ESSA - Resumos Indexados à WoS/Scopus
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- Contribution of red cell mass and UGT1A1 alleles in serum bilirubin levels of the portuguese populationPublication . Rodrigues, Carina; Costa, Elísio; Santos-Silva, Alice; Santos, Rosário; Bronze-da-Rocha, ElsaHepatic glucuronization of insoluble bilirubin is catalyzed by isoenzyme 1A1 of UDP-glucuronosyltransferase (UGT1A1), which is essential for efficient biliary excretion of bilirubin. The main cause of Gilbert syndrome (GS) in all populations studied to date is a TA duplication [(TA)7 allele] in the repetitive TATA-box sequence of the gene promoter, which normally consists of six TA repeats. However, this genetic polymorphism is not sufficient for the clinical phenotype of GS. By this reason, some studies have been performed to provide information about additional factors that could contribute to the pathogenesis of this disease. Recently, it was described that increased red cell mass probably plays a role in the pathogenesis of GS (Buyukasik et al. 2008 Am J Med Sci. 335,115-119). The aim of this work is to investigate the putative role of increased red cell mass and the (TA)7 allele in bilirubin serum levels, in the Portuguese population. This study was performed in 109 volunteer healthy young adults (20.3±1.9 years) without liver and/or hematological disorders, chronic infection, recent inflammation, malignancy, hemorrhage and medication. Blood samples were collected and processed in order to determine bilirubin serum levels, complete blood cells count, and DNA extraction. The TATA-box region was analyzed by PCR amplification followed by subsequent analysis by automated capillary electrophoresis. Among our population, 6 were homozygous for the (TA)7 allele, 55 were heterozygous and 48 were homozygous for the normal allele. One of the subjects was a compound heterozygous for the (TA)5 and (TA)7 alleles. Comparing the blood cells counts and the bilirubin serum levels according to the UGT1A1 genotype, we found statistically differences only in bilirubin levels [(TA)6/(TA)6: 0.49±0.20 mg/dL; (TA)6/(TA)7: 0.70±0.32 mg/dL; (TA)7/(TA)7: 1.10±0.74 mg/dL, p<0.05]. A positive statistically significant correlation (p<0.05) were found between bilirubin serum levels and haematocrit and mean cell volume. Our work showed that higher bilirubin serum levels are correlated with an increase red blood mass. However, no association was found between higher red blood mass and abnormal number of TA repeats in the promoter of UGT1A1 gene. This data suggests that in our population the presence of abnormal number of TA repeats in the UGT1A1 gene is associated with increased bilirubin levels but not with higher red blood mass, as previously described for GS patients.
- Contribution of red cell mass and UGT1A1 alleles in serum bilirubin levels of the portuguese populationPublication . Rodrigues, Carina; Costa, Elísio; Santos-Silva, Alice; Santos, M.R.; Bronze-da-Rocha, ElsaHepatic glucuronization of insoluble bilirubin is catalyzed by isoenzyme 1A1 of UDP-glucuronosyltransferase (UGT1A1), which is essential for efficient biliary excretion of bilirubin. The main cause of Gilbert syndrome (GS) in all populations studied to date is a TA duplication [(TA)7 allele] in the repetitive TATA-box sequence of the gene promoter, which normally consists of six TA repeats. However, this genetic polymorphism is not sufficient for the clinical phenotype of GS. By this reason, some studies have been performed to provide information about additional factors that could contribute to the pathogenesis of this disease. Recently, it was described that increased red cell mass probably plays a role in the pathogenesis of GS. The aim of this work is to investigate the putative role of increased red cell mass and the (TA)7 allele in bilirubin serum levels, in the Portuguese population. This study was performed in 109 volunteer healthy young adults (20.3 ± 1.9 years) without liver and/or hematological disorders, chronic infection, recent inflammation, malignancy, hemorrhage and medication. Blood samples were collected and processed in order to determine bilirubin serum levels, complete blood cells count, and DNA extraction. The TATA-box region was analyzed by PCR amplification followed by subsequent analysis by automated capillary electrophoresis. Among our population, 6 were homozygous for the (TA)7 allele, 55 were heterozygous and 48 were homozygous for the normal allele. One of the subjects was a compound heterozygous for the (TA)5 and (TA)7 alleles. Comparing the blood cells counts and the bilirubin serum levels according to the UGT1A1 genotype, we found statistically differences only in bilirubin levels [(TA)6/(TA)6: 0.49 ± 0.20 mg/dL; (TA)6/(TA)7: 0.70 ± 0.32 mg/dL; (TA)7/(TA)7: 1.10 ± 0.74 mg/dL, p<0.05]. A positive statistically significant correlation (p<0.05) were found between bilirubin serum levels and haematocrit and mean cell volume. Our work showed that higher bilirubin serum levels are correlated with an increase red blood mass. However, no association was found between higher red blood mass and the presence of abnormal number of TA repeats in the promoter of UGT1A1 gene. This data suggests that in our population the presence of abnormal number of TA repeats in the UGT1A1 gene is associated with increased bilirubin levels and that increased haematocrit and mean cell volume could contribute for this phenotype. Further studies comparing a larger group of GS patients, homozygous for the (TA)7) allele, are required to better understand the contribution of the red blood mass in the hiperlirubinemia.
- Thyroid Incidentalomas detected by 68Ga-DOTANOC PET/CT - Correlation of clinical findings and maximum standardized value uptake (SUVmax)Publication . Violante, L.C. Sobral; Teixeira, João Paulo Fernandes; Sampaio, I.L.; Duarte, Aida; Soares, O.; Lopes, F.; Costa, Lígia; Fonseca, A.; Couto, J.; Duarte, HugoAim: In this retrospective study we investigated the clinical relevance of focal increased 68Ga‐DOTANOC uptake in the thyroid gland in patients with no previous history of thyroid disease. The aim was to assess the incidence of malignant disease in these incidental findings and to inspect the potential diagnostic SUVmax ability to differentiate malignant from benign lesions. Material and methods: A total of 954 68Ga‐DOTANOC PET/ CT scans acquired between August 2010 and July 2013 were reviewed and 43 cases were retrospectively studied in which incidental thyroid 68Ga‐DOTANOC increased uptake was reported. Eighteen patients (pts) were excluded due to previous history of thyroid disease. Patients found to have focal thyroid uptake were subsequently correlated with thyroid ultrasonography (US), US‐fine needle aspiration (FNA) cytology or pathology of the specimen from surgical excision. SUVmax of each focal abnormal thyroid uptake was calculated. Results: Thyroid incidentalomas was found by 68Ga‐DOTANOC PET/CT in 2.6% of pts (25/954). Demographics on these 25 pts included 18 women, 7 men, an age range of 36 to 79 years and mean age of 58 years. Five pts did not have clinical follow‐up and of the remaining 20 cases, 2 had an inconclusive FNA citology result and US did not reveal thyroid alterations in other 2. Conclusive diagnosis by US‐FNA cytology or pathology of the specimen was available in 16 cases: 7 (44%) revealed malignant lesions (SUVmax: 2.36 to 9.63; average: 6.10; median: 6.22) corresponding to six well‐differentiated papillary carcinoma and one case of secondary lesion, 9 (56%) were benign nodules (SUVmax: 2.59 to 11.59; average: 6.46; median: 6.27). No statistically significant difference was found between SUVmax of benign and malignant lesions (p=0.918, Mann‐ Whitney test). Conclusion: Our results showed that focal thyroid uptake in 68Ga‐DOTANOC PET/CT was related to a high incidence of malignancy (44%), which suggests that these findings should always be reported and investigated. In our study, SUVmax was not a reliable mean to differentiate malignancy from a benign process, but a larger sample is needed to further validate this statement.
- Biomonitoring of firefighters occupational exposure to polycyclic aromatic hydrocarbons during the 2014 hot seasonPublication . Oliveira, Mónica; Slezakova, Klara; Fernandes, Adília; Vaz, Josiana A.; Teixeira, João Paulo Fernandes; Delerue-Matos, Cristina; Pereira, Maria do Carmo; Morais, SimoneHuman biomonitoring is an important tool in environmental medicine that is used to assess the level of internal exposure to environmental pollutants. Firefighters are one of the most exposed and least studied occupations. During fire suppression, firefighters are heavily exposed to a wide range of chemicals. Polycyclic aromatic hydrocarbons (PAH) are ubiquitous environmental pollutants that are considered as the largest known group of carcinogens due to their cytotoxic and mutagenic properties. Smoke and ashes released during a fire are important sources of PAH. Firefighters can be also exposed to PAH through smoking, via polluted ambient air, water, soil, and through consumption of food. Metabolites of PAH (OH-PAHs), such as 1-hydroxynaphthalene (1OHNapt), 1-hydroxyacenaphthene(1OHAce), 1-hydroxypyrene (1OHPy) and 3-hydroxybenzo[a]pyrene (3OHB[a]P) have been used as biological markers for measurements of human internal exposure to PAH. The present work aims to quantify the urinary metabolites of PAH, namely 1OHNapt, 1OHAce, 1OHPy and 3OHB[a]P in study population of firefighters. Firemen exposed to fires that occurred during 2014 season were asked to fill a post-fire questionnaire and to collect urinary samples. A control study population group was selected to collect samples of urines during the pre-fires season (winter). Among all participating firemen only healthy no-smoking subjects were considered. OH-PAHs were analysed by high-performance liquid chromatography with fluorescence detection. Overall, 1OHNapt and 1OHAce were the most abundant OH-PAHs in firemen urine samples, accounting for approximately 90% of the total OH-PAHs. The urinary OH-PAHs in exposed firefighters were higher than those of control group. Data collected with the individual questionnaire were further used to analyse the concentrations of OH-PAH between (and within) control and exposed groups of firemen. Additionally, 1OHPy concentrations in the exposed firefighters will be compared with the available proposed guidelines.
- Polypharmacy and potentially inappropriate medication in elderly of Northern PortugalPublication . Pinto, Isabel C.; Pereira, Fernando A.; Mateos-Campos, R.Introduction The growing aging of population and increasing prevalence of chronic diseases require the simultaneous use of drugs, lead to the issue of polypharmacy and potentially interactions and inappropriate use. Aim To characterize polymedicated elderly and related factors, identify potentially interactions and inappropriate medication in elderly. Material and Methods This cross-sectional study was based on a questionnaire applied to 69 elderly (≥65 years) from northern Portugal. It was considered as polymedicated seniors taking ≥5 drugs. Beers list and the Delafuente classification were used to evaluate the therapeutic and possible interactions. It was used descriptive statistics and a model of binary regression, with a significance of 5%. The study was approved by Ethics Committee. Results The sample consisted mainly of males (53.6% vs. 46.4%), aged between 66 and 99 years (mean 82.01), while 65.2% have more than 80 years. However, most elderly are not polymedicated (58%), on average 4.61 different drugs are administered per day (maximum=19), antihypertensives (36.2%) and antacids (30.04%) are the most prescribed. Hypertension and depression increase the risk of polymedication eightfold (P = 0.004) and fivefold (P = 0.011) respectively. Female gender seems increase the risk of polypharmacy threefold, although not statistically significant (P = 0.102), and regarding age, the older age group (>85 years) seems reduces the risk of polypharmacy in 0.6 fold, but also not statistically significant. According with Delafuente classification, 1.4% of elderly has potentially drug interactions (Omeprazole and Iron salts). According to the list of Beers, 5.8% of seniors take drugs that classified as having some indications (hydroxyzine, amitriptyline). Conclusions Regarding polypharmacy, 42% of elderly are polymedicated with an average of about 5 different drugs per day, antihypertensives and antacids the most prescribed. Hypertension and depression are highly associated with polypharmacy. We identified one potentially drug interaction and about 6% of elderly taking drugs that classified as having some indications.
- Varenicline suicidal ideation in psychiatric patients − a case report and systematic reviewPublication . Rodrigues, Carina; Andrade, M.; Bettencourt, Mariana Mendonça; Palma, V.; Cardoso, C.Varenicline, a partial agonist selective for a4b2 nicotinic acetylcholine receptor subtypes, was approved in 2006 by the FDA as an aid for smoking cessation in association to counselling. Since its commercialization, many individual cases reported psychiatric adverse effects on patients prescribed with varenicline− such as depressive mood, anxiety, suicidal ideation or even suicidal attempt. Subsequently, the FDA required the addition of a Boxed Warning to this drug. It is believed this reports leaded to some apprehension on its prescription [1].
- Use of whole blood to measure DNA damage in a group of wildland firefighterPublication . Abreu, Ana M.; Teixeira-Gomes, Armanda; Silva, Susana; Morais, Simone; Pereira, Maria do Carmo; Fernandes, Adília; Costa, Solange; Teixeira, João Paulo FernandesGenotoxicity evaluation is a valuable tool for studying the most important occupational hazards allowing a reasonable epidemiological evaluation of potential health effects. Comet assay has proven to be a very sensitive Corrigendum Abstracts of the 12th International Comet Assay Workshop held at the University of Navarra, Pamplona, Spain, 29–31 August 2017 (https://icaw. vito.be/) Mutagenesis, Volume 32, Issue 6, 31 December 2017, Pages e1–e28, https://doi.org/10.1093/mutage/gex037 tool for the detection of different levels of DNA damage in human bio monitoring. Although lymphocytes are the preferred cells whole blood has been presented as a viable and easier alternative to lymphocytes in the comet assay. Its use avoids additional DNA damage from lymphocyte isolation steps and loss of cells. Portugal is among the European countries more devastated by forest fires in the summer each year. Firefighters are exposed to many toxic combustion products, including many known, probable or possible carcinogens. There are a limited number of studies evaluating genotoxic effects in firefighters results reported are inconsist ent and inconclusive. In this context, the aim of the present study was to assess DNA damage and oxidative stress in whole blood of Portuguese wildland firefighters. Study population consisted of a total of 61 non smoking male subjects, 30 firefighters and 31 control subjects.
- Satisfaction with maternal care in migrants and natives: a population-based study from PortugalPublication . Muralova, Ana; Teixeira, Cristina; Barros, HenriqueWomen’s satisfaction is an indicator of maternal healthcare quality. As migrant population contributed for 8.8% of births in Portugal in 2016, maternal care providers should evaluate the effect of multicultural diversity in women’s satisfaction. The aim of this paper is to assess the degree of maternal satisfaction with care during labour and delivery by migrant groups in Portugal. Methods: This is a part of the baMBINO project, an ongoing populationbased study enrolling native and foreign-born women recruited in 32 Portuguese public hospitals during admission for delivery. For this analysis, foreign-born women (n = 1385) were classified into long-term (LT, >8 years) and recent (RM) migrants from Portuguese Speaking African Countries (PSAC), Brazil (B) and Non-Portuguese Speaking Countries (NPSC). Such groups were compared with native women (n = 1167) for the prevalence of satisfaction with healthcare received, time spent by the professionals in providing explanations, how professionals were respectful, helpful and encouraging. Multivariate logistic regression models were used. Results: There was variation between groups for the prevalence of satisfaction with healthcare received (p<0.001) from 90.8% (B-RM) to 98.1% (PSAC-RM); time spent by professionals to provide explanations (p<0.004) from 88,3%(NPSC-RM) to 93,2% (PSAC-RM); how professionals were helpful (p = 0.035) from 94,3% (B-RM) to 98,6% (B-LTM), respectful (p = 0.038) from 93.6% (B-RM) to 98.4% (NPSC-LT) and encouraging (p = 0.002) from 88.7% (B-RM) to 96.5% (BLT). Differences remained after adjusting for maternal age, educational level, mode of delivery and complications. Conclusions: Although the prevalence of satisfied women is high, there is heterogeneity in the satisfaction with some aspects of maternal care between groups of migrant women. Key messages: Professionals should be aware about the effect of cultural background in women’s satisfaction with care. It is important to consider significance of determinants of satisfaction to improve care for migrants.
- Obstetric interventions among native and migrant women: a survey of episiotomy in PortugalPublication . Lorthe, Elsa; Teixeira, Cristina; Rodrigues, Teresa; Barros, HenriqueIt is unclear whether migrant women experience worse pregnancy outcomes than native women. A better comprehension of obstetric care provision, including controversial interventions such as episiotomy, is important to improve equity of service provision, overall maternal and neonatal health and to support evidence-informed perinatal health policy-making. We aimed to determine if migrant and native women giving birth vaginally have different risks of episiotomy and if the risk differs by migrant sub-groups. Methods: This study is based on a cross-sectional survey of foreign-born women with a random sample of native women, implemented in 32 public maternity units in mainland Portugal. We included 3583 women with vaginal delivery. Migrant status was defined by the woman’s country of birth (migrants, born abroad, vs natives, born in Portugal), then as subgroups of migrants from Brasil, Portuguese-speaking African countries (PSAC) and non Portuguese-speaking countries vs natives. The association between migrant status and episiotomy was assessed using multilevel logistic regression models, stratified by delivery mode, and adjusted for main risk factors of episiotomy. Results: The overall frequencies of episiotomy were 52.6% and 48.2% among the 1707 natives and the 1876 migrants, respectively (p = 0.01). With spontaneous delivery, migrant women had decreased odds of having an episiotomy (adjusted OR 0.70 [95% CI 0.58-0.83]), especially those from PSAC (aOR 0.57 [0.46-0.71]). However, with instrumental delivery, migrant women had increased odds of episiotomy (aOR 2.47 [95% CI 1.50-4.07]), especially those from Brasil (aOR 3.24 [1.18-8.92]) and non Portuguese-speaking countries (aOR 3.75 [1.827.71]). Conclusions: These results suggest non-medically justified differential care during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use, in a country with a high frequency of medical intervention during delivery. Key messages: Portugal displays a high frequency of medical interventions during delivery, including episiotomy, highlighting the need for developing evidence-based recommendations. Migrant and native women have different risks of episiotomy, suggesting non-medically justified differential care
- Equitable perinatal healthcare for migrants, Portugal: comparative analysis of a self-assessment toolPublication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, HenriqueMigration is seen as a common risk factor in obstetricmanagement. Migrants often have a higher risk of experience worse pregnancy outcomes, higher rates of operative delivery, and a higher likelihood to receive less adequate postpartum care when compared to native women. This study evaluates self-perceived assessment of migrant women and hospital directors on equitable migrant friendly perinatal healthcare quality and access during intrapartum and postpartum period at public maternity units across Portuguese mainland between 2017-2019. This cross-sectional study analyses perinatal health data from migrant women over 18 years giving birth in public maternity units from between April 2017 and March 2019 as part of the baMBINO project. Data on the assessments of maternity units’ directors on equitable migrant friendly healthcare was collected in a self-assessment tool. Two standards on healthcare access and on healthcare quality were developed by: 1) scoring 25 and 30 questions, respectively, from 0 (worst) to 5 (best); 2) calculating the average of each score. The OneSample Wilcoxon Test (non-parametric) was applied to compare the assessment of hospital directors with the migrant mothers and the Kruskal-Wallis one-way analysis of variance to test for regional differences. Significant differences between migrant woman and healthcare directors’ assessments on migrant friendly healthcare access and quality of care were found. Directors rated healthcare access with a median score of 2.4, twice as good as migrant women (1.3). Migrant women rated healthcare quality with a median score of 4.0 (directors: 3.2). Significant differences between the regions for quality of care and healthcare access were found. Statistically significant difference between migrants from Portuguese and non-Portuguese speaking countries was identified for healthcare access (p-value <0.001) and healthcare quality (p-value < 0.05).