Browsing by Issue Date, starting with "2010"
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- Helicobacter pylori colonization of the adenotonsillar tissue: fact or fiction?Publication . Vilarinho, S; Guimarães, NM; Ferreira, RM; Gomes, B; Wen, XG; Vieira, MJ; Carneiro, F; Godinho, T; Figueiredo, COBJECTIVE: The transmission of the gastric pathogen Helicobacter pylori involves the oral route. Molecular techniques have allowed the detection of H. pylori DNA in samples of the oral cavity, although culture of H. pylori from these type of samples has been sporadic. Studies have tried to demonstrate the presence of H. pylori in adenotonsillar tissue, with contradictory results. Our aim was to clarify whether the adenotonsillar tissue may constitute an extra gastric reservoir for H. pylori. METHODS: Sixty-two children proposed for adenoidectomy or tonsillectomy were enrolled. A total of 101 surgical specimens, 55 adenoid and 46 tonsils, were obtained. Patients were characterized for the presence of anti-H. pylori antibodies by serology. On each surgical sample rapid urease test, immunohistochemistry, fluorescence in situ hybridization (FISH) with a peptide nucleic acid probe for H. pylori, and polymerase chain reaction-DNA hybridization assay (PCR-DEIA) directed to the vacA gene of H. pylori were performed. RESULTS: Thirty-nine percent of the individuals had anti-H. pylori antibodies. Rapid urease test was positive in samples of three patients, all with positive serology. Immunohistochemistry was positive in samples of two patients, all with negative serology. All rapid urease test or immunohistochemistry positive cases were negative by FISH. All samples tested were negative when PCR-DEIA for H. pylori detection was used directly in adenotonsillar specimens. CONCLUSIONS: The adenotonsillar tissue does not constitute an extra gastric reservoir for H. pylori infection, at least a permanent one, in this population of children. Moreover, techniques currently used for detecting gastric H. pylori colonization are not adequate to evaluate infection of the adenotonsillar tissues.
- Cortical linear lesions in Wernicke's encephalopathy: can diffusion-weighted imaging herald prognostic information?Publication . Machado, A; Ribeiro, M; Soares-Fernandes, J; Cerqueira, J; Mare, R
- Metástases Raras de Carcinoma da Mama: A propósito de um caso clínicoPublication . Ribas, S; Silva, E; Carneiro, T; Luís, D; Gomes, A
- Preditores de demora pré-hospitalar em doentes com enfarte agudo do miocárdio com elevação do segmento STPublication . Ribeiro, S; Gaspar, A; Rocha, S; Nabais, S; Azevedo, P; Salgado, A; Pereira, MA; Correia, ABACKGROUND: Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis. METHODS: We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007. The cutoff for longer pre-hospital delay was defined as three hours. We analyzed demographic, clinical and echocardiographic data and determined the predictors of pre-hospital delay of > or = 3 h. RESULTS: Of the 797 patients, 77% were male and mean age was 62 +/- 13.64 years. Patients with longer pre-hospital delay were older (p < 0.001), with a higher proportion of female (p = 0.001), hypertensive (p = 0.002), diabetic (p < 0.001), and surgically revascularized patients (p = 0.007), and those with symptom onset between 10 pm and 8 am (p = 0.001). The group with shorter pre-hospital delay included more men (p = 0.001), patients with prior myocardial infarction (p = 0.025) and smokers (p = 0.009). Independent predictors of pre-hospital delay of 3 h included female gender (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.03-2.16), diabetes (OR 1.78, 95% CI 1.23-2.56), systemic arterial hypertension (OR 1.41, 95% CI 1.04-1.93), and symptom onset between 10 pm and 8 am (OR 1.76, 95% CI 1.31-2.38). Independent predictors of pre-hospital delay of > or = 3 h included male gender (OR 0.67, 95% CI 0.46-0.97) and prior myocardial infarction (OR 0.48, 95% CI 0.27-0.84). Reperfusion therapy was performed in 72%, 52% and 12% of patients with pre-hospital delay of <3 h, 3-12 h and >12 h, respectively (p for trend <0.001). Patients with longer delay more often had severely reduced left ventricular ejection fraction (LVEF) (p = 0.004). A non-significant trend was observed towards increased in-hospital mortality with longer delay (8.3% vs. 6.6%, p for trend = 0.342). CONCLUSIONS: A significant proportion of patients continue to have long pre-hospital delay. Female patients and those with diabetes, systemic arterial hypertension and symptom onset between 10 pm and 8 am made up the majority of this group. Longer pre-hospital delay was associated with a lower probability of being treated with reperfusion therapy, a higher frequency of severely depressed LVEF and a non-significant increase in in-hospital mortality. It is essential to develop mechanisms to reduce pre-hospital delay.
- Methylaminolevulinate photodynamic therapy for granuloma annulare: A case reportPublication . Rocha, J; Brito, C; Ventura, F; Duarte, ML
- Afastadores interespinhosos resultados e indicações cirúrgicosPublication . Morais, N; Moreira da Costa, JA
- Hypochondriacal symptoms as the first sign of frontotemporal dementiaPublication . Machado, A; Simões, S
- Fraqueza Muscular Adquirida nos Cuidados Intensivos: Sub ou Sobrediagnosticada?Publication . Morgado, S; Moura, SIntensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem, associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a wide range of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”, “critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, these designations are considered somewhat restrictive, therefore most authors adopt the more wide range designation of “ICU-Acquired Weakness”.Generally, these patients have a flacid tetraparesis without cranial nerve palsy, normal or diminished osteotendinous reflexes and no sensitive alterations unless on the cases traditionally classified as polyneuropathy. The diagnosis of ICU-AW is often difficult, and should be suspected whenever a critical ill patient has unexplained weakness. Traditionally, the diagnosis of neuromuscular diseases is based in nerve conduction studies and electromyography. Muscle biopsy can be used to confirm or exclude myopathy, but is not a routine exam. Since there is a significant percentage of critical patients that develop muscle weakness it is important to screen all patients in the ICU, avoid potential toxic re-exposures on the identified patients and begin early rehabilitation. However, two questions arise from this screening: if the screening is only clinical are we underestimating these patients? If electrophysiological are we overestimating ICU-AW? There are no specific therapies for ICU-AW. The criterious use of some drugs is one of the possible measures to be taken. On the other hand, the early inclusion of these patients in a rehabilitation program seems to be helpful for a speedy functional recovery. There are few studies regarding ICU-AW, and systematic studies with longer follow-ups and bigger samples are necessary to determine the most effective rehabilitation approach for these patients.
- Efficacy and safety of etanercept in patients with psoriasis and hepatitis CPublication . Ventura, F; Gomes, J; Duarte, ML; Fernandes, JC; Brito, C