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The hospital anxiety and depression scale, in patients with multiple sclerosis
Get PDFPurpose: Multiple sclerosis (MS) is a long-lasting disabling disease with psychological implications. Hospital Anxiety and Depression Scale (HADS) is a questionnaire developed to screen anxiety and depression among patients in hospital settings. The objective of this report was to study the metric properties of the Portuguese version of HADS regarding MS.
Materials and methods: This was a cross-sectional study. Three hundred and eighty individuals with a diagnosis of MS, according to the revised McDonald criteria, were recruited from an outpatient Neuroimmunology Clinic of the city of Porto. Participants had a mean age of 40.04 years (SD =10.86), 63.9% of them were female. HADS consists of two subscales - anxiety and depression - scored separately, with seven items each.
Results: The results of our study show the appropriateness of HADS for the identification of mood changes in people with MS and show good metric properties.
Conclusion: It seems to be a useful tool for the scrutiny of mood disorders in Portuguese patients with MS. The questionnaire is also sensitive to disease when compared to people with other severe illnesses, and with people without the disease.info:eu-repo/semantics/publishedVersio
Iron-enriched diet contributes to early onset of osteoporotic phenotype in a mouse model of hereditary hemochromatosis
Get PDFOsteoporosis is associated with chronic iron overload secondary to hereditary hemochromatosis (HH), but the causative mechanisms are incompletely understood. The main objective of this study was to investigate the role of dietary iron on osteoporosis, using as biological model the Hfe-KO mice, which have a systemic iron overload. We showed that these mice show an increased susceptibility for developing a bone loss phenotype compared to WT mice, which can be exacerbated by an iron rich diet. The dietary iron overload caused an increase in inflammation and iron incorporation within the trabecular bone in both WT and Hfe-KO mice. However, the osteoporotic phenotype was only evident in Hfe-KO mice fed the iron-enriched diet. This appeared to result from an imbalance between bone formation and bone resorption driven by iron toxicity associated to Hfe-KO and confirmed by a decrease in bone microarchitecture parameters (identified by micro-CT) and osteoblast number. These findings were supported by the observed downregulation of bone metabolism markers and upregulation of ferritin heavy polypeptide 1 (Fth1) and transferrin receptor-1 (Tfrc), which are associated with iron toxicity and bone loss phenotype. In WT mice the iron rich diet was not enough to promote a bone loss phenotype, essentially due to the concomitant depression of bone resorption observed in those animals. In conclusion the dietary challenge influences the development of osteoporosis in the HH mice model thus suggesting that the iron content in the diet may influence the osteoporotic phenotype in systemic iron overload conditions.his research was partially supported by National Funds through Foundation for Science and Technology (FCT), under the project “CCMAR/Multi/04326/2013” and Norte-01-0145-FEDER-000012 –“Structured program on bioengineered therapies for infectious diseases and tissue regeneration”. M. Simão was supported by a PhD fellowship from the Portuguese Foundation for Science and Technology (FCT) with the reference SFRH/BD/77056/2011. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio
Femoral neck stress fracture in a young female recruit: case report
Get PDFIntroduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity. Their prevalence is higher among runners and military recruits, and women seem to be at higher risk.
Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture.
Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture.
Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.info:eu-repo/semantics/publishedVersio
Anuário Científico do CHP 2017
No full textO Anuário Científico de 2017 é um documento integrador da produção científica do Centro Hospitalar do Porto (CHP). O Gabinete Coordenador da Investigação do Departamento de Ensino, Formação e Investigação (DEFI), com a edição deste anuário, pretende partilhar a atividade científica hospitalar com a comunidade e os seus profissionaisinfo:eu-repo/semantics/publishedVersio
Peritoneal Dialysis in the elderly: challenge accepted
Get PDFAt present, mostly in Western countries, age is no longer an absolute limitation for renal replacement therapy (RRT); however, some elderly patients are still not considered for peritoneal dialysis (PD), mainly due to late referral, social isolation, low functional capacity or lower life expectancy. In this review, we address the challenges posed by older patients on PD programs, focusing on a SWOT (strengths, weaknesses, opportunities and threats) analysis and illustrate how PD may have successful outcomes in this population, worldwide and in Portugal. Finally, we will enumerate strategies to overcome the barriers to this technique. From January to December 2017, we conducted a systematic review of the literature using MEDLINE, the Cochrane Library and Web of Knowledge. Studies on PD and HD were included. All searches were limited to English and Portuguese and were augmented by review of bibliographic references from the studies included. Findings concerning modality superiority and better outcome in older people are still scarce and controversial, however according to several well-established PD programs worldwide, including assisted PD, elderly patients presented similar technique survival, hospitalization rates and frequency of peritonitis as compared to younger PD patients and HD patients. As expected, older patients had higher mortality though, especially in patients with more comorbidities. On the other hand, PD was associated with less cognitive loss and showed benefit in perceived quality of life. In Portugal, the low utilization of PD and the patients’ age discrepancy between both modalities explains the limited literature and the discrepante results (some studies show lower peritonitis rate, superior technique and patient survival and others presente higher hospitalization episodes and mortality rates); however, it appears to be a good (cost-effective) option for elderly patients. Overall, PD is an equally suitable modality for elderly patients in the long term.info:eu-repo/semantics/publishedVersio
The Core Techniques of Morenian Psychodrama: A Systematic Review of Literature
Get PDFThe original theory of psychodrama proposed by Moreno in 1921 has been adjusted and re-interpreted by several authors over the last three decades. This resulted in the proliferation of techniques whose definitions and contexts of application are unclear and poorly documented in the literature. The purpose of this review was three-fold: (1) to identify the psychodramatic techniques currently used for research and clinical purposes, (2) to extract and create a list of core techniques which are consensually used by psychodramatists, and which reflect the main principles of the Morenian theory of psychodrama, and (3) to propose an operationalised definition of the core psychodramatic techniques identified. To achieve this, a systematic review was conducted, according to the PRISMA guidelines (Moher et al., 2009). The search was conducted between June and September of 2012 in the main electronic databases (e.g., PubMed, Embase, PsychINFO) and using the following keywords: "psychodrama," "group psychotherapy," "experiential psychotherapy," "Moreno," "intervention," and "techniques." Fifty-six techniques were extracted from the 21 papers selected for review. Of these, a preliminary list of 30 techniques was selected, which was reduced to a total of 11 core techniques: soliloquy, double, mirror, role reversal, resistance interpolation, sculpture, social atom, intermediate objects, games, sociometry, role training. The credibility of this final core list was first checked with an expert in Morenian psychodrama, and later discussed with a network of 22 European psychodramatists to ensure full consensus. Overall, this review provides a contemporary framework for psychodramatists that reconciles the current approaches to psychodrama with the core techniques proposed by Moreno, and updates the definitions of these techniques, by merging the interpretations of different experts in the field. To have a list of core techniques which is consensually accepted from an international point of view is paramount not only for future research, but also for training purposes. The implications of this review for clinical practice are also discussed.No funding was received for this study, nor for the Ph.D. project from which this study derived. CS is currently receiving funding from the Portuguese Foundation for Science and Technology (FCT UID/PSI/00050/2013 and EU FEDER and COMPETE programmes (POCI-01-0145-FEDER-007294).info:eu-repo/semantics/publishedVersio
The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis
Get PDFBackground: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia.
Methods and findings: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria.
Conclusion: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.info:eu-repo/semantics/publishedVersio
The association between 25(OH)D levels, frailty status and obesity indices in older adults
Get PDFBackground: Vitamin D deficiency is common in older adults and has been linked with frailty and obesity, but it remains to be studied whether frail obese older adults are at higher risk of vitamin D deficiency. Therefore, the aim of this study is to explore the association between frailty, obesity indices and serum 25(OH)D concentrations.
Methods: 1447 individuals with 65 years or older, participating in a cross-sectional study (Nutrition UP 65) were included. Frailty, according to Fried et al., body mass index (BMI), waist circumference (WC), body roundness index (BRI) and body shape index (ABSI) were evaluated. A stepwise multinomial logistic regression was carried out to quantify the association between 25(OH)D quartiles and independent variables.
Results: Median 25(OH)D levels were lower in individuals presenting both frailty and obesity (p<0.001). In the multivariate analysis, pre-frailty (OR: 2.65; 95% CI: 1.63-4.33) and frailty (OR: 3.77; 95% CI: 2.08-6.83) were associated with increased odds of lower 25(OH)D serum levels (first quartile). Regarding obesity indices, the highest categories of BMI (OR: 1.74; 95% CI: 1.06-2.86), WC (OR: 3.46; 95% CI: 1.95-6.15), BRI (OR: 4.35; 95% CI: 2.60-7.29) and ABSI (OR: 3.17 95% CI: 1.86-5.38) were directly associated with lower 25(OH)D serum levels (first quartile).
Conclusions: A positive association between frailty or obesity and lower vitamin D levels was found. Moreover, besides BMI and WC, other indicators of body adiposity, such as BRI and ABSI, were associated with lower 25(OH)D serum concentrations.info:eu-repo/semantics/publishedVersio
Metabolic control of T cell immune response through glycans in inflammatory bowel disease
Get PDFMucosal T lymphocytes from patients with ulcerative colitis (UC) were previously shown to display a deficiency in branched N-glycosylation associated with disease severity. However, whether this glycosylation pathway shapes the course of the T cell response constituting a targeted-specific mechanism in UC remains largely unknown. In this study, we demonstrated that metabolic supplementation of ex vivo mucosal T cells from patients with active UC with N-acetylglucosamine (GlcNAc) resulted in enhancement of branched N-glycosylation in the T cell receptor (TCR), leading to suppression of T cell growth, inhibition of the T helper 1 (Th1)/Th17 immune response, and controlled T cell activity. We further demonstrated that mouse models displaying a deficiency in the branched N-glycosylation pathway (MGAT5-/-, MGAT5+/-) exhibited increased susceptibility to severe forms of colitis and early-onset disease. Importantly, the treatment of these mice with GlcNAc reduced disease severity and suppressed disease progression due to a controlled T cell-mediated immune response at the intestinal mucosa. In conclusion, our human ex vivo and preclinical results demonstrate the targeted-specific immunomodulatory properties of this simple glycan, proposing a therapeutic approach for patients with UC.We thank Dr. Hiroaki Korekane and Fumi (RIKEN) for
support in preparation of the fluorescent oligosaccharide acceptor substrate.
We thank Dr. Michael Pierce for kindly providing the MGAT5 knockout mice.
We also thank Paula Paíga (REQUIMTE/LAQV) for technical support with the
HPLC system. The Institute of Molecular Pathology and Immunology of the
University of Porto integrates the i3S research unit, which is partially supported
by the Portuguese Foundation for Science and Technology (FCT). This
article is a result of the project NORTE-01-0145-FEDER-000029, supported by
the Norte Portugal Regional Programme (NORTE 2020) under the PORTUGAL
2020 Partnership Agreement through the European Regional Development
Fund. This work was also funded by Fundo Europeu de Desenvolvimento Regional
(FEDER) funds through the COMPETE 2020—Operacional Programme
for Competitiveness and Internationalization (POCI), Portugal 2020, and by
Portuguese funds through the FCT in the framework of the project (POCI-01/
0145-FEDER-016601 and PTDC/DTP-PIC/0560/2014). S.S.P. acknowledges the European
Crohn’s and Colitis Organization (ECCO) for ECCO Grant 2017, the
Broad Medical Research Program at the Crohn’s and Colitis Foundation of
America, and the Portuguese Group of Study in IBD (GEDII) for funding.
A.M.D. [PD/BD/105982/2014], A.C. [SFRH/BPD/91623/2012], and M.S.P. [SFRH/
BD/110148/2015] received funding from the FCT. M. Lima thanks the CHP for
the research support.info:eu-repo/semantics/publishedVersio
Sutura de Pereira modificada como uma opção eficaz para tratar a hemorragia causada por atonia uterina
Get PDFNowadays, postpartum hemorrhage is the major cause of maternal mortality and morbidity worldwide. Uterine atony is its main cause; thus, prophylactic measures, as well as medical and surgical fast approaches, have been developed to manage it. The uterine compression sutures are a possible treatment that preserves the uterus and, consequently, the fertility potential. Bearing that in mind, we report two cases of postpartum hemorrhage after caesarean section, successfully treated with a new modification of Pereira suture - longitudinal and transverse uterine sutures were applied after no response was registered to the first-line therapies. Both women recovered, and the postpartum evaluation revealed a normal uterus with an adequate blood supply, suggesting potential fertility, as described in the literature regarding this kind of therapeutic approach.Atualmente, a hemorragia pós-parto é a maior causa de morbimortalidade materna em todo o mundo. Sua principal causa é a atonia uterina, pelo que têm sido instituídas e desenvolvidas medidas profiláticas, bem como tratamentos médicos e cirúrgicos para esta complicação. As suturas uterinas de compressão representam uma possibilidade terapêutica que permite a preservação do útero e, por conseguinte, do potencial fértil. Tendo isso por base, apresentamos dois casos de hemorragia pós-parto após cesariana, que foram tratados com sucesso com uma nova modificação da sutura de Pereira — suturas uterinas longitudinais e transversais foram efetuadas após falha das terapias de primeira linha. Ambas as pacientes se recuperaram, e na reavaliação pós-parto objetivou-se um útero normal com manutenção de uma irrigação adequada, sugerindo a preservação do seu potencial fértil, tal como vem sendo descrito na literatura em relação a este tipo de procedimento.info:eu-repo/semantics/publishedVersio