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- Orthostatic hypotension and cardiovascular events: closing the link?Publication . Pereira, Telmo
- 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.
- Randomized study of the effect of cocoa, on the blood pressure of healthy young individualsPublication . Coutinho, D; Pereira, J; Pereira, TelmoIntroduction: Since ancient times, chocolate is a food highly appreciated by people and, therefore, is present in varied eating patterns. When rich in cocoa, it has a higher concentration of flavonoids. The consumption of foods rich in flavanols has been associated with a reduction in some risk factors for cardiovascular diseases, such as hypertension. Objectives: To evaluate the effects of frequent consumption of a fixed dose of cocoa-rich chocolate on the blood pressure of healthy young individuals. Methods: Thirty healthy individuals of both sexes, aged between 18 and 35 years, were randomized, but only 28 people completed the intervention. A baseline blood pressure assessment was performed. After this the different types of chocolate were distributed by the control group (55% cocoa) and the intervention group (90% cocoa). The daily consumption of 20 grams of chocolate ran for thirty days. Two days after finishing the ingestion of the chocolate, the second evaluation was carried out. For the different evaluations, the oscillometric method was used. Results: In the different variables studied, there was a general improvement in both groups (control and intervention). However, there were only statistically significant differences in systolic blood pressure (p = 0.01) and pulse pressure (p = 0.001), in the control group. In the baseline assessment, it was found that there were no statistically significant differences between the two groups. Conclusions: This study showed that chocolate, with 55% cocoa, has beneficial effects on the blood pressure of healthy young individuals, when consumed frequently. Further research is needed with regard to the mechanisms associated with these effects, so that we can clarify the role of flavonoids.
- Respiratory function and muscular capacity in old adults: the AGA@4life projectPublication . Pedroso, Daniel Alexandre Dias; Pereira, Telmo; Conde, Jorge
- Avaliação laboratorial do efeito antioxidante e anti-inflamatório do Resveratrol na função vascularPublication . Silva, Ana Margarida; Ferreira, Carla; Dias, Beatriz; Silva, Isabel; Clemente, Mariana; Figueiredo, João; Pereira, Telmo; Caseiro, ArmandoIntrodução: O resveratrol é uma fitoalexina natural cujos principais benefícios devem-se às suas propriedades anti-inflamatórias e antioxidantes. Os seus efeitos sugerem que este é um suplemento útil para a redução da inflamação, podendo desempenhar um papel fundamental na prevenção das doenças cardiovasculares. Este promove a vasodilatação pela indução da síntese de óxido nítrico (NO), possui atividade antitrombótica e evita a agregação plaquetária. O fator de crescimento endotelial vascular ( VEGF) é responsável pela angiogénese, sendo a sua expressão infuenciada pelo resveratrol. Objetivos: Avaliar o efeito do resveratrol no perfl vascular pela determinação da pressão arterial e dos biomarcadores interleucina-6 (IL-6), proteína C reativa (PCR), VEGF e NO. Material e Métodos: 27 alunos com idades compreendidas entre os 18 e os 22 anos foram divididos em grupo controlo (GC) e grupo de intervenção (GI), que consumiram placebo e 100 mg de resveratrol por dia, respetivamente, durante 1 mês. A pressão arterial foi medida com aparelho automático validado. Os níveis de PCR foram obtidos por imunoturbidimetria, os de IL-6 e VEGF por slot blot e a quantifcação de NO por espectrofotometria. Resultados: Entre os grupos observou-se uma diminuição da pressão arterial braquial e central (ρ˂0.05). A variação negativa no NO apresentou-se superior no GC apesar das diferenças não serem signifcativas (p>0,05). Nos restantes marcadores avaliados não se observaram diferenças signifcativas. Conclusões: A ingestão regular de resveratrol parece ser uma abordagem preventiva a nível vascular, dado que modula positivamente o perfl vascular, reduzindo a pressão arterial. A variação nos níveis de NO poderá ajudar a explicar os benefícios verifcados.
- Acute effects of smoking on the arterial function of young healthy smokersPublication . Pereira, Telmo; Costa, TatianaSeveral studies have supported the idea that smoking induces changes with direct impact on endothelial function and arterial stiffness. The main purpose of this study was to assess the acute effects of smoking on vascular function in healthy young adults. METHODS: We designed a quasi-experimental study, including ninety participants aged between 18 and 25 years. Participants were divided into three groups: Active exposure group (AG) - 30 usual smokers; passive exposure group (PG) and non-exposure control group (CG), each including 30 non-smokers matched for age, gender and overall lifestyle. Heart rate (HR), brachial blood pressure (bBP), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and carotid pulse wave analysis (PWA) were evaluated in two moments: baseline and 30 minutes after smoking exposition (AG and PG) or 30 minutes after the first evaluation (CG). RESULTS: Significant changes from baseline were observed only in the AG, with an increase in PWV, from 5.6 ± 0.7 m/s to 6.1 ± 0.2 m/s post-smoking (p = 0.040), and a decrease in FMD of about -5.7 ± 2.3% after smoking one cigarette (p < 0.001). A significant increase in brachial and central BP was also observed in the AG. A trend for increase in brachial and central BP, and decrease in the FMD was observed in the PG and no significant changes were depicted in the CG. CONCLUSION: Just one cigarette produces significant detrimental acute effects on the vascular endothelium and hemodynamic profile of healthy young short-term smokers. Changes are also observed, although to a lesser extent, in passive smokers.
- Influence of permanent night work on the circadian rhythm of blood pressurePublication . Pereira, Joaquim; Alves, Ana; Simões, Helder; Pereira, TelmoAbstract. Night workers exercise their labours activities and rest in contrary schedules to the chronobiological standards. This inversion leads the body to several adaptations, including changes in the circadian rhythm of blood pressure (BP). Objectives: To evaluate the BP in individuals who perform work at night, in order to objectively detail the BP circadian rhythm adaptations infixed night workers. Methods: A cross-sectional study enrolling 23 fixed night workers, both genders, was performed, with 24h BP measured with ambulatory blood pressure monitoring (ABPM) during a normal working day. Risk factors, anthropometric and lifestyle information were collected using a standard questionnaire. Results: Ambulatory BP demonstrated a pattern of adaptation to the sleep/activity cycle in all participants. BP dropped during the sleeping period (mean drop: -11.35±6.85) and was higher during the awakening period, reaching the highest results and greater BP variability during the working period. The chronobiological adaptation of the 24h BP was not dependent on sociodemographic or clinical characteristics. In addition, age, male gender, obesity, and those working less time were associated with higher BP mean values. Conclu-sions: The circadian rhythm of BP follows the working circadian profile of the individual.
- O modelo AGA@4life na promoção de um envelhecimento ativo e saudávelPublication . Pereira, TelmoO envelhecimento das populações constitui um importante desafio na atualidade. Para corresponder a esta problemática transversal aos vários sectores da sociedade,desenvolveu-se um modelo que visa a promoção de um envelhecimento ativo e saudável através da implementação de um modelo de intervenção fundado na abordagem geriátrica ampla (AGA), incorporando também recursos endógenos da região, e envolvendo o meio académico da área das Ciências da Saúde. O modelo de AGA proposto, designado AGA@4life, assenta num protocolo de avaliação individual, de natureza holística e multidisciplinar, e consequente delineamento e implementação de estratégias de intervenção ajustadas a cada indivíduo, visando a prevenção da fragilidade e do declínio funcional, cognitivo e social do idoso. As ações de intervenção centram-se em programas personalizados de exercício físico, educação nutricional, estimulação cognitiva, monitorização de comorbilidades, aconselhamento fármacoterapêutico e promoção global do bem-estar.
- O exercício físico aplicado a pessoas idosasPublication . De Noronha Cipriano, Inês; Pereira, TelmoO envelhecimento caracteriza-se por uma perda gradual de funções fisiológicas, sendo um processo natural e fisiológico, e marcadamente heterogéneo. No entanto, é possível modificar as trajetórias de declínio funcional e promover um envelhecimento bem-sucedido. Uma das formas mais consensualmente identificadas, de promoção de um envelhecimento biologicamente mais favorável é a prática de exercício físico e a promoção de uma vida fisicamente ativa. Diversos estudos têm demonstrado os benefícios da prática regular de exercício físico a nível fisiológico, funcional, social, e na promoção de melhor qualidade de vida e bem-estar na pessoa idosa. Não obstante, tendo em consideração as particularidades desta população, nomeadamente atendendo à coexistência de comorbilidades, torna-se essencial uma prescrição de planos adaptados de exercício físico, bem como a monitorização da sua implementação. Por outro lado, estes planos deverão ser integrados numa estratégia mais abrangente de promoção de um envelhecimento ativo e saudável, como o preconizado no Modelo de Intervenção AGA@4life.
- A função cognitiva no envelhecimentoPublication . Pereira, TelmoO envelhecimento biológico traduz-se por uma trajetória de perda de funções fisiológicas que se transpõem, entre outras consequências, na deterioração progressiva da função cognitiva. Esta perda de competências cognitivas tem um impacto na vida quotidiana da pessoa idosa, que será tanto mais importante quanto maior for o grau de compromisso cognitivo identificado. Nesse sentido, a promoção de um envelhecimento ativo e saudável deverá necessariamente contemplar a dimensão cognitiva, mediante a implementação de estratégias de intervenção que estimulem e promovam uma cognição ajustada, ou mesmo otimizada, face ao esperado biologicamente pela idade e contexto clínico global. A adoção de instrumentos de mensuração objetiva da função cognitiva do indivíduo revela-se um requisito operacional adicional, na medida em que a informação providenciada permite a identificação de trajetórias longitudinais individualizadas da cognição, traduzindo-se assim num instrumento de aferição da eficácia das estratégias de intervenção e na identificação de formas subclínicas de processos patológicos que careçam de intervenção clínica especializada.