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A comparison of estimates of glomerular filtration in critically ill patients with augmented renal clearance

Baptista, JP; Udy, AA; Sousa, E; Pimentel, J; Wang, L; Roberts, JA; Lipman, J
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
INTRODUCTION: Increasingly, derived estimates of glomerular filtration, such as the modification of diet in renal disease (MDRD) equation and Cockcroft-Gault (CG) formula are being employed in the intensive care unit (ICU). To date, these estimates have not been rigorously validated in those with augmented clearances, resulting in potentially inaccurate drug prescription. METHODS: Post-hoc analysis of prospectively collected data in two tertiary level ICU's in Australia and Portugal. Patients with normal serum creatinine concentrations manifesting augmented renal clearance (ARC) (measured creatinine clearance (CLCR) > 130 ml/min/1.73 m2) were identified by chart review. Comparison between measured values and MDRD and CG estimates were then undertaken. Spearman correlation coefficients (rs) were calculated to determine goodness of fit, and precision and bias were assessed using Bland-Altman plots. RESULTS: Eighty-six patients were included in analysis. The median [IQR] measured CLCR was 162 [145-190] ml/min/1.73 m2, as compared to 135 [116-171], 93 [83-110], 124[102-154], and 108 [87-135] ml/min/1.73 m2 estimated by CG, modified CG, 4-variable MDRD and 6-variable MDRD formulae. All of the equations significantly under-estimated the measured value...

Scanning Patterns of Faces do not Explain Impaired Emotion Recognition in Huntington Disease: Evidence for a High Level Mechanism

van Asselen, M; Júlio, F; Januário, C; Campos, EB; Almeida, I; Cavaco, S; Castelo-Branco, M
Fonte: Frontiers Publicador: Frontiers
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
In the current study, we aimed to investigate the emotion recognition impairment in Huntington's disease (HD) patients and define whether this deficit is caused by impaired scanning patterns of the face. To achieve this goal, we recorded eye movements during a two-alternative forced-choice emotion recognition task. HD patients in pre-symptomatic (n = 16) and symptomatic (n = 9) disease stages were tested and their performance was compared to a control group (n = 22). In our emotion recognition task, participants had to indicate whether a face reflected one of six basic emotions. In addition, and in order to define whether emotion recognition was altered when the participants were forced to look at a specific component of the face, we used a second task where only limited facial information was provided (eyes/mouth in partially masked faces). Behavioral results showed no differences in the ability to recognize emotions between pre-symptomatic gene carriers and controls. However, an emotion recognition deficit was found for all six basic emotion categories in early stage HD. Analysis of eye movement patterns showed that patient and controls used similar scanning strategies. Patterns of deficits were similar regardless of whether parts of the faces were masked or not...

Fulminant hepatic failure: a Portuguese experience

Areia, M; Romãozinho, JM; Ferreira, M; Amaro, P; Leitão, M
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2007 Português
BACKGROUND: Fulminant hepatic failure (FHF) is a rare condition. Several series have been reported either by individual centres or in multicentre studies but, to our knowledge, this is the first report from a Portuguese population and might be a good example of FHF cases in a SouthWestern European population. AIMS: To present the experience in FHF of a Portuguese Hepatogastroenterological Intensive Care Unit. MATERIALS AND METHODS: Retrospective study of 61 cases of FHF consecutively admitted between February 1992 and October 2006. Definition and classification of FHF were those suggested by Trey and Davidson (1970) and O'Grady et al. (1993), respectively. Criteria and contraindications for hepatic transplantation (HT) were those proposed by Bernuau et al. (1991) and Muñoz (1993), respectively. RESULTS: Fifty-seven per cent of patients were women and median age was 37 years (range: 8-73). Most common cause of FHF was indeterminate (26%) followed by viral (23%) and drug-induced (23%), with 51% of cases with a hyperacute evolution. Global HT rate was 54% with criteria for HT present in 87% of the patients resulting in an applicability rate of 62%. Overall survival was 69% and transplant-free survival was 15%; transplanted patients had survival rates of 70 and 68% at 6 and 12 months...

Crohn's disease in a southern European country: Montreal classification and clinical activity

Magro, F; Portela, F; Lago, P; Ramos de Deus, J; Vieira, A; Peixe, P; Cremers, I; Cotter, J; Cravo, M; Tavares, L; Reis, J; Gonçalves, R; Lopes, H; Caldeira, P; Ministro, P; Carvalho, L; Azevedo, L; Costa-Pereira, A
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
BACKGROUND: Given the heterogeneous nature of Crohn's disease (CD), our aim was to apply the Montreal Classification to a large cohort of Portuguese patients with CD in order to identify potential predictive regarding the need for medical and/or surgical treatment. METHODS: A cross-sectional study was used based on data from an on-line registry of patients with CD. RESULTS: Of the 1692 patients with 5 or more years of disease, 747 (44%) were male and 945 (56%) female. On multivariate analysis the A2 group was an independent risk factor of the need for steroids (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.3) and the A1 and A2 groups for immunosuppressants (OR 2.2; CI 1.2-3.8; OR 1.4; CI 1.0-2.0, respectively). An L3+L3(4) and L(4) location were risk factors for immunosuppression (OR 1.9; CI 1.5-2.4), whereas an L1 location was significantly associated with the need for abdominal surgery (P < 0.001). After 20 years of disease, less than 10% of patients persisted without steroids, immunosuppression, or surgery. The Montreal Classification allowed us to identify different groups of disease severity: A1 were more immunosuppressed without surgery, most of A2 patients were submitted to surgery, and 52% of L1+L1(4) patients were operated without immunosuppressants. CONCLUSIONS: Stratifying patients according to the Montreal Classification may prove useful in identifying different phenotypes with different therapies and severity. Most of our patients have severe disease.

Fetopatia pelo uso de inibidores da enzima de conversão da angiotensina; Fetopathy associated with exposure to angiotensin converting enzyme inhibitors

Neves, S; Santos, R; Gomes, C; Correia, AJ
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
Angiotensin Converting Enzyme Inhibitors (ACEI) are commonly used antihypertensive drugs, although contraindicated during pregnancy by fetopathy association such as renal dysgenesis, oligohydramnios, hipocalvaria, pulmonary hypoplasia, intrauterine growth restriction, and neonatal anuric renal failure. The authors present a clinical report of a child that developed neonatal anuric renal failure with peritoneal dialysis support by an in uterus exposure to ACEI with very good recovery. This case and literature review states the need to avoid ACEI prescription to Young women and it's suspension as soon as possible during pregnancy.

A genome-wide scan for common alleles affecting risk for autism

Anney, R; Klein, L; Pinto, D; Pegan, R; Magalhães, TR; Almeida, J; Oliveira, G
Fonte: Oxford Journals Publicador: Oxford Journals
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
Although autism spectrum disorders (ASDs) have a substantial genetic basis, most of the known genetic risk has been traced to rare variants, principally copy number variants (CNVs). To identify common risk variation, the Autism Genome Project (AGP) Consortium genotyped 1558 rigorously defined ASD families for 1 million single-nucleotide polymorphisms (SNPs) and analyzed these SNP genotypes for association with ASD. In one of four primary association analyses, the association signal for marker rs4141463, located within MACROD2, crossed the genome-wide association significance threshold of P < 5 × 10(-8). When a smaller replication sample was analyzed, the risk allele at rs4141463 was again over-transmitted; yet, consistent with the winner's curse, its effect size in the replication sample was much smaller; and, for the combined samples, the association signal barely fell below the P < 5 × 10(-8) threshold. Exploratory analyses of phenotypic subtypes yielded no significant associations after correction for multiple testing. They did, however, yield strong signals within several genes, KIAA0564, PLD5, POU6F2, ST8SIA2 and TAF1C.

Genetic screening of Alzheimer's disease genes in Iberian and African samples yields novel mutations in presenilins and APP

Guerreiro, RJ; Baquero, M; Blesa, R; Boada, M; Bras, JM; Bullido, MJ; Calado, A; Crook, R; Ferreira, C; Frank, A; Machado, A; Oliveira, CR; Santana, I
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
Mutations in three genes (PSEN1, PSEN2, and APP) have been identified in patients with early-onset (<65 years) Alzheimer's disease (AD). We performed a screening for mutations in the coding regions of presenilins, as well as exons 16 and 17 of the APP gene in a total of 231 patients from the Iberian peninsular with a clinical diagnosis of early-onset AD (mean age at onset of 52.9 years; range 31-64). We found three novel mutations in PSEN1, one novel mutation in PSEN2, and a novel mutation in the APP gene. Four previously described mutations in PSEN1 were also found. The same analysis was carried in 121 elderly healthy controls from the Iberian peninsular, and a set of 130 individuals from seven African populations belonging to the Centre d'Etude du Polymorphisme Humain-Human Genome Diversity Panel (CEPH-HGDP), in order to determine the extent of normal variability in these genes. Interestingly, in the latter series, we found five new non-synonymous changes in all three genes and a presenilin 2 variant (R62H) that has been previously related to AD. In some of these mutations, the pathologic consequence is uncertain and needs further investigation. To address this question we propose and use a systematic algorithm to classify the putative pathology of AD mutations.

Drenagem pleuro-amniótica; Pleuroamniotic shunting--case report

Rodrigues, CT; Maciel, P; Ribeiro, SC; Carvalho, CL; Correia, JP; Matos, LF; Mesquita, JB; Couceiro, AB; Jardim, FR
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2005 Português
Fetal hydrothorax refers to a collection of fluid within the fetal thorax that may be the result of chylous leak from the thoracic duct (primary hydrothorax) or generalized fluid retention associated with immune or no immune fetal hydrops (secondary hydrothorax). The authors' presents a case report occurred in 2002, of a pregnant woman that at 25 weeks' gestation that was referred to Maternidade Bissaya-Barreto-Coimbra because of a fetal hydrothorax at left, under tension and with cardiac decompensation signs. A fetal thoracocentesis was performed and the diagnosis was chylothorax. Because of a rapid reaccumulation of fluid a pleuroamniotic shunt was placed. The effusion and the cardiac decompensation signs regressed. The delivery was at 38 weeks' gestation. The newborn had been stable. Actually he has 10 months, is healthy and has a normal grow and development.

Isolated anaemia as a manifestation of Rh isoimmunisation

Roda, J; Mimoso, G; Benedito, M; Pereira, DF
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2012 Português
Rh isoimmunisation leads to haemolytic anaemia and hyperbilirubinaemia in the first h of life. Isolated early onset neonatal anaemia has rarely been reported. The authors describe the case of a term infant, born to an 'A' negative, second gravida mother. On the second day of life, pallor was noticed. His haemoglobin (Hb) was 6.8 g/dl, he had reticulocytosis and a positive direct antiglobulin test. However, he did not have a high total serum bilirubin (TSB) (87.2 μmol/l). He was transfused with red blood cells and kept under phototherapy for 3 days. Three weeks later, he received another transfusion for severe anaemia (Hb 6 5 g/dl). During this period, he was never jaundiced and the maximum level of TSB was 122 μmol/l. On follow-up, his Hb stabilised and he had no further problems. This report highlights the possibility of early onset anaemia without jaundice as the sole manifestation of Rh isoimmunisation.

Reconstrução do ligamento patelo-femoral lateral: resultados preliminares

Oliveira, JP; Amaral, P; Rebelo, PE; Fonseca, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2012 Português

Encerramento de feridas com elásticos vasculares “shoelace tecnique”

Rebelo, E; Serrano, P; Garruço, A; Fonseca, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2012 Português

Módulo 4 - 2º Curso de Formação para Internos 2013 - 2014: Cirurgia, Anestesiologia, Ortopedia, Neurocirurgia, Oftalmologia e ORL

Oliveira, G; Bento, C; Rodrigues, F; Brito, MJ; Lopes, MF
Fonte: Centro de Investigação e Formação Clínica Publicador: Centro de Investigação e Formação Clínica
Tipo: Parte de Livro
Publicado em //2014 Português

Why do I perform PFP ?

Fonseca, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2014 Português

Biomechanical properties of fixation methods

Fonseca, F; Completo, A
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2014 Português

Infecção em ATJ - tratamento em dois tempos cirúrgicos

Fonseca, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2013 Português

Osteogénese por distracção – velocidade de crescimento do regenerado ósseo, em pseudartrose séptica da tíbia

Nascimento, M; Carvalho, M; Bento, J; Garruço, A; Fonseca, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2013 Português

Autoria de um Artigo Científico

Donato, H
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2014 Português

Publicações Médicas Nacionais: Passado, Presente e Futuro

Donato, H
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2014 Português

Como tratar a condropatia patelo-femoral?; Treating patellofemoral chondral lesions? Personal experience

Fonseca, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Conferência ou Objeto de Conferência
Publicado em //2015 Português

A tomada de decisão ético-deontológica dos enfermeiros

Morgado, T; Seabra, S; Ferreira, F; Tinoco-Mendes, A; Mateus, F; Pereira, F; Morais, ME
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2014 Português