PubMed Health⌕ Search

Biomedical subjects

A Porto

Publications and source records attributed to A Porto.

17 recordsLinked to original sources
PubMed1999

Graft versus host disease in autologous stem cell transplantation.

Relapse remains the major cause of mortality in haematological malignancies treated with autologous stem cell transplantation (ASCT). Graft versus tumour reaction (GVT) associated to autologous graft versus host disease (GVDH) may contribute to eliminate minimal residual disease (MRD) after ASCT. Eighty patients with several diagnostics were submitted to ASCT. After stem cell infusion, patients randomised in 4 groups. Groups were treated as follows: Group A received either a IFN (alpha Interferon--1,000,000 U/d), Cyclosporine A (CSA--1 mg/-kg/d intravencus) for 28 days, and granulocyte-macrophage colony stimulating factor (GM-CSF-250/m2/d) until engraftment; B: CSA (same dose and way) and GM-CSF; C: CSA (1 mg/kg/d orally) and GM-CSF and D: only GM-CSF. Patients were inspected daily and if skin rash was detected, a skin biopsy was obtained at that moment, otherwise biopsies were obtained at day 21 after ASCT. GVHD was positive in 23 patients (13 from group A and 10 from group B). All cases were grades I and II. A majority of CD4+ T lymphocytes was seen in skin infiltrates. No significant differences were seen in WBC and platelets engraftment times, antibiotic administration or hospitalisation days required among the four groups. With a median follow up of 18 months, there were no differences in disease free survival (DFS) or overall survival (OS) between the patients who developed GVHD and the others. However, considering that myeloma cells do not express antigen MCH II, which is necessary for GVT effect, we excluded patients with multiple myeloma (MM) from survival analysis, thus obtaining a significant difference in OS results between patients who developed GVHD and those in whom this reaction was not observed (81% vs 58% p:0.05). We conclude that pharmacological induction of GVHD in ASCT is possible with CSA administration (1 mg/kg/d i.v.). Development of GVHD showed a better outcome for patients in our study except for those patients with MM. This results must be confirmed by a longer follow up of our patients and further studies.

Adolescent↗
PubMed1998

Immune phenotype of chronic liver disease.

Immune disorders in chronic liver disease may reflect common host propensities or disease-specific factors. Our aim was to determine the principal bases for these expressions. Four hundred fifty-one patients with various chronic liver diseases were assessed prospectively for concurrent immune disorders. Individuals with immune diseases were more frequently women (73% vs 60%, P = 0.02) and they had HLA DR4 more often than counterparts with other HLA (46% vs 23%, P = 0.000008). The association between HLA DR4 and immune disease was apparent within individual liver diseases and within different categories of liver disease. Women with HLA DR4 had a higher frequency of immune disease than women without HLA DR4 (52% vs 22%, P < or = 0.000001), and they also had immune diseases more commonly than DR4-positive men (52% vs 31%, P = 0.03). DR4-positive men, however, had higher frequencies of immune disease than DR4-negative men, especially in the nonimmune types of liver disease (26% vs 4%, P = 0.002). We conclude that HLA DR4 and female gender constitute an immune phenotype that is an important basis for autoimmune expression in chronic liver disease.

Autoantibodies↗
PubMed1998

[Left ventricular filling in young patients with systemic lupus erythematosus in stable phase].

OBJECTIVE: The aim of this study was to evaluate the left ventricle filling pattern in patients with stable systemic lupus erythematosus (SLE). METHODS: This prospective study was performed in 22 healthy controls and in 24 patients with stable SLE. These two groups were submitted to a clinical, electrocardiographic and echocardiographic evaluation. RESULTS: Gender distribution and mean age were similar in both groups (p = NS). Patients with SLE were more symptomatic (21%) than control patients (0%) (p < 0.01). Left ventricular dimensions, wall thickness, and systolic function were not significantly different between the two groups. However, pericardial effusion was more frequently found in patients with SLE (21%) when compared to the control group (0%) (p < 0.05). When compared to the control group, patients with SLE showed an abnormal left ventricular filling pattern. Peak late mitral flow velocity was 0.45 +/- 0.2 m/sec in SLE patients and 0.36 +/- 0.1 m/sec in the control group (p = 0.001). CONCLUSION: These results demonstrate that patients with stable SLE, when compared to healthy controls, are frequently associated with cardiovascular symptoms, asymptomatic pericardial effusion, and an abnormal left ventricular filling pattern.

Adult↗
PubMed1998

[Research in education programs].

Postgraduate medical training is intended to give competence in a specific field of medicine. Postgraduate programs should therefore be designed to offer the appropriate opportunities for the acquisition of specific knowledge and skills required for expertise in that particular medical or surgical specialty. The trained physician should not only be able to practice his specialty, but also have a deep understanding of the fundamental knowledge involved and convey this experience to others. Scientific curiosity, critical reasoning, persistence, and the ability to work in a team are important qualities that should be developed during post graduate training. Due to its requirements and methods, research clearly emerges as an important tool in promoting the timely achievement of these main objectives. All departments should be involved in basic or clinical research, and this work should be part of the postgraduate program. Finally, research activities should be appropriately valorized in the overall appreciation of the trainee's curriculum.

Curriculum↗
PubMed1997

[Sex hormones and osteoporosis: a physiological perspective for prevention and therapy].

Estrogen deficiency is the main cause of post-menopausal osteoporosis and hormone replacement therapy is consensually regarded as the first line choice for its prevention. Hormone-replacement has also been shown to prevent bone loss associated with rheumatoid arthritis (RA) and corticotherapy. The rationale for its use in RA is reinforced by evidence of beneficial effects on disease activity. Estrogens also have bone-protective effects in males. C-19 progestagens seem to potentiate the skeletal effects of estrogens whereas C-21 derivatives appear to have no significant influence. Progestagens may be particularly useful in the prevention of steroid-induced osteopenia. Testosterone is an effective treatment for male osteoporosis associated with hypogonadism and is also promising in the treatment of osteoporosis in aged eugonadal males. The association of this hormone potentiates the effects of estrogens on bone mineral density in post-menopausal women. However, anabolic androgens have been preferred in this condition, due to a lower androgenizing effect. They represent a valid therapeutic alternative, particularly in cases of cortical osteoporosis with low bone turnover and in the aged and frail. In general, the different modalities of hormonal therapy clearly deserve a higher degree of preference in the treatment and prevention of osteoporosis than common present practice in our country. It is time to reassess this matter, clear unfounded fears and reinforce the physiological and scientific foundations of our therapeutic options for osteoporosis.

Androgens↗
PubMed1994

Double-blind study evaluating by endoscopy the tolerability of nimesulide and diclofenac on the gastric mucosa in osteoarthritic patients.

The gastric tolerability of nimesulide, a new nonsteroidal anti-inflammatory drug (NSAID), was compared with diclofenac, an established NSAID for the treatment of osteoarthritis (OA). A randomised, double-blind parallel group study was undertaken comparing the tolerability and efficacy of nimesulide (100 mg bds) with diclofenac (50 mg tds) over a one month period. Gastroduodenal endoscopy revealed that after 30 days 4 patients had developed ulcers (1 nimesulide patient) and 6 patients had developed erosions (4 nimesulide patients). However, there was no statistically significant difference between the two treatments. Both drugs were clinically very well tolerated and only 10 patients withdrew from the study due to adverse events (5 in each group). Efficacy was assessed by measuring pain on visual analogue scales, by means of the functional index of Lequesne and by scoring spontaneous pain, pain on passive movement and functional impairment. Nocturnal pain was also checked. All efficacy parameters showed a significant improvement during the study without any observed treatment differences.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Epidemiology of hepatitis C in central Portugal. Prevalence of anti-HCV in the population of the Coimbra District.

Anti-hepatitis C virus antibody (anti-HCV) screening was performed in a sample of the adult population of the Coimbra District. 657 persons were included (267 male and 390 female, mean age of 42.7 + 13.1 years), aleatorily chosen from four characteristic regions. Anti-HCV was detected using an ELISA-2 test and all positive sera were also tested with RIBA-2. General prevalence of anti-HCV was 0.46%. All positive patients live in urban areas and presented risk factors for HCV infection. Anti-HCV was found in 33.3% of intravenous drug abusers, in 1.8% of transfused individuals, in 1.33% of alcoholics (higher than 80 g/d alcohol ingestion), in 1% of cases with history of surgical operations, and in 0.65% of persons who lived in risk regions for hepatitis B. We conclude that anti-HCV prevalence is low in our region. We think it is important to perform other studies on larger samples of general population and to study risk groups.

Adult↗
PubMed1994

[Medical education: challenges for the future].

With the objective of contributing to the Reform of Medical Education, presently in progress in Portugal, this paper presents a short review of the main reasons to change, as well as international movements and pedagogical trends in Medical Education. Some specificities of medical education in Portugal are discussed and the main difficulties and strategies for change are addressed. The experience of the Karolinska Institute in Stockholm is reviewed and its potential correlations to the Portuguese situation are explored.

Curriculum↗
PubMed1993

[Hepatitis C epidemiology in the central area of Portugal. Prevalence of anti-HCV in the population of the district of Coimbra].

Anti-hepatitis C virus antibody (anti-HCV) screening was performed in a sample of the adult population of the Coimbra District. 657 persons were included (267 male and 390 female, mean age of 42.7 +/- 13.1 years), aleatorily chosen from four characteristic councils. Anti-HCV was detected using an ELISA-2 test and all positive sera were also tested with RIBA-2. General prevalence of anti-HCV was 0.46%. All positive patients live in urban areas and presented risk factors for HCV infection. Anti-HCV was found in 33.3% of intravenous drug abusers, in 1.8% of transfused individuals, in 1.33% of alcoholics (higher than 80 g/d alcohol ingestion), in 1% of cases with history of surgical operations, and in 0.65% of persons who lived in risk regions for hepatitis B. We conclude that anti-HCV prevalence is low in our region. We think it is important to perform other studies in larger samples of general population and to study risk groups.

Adult↗
PubMedDate not supplied

[HCV genotypes. Liver histopathology and immunologic profile in four groups of patients].

AIM: Study on the prevalence of MCV genotypes, and correlation with liver pathology and immunological parameters. PATIENTS AND METHODS: 77 chronic hepatitis C patients (52 males, 25 females), mean age 44 +/- 14 years, belonging to four groups: (1) 23 (11 males) without other aetiology, (II) 19 (18 males) excessive drinkers, (III) 18 (12 males) haemodialysed, (IV) 17 (11 males) renal transplantation patients Genotyping was done by PCR (primers of the core, and hybridisation with specific probes). Serum Igs A, G, and M (by nephelometry), and peripheral blood lymphocyte (PBL) subsets (by flow cytometry) were determined. RESULTS: One genotype was found in 62 patients (1b 69.2%, 1a 21.5%, 2a 3.1%, 2b 3.1%, 3a 9.2%), and two genotypes in 4 patients (1b + 3a in 1 of group 1, 1b + 2a in 2 and 1a + 3a in 1 of group 111). Twelve cases (15.6%) were not identified (NI). Relative prevalence was not different in the four groups, but in 7 drug addicts 1 b was not found (Ia in 71.4%, 3 a 28.6%) The relationship between genotypes and age was significant (p < 0.05): in the 34 patients with less than 40 years, 1b was found in 38.2%, in the others in 41.2%, and NI in 20.6%; in those with 40-60 years, 1b was found in 68.8%, in the others in 15.6%, M in 15.6%; in those above 60 years, 1b was found in 90.9%, in the others in 9.1%. Of those identified, only genotype 1 (1a and 1b) was associated to moderate or severe activity, and infected 11/13 cases of cirrhosis or severe fibrosis. IgM (g/dL) was lower in 1b than in the others: 1.58 + 1.23 vs. 2.53 + 1.93 (p < 0.01). PBL (per mm3) were lesser in 1b than in the others, with significance for the CD8+: 540t239 vs. 739 + 420 (p < 0.01). CONCLUSIONS: Genotype 1b was the most prevalent in Portuguese patients, more significantly in the elderly, and was absent in drug addicts. The prevalence of genotypes is similar in general patients, in chronic haemodialysed, in renal transplantation recipients and in alcoholics. More severe liver pathology was associated with 1b and 1a genotypes. IgM and CD8+ had lower mean values in 1b infected patients. Other genotypes are certainly important in Portugal.

Adolescent↗