH rat model. The authors found that normal fetal lung explants treated with RA, bombesin and ghrelin showed an increase in lung growth. Hypoplastic lungs presented higher expression levels of the RA receptors α and γ. Moreover bombesin and ghrelin supplementation, in vitro, to normal lungs increased RA receptor α/γ expression whereas administration of bombesin and ghrelin antagonists to normal and hypoplastic lungs decreased it. These data reveal for the first time that there is a link between neuroendocrine factors and RA, and that neuroendocrine factors sensitise the lung to the RA action through RA receptor modulation.
- Prevalence of bacterial vaginosis in Portuguese pregnant women and vaginal colonization by Gardnerella vaginalisPublication . Machado, D; Castro, J; Martinez-de-Oliveira, J; Nogueira-Silva, C; Cerca, NBACKGROUND: We aimed to determine the prevalence of vaginal colonization by Gardnerella vaginalis and of bacterial vaginosis (BV) in Portuguese pregnant women, and to identify risk factors for BV and G. vaginalis colonization in pregnancy. METHODS: A cross-sectional study was conducted among pregnant women aged ≥ 18 years who were attending in two public hospitals of the Northwest region of Portugal. Epidemiological data was collected by anonymous questionnaire. BV was diagnosed by Nugent criteria and G. vaginalis presence was identified by polymerase chain reaction. Crude associations between the study variables and BV or G. vaginalis colonization were quantified by odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: The prevalences of BV and of G. vaginalis colonization among Portuguese pregnant women were 3.88% and 67.48%, respectively. Previous preterm delivery and colonization by G. vaginalis were factors with very high OR, but only statistically significant for a 90% CI. Conversely, higher rates of G. vaginalis colonization were found in women with basic educational level (OR = 2.77, 95% CI [1.33-5.78]), during the second trimester of pregnancy (OR = 6.12, 95% CI [1.80-20.85]) and with BV flora (OR = 8.73, 95% CI [0.50-153.60]). DISCUSSION: Despite the lower number of women with BV, prevalence ratios and association with risk factors were similar to recent European studies. However, the percentage of healthy women colonized by G. vaginalis was significantly higher than many previous studies, confirming that G. vaginalis colonization does not always lead to BV development.
- Risk Factors for Persistent Postsurgical Pain in Women Undergoing Hysterectomy Due to Benign Causes: A Prospective Predictive StudyPublication . Pinto, PR; McIntyre, T; Nogueira-Silva, C; Almeida, A; Araújo-Soares, VPersistent postsurgical pain (PPSP) is a major clinical problem with significant individual, social, and healthcare costs. The aim of this study was to examine the role of demographic, clinical, and psychological risk factors in the development of PPSP after hysterectomy due to benign disorders. In a prospective study, a consecutive sample of 186 women was assessed 24 hours before surgery (T1), 48 hours after surgery (T2), and 4 months after surgery (T3). Regression analyses were performed to identify predictors of PPSP. Four months after hysterectomy, 93 (50%) participants reported experiencing pain (numerical rating scale >0). Age, pain due to other causes, and type of hysterectomy emerged as significant predictive factors. Baseline presurgical psychological predictors identified were anxiety, emotional illness representation of the condition leading to surgery, and pain catastrophizing. Among the identified psychological predictors, emotional illness representation emerged as the strongest. Acute postsurgical pain frequency and postsurgical anxiety also revealed a predictive role in PPSP development. These results increase the knowledge on PPSP predictors and point healthcare professionals toward specific intervention targets such as anxiety (presurgical and postsurgical), pain catastrophizing, emotional illness representations, and acute pain control after surgery. PERSPECTIVE: This study found that presurgical anxiety, emotional illness representations, and pain catastrophizing are risk factors for PPSP 4 months after hysterectomy, over and above age and clinical variables. These findings improve knowledge on PPSP and highlight potential intervention targets for healthcare professionals.
- Role of the RAD51 G172T polymorphism in the clinical outcome of cervical cancer patients under concomitant chemoradiotherapyPublication . Nogueira, A; Catarino, R; Faustino, I; Nogueira-Silva, C; Figueiredo, T; Lombo, L; Hilário-Silva, I; Pereira, D; Medeiros, RINTRODUCTION: Cervical cancer is one of the most common cancers diagnosed in women worldwide. Mammalian cells are constantly exposed to a wide variety of genotoxic agents from both endogenous and exogenous sources. The RAD51 protein is required for meiotic and mitotic recombination and plays a central role in homology-dependent recombinational repair of double-strand breaks (DSBs). Given the functional relevance of the DNA repair system on carcinogenesis, potential associations between genetic polymorphisms of DNA repair genes, cancer risk and response to therapy have been intensively evaluated. This is the first study evaluating the role of the RAD51 G172T genetic variants in cancer prognosis and clinical outcome of cervical cancer patients. MATERIAL AND METHODS: We analyzed RAD51 G172T polymorphism genotypes in cervical cancer patients who underwent a platinum-based chemotherapy in combination with radiotherapy. Genotyping was performed by Taqman™ Allelic Discrimination methodology. RESULTS AND DISCUSSION: Concerning the overall survival rates found using Kaplan-Meier method and Log Rank Test, we observed that the mean survival rates were statistically different according to the patients RAD51 genotypes. The group of patients carrying the T allele present a higher mean survival rate than the other patients (102.3months vs. 86.4months, P=0.020). Using the Cox regression analysis, we found an increased overall survival time for T-carrier patients, when compared with GG genotype, with tumor stage, age and presence of lymph nodes as covariates [hazard ratio (HR), 0.373; 95% CI, 0.181-0.770; P=0.008]. Among patients (n=193), RAD51 genotype frequency distributions were not under the influence of clinicopathologic characteristics, namely, treatment response (P=0.508), recurrence (P=0.150) and tumor stage (P=0.250). CONCLUSIONS: This is the first study evaluating the role of the RAD51 G172T genetic variants in cancer prognosis and clinical outcome of cervical cancer patients. Our results indicate an influence of the RAD51 genetic variants in overall survival of cervical cancer. Thereby, RAD51 G172T genotypes may provide additional prognostic information in cervical cancer patients who underwent cisplatin-based chemotherapy in combination with radiotherapy.