Browsing by Author "Pereira, M"
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- Afinal os antecedentes cirúrgicos são importantes: a propósito de um caso clínicoPublication . Oliveira, C; Dinis, C; Gomes, C; Pereira, M
- Avaliação das Anomalias do Metabolismo da Glicose Após a Gravidez Complicada por Diabetes GestacionalPublication . Matos, C; Pereira, Mntroduction: Gestational Diabetes Mellitus (GDM) is associated with an increased risk of maternal Diabetes Mellitus (DM). Our objective was to analyse post-partum reclassification anomalies, and its relation with maternal history, pregnancy data and neonatal outcomes. Methods: Retrospective analysis of women with gestational diabetes between the year 2000 to 2007, aged from 16 to 45 years old; 47.2% had positive familiar history of DM and 9.1% had past history of GDM. Other maternal and gestational characteristics were collected; newborn weight and morbidity and reclassification results were evaluated. Statistical analysis was based on descriptive methods and Spearman correlation, Kruskal-Wallis, Mann-Whitney, Qui-square and Fisher tests, and multivariate analysis by logistic regression. Results: 424 women; 69.6% underwent reclassification; 6.1% were diagnosed impaired fasting glucose, 12.5% impaired glucose tolerance and 3.7% DM. A relation was established, between progression to impaired glucose metabolism and family history of diabetes, elevated BMI before pregnancy, earlier gestational age at diagnosis and need for insulin therapy. Discussion: Only elevated BMI before pregnancy seems to predict progression to altered glucose metabolism. Therefore, it is important to develop preventive strategies for obesity and be aware that every woman with GDM undergoes reclassification tests.
- Diabetes e hiperglicemia: factores de prognóstico na pneumonia adquirida na comunidade – estudo retrospectivo em doentes admitidos no Hospital de BragaPublication . Fernandes, V; Ramalho, J; Santos, MJ; Oliveira, N; Pereira, M
- Doença de arranhadela do gato em adolescente - uma apresentação atípicaPublication . Pereira, M; Carneiro, S; Braz, M; Bacalhau, S; Borges, C; Neto, A
- Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic reviewPublication . Santos, Hugo; Baleia, Isabel; Brás, B; Santos, F; Pereira, M; Lucas, R; Henriques, SIntroduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm results
- Epidemiology of Psoriasis in Portugal: A Population-Based StudyPublication . Torres, T; Filipe, P; Menezes Brandão, F; Figueiredo, A; Pinto Soares, A; Sousa Basto, A; Rebelo, C; Correia, O; Ferreira, P; Brasileiro, A; Mendes-Bastos, P; Paiva-Lopes, MJ; Marques Pinto, G; Severo, M; Mendonça, D; Oliveira, P; Selores, M; Massa, A; Pereira, M; Tavares Bello, R; Portuguese Society of Dermatology and Venereology, On behalf of the Portuguese Psoriasis Group of theIntroduction: Psoriasis is a common, chronic, and inflammatory skin disorder with a high personal, social and economic burden and important implica-tions for healthcare systems. The aim of this study was to provide an epidemiological characterization of individuals with psoriasis in Portugal.Material and Methods: A large observational, cross-sectional, nationwide, population-based survey study developed by the Portuguese Psoriasis Group of the Portuguese Society of Dermatology and Venereology (GPP-SPDV). A structured questionnaire was designed and applied by experienced inter-viewers to a random, representative sample of Portuguese individuals with psoriasis and/or psoriatic arthritis. Patients were considered to have psoriasis if they replied positively to one of the following questions: “Does any physician have ever diagnosed you with psoriasis?” or “Do you have a skin disorder characterized by scaling, reddish skin lesions located in the elbows/knees/scalp?”.Results: A total of 6381 individuals were interviewed, of which 283 met the criteria for psoriasis, corresponding to a prevalence rate of 4.4% (95% CI 3.95 – 4.98). Out of the participants that met psoriasis criteria, 24% had suggestive signs/symptoms but did not have a clinical diagnosis established and were not being monitored by a physician. Although more than 70% of participants had active disease (scaling, erythema, or pruritus) and one third had joint symptoms, only 12% were on systemic treatment. Fifty percent of participants with psoriasis (n = 139) had relevant comorbidities (most frequently depression/anxiety and cardiometabolic diseases). Sixteen percent of participants with psoriasis (n = 46) reported that psoriasis interfered with their daily activities (median impact of 5 in a 0 – 10 scale) and 12% mentioned the disease had an impact in their sexual life (median impact of 5 in a 0 – 10 scale). Conclusion: The results of this study suggest that the prevalence rate of psoriasis is likely to be high in Portugal, and several gaps exist at different levels of healthcare delivery to these patients, from diagnosis to treatment. This study provides important data for the future planning of interventions targeting the improvement of psoriasis care in Portugal.
- Multidisciplinary Development and Initial Validation of a Clinical Knowledge Base on Chronic Respiratory Diseases for mHealth Decision Support SystemsPublication . Pereira, AM; Jácome, C; Jacinto, T; Amaral, R; Pereira, M; Sá-Sousa, A; Couto, M; Vieira-Marques, P; Martinho, D; Vieira, A; Almeida, A; Martins, C; Marreiros, G; Freitas, A; Almeida, R; Fonseca, JAMost mobile health (mHealth) decision support systems currently available for chronic obstructive respiratory diseases (CORDs) are not supported by clinical evidence or lack clinical validation. The development of the knowledge base that will feed the clinical decision support system is a crucial step that involves the collection and systematization of clinical knowledge from relevant scientific sources and its representation in a human-understandable and computer-interpretable way. This work describes the development and initial validation of a clinical knowledge base that can be integrated into mHealth decision support systems developed for patients with CORDs. A multidisciplinary team of health care professionals with clinical experience in respiratory diseases, together with data science and IT professionals, defined a new framework that can be used in other evidence-based systems. The knowledge base development began with a thorough review of the relevant scientific sources (eg, disease guidelines) to identify the recommendations to be implemented in the decision support system based on a consensus process. Recommendations were selected according to predefined inclusion criteria: (1) applicable to individuals with CORDs or to prevent CORDs, (2) directed toward patient self-management, (3) targeting adults, and (4) within the scope of the knowledge domains and subdomains defined. Then, the selected recommendations were prioritized according to (1) a harmonized level of evidence (reconciled from different sources); (2) the scope of the source document (international was preferred); (3) the entity that issued the source document; (4) the operability of the recommendation; and (5) health care professionals' perceptions of the relevance, potential impact, and reach of the recommendation. A total of 358 recommendations were selected. Next, the variables required to trigger those recommendations were defined (n=116) and operationalized into logical rules using Boolean logical operators (n=405). Finally, the knowledge base was implemented in an intelligent individualized coaching component and pretested with an asthma use case. Initial validation of the knowledge base was conducted internally using data from a population-based observational study of individuals with or without asthma or rhinitis. External validation of the appropriateness of the recommendations with the highest priority level was conducted independently by 4 physicians. In addition, a strategy for knowledge base updates, including an easy-to-use rules editor, was defined. Using this process, based on consensus and iterative improvement, we developed and conducted preliminary validation of a clinical knowledge base for CORDs that translates disease guidelines into personalized patient recommendations. The knowledge base can be used as part of mHealth decision support systems. This process could be replicated in other clinical areas.
- Outcomes of sleeve gastrectomy and predictors of successPublication . Goulart, A; Maia da Costa, J; Manso, F; Pereira, M; Fernandes, A; Leão, P
- Skin tests and challenge-based drug allergy diagnosis: a retrospective study of patients with confirmed drug allergyPublication . Pereira, AM; Couto, M; Pereira, M; Araújo, LObjectives. To describe clinical manifestations and performed diagnostic workup, focusing drug challenge tests (DCT), in patients with drug allergy. Methods. Retrospective study including all patients with skin tests (STs) or DCT-based drug allergy diagnosis, between 01/2014 - 06/2018 in a Portuguese allergy unit. Data were collected from electronic and paper-based clinical records. Results. We had 75 drug allergy diagnoses. Most index reactions were mild and major or equal 1 hour after drug intake. 59 (78%) diagnoses were based on DCTs, all based on multistep protocols with major or equal 3 predicted steps. Only 10% of the DCT were positive during up-dosing; timing and severity of the index reaction predicted DCT interruption during up-dosing. Conclusions. Most drug allergy diagnoses were based on multistep DCT. The identified predictors of DCT interruption during up-dosing can support the development of more personalized DCTs protocols.
- Sleeve Gástrico : Resultados e Fatores Preditores de Perda de PesoPublication . Goulart, A; Branco, C; Maia da Costa, J; Manso, F; Pereira, M; Fernandes, A; Costa, P; Leão, P