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- Impacto do EEG Ambulatório de 24 Horas na abordagem clínica a doentes com suspeita de EpilepsiaPublication . Batista, Carla; Borges, Daniel Filipe; Coelho, Paulo; Ferreira, Axel; Pereira, Telmo; Conde, JorgeIntrodução: O eletroencefalograma constitui a técnica gold-standard para avaliar a atividade cortical epileptógenea. No entanto, a sua sensibilidade revela-se baixa nas modalidades de registo de curta duração, sendo que, neste contexto, a utilização do EEG Ambulatório de 24 horas (EEGa) veio permitir uma maior capacidade diagnóstica, enquanto registo prolongado, a custos controlados. Objetivo: Analisar o impacto do EEGa na avaliação de doentes com suspeita de epilepsia, através da sua sensibilidade e especificidade para esse diagnóstico clínico. Secundariamente, a) avaliar a sensibilidade em função da distância temporal à última crise, b) averiguar se existe relação entre a presença de atividade paroxística e lesão, c) avaliar o follow-up dos doentes e d) determinar possíveis fatores preditivos. Material e Métodos: Estudo observacional retrospetivo de uma amostra contínua dos pacientes com suspeita de epilepsia que realizaram EEGa entre maio de 2011 e maio de 2018 no Laboratório de Neurofisiologia da Unidade Local de Saúde de Matosinhos. Resultados: Amostra de 83 indivíduos, com idade média de 44.5 anos (79 adultos e 4 pediátricos). A sensibilidade foi de 97% e especificidade de 73% para o diagnóstico de epilepsia, com uma taxa de falsos positivos e falsos negativos de 5% e 7%, respetivamente. Conclusões: O EEGa deve ser um estudo neurofisiológico a considerar mais frequentemente na prática clínica, almejando um diagnóstico mais precoce de epilepsia ou contrariando este, designadamente nos casos em que os exames de primeira linha sejam normais e a convicção clínica permaneça. A brevidade obtida para o diagnóstico evita as expectáveis e demais consequências.
- Clinical usefulness of the electroencephalogram in acute stroke: a preliminary studyPublication . Borges, Daniel Filipe; Silva, Mariana; Ferreira, Axel; Coelho, Paulo Simões; Pereira, Telmo; Conde, JorgeIntroduction: Stroke is the main cause of disability worldwide, being the first cause of death in Portugal. In the first hours of the event, the cranioencephalic CT scan (CT Scan) does not show the lesion in about 74% of cases, making validation of alternative diagnostic approaches of utmost importance. The electroencephalogram (EEG) may provide useful information for the diagnosis and prognosis of stroke. Objective: To study the potential usefulness of the EEG for the early diagnosis of acute stroke in patients with initial negative CT Scan, and for the evaluation of the functional status and risk of epilepsy. Methods: Retrospective analysis of patients with ischemic stroke who underwent EEG and acute phase CT scan between January 2014 and February 2018. Patient characteristics and stroke were classified according to the Oxfordshire Community Stroke Project (OCSP) criteria. The patients were functionally evaluated at 12 months post-stroke by the modified Rankin Scale (mRS) and the existence of post-stroke epilepsy was determined by telephone interview on February 2018. Results: Thirty patients (25 females and 5 males, mean age 70.5 years) were included. According to the OCSP were identified: 40% TACS, 37% PACS, 10% LACS and 13% POCS. 50% with acute vascular injury visible on the initial CT Scan performed with 7 hours of evolution in median. All patients underwent EEG with a median of 3 days of evolution, and slow focal activity was observed in all patients, and focal paroxysmal activity (PA) was seen in 17% of the participants. 17 patients (58% of patients) developed post-stroke epilepsy (PSE) with 4 of these having PA evidence in the initial EEG (24%). One of the patients with PA in the initial EEG did not develop epilepsy during a 4 years follow-up period. In patients without PA, the average of mRs at follow-up was 3.8 and the mortality was 24%, whereas in patients with PA, the mean of the mRs was 5.0 and the mortality was 40%. Conclusion: In this study, unlike CT Scan, the acute-phase EEG presented with abnormal features in all patients with acute stroke, therefore the EEG may potentially provide significant diagnostic information, estimates of risk for developing future epilepsy and also overall risk stratification. Further studies are needed to validate this hypothesis.
- Respiratory function and muscular capacity in old adults: the AGA@4life projectPublication . Pedroso, Daniel Alexandre Dias; Pereira, Telmo; Conde, Jorge
- Vascular changes in healthy youngsters with and without influence of oral contraceptionPublication . Pereira, Anabela; Santos, Helder; Pereira, Telmo; Conde, JorgeINTRODUCTION: Cardiovascular diseases are one of the leading causes of mortality worldwide. It is known to have a reduced incidence in premenopausal women compared to the opposite sex. This appears to be related to the female hormones and their fluctuation throughout the menstrual cycle. Objectives: To evaluate and correlate behavior patterns of cerebral dynamics and arterial reactivity throughout the menstrual cycle and to identify possible differences caused by the use of oral contraceptives (OC). METHODS: The sample consisted of 21 healthy, eumenorrheic and non-smoking young womens, belonging to the 18-21 age group. There were two distinct groups: 11 in the group without oral contraceptive (SCO) and 10 in the oral contraceptive group (CCO). Both groups performed an evaluation in the menstrual phase (MP), from the 1st to the 4th day, and in the ovulatory phase (OP), from the 12th to the 16th day. The third evaluation was performed in the late luteal phase (LLP) from the 26th to the 30th day, in the SCO group and in the OC pause, from the 21st to the 28th day, in the CCO group. Four noninvasive procedures were performed: blood pressure measurement, axillary temperature, carotid and right brachial artery sonography. RESULTS: There were no statistically significant differences in carotid parameters, however, there were variations in the velocity of the systolic peak (VPS) of the common carotid artery (CCA) and internal carotid artery (ICA) and the ICA resistance index (IR), throughout the cycle. The SCO group showed a significant increase in FMD from MF to OF (p = 0.023), decreasing in LL (p = 0.012). The CCO group demonstrated a relative stabilization of FMD values. In OP, there were statistically significant differences between the two groups in relation to the FMD value (p = 0.040). CONCLUSIONS: Cyclic fluctuations of estrogen appear to influence cerebral vascular impedance and arterial reactivity but in different proportions. In conclusion, this study supports the idea of standardizing the timing of vascular testing in a premenopausal woman.
- Intra‑observer reproducibility and inter‑observer agreement of Fels skeletal age assessments among male tennis players 8–16 yearsPublication . Sousa-e-Silva, Paulo; Coelho-e-Silva, Manuel J.; Celis-Moreno, Jorge M; Costa, Daniela C.; Martinho, Diogo V.; Ribeiro, Luis P.; Oliveira, Tomás; Gonçalves-Santos, João; Tavares, Oscar M.; Castanheira, Joaquim; Pereira, Telmo; Conde, Jorge; Cayolla, Ricardo R.; Duarte-Mendes, Pedro; Myburgh, Gillian K.; Cumming, Sean P.; Malina, Robert M.Background Skeletal age (SA) is an estimate of biological maturity status that is commonly used in sport-related medical examinations. This study considered intra-observer reproducibility and inter-observer agreement of SA assessments among male tennis players. Methods SA was assessed with the Fels method in 97 male tennis players with chronological ages (CA) spanning 8.7–16.8 years. Radiographs were evaluated by two independent trained observers. Based on the difference between SA and CA, players were classified as late, average or early maturing; if a player was skeletally mature, he was noted as such as an SA is not assigned. Results The magnitude of intra-individual differences between repeated SA assessments were d = 0.008 year (observer A) and d = 0.001 year (observer B); the respective coefficients of variation were 1.11% and 1.75%. Interobserver mean differences were negligible (t = 1.252, p = 0.210) and the intra-class correlation coefficient was nearly perfect (ICC = 0.995). Concordance of classifications of players by maturity status between observers was 90%. Conclusion Fels SA assessments were highly reproducible and showed an acceptable level of inter-observer agreement between trained examiners. Classifications of players by skeletal maturity status based on assessments of the two observers were highly concordant, though not 100%. The results highlight the importance of experienced observers in skeletal maturity assessments.