Browsing by Author "Dias, C"
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- Clinical practice in Crohn's disease in bordering regions of two countries: Different medical options, distinct surgical eventsPublication . Magro, F; Barreiro-de Acosta, M; Lago, P; Carpio, D; Cotter, J; Echarri, A; Gonçalves, R; Pereira, S; Carvalho, L; Lorenzo, A; Barros, L; Castro, J; Dias, JA; Rodrigues, S; Portela, F; Dias, C; Costa-Pereira, A; EIGA; GEDIIContemplating the multifactorial nature of Crohn's disease (CD), the purpose of this study was to compare two neighbouring CD populations from different nations and examine how clinical characteristics of patients can influence therapeutic strategies and consequently different surgical events in routine clinical practice. Cross-sectional study based on data of an on-line registry of patients with CD in northern Portugal and Galicia. Of the 1238 patients, all with five or more years of disease, 568 (46%) were male and 670 (54%) female. The Portuguese and Galician populations were similar regarding Montreal categories, age at diagnosis, and years of follow-up. Galician B2 patients were associated with immunosuppression (OR 3.6; CI 2.2-6.1) and biologic treatment (OR 1.8; CI 1.0-3.1). In both populations ileocolonic disease was associated with immunosuppression and biologic treatment and the penetrating group was linked to immunosuppression. In the north of Portugal 47% and 16% of patients, and in Galicia 63% and 33%, were treated with immunosuppressants and biologic treatment, respectively. In the north of Portugal 44% of patients classified as stricturing behavior were operated without immunomodulation, in contrast to 12% in Galicia. In the latter it was possible to maintain 16% of B2 patients and 40% of B3 patients without surgery with adequate immunosuppression and/or biologic treatment. The delta of surgeries in B2 patients was 8% and in B3 26%. CONCLUSIONS: Stratifying patients according to the Montreal classification identified similar clinical patterns in disparate geographic populations, and revealed that differing medical therapeutic practices may influence the occurrence of surgical events.
- A large outbreak of Legionnaires’ Disease in an industrial town in PortugalPublication . George, F; Shivaji, T; Pinto, CS; Serra, LA; Valente, J; Albuquerque, MJ; Vicêncio, PC; San-Bento, A; Diegues, P; Nogueira, PJ; Marques, T; Rebelo, H; Costa, F; Rodrigues, R; Nunes, A; Borges, V; Gomes, JP; Sampaio, D; Barreiro, P; Duarte, S; Carpinteiro, D; Mendonça, J; Silva, C; Vieira, L; Simões, MJ; Gonçalves, P; Nunes, B; Dias, C; Machado, J; Almeida, F; Goncalves, EA; Carvalho, L; Viterbo, P; Jardim, D; Lacasta, N; Boavida, F; Perez, A; Santana, I; Matias, P; Banza, N; Rabacal, CBackground We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak's attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
- Titration with automatic continuous positive airway pressure in obstructive sleep apneaPublication . Dias, C; Sousa, L; Batata, L; Reis, R; Teixeira, F; Moita, J; Moutinho Dos Santos, JBackground and objective Autotitrating positive airway pressure (APAP) is an accepted titration method to determine the optimal positive airway pressure (PAP), for the treatment of obstructive sleep apnea (OSA). The required duration of APAP monitoring to determine a fixed continuous positive airway pressure level still remains to be established. We aimed to evaluate the variation in PAP level, delivered by APAP devices, at different periods of treatment, to determine the APAP treatment duration required to reach an effective and stable PAP level. Methods A cross-sectional study of 62 patients newly diagnosed with OSA were evaluated after 3 months of APAP therapy. APAP data corresponding to the first day (D1), first week (W1), seventh week (W7) and twelfth week (W12) under APAP therapy was collected. For the analysis of the pressure behaviour, the difference of P95th pressure level between W12 and W7 (P W12–W7), W12 and W1 (P W12–W1) and W12 and D1 (P W12–D1) was calculated. Results There was a high correlation in P95th pressure level between D1 and W12 (r = 0.771; p > 0.0001), W1 and W12 (r = 0.817; p > 0.0001), and W7 and W12 (r = 0.926; p > 0.0001). This correlation progressively increased with APAP use. A significance difference was found in concordance between P W12–W7 and P W12–D1 (p = 0.046) within the pressure range ±2 cmH2O. However there was no significant difference in concordance between P W12–W7 and P W12–W1. Conclusions One week of APAP therapy seems sufficient to determine an effective and stable PAP level, within the pressure range ±2 cmH2O.
- Ulcerative colitis in northern Portugal and Galicia in SpainPublication . Barreiro-da-Costa, M; Magro, F; Carpio, D; Lago, P; Echarri, A; Cotter, J; Pereira, S; Gonçalves, R; Lorenzo, A; Carvalho, L; Castro, J; Barros, L; Dias, JA; Rodrigues, S; Portela, F; Dias, C; Costa-Pereira, ABACKGROUND: Clinical and therapeutic patterns of ulcerative colitis (UC) are variable in different world regions. The purpose of this study was to examine two close independent southern European UC populations from 2 bordering countries and observe how demographic and clinical characteristics of patients can influence the severity of UC. METHODS: A cross-sectional study was conducted during a 15-month period (September 2005 to December 2006) based on data of 2 Web registries of UC patients. Patients were stratified according to the Montreal Classification and disease severity was defined by the type of treatment taken. RESULTS: A total of 1549 UC patients were included, 1008 (65%) from northern Portugal and 541 (35%) from Galicia (northwest Spain). A female predominance (57%) was observed in Portuguese patients (P < 0.001). The median age at diagnosis was 35 years and median years of disease was 7. The majority of patients (53%) were treated only with mesalamine, while 15% had taken immunosuppressant drugs, and 3% biologic treatment. Most patients in both groups were not at risk for aggressive therapy. Extensive colitis was a predictive risk factor for immunosuppression in northern Portugal and Galicia (odds ratio [OR] 2.737, 95% confidence interval [CI]: 1.846-4.058; OR 5.799, 95% CI: 3.433-9.795, respectively) and biologic treatment in Galicia (OR 6.329, 95% CI: 2.641-15.166). Younger patients presented a severe course at onset with more frequent use of immunosuppressors in both countries. CONCLUSIONS: In a large population of UC patients from two independent southern European countries, most patients did not require aggressive therapy, but extensive colitis was a clear risk factor for more severe disease