Browsing by Issue Date, starting with "2015-04"
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- Painful Purple Nodule on the Right ThighPublication . Oliveira, A; Brás, S; Milheiro, A; Cardoso, J
- Prevalence of Microalbuminuria in Hypertensive Patients With or Without Type 2 Diabetes in a Portuguese Primary Care Setting: The RACE (MicRoAlbumin sCreening survEy) StudyPublication . Marques da Silva, P; Carvalho, D; Nazaré, J; Martins, L; Aguiar, C; Manso, MC; Carqueja, T; Polónia, JIntrodução e objetivos: Determinar a prevalência de microalbuminúria (MAU) em doentes hipertensos (HTA) e/ou diabéticos tipo 2 (DM2) e em normotensos não diabéticos (grupo controlo). Como objetivos secundários, analisar as diferenças de distribuição da MAU nas quatro subpopulações e observar a associação de variáveis clínicas e epidemiológicas diversas com a MAU. Métodos: O RACE (micRoAlbuminsCreeningsurvEy) é um estudo epidemiológico descritivo, observacional de corte transversal, multicêntrico, que incluiu doentes acompanhados nos Cuidados de Saúde Primários (CSP) em Portugal. Os doentes com causas potenciais de falsos positivos para MAU foram excluídos. As avaliações principais foram a frequência da MAU, determinada pelo teste da tira reativa Micral-Test®, a pressão arterial (PA), as variáveis demográficas, as doenças concomitantes, a medicação cardiovascular e antidiabética e as variáveis bioquímicas. Resultados: Um total de 9198 participantes (3769 hipertensos, 3100 diabéticos tipo 2 hipertensos, 423 diabéticos normotensos e 1906 controlos), 54,7% do sexo feminino, foram incluídos na análise primária. A prevalência de MAU foi de 58% nos doentes com HTA + DM2, 51% nos doentes com DM2, 43% nos doentes com HTA e de 12% no grupo controlo ( 2: p < 0,001 para todos os subgrupos). Numa análise multivariada, os preditores de MAU foram presenc¸a de DM2 ou de HTA, a HbA1c, o sexo masculino, a idade, a PA sistólica e o colesterol total. Conclusões: A MAU é extremamente frequente nos doentes em CSP com diabetes e/ou hipertensão, particularmente em doentes com HTA e DM2 com risco cardiovascular elevado. O rastreio da MAU poderá facilitar a identificação de indivíduos em risco e aumenta a atenção para a doença renal e as lesões nos órgãos alvo.
- Predictive Impact on Medium-Term Mortality of Hematological Parameters in Acute Coronary Syndromes: Added Value on Top of GRACE Risk ScorePublication . Timóteo, AT; Papoila, AL; Lousinha, A; Alves, M; Miranda, F; Ferreira, ML; Cruz Ferreira, RBACKGROUND: Red Cell Distribution Width (RDW) prognostic value in patients with Acute Coronary Syndrome (ACS) has been well validated whereas that of Platelet Distribution Width (PDW) is less well known. OBJECTIVES: Investigate the incremental prognostic value, on top of GRACE risk score, of a new variable resulting from the combination of RDW and PDW. METHODS: Consecutive patients with ACS. Complete blood count, with RDW and PDW, was obtained. Primary endpoint was one-year all-cause mortality and Cox regression models were used to measure the influence of RDW and PDW on patients' survival time. A new combination categorical variable (RDW/PDW) was created with both discretized RDW and PDW and logistic regression models were used. Predictive value and discriminative ability of the model with GRACE risk score alone and of the model with inclusion of RDW/PDW was assessed. RESULTS: We included 787 patients. Hospital and one-year mortality rates were 5.1% and 7.8%, respectively. Both continuous RDW and PDW were independent predictors of death. The best cut-off for RDW was 13.9%, and 14.5% for PDW. Inclusion of RDW/PDW in a model with GRACE risk score improved the AUC from 0.81 (95% CI 0.75-0.86) to 0.84 (95% CI 0.79-0.90) (p=0.024) with an improvement in total NRI (56%) and IDI (0.048). CONCLUSIONS: Simple markers such as RDW and PDW can be useful in risk stratification of death after ACS. Combining both markers with GRACE risk score improved the predictive value for all-cause mortality and reduced the estimated risk of those who did not die.
- Urinary Tract Effects of HPSE2 MutationsPublication . Stuart, H; Roberts, N; Hilton, E; McKenzie, E; Daly, S; Hadfield, K; Rahal, J; Gardiner, N; Tanley, S; Lewis, M; Sites, E; Angle, B; Alves, C; Lourenço, T; Rodrigues, M; Calado, A; Amado, M; Guerreiro, N; Serras, I; Beetz, C; Varga, R; Silay, M; Darlow, J; Dobson, M; Barton, D; Hunziker, M; Puri, P; Feather, S; Goodship, J; Goodship, T; Lambert, H; Cordell, H; Saggar, A; Kinali, M; Lorenz, C; Moeller, K; Schaefer, F; Bayazit, A; Weber, S; Newman, W; Woolf, AUrofacial syndrome (UFS) is an autosomal recessive congenital disease featuring grimacing and incomplete bladder emptying. Mutations of HPSE2, encoding heparanase 2, a heparanase 1 inhibitor, occur in UFS, but knowledge about the HPSE2 mutation spectrum is limited. Here, seven UFS kindreds with HPSE2 mutations are presented, including one with deleted asparagine 254, suggesting a role for this amino acid, which is conserved in vertebrate orthologs. HPSE2 mutations were absent in 23 non-neurogenic neurogenic bladder probands and, of 439 families with nonsyndromic vesicoureteric reflux, only one carried a putative pathogenic HPSE2 variant. Homozygous Hpse2 mutant mouse bladders contained urine more often than did wild-type organs, phenocopying human UFS. Pelvic ganglia neural cell bodies contained heparanase 1, heparanase 2, and leucine-rich repeats and immunoglobulin-like domains-2 (LRIG2), which is mutated in certain UFS families. In conclusion, heparanase 2 is an autonomic neural protein implicated in bladder emptying, but HPSE2 variants are uncommon in urinary diseases resembling UFS.
- Off-the-Person Electrocardiography: Performance Assessment and Clinical CorrelationPublication . Plácido da Silva, H; Carreiras, C; Lourenço, A; Fred, A; César das Neves, R; Cruz Ferreira, RPrevious work by our group introduced a novel concept and sensor design for “off-the-person” ECG, for which evidence on how it compares against standard clinical-grade equipment has been largely missing. Our objectives with this work are to characterise the off-the-person approach in light of the current ECG systems landscape, and assess how the signals acquired using this simplified setup compare with clinical-grade recordings. Empirical tests have been performed with real-world data collected from a population of 38 control subjects, to analyze the correlation between both approaches. Results show off-the-person data to be correlated with clinical-grade data, demonstrating the viability of this approach to potentially extend preventive medicine practices by enabling the integration of ECG monitoring into multiple dimensions of people’s everyday lives.