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Lourenço I, Gomes H, Ribeiro J, Caeiro F, Rocha P, Francisco C. Screening for Preeclampsia in the First Trimester and Aspirin Prophylaxis: Our First Year. Rev Bras Ginecol Obstet 2020; 42:390-396. [PMID: 32559792 PMCID: PMC10309226 DOI: 10.1055/s-0040-1712124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. METHODS Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria were multiple pregnancy and major fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of early-onset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150 mg at night) was offered to these women from screening until 36 weeks. RESULTS From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. CONCLUSION There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.
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Affiliation(s)
- Inês Lourenço
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Helena Gomes
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Ribeiro
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Filipa Caeiro
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pedro Rocha
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carla Francisco
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
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Ribeiro J, Mira E, Lourenço I, Santos M, Braúna M. The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro - Portugal. Cien Saude Colet 2019; 24:1585-1596. [PMID: 31166494 DOI: 10.1590/1413-81232018245.04452019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 02/19/2019] [Indexed: 11/21/2022] Open
Abstract
Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.
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Affiliation(s)
- Jaime Ribeiro
- Instituto Politécnico de Leiria . R. Gen. Norton de Matos, 2411-901. Leiria Portugal .
| | - Eva Mira
- Instituto Politécnico de Leiria . R. Gen. Norton de Matos, 2411-901. Leiria Portugal .
| | - Inês Lourenço
- Instituto Politécnico de Leiria . R. Gen. Norton de Matos, 2411-901. Leiria Portugal .
| | - Mariana Santos
- Instituto Politécnico de Leiria . R. Gen. Norton de Matos, 2411-901. Leiria Portugal .
| | - Mônica Braúna
- Instituto Politécnico de Leiria . R. Gen. Norton de Matos, 2411-901. Leiria Portugal .
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Gomes HH, Lourenço I, Ribeiro J, Martins D, Ribeiro R, Francisco C. Cell-free DNA and contingent screening: Our first year. J Gynecol Obstet Hum Reprod 2019; 48:509-514. [PMID: 30951890 DOI: 10.1016/j.jogoh.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Analysis of cell-free DNA (cfDNA) from maternal blood has showed a great potential as a screening method for fetal aneuploidies. cfDNA can be used as a first line screening tool or in a contingent model, after the combined test. METHODS Prospective study of women attending for first trimester combined screening in our Hospital, in the first year of contingent cfDNA screening. According to the combined screening test result patients were divided in high-risk (offered invasive test or routine follow-up), intermediate-risk (counselled for cfDNA, invasive or routine follow-up) or low-risk (routine ultrasound follow-up). Pregnancy outcomes and performance of screening were evaluated. A cost-effectiveness analysis was also done. RESULTS The majority of the 1272 enrolled participants were Caucasian (82,6%), multiparous (51,7%) and the median maternal age was 30 years old. Thirty women screened high-risk and 83,3% of them opted for an invasive test. Forty-nine patients had an intermediate risk and 75,5% of them choose cfDNA testing. Our rate of invasive tests decreased from 3.5% to 2.4%. DISCUSSION The cut-offs used to determine high and intermediate-risk are based on a compromise between detection rate, pregnancy lost rate and cost. Above a determined cut-off in the intermediate-risk group, the cost for each additional detected trisomy case is very high. One major benefit of this contingent model was the decrease in invasive testing. CONCLUSION The contingent cfDNA screening model can be easily implemented in a public hospital with a low-risk population. Since cost/benefit is an important issue, further studies are needed to determine the ideal cut-off for our country.
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Affiliation(s)
- Helena Henriques Gomes
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
| | - Inês Lourenço
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
| | - Joana Ribeiro
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
| | - Diana Martins
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
| | - Rita Ribeiro
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
| | - Carla Francisco
- Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 514, Loures, Portugal.
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Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol 2018; 31:385-394. [PMID: 29991883 PMCID: PMC6033757 DOI: 10.20524/aog.2018.0264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/26/2018] [Indexed: 12/15/2022] Open
Abstract
Pregnancy is characterized by numerous physiological changes that may lead to a diversity of symptoms and frequently to gastrointestinal complaints, such as heartburn, nausea and vomiting, or constipation. Chronic gastrointestinal diseases require treatment maintenance during this period, raising the challenging question whether outcomes beneficial to the mother may be harmful for the fetus. In addition, certain diseases, such as acute fatty liver of pregnancy, only develop during pregnancy and may require urgent procedures, such as fetus delivery. Even though they are not present in our day-to-day practice, knowledge of pregnancy-related diseases is fundamental and collaboration between gastroenterologists and obstetricians is often necessary. Herein, we review pregnancy-related diseases and systematize the most appropriate treatment choices according to the recent literature and guidelines, so that the article can serve as a guide to the gastroenterologist regarding the medical approach to pregnancy-related gastrointestinal and liver diseases and their therapeutic management.
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Affiliation(s)
- Catarina Frias Gomes
- Surgical Department, Gastroenterology Division (Catarina Frias Gomes, Joana Torres), Hospital Beatriz Ângelo, Loures, Portugal
| | - Mónica Sousa
- Medicine Department, Internal Medicina Division (Mónica Sousa);), Hospital Beatriz Ângelo, Loures, Portugal
| | - Inês Lourenço
- Surgical Department, Gynaecology and Obstetrics Division (Inês Lourenço, Diana Martins), Hospital Beatriz Ângelo, Loures, Portugal
| | - Diana Martins
- Surgical Department, Gynaecology and Obstetrics Division (Inês Lourenço, Diana Martins), Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Surgical Department, Gastroenterology Division (Catarina Frias Gomes, Joana Torres), Hospital Beatriz Ângelo, Loures, Portugal
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Alves MJ, Fernandes Â, Barreira JCM, Lourenço I, Fernandes D, Moura A, Ribeiro AR, Salgado J, Antonio A, Ferreira ICFR. How gamma-rays and electron-beam irradiation would affect the antimicrobial activity of differently processed wild mushroom extracts? J Appl Microbiol 2015; 118:592-8. [PMID: 25487785 DOI: 10.1111/jam.12718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/15/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022]
Abstract
AIMS The effects of irradiation (gamma-rays and electron-beams), up to 10 kGy, in the antimicrobial activity of mushroom species (Boletus edulis, Hydnum repandum, Macrolepiota procera and Russula delica) differently processed (fresh, dried, freeze) were evaluated. METHODS AND RESULTS Clinical isolates with different resistance profiles from hospitalized patients in Local Health Unit of Mirandela, Northeast of Portugal, were used as target micro-organisms. The mushrooms antimicrobial activity did not suffer significant changes that might compromise applying irradiation as a possible mushroom conservation technology. CONCLUSIONS Two kGy dose (independently of using gamma-rays or electron-beams) seemed to be the most suitable choice to irradiate mushrooms. SIGNIFICANCE AND IMPACT OF THE STUDY This study provides important results in antimicrobial activity of extracts prepared from irradiated mushroom species.
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Affiliation(s)
- M J Alves
- Escola Superior de Saúde, Instituto Politécnico de Bragança, Bragança, Portugal; Unidade Local de Saúde do Nordeste - Unidade de Mirandela, Mirandela, Portugal; Centro de Investigação de Montanha (CIMO), ESA, Instituto Politécnico de Bragança, Bragança, Portugal
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Alves M, Ferreira I, Lourenço I, Castro A, Pereira L, Martins A, Pintado M. Wild mushroom extracts potentiate the action of standard antibiotics against multiresistant bacteria. J Appl Microbiol 2013; 116:32-8. [DOI: 10.1111/jam.12348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/27/2013] [Accepted: 09/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- M.J. Alves
- CBQF-Escola Superior de Biotecnologia; Universidade Católica Portuguesa Porto; Porto Portugal
- Centro Hospitalar de Trás-os-Montes e Alto Douro- Unidade de Chaves; Chaves Portugal
- ESA; Instituto Politécnico de Bragança; Centro de Investigação de Montanha (CIMO); Bragança Portugal
- Escola Superior de Saúde; Instituto Politécnico de Bragança; Bragança Portugal
| | - I.C.F.R. Ferreira
- ESA; Instituto Politécnico de Bragança; Centro de Investigação de Montanha (CIMO); Bragança Portugal
| | - I. Lourenço
- Escola Superior de Saúde; Instituto Politécnico de Bragança; Bragança Portugal
| | - A. Castro
- Escola Superior de Saúde; Instituto Politécnico de Bragança; Bragança Portugal
| | - L. Pereira
- Escola Superior de Saúde; Instituto Politécnico de Bragança; Bragança Portugal
| | - A. Martins
- ESA; Instituto Politécnico de Bragança; Centro de Investigação de Montanha (CIMO); Bragança Portugal
| | - M. Pintado
- CBQF-Escola Superior de Biotecnologia; Universidade Católica Portuguesa Porto; Porto Portugal
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Bugalho A, Oliveira A, Semedo J, Lourenço I, Carreiro L. Argon-plasma treatment in benign metastasizing leiomyoma of the lung: a case report. Rev Port Pneumol 2010; 16:921-925. [PMID: 21067700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Benign metastasizing leiomyomas of the lung are rare smooth muscle cells tumours. We report the case of a 48 year-old female who was evaluated due to persistent cough, progressive dyspnoea and constitutional symptoms. Chest computed tomography revealed a left endobronchial mass, multiple parenchyma nodules and a pleural effusion. Bronchial biopsy histological features were consistent with benign metastasizing leiomyoma. The patient was successfully treated with argon-plasma and mechanical debulking. There was no disease relapse in the last four years.
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Affiliation(s)
- A Bugalho
- Interventional Pneumology Unit, Department of Pneumology, Hospital Pulido Valente, Lisbon, Portugal.
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Lourenço I, Rodrigues S, Figueiredo E, Godinho MC, Marques C, Amaro F, Mexia A. The effect of crop protection strategy on pest and beneficials incidence in protected crops. Meded Rijksuniv Gent Fak Landbouwkd Toegep Biol Wet 2002; 67:569-73. [PMID: 12696424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
This study took place in the Oeste region from 1996-1999 and it intended to analyse if the crop protection strategy followed by the farmer influenced the arthropod incidence and the natural control in protected vegetable crops under Mediterranean conditions. The observations were made fortnightly (Autumn/Winter) or weekly (Spring/Summer) in 30-60 plants/parcel (1 plant/35 m2) in order to evaluate incidences. Samples of pests and natural enemies were collected for systematic identification in two greenhouses for each protection strategy (traditional chemical control (TCC), integrated pest management (IPM) and pest control allowed in organic farming (OF)) in lettuce, tomato, green beans and cucumber. Data on incidence of mites, aphids, caterpillars, leafminers, whiteflies, thrips and respective natural enemies were registered as well as phytosanitary treatments performed (farmers' information and/or in loco traces). The leafminers were the pest whose incidence more often presented significant statistical differences between the studied protection strategies. In relation to this pest, the main results obtained were: a higher feeding punctures incidence in TCC than in IPM; higher incidence of adults, mines and feeding punctures in TCC than in OF; and a higher mines' incidence in IPM than in OF. Both in TCC and IPM high percentages of plants with mines were found although without an adult proportional presence. In the first case this was due to the repeatedly phytosanitary treatments applied; in the second case it was due to the natural control, since in IPM and OF greenhouses the collected larvae were mostly parasitized or dead. In spite of the fact these two strategies have as final result a similar mines and adults incidence, their production and environmental costs are quite different. Significant differences at the beneficials' population level between TCC greenhouses and IPM or OF greenhouses were found. As the farmers did no biological treatments these differences are related to different levels of beneficial populations due to different secondary effects of the pesticides applied.
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Affiliation(s)
- I Lourenço
- Escola Superior Agrária de Beja, Apartado 158, 7801-902 Beja, Portugal
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Baleiras C, Campos A, Lourenço I, Revez AI. [Urinary tract infections and pregnancy]. ACTA MEDICA PORT 1998; 11:839-46. [PMID: 10021778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Infection of the urinary tract is the most common type of infection in pregnant women, with a prevalence ranging from 5% to 10%. The majority of symptomatic upper urinary tract infections occur in women with pre-existent asymptomatic bacteriuria, due to the changes the urinary tract undergoes during pregnancy. In order to avoid potentially serious complications affecting maternal and fetal health, an early diagnosis followed by immediate and adequate care is mandatory. The authors have developed a procedure protocol based on the retrospective evaluation of all urinary tract infection cases during pregnancy, diagnosed in Dr. Alfredo da Costa Maternity Hospital during the year of 1994. The purpose of this protocol is to make the procedures as uniform and as adequate as possible, thus lowering the probability of complications.
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Affiliation(s)
- C Baleiras
- Serviço de Medicina Materno-Fetal, Maternidade Dr. Alfredo da Costa, Lisboa
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Lima C, Pinho C, Abecasis P, Lourenço I, Franca T, Aldomiro F, de Miranda AC. [Gastric carcinoid associated with pernicious anemia]. ACTA MEDICA PORT 1992; 5:551-4. [PMID: 1492606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A clinical case of a patient with pernicious anaemia and a carcinoid tumor of the gastric fundus is described. In the context of the case the relationship between pernicious anaemia, achlorhydria, atrophic gastritis and gastric carcinoid is discussed. The gastric neuroendocrine tumours and their structural and functional characteristics were reviewed in an attempt to clarify the nomenclature and the diagnostic and therapeutic approach in these situations.
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Affiliation(s)
- C Lima
- Serviço de Medicina 1, Hospital Curry Cabral, Lisboa
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Duarte P, Luz Z, Lourenço I, Reis B, Alvelos A. [Gastrinoma localized in the pylorus in a patient with recurrent peptic ulcer]. ACTA MEDICA PORT 1992; 5:393-6. [PMID: 1442186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a clinical case of a woman, 56 years old, with a history of duodenal ulcer and esophagitis, under medication with H2 receptors blockers during 3 years. Plasma basal gastrin was near normal levels. A stimulation test with secretin was compatible with gastrinoma. CT scan and selective angiography didn't localize the tumor. At laparotomy we found a pyloric nodule that prove to be the gastrinoma. Eighteen months after surgery the patient is asymptomatic and with a normal endoscopic examination and secretin stimulation test.
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Affiliation(s)
- P Duarte
- Serviços de Gastrenterologia e Cirurgia 5, Hospital de S. António dos Capuchos, Lisboa
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