Browsing by Author "Lago, P"
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- Assessment of Continuous Pain in Newborns Admitted to NICUs in 18 European CountriesPublication . Anand, K; Eriksson, M; Boyle, E; Avila-Alvarez, A; Andersen, R; Sarafidis, K; Polkki, T; Matos, C; Lago, P; Papadouri, T; Attard-Montalto, S; Ilmoja, ML; Simons, S; Tameliene, R; van Overmeire, B; Berger, A; Dobrzanska, A; Schroth, M; Bergqvist, L; Courtois, E; Rousseau, J; Carbajal, RAIM: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. METHODS: A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission. RESULTS: Only 2113 of 6648 (31.8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46.0%), noninvasive ventilation (NiV, 35.0%) and no ventilation (NoV, 20.1%) groups (p < 0.001). Daily assessments for continuous pain occurred in only 10.4% of all neonates (TrV: 14.0%, NiV: 10.7%, NoV: 7.6%; p < 0.001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions and surgical admissions (all p < 0.01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anaesthetics (O-SH-GA) (all p < 0.001), or surgery (p = 0.028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1.60, p < 0.001) and NiV groups (OR:1.40, p < 0.001). CONCLUSION: Assessments of continuous pain occurred in less than one-third of NICU admissions and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.
- Composite Outcomes in Observational Studies of Ulcerative Colitis: a Systematic Review and Meta‐AnalysisPublication . Magro, F; Alves, C; Santiago, M; Ministro, P; Lago, P; Correia, L; Gonçalves, R; Carvalho, D; Portela, F; Dias, C; Dignass, A; Danese, S; Peyrin‐Biroulet, L; Estevinho, MM; Moreira, PBackground: Ulcerative colitis (UC) has been the focus of numerous observational studies over the years and a common strategy employed in their design is the use of composite and aggregate outcomes. Objective: This systematic review and meta-analysis aims to identify composite and aggregate outcomes of observational studies in UC and to evaluate how the number and type of variables included and the length of follow-up affect the frequency of patients that achieve these outcomes. Methods: A systematic literature search was carried out using MEDLINE [via PubMed], Scopus, and Web of Science online databases. Observational studies that included UC patients and reported composite or aggregate outcomes were identified. A set of variables considered to be representative of progressive or disabling UC was defined, the proportion of patients attaining the outcomes was determined and a random-effects meta-analysis was performed by dividing the identified studies into subgroups according to different criteria of interest. Results: A total of 10,264 records were identified in the systematic search, of which 33 were retained for qualitative analysis and 20 were included in the meta-analysis. The mean frequency for composite outcomes was 0.363 [95% confidence interval (CI) 0.323-0.403]. The frequency of composite outcome for the subgroup of studies that included the variable "Biologics" was significantly higher than for those in which this variable was not reported [0.410; 95% CI 0.364-0.457 versus 0.298; 95% CI 0.232-0.364; p = 0.006]. Composite outcomes were also more frequent as the follow-up duration increased. Conclusion: The frequency of composite outcomes in observational studies of UC is dependent on the specific identity of the variables being reported. Moreover, longer follow-up periods are associated with higher frequencies of composite outcomes. The evidence provided here is useful for the design of future observational studies of UC that aim to maximize the frequency of patients that achieve composite outcomes.
- Decisões Clínicas na Doença de CrohnPublication . Magro, F; Correia, L; Lago, P; Macedo, G; Peixe, P; Portela, F; Amil Dias, J; Barros, L; Belo, T; Caldeira, P; Cerqueira, R; Chagas, C; Correia, M; Ferreira, A; Freire, P; Gonçalves, AR; Gonçalves, R; Herculano, R; Lopes, S; Moura Santos, P; Machado, A; Morna, H; Pimentel, R; Ramos, J; Reis, J; Rodrigues, S; Rosa, I; Salgado, M; Vasconcelos, H; Vieira, AIA doença de Crohn é uma doença inflamatória crónica do trato gastrointestinal. O aumento da incidência e a heterogeneidade desta patologia, com diferentes apresentações e prognóstico leva a uma constante preocupação em desenvolver e melhorar a sua classificação e tratamentoObjectivos: Elaborar recomendações (com base no nível de evidência e grau de recomendação) para 5 questões consideradas como os desafios clínicos na abordagem terapêutica da doença de Crohn na actualidade. Métodos: A metodologia adoptada pelo grupo de trabalho DC2 (Desafios Clínicos na Doença de Crohn) baseou‑se na seleção de 5 questões‑problema, por votação; elaboração, por cada subgrupo, de recomendações e reflexões nacionais para cada questão‑problema; discussão e aprovação das respostas e reflexões de cada questão, em reunião de consenso. Conclusões: Foi possível efectuar conclusões alicerçadas na evidência para as questões colocadas, recomendando‑se: 1) são factores preditivos de mau prognóstico o aparecimento da doença de Crohn antes dos 40 anos, doença estenosante e doença anal; 2) poder‑se‑á ponderar suspender os biológicos em doentes com remissão endoscópica e com biomarcadores normais; 3) os doentes com marcadores bioquímicos de atividade (nomeadamente a PCR e a calprotectina) têm maior probabilidade de recidiva; 4) perante uma falência aos biológicos é essencial assegurar que o tratamento com o primeiro fármaco foi optimizado. No caso do infliximab, está demonstrado que quer a redução do intervalo das administrações ou o aumento da dose permitem recuperar a resposta na larga maioria dos doentes. Em relação ao adalimumab, os doentes deverão passar de terapêutica quinzenal para semanal 5) em situação de doença de Crohn com cirurgia intestinal, o recurso a terapêutica de redução da recorrência pós‑cirurgia, particularmente imunossupressores e biológicos está indicado.
- Sedation and Analgesia Practices in Neonatal Intensive Care Units (EUROPAIN): Results from a Prospective Cohort StudyPublication . Carbajal, R; Eriksson, M; Boyle, E; Avila-Alvarez, A; Dovland Andersen, R; Sarafidis, K; Polkki, T; Matos, C; Lago, P; Papadouri, T; Attard Montalto, S; Ilmoja, ML; Simons, S; Tameliene, R; Overmeire, B; Berger, A; Dobrzanska, A; Schroth, M; Bergqvist, L; Lagercrantz, H; Anand, KBACKGROUND: Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries. METHODS: EUROPAIN (EUROpean Pain Audit In Neonates) was a prospective cohort study of the management of sedation and analgesia in patients in NICUs. All neonates admitted to NICUs during 1 month were included in this study. Data on demographics, methods of respiration, use of continuous or intermittent sedation, analgesia, or neuromuscular blockers, pain assessments, and drug withdrawal syndromes were gathered during the first 28 days of admission to NICUs. Multivariable linear regression models and propensity scores were used to assess the association between duration of tracheal ventilation (TV) and exposure to opioids, sedatives-hypnotics, or general anaesthetics in neonates (O-SH-GA). This study is registered with ClinicalTrials.gov, number NCT01694745. FINDINGS: From Oct 1, 2012, to June 30, 2013, 6680 neonates were enrolled in 243 NICUs in 18 European countries. Mean gestational age of these neonates was 35.0 weeks (SD 4.6) and birthweight was 2384 g (1007). 2142 (32%) neonates were given TV, 1496 (22%) non-invasive ventilation (NIV), and 3042 (46%) were kept on spontaneous ventilation (SV). 1746 (82%), 266 (18%), and 282 (9%) neonates in the TV, NIV, and SV groups, respectively, were given sedation or analgesia as a continuous infusion, intermittent doses, or both (p<0.0001). In the participating NICUs, the median use of sedation or analgesia was 89.3% (70.0-100) for neonates in the TV group. Opioids were given to 1764 (26%) of 6680 neonates and to 1589 (74%) of 2142 neonates in the TV group. Midazolam was given to 576 (9%) of 6680 neonates and 536 (25%) neonates of 2142 neonates in the TV group. 542 (25%) neonates in the TV group were given neuromuscular blockers, which were administered as continuous infusions to 146 (7%) of these neonates. Pain assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and 916 (30%) of 3017 neonates in the TV, NIV, and SV groups, respectively (p<0.0001). In the univariate analysis, neonates given O-SH-GA in the TV group needed a longer duration of TV than did those who were not given O-SH-GA (mean 136.2 h [SD 173.1] vs 39.8 h [94.7] h; p<0.0001). Multivariable and propensity score analyses confirmed this association (p<0.0001). INTERPRETATION: Wide variations in sedation and analgesia practices occur between NICUs and countries. Widespread use of O-SH-GA in intubated neonates might prolong their need for mechanical ventilation, but further research is needed to investigate the therapeutic and adverse effects of O-SH-GA in neonates, and to develop new and safe approaches for sedation and analgesia. FUNDING: European Community's Seventh Framework Programme.
- Septic Arthritis in a HIV Positive Hemophilia A PatientPublication . Lago, P; Antunes, M; Santos, M; Diniz, MJ
- Soluble Human Suppression of Tumorigenicity 2 Is Associated with Endoscopic Activity in Patients with Moderate-to-Severe Ulcerative Colitis Treated with GolimumabPublication . Magro, F; Lopes, S; Silva, M; Coelho, R; Portela, F; Branquinho, D; Correia, L; Fernandes, S; Cravo, M; Caldeira, P; Tavares de Sousa, H; Patita, M; Lago, P; Ramos, J; Afonso, J; Redondo, I; Machado, P; Philip, G; Lopes, J; Carneiro, FBackground: Suppressor of Tumorigenicity 2 (ST2) is an IL33 receptor detected in the mucosa and serum of ulcerative colitis (UC) patients. We evaluated soluble ST2 (sST2) as a surrogate biomarker of disease outcome and therapeutic response, in moderate-to-severe UC patients treated with golimumab. Methods: We conducted an open-label single-arm multicentre prospective study. At screening/baseline, week 6 (W6) and week 16 (W16), clinical and endoscopic activity (total Mayo score), histologic activity (Geboes index) and biomarkers were evaluated. Results: From 38 patients, 34 (89.5%) completed W6 and 29 (76.3%) completed W16. Mean age (±SD) was 34.6 ± 12.6 years; 55.9% were female. At W16, 62.1% achieved clinical response. Patients with endoscopic activity at W6 (n = 20) had higher baseline sST2 (median, 24.5 versus 18.7 ng/ml, p = 0.026) and no decrease from baseline (median change, 0.8 versus -2.7, p = 0.029). At W6, sST2 levels correlated with endoscopic activity (rs = 0.45, p = 0.007) but not with histological activity (rs = 0.25, p = 0.151). The best cut-offs for endoscopic activity were sST2 = 16.9 ng/ml (sensitivity = 85%; specificity = 71%) and faecal calprotectin (FC) = 353 μg/g (sensitivity = 90%, specificity = 67%). Patients with histological activity at W6 (n = 27) had higher baseline ST2 levels (median, 23.0 versus 13.7 ng/ml, p = 0.035). sST2 did not correlate with FC or serum C-reactive protein. FC levels correlated with histological activity and baseline FC were higher when Geboes ⩾3.1 at W6. Conclusions: sST2 may be a surrogate biomarker of UC activity and therapeutic response as it correlates with endoscopic and clinical activity at W6 of golimumab treatment, and subjects with endoscopic and histological activity at W6 had higher baseline ST2 levels.
- The Who-When-Why Triangle of CAM Use Among Portuguese IBD PatientsPublication . Portela, F; Dias, C; Caldeira, P; Cravo, M; Deus, J; Gonçalves, R; Lago, P; Morna, H; Peixe, P; Ramos, J; Sousa, H; Tavares, L; Vasconcelos, H; Magro, F; Ministro, PBACKGROUND: The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. AIM: This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. METHODS: Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. RESULTS: Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort. CONCLUSIONS: Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.