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- Cortical maturation in fetuses referred for ‘isolated’ mild ventriculomegaly: a longitudinal ultrasound assessmentPublication . Miguelote, RF; Vides, B; Santos, RF; Palha, JA; Matias, A; Sousa, NOBJECTIVES: To compare cortical maturation between fetuses with isolated mild ventriculomegaly (IMV) and healthy fetuses, and to explore its potential prognostic value in IMV. METHODS: This prospective study quantified cortical maturation by ultrasound in 24 fetuses with IMV and 46 healthy fetuses. Depth and grading the developmental pattern of the parieto-occipital fissure (POF), calcarine fissure (CF) and sylvian fissure, and grading the Sylvian fissure operculization at 23-25, 27-28 and 31-32 weeks gestation were determined. RESULTS: At 23-25 and 27-28 gestational weeks, POF and CF mean depths were statistically lower in the IMV group. The POF and CF depth distribution had a normal distribution in the control group but displayed a bimodal distribution in the IMV group. IMV with progression of ventricular dilatation showed mean depth of CF lower than IMV in which ventriculomegaly regressed or remained stable. The sensitivity, specificity, positive predictive value and negative predictive value of a CF depth below the fifth percentile to predict progression of ventricular dilatation were, at 28 weeks, 100%, 88%, 67% and 100%, respectively. CONCLUSIONS: Cortical fissure assessment by ultrasound allowed the differentiation of a subgroup of IMV fetuses with a higher risk of progression of ventricular dilatation.
- Determinantes da colonização materna e da infecção neonatal por Streptococcus do grupo BPublication . Areal, A; Moreira, M; Nunes, S; Faustino, MA; Cardoso, L; Sá, CAim and Objective: During the past three decades, group B Streptococcus (GBS) neonatal infection has been the subject of little research. The aim of this study was to evaluate the association between maternal risk factors, as established by the Center for Disease Control and Prevention (CDC), and maternal colonization. We also analysed the association between risk factors present in newborns and early-onset GBS disease. Study design: Cross-sectional study. Population: All pregnant women admitted for delivery in our institution and their newborns, between 1st February and 31st July 2005. Methods: Maternal and neonatal characteristics were collected from hospital clinical data, including information on risk factors established by the CDC. Descriptive statistics was used to characterize the study sample. Qui-square and Mantel-haenszel tests were applied to compare proportions and to measure the strength of associations, respectively, setting significance at p < 0,05. Results: In this sample only 47% of women were screened for GBS colonization in suitable time and 34,9% of these women were colonized. The incidence of early neonatal infection by SGB was 9/1000 neonates. Significant associations between GBS maternal colonization ant the following parameters were observed: maternal age [p=0,012; OR=1,659 (IC a 95%, 1,218-2,260)], gestational age at labour [p=0,001; OR= 2,621 (IC a 95%, 1,641- 4,188)], and urinary GBS infection during pregnancy (p<0,001). Maternal colonization occurred in women without CDC defined risk factors. Early neonatal infection by SGB was strongly associated with unscreened women (p=0,014). Conclusion: In this study, maternal GBS colonization occurred in the absence of CDC defined risk factors and varied according to maternal age and gestational week. Neonatal GBS infection was more frequent in unscreened women.
- Disfunção sexual feminina em idade reprodutiva: prevalência e factores associadosPublication . Ribeiro, B; Magalhães, AT; Mota, IObjetivos: A disfunção sexual feminina (DSF) é altamente prevalente, situando-se entre os 40% e 70% em Portugal, e traduz-se por uma alteração em qualquer uma das fases do ciclo de resposta sexual da mulher (desejo, excitação e orgasmo) ou ainda por perturbações dolorosas associadas ao ato sexual. O presente estudo pretendeu estudar a prevalência da DSF numa amostra de mulheres em idade reprodutiva, a prevalência dos diferentes subtipos de DSF e a existência de fatores associados. Tipo de estudo: Tratou-se de um estudo observacional, transversal e analítico. Local: Unidades de Saúde Familiar (USF) Novo Cuidar, Centro de Saúde de Fafe. População: Mulheres entre os 18 e os 58 anos utentes da USF Novo Cuidar. Métodos:A uma amostra aleatória de 346 utentes foi aplicado um questionário anónimo e confidencial de autorresposta. Usaram-se os testes Qui-Quadrado ou de Fisher para comparar proporções, o Odds Ratio para determinar a força de associação entre variáveis e os testes t-Student e Mann-Whitney para testar a associação entre variáveis qualitativas e quantitativas (adotou-se um nível de significância de 0,05). Resultados: A taxa de resposta foi de 86,4% e a prevalência de DSF foi de 77,2% (IC95% 72,0-82,7), tendo a perturbação do orgasmo sido o subtipo mais prevalente, 55,8% (IC95% 51,0-63,9). Foi encontrada uma associação entre a contraceção hormonal e a perturbação do desejo (p = 0,003). A aversão sexual foi estatisticamente relacionada com experiências sexuais indesejadas prévias (p = 0,001). Conclusões: A DSF em idade reprodutiva é muito prevalente apesar de apenas metade das mulheres a considerarem um problema. Foram encontradas associações com alguns fatores que podem ter importância na vivência de uma sexualidade feliz pela mulher.
- A infecção peri-natal por Streptococcus agalactiae pode ser evitada: prevalência da colonização em parturientes no Hospital de S. Marcos, factores de risco e sua relação com a infecção peri-natalPublication . Areal, A; Nunes, S; Moreira, M; Faustino, MA; Cardoso, L; Sá, Cntrodução: O Streptococcus agalactiae (SGB) é o agente mais frequente de infecção neonatal precoce, sendo possível a sua prevenção. Em Portugal é desconhecida a prevalência de mulheres colonizadas por SGB. O estudo da Unidade de Vigilância Pediátrica refere uma prevalência nacional de infecção neonatal por SGB de 0,5:1000 nados-vivos. Objectivo: Determinar a prevalência da colonização materna e da infecção perinatal por SGB no Hospital de S. Marcos, Braga (HSM), de modo a avaliar a importância da implementação do rastreio universal e o uso de medidas profiláticas. Método: De 1 de fevereiro a 31 de julho de 2005 foi realizado um estudo transversal com análise de coortes anichada, avaliando todas as grávidas assistidas para trabalho de parto no HSM e respectivos recém-nascidos. Os dados foram submetidos a análise estatística bi-variada pelo teste do qui-quadrado, com um nível de significância de 5% (p<0,05). Resultados: A prevalência da colonização nas grávidas rastreadas na região de Braga foi de 34,9 % [intervalo de confiança a 95% (IC95%), 31,5-38,3%]. No HSM o diagnóstico de infecção neonatal precoce por SGB ocorreu em 9:1000 recém-nascidos. O risco relativo de ocorrência de infecção perinatal entre os recém-nascidos dos grupos de mães rastreadas e não rastreadas foi de 0,3 [IC95% 0,2,7-0,32]. Conclusão: O rastreio bacteriológico positivo para colonização materna por SGB associado à adequada profilaxia intra-parto reduziu significativamente a infecção neonatal precoce, em relação ao grupo de gestantes não rastreadas (p=0,014). Consideramos que é recomendável a instituição do rastreio universal das grávidas e a profilaxia adequada quando indicada.
- Leukemia inhibitory factor in rat fetal lung development: expression and functional studiesPublication . Nogueira-Silva, C; Piairo, P; Carvalho-Dias, E; Peixoto, FO; Moura, RS; Correia-Pinto, JBACKGROUND: Leukemia inhibitory factor (LIF) and interleukin-6 (IL-6) are members of the family of the glycoprotein 130 (gp130)-type cytokines. These cytokines share gp130 as a common signal transducer, which explains why they show some functional redundancy. Recently, it was demonstrated that IL-6 promotes fetal lung branching. Additionally, LIF has been implicated in developmental processes of some branching organs. Thus, in this study LIF expression pattern and its effects on fetal rat lung morphogenesis were assessed. METHODOLOGY/PRINCIPAL FINDINGS: LIF and its subunit receptor LIFRα expression levels were evaluated by immunohistochemistry and western blot in fetal rat lungs of different gestational ages, ranging from 13.5 to 21.5 days post-conception. Throughout all gestational ages studied, LIF was constitutively expressed in pulmonary epithelium, whereas LIFRα was first mainly expressed in the mesenchyme, but after pseudoglandular stage it was also observed in epithelial cells. These results point to a LIF epithelium-mesenchyme cross-talk, which is known to be important for lung branching process. Regarding functional studies, fetal lung explants were cultured with increasing doses of LIF or LIF neutralizing antibodies during 4 days. MAPK, AKT, and STAT3 phosphorylation in the treated lung explants was analyzed. LIF supplementation significantly inhibited lung growth in spite of an increase in p44/42 phosphorylation. On the other hand, LIF inhibition significantly stimulated lung growth via p38 and Akt pathways. CONCLUSIONS/SIGNIFICANCE: The present study describes that LIF and its subunit receptor LIFRα are constitutively expressed during fetal lung development and that they have an inhibitory physiological role on fetal lung
- Local fetal lung renin-angiotensin system as a target to treat congenital diaphragmatic herniaPublication . Nogueira-Silva, C; Carvalho-Dias, C; Piairo, P; Nunes, S; Baptista, MJ; Moura, RS; Correia-Pinto, JAntenatal stimulation of lung growth is a reasonable approach to treat congenital diaphragmatic hernia (CDH), a disease characterized by pulmonary hypoplasia and hypertension. Several evidences from the literature demonstrated a possible involvement of renin-angiotensin system (RAS) during fetal lung development. Thus, the expression pattern of renin, angiotensin-converting enzyme, angiotensinogen, type 1 (AT₁) and type 2 (AT₂) receptors of angiotensin II (ANGII) was assessed by immunohisto-chemistry throughout gestation, whereas the function of RAS in the fetal lung was evaluated using fetal rat lung explants. These were morphometrically analyzed and intracellular pathway alterations assessed by Western blot. In nitrofen-induced CDH model, pregnant rats were treated with saline or PD-123319. In pups, lung growth, protein/DNA ratio, radial saccular count, epithelial differentiation and lung maturation, vascular morphometry, right ventricular hypertrophy and overload molecular markers, gasometry and survival time were evaluated. Results demonstrated that all RAS components were constitutively expressed in the lung during gestation and that ANGII had a stimulatory effect on lung branching, mediated by AT₁ receptor, through p44/42 and Akt phosphorylation. This stimulatory effect on lung growth was mimicked by AT₂-antagonist (PD-123319) treatment. In vivo antenatal PD-123319 treatment increased lung growth, ameliorated indirect parameters of pulmonary hypertension, improved lung function and survival time in nonventilated CDH pups, without maternal or fetal deleterious effects. Therefore, this study demonstrated a local and physiologically active RAS during lung morphogenesis. Moreover, selective inhibition of AT₂ receptor is presented as a putative antenatal therapy for CDH.
- Local Fetal Lung Renin-Angiotensin System as a Target to Treat Congenital Diaphragmatic HerniaPublication . Nogueira-Silva, C; Carvalho-Dias, E; Piairo, P; Nunes, S; Baptista, MJ; Moura, RS; Correia-Pinto, JAntenatal stimulation of lung growth is a reasonable approach to treat congenital diaphragmatic hernia (CDH), a disease characterized by pulmonary hypoplasia and hypertension. Several evidences from the literature demonstrated a possible involvement of renin-angiotensin system (RAS) during fetal lung development. Thus, the expression pattern of renin, angiotensin-converting enzyme, angiotensinogen, type 1 (AT(1)) and type 2 (AT(2)) receptors of angiotensin II (ANGII) was assessed by immunohistochemistry throughout gestation, whereas the function of RAS in the fetal lung was evaluated using fetal rat lung explants. These were morphometrically analyzed and intracellular pathway alterations assessed by Western blot. In nitrofen-induced CDH model, pregnant rats were treated with saline or PD-123319. In pups, lung growth, protein/DNA ratio, radial saccular count, epithelial differentiation and lung maturation, vascular morphometry, right ventricular hypertrophy and overload molecular markers, gasometry and survival time were evaluated. Results demonstrated that all RAS components were constitutively expressed in the lung during gestation and that ANGII had a stimulatory effect on lung branching, mediated by AT(1) receptor, through p44/42 and Akt phosphorylation. This stimulatory effect on lung growth was mimicked by AT(2)-antagonist (PD-123319) treatment. In vivo antenatal PD-123319 treatment increased lung growth, ameliorated indirect parameters of pulmonary hypertension, improved lung function and survival time in non-ventilated CDH pups, without maternal or fetal deleterious effects. Therefore, this study demonstrated a local and physiologically active RAS during lung morphogenesis. Moreover, selective inhibition of AT(2) receptor is presented as a putative antenatal therapy for CDH.
- Operação de Wertheim-Meigs em carcinoma do colo do útero e tratamento complementar: análise crítica de cinco anosPublication . Freitas, D; Rodrigues, F; Fernandes, D; Petiz, AOBJECTIVES: Review and critical analysis of the Wertheim-Meigs Operations performed at our institution in the context of cervical cancer and to assess the proportion who underwent treatment with adjuvant radiotherapy (with or without chemotherapy) and the main indications. MATERIAL AND METHODS: Retrospective review of Wertheim-Meigs operations, conducted in the context of carcinoma of the cervix, between 01.01.2005 and 31.12.2010, through consultation with clinical processes. It was later performed a descriptive statistical analysis of the cases. RESULTS: During this period 119 Wertheim-Meigs Operations were performed. Four were excluded: two, for primary indication for adjuvant therapy due to histological subtype; two for the inability to exclude invasive disease preoperatively and the invasion was not confirmed after surgery. A total of 115 cases were reviewed and analyzed, and of these 50 (43.5%) underwent complementary therapy, the main indication being the presence of lymphovascular invasion in 21 cases (42% of cases submitted to complementary therapy ). CONCLUSIONS: The mean age of patients undergoing radical surgery is 49 years, with stage IB1 most often determining its performance. Complementary therapy was performed in 43.5% of cases, the main indication being lymphovascular invasion (42%) followed by lymph node invasion (16%). Internal audit to the Service is satisfactory, with 16.5% surgical complication rate and high technical performance.
- Risk Factors for Persistent Postsurgical Pain in Women Undergoing Hysterectomy Due to Benign Causes: A Prospective Predictive StudyPublication . Pinto, PR; McIntyre, T; Nogueira-Silva, C; Almeida, A; Araújo-Soares, VPersistent postsurgical pain (PPSP) is a major clinical problem with significant individual, social, and healthcare costs. The aim of this study was to examine the role of demographic, clinical, and psychological risk factors in the development of PPSP after hysterectomy due to benign disorders. In a prospective study, a consecutive sample of 186 women was assessed 24 hours before surgery (T1), 48 hours after surgery (T2), and 4 months after surgery (T3). Regression analyses were performed to identify predictors of PPSP. Four months after hysterectomy, 93 (50%) participants reported experiencing pain (numerical rating scale >0). Age, pain due to other causes, and type of hysterectomy emerged as significant predictive factors. Baseline presurgical psychological predictors identified were anxiety, emotional illness representation of the condition leading to surgery, and pain catastrophizing. Among the identified psychological predictors, emotional illness representation emerged as the strongest. Acute postsurgical pain frequency and postsurgical anxiety also revealed a predictive role in PPSP development. These results increase the knowledge on PPSP predictors and point healthcare professionals toward specific intervention targets such as anxiety (presurgical and postsurgical), pain catastrophizing, emotional illness representations, and acute pain control after surgery. PERSPECTIVE: This study found that presurgical anxiety, emotional illness representations, and pain catastrophizing are risk factors for PPSP 4 months after hysterectomy, over and above age and clinical variables. These findings improve knowledge on PPSP and highlight potential intervention targets for healthcare professionals.
- Role of the RAD51 G172T polymorphism in the clinical outcome of cervical cancer patients under concomitant chemoradiotherapyPublication . Nogueira, A; Catarino, R; Faustino, I; Nogueira-Silva, C; Figueiredo, T; Lombo, L; Hilário-Silva, I; Pereira, D; Medeiros, RINTRODUCTION: Cervical cancer is one of the most common cancers diagnosed in women worldwide. Mammalian cells are constantly exposed to a wide variety of genotoxic agents from both endogenous and exogenous sources. The RAD51 protein is required for meiotic and mitotic recombination and plays a central role in homology-dependent recombinational repair of double-strand breaks (DSBs). Given the functional relevance of the DNA repair system on carcinogenesis, potential associations between genetic polymorphisms of DNA repair genes, cancer risk and response to therapy have been intensively evaluated. This is the first study evaluating the role of the RAD51 G172T genetic variants in cancer prognosis and clinical outcome of cervical cancer patients. MATERIAL AND METHODS: We analyzed RAD51 G172T polymorphism genotypes in cervical cancer patients who underwent a platinum-based chemotherapy in combination with radiotherapy. Genotyping was performed by Taqman™ Allelic Discrimination methodology. RESULTS AND DISCUSSION: Concerning the overall survival rates found using Kaplan-Meier method and Log Rank Test, we observed that the mean survival rates were statistically different according to the patients RAD51 genotypes. The group of patients carrying the T allele present a higher mean survival rate than the other patients (102.3months vs. 86.4months, P=0.020). Using the Cox regression analysis, we found an increased overall survival time for T-carrier patients, when compared with GG genotype, with tumor stage, age and presence of lymph nodes as covariates [hazard ratio (HR), 0.373; 95% CI, 0.181-0.770; P=0.008]. Among patients (n=193), RAD51 genotype frequency distributions were not under the influence of clinicopathologic characteristics, namely, treatment response (P=0.508), recurrence (P=0.150) and tumor stage (P=0.250). CONCLUSIONS: This is the first study evaluating the role of the RAD51 G172T genetic variants in cancer prognosis and clinical outcome of cervical cancer patients. Our results indicate an influence of the RAD51 genetic variants in overall survival of cervical cancer. Thereby, RAD51 G172T genotypes may provide additional prognostic information in cervical cancer patients who underwent cisplatin-based chemotherapy in combination with radiotherapy.