Browsing by Author "Coelho, R."
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Association between Polymorphisms in Antioxidant Genes and Inflammatory Bowel DiseasePublication . Costa-Pereira, C.; Durães, C.; Coelho, R.; Grácio, D.; Silva, M.; Peixoto, A.; Lago, P.; Pereira, M.; Catarino, T.; Pinho, S.; Teixeira, J.; Macedo, G.; Annese, V.; Magro, F.Inflammation is the driving force in inflammatory bowel disease (IBD) and its link to oxidative stress and carcinogenesis has long been accepted. The antioxidant system of the intestinal mucosa in IBD is compromised resulting in increased oxidative injury. This defective antioxidant system may be the result of genetic variants in antioxidant genes, which can represent susceptibility factors for IBD, namely Crohn's disease (CD) and ulcerative colitis (UC). Single nucleotide polymorphisms (SNPs) in the antioxidant genes SOD2 (rs4880) and GPX1 (rs1050450) were genotyped in a Portuguese population comprising 436 Crohn's disease and 367 ulcerative colitis patients, and 434 healthy controls. We found that the AA genotype in GPX1 is associated with ulcerative colitis (OR = 1.93, adjusted P-value = 0.037). Moreover, we found nominal significant associations between SOD2 and Crohn's disease susceptibility and disease subphenotypes but these did not withstand the correction for multiple testing. These findings indicate a possible link between disease phenotypes and antioxidant genes. These results suggest a potential role for antioxidant genes in IBD pathogenesis and should be considered in future association studies.
- Calprotectin and the Magnitude of Antibodies to Infliximab in Clinically-stable Ulcerative Colitis Patients are More Relevant Than Infliximab Trough Levels and Pharmacokinetics for Therapeutic EscalationPublication . Magro, F.; Afonso, J.; Lopes, S.; Coelho, R.; Gonçalves, R.; Caldeira, P.; Lago, P.; Sousa, H.; Ramos, J.; Gonçalves, A.; Ministro, P.; Rosa, I.; Vieira, A.; Andrade, P.; Soares, J.; Carvalho, D.; Sousa, P.; Meira, T.; Lopes, J.; Moleiro, J.; Dias, C.; Falcão, A.; Geboes, K.; Carneiro, F.Although infliximab (IFX) is an efficient therapy for ulcerative colitis (UC) patients, a considerably high rate of therapeutic failures still occurs. This study aimed at a better understanding of IFX pharmacokinetics and pharmacodynamics among clinically-asymptomatic UC patients. This was a multicentric and prospective study involving 65 UC patients in the maintenance phase of IFX therapy. There were no significant differences between patients with positive and negative clinical, endoscopic and histological outcomes concerning their IFX trough levels (TLs), area under the IFX concentration vs. time curve (AUC), clearance and antibodies to infliximab (ATI) levels. However, the need to undergo therapeutic escalation later in disease development was significantly associated with higher ATI levels (2.62μg/mL vs. 1.15μg/mL, p=0.028). Moreover, and after adjusting for disease severity, the HR (hazard ratio) for therapeutic escalation was significantly decreased for patients with an ATI concentration below 3μg/mL (HR=0.119, p=0.010), and increased for patients with fecal calprotectin (FC) level above 250μg/g (HR=9.309, p=0.018). In clinically-stable UC patients, IFX pharmacokinetic features cannot predict therapeutic response on a short-term basis. However, high levels of ATIs or FC may be indicative of a future therapeutic escalation.
- Clinical performance of an infliximab rapid quantification assayPublication . Magro, F.; Afonso, J.; Lopes, S.; Coelho, R.; Gonçalves, R.; Caldeira, P.; Lago, P.; Sousa, H.; Ramos, J.; Gonçalves, A.; Ministro, P.; Rosa, I.; Meira, T.; Andrade, P.; Soares, J.; Carvalho, D.; Sousa, P.; Vieira, A.; Lopes, J.; Dias, C.; Geboes, K.; Carneiro, F.BACKGROUND: Therapeutic drug monitoring (TDM)-based algorithms can be used to guide infliximab (IFX) adjustments in inflammatory bowel disease (IBD) patients. This study aimed to explore a rapid IFX-quantification test from a clinical perspective. METHODS: This manuscript describes a prospective cohort study involving 110 ulcerative colitis (UC) patients on the maintenance phase of IFX. IFX trough levels were quantified using a rapid quantification assay and a commonly-used reference kit. RESULTS: Irrespective of the assay used to measure IFX, its through levels were statistically different between patients with and without endoscopic remission (Mayo endoscopic score = 0), as well as between patients stratified by their faecal calprotectin (FC) levels. Despite the fact that the two methods correlated well with each other [Spearman's rank correlation coefficient = 0.843, p < 0.001; intraclass correlation coefficients = 0.857, 95% confidence interval (CI): 0.791-0.903], there was a discernible systematic variation; values obtained with the reference kit were on average 2.62 units higher than those obtained with the rapid assay. Notwithstanding, 3 µg/ml was shown to be an acceptable cut-off to assess endoscopic status and inflammatory burden levels using both assays. The percentage of patients that had a positive outcome when the IFX concentration measured by the rapid assay ranked above 3 µg/ml was 88% both for a Mayo endoscopic score ⩽ 1 and for an FC concentration <250 µg/g. CONCLUSIONS: Based on this study, we concluded that using the rapid IFX assessment system with a 3 µg/ml threshold is a reliable alternative to the time-consuming enzyme-linked immunosorbent assays in patients on the maintenance phase of IFX.
- Complicações e tratamento da obesidade na criançaPublication . Coelho, R.; Bragança, G.RESUMO Nas últimas décadas, a prevalência da obesidade na infância e na adolescência e a consequente morbilidade e mortalidade aumentaram de uma forma alarmante. A obesidade é um importante factor de risco cardiovascular, associando- se a hipertensão arterial, a diabetes mellitus tipo 2 e a dislipidemia. Está descrita a associação com doenças osteoarticulares, esteatose hepática, apneia do sono, pseudotumor cerebri e problemas psico-afectivos. Devido à gravidade e à precocidade das complicações, o tratamento deve ser precoce, centrado na família e basear-se na reeducação alimentar e no incentivo ao exercício físico. Como o tratamento tem, em princípio, uma eficácia limitada, a prevenção torna-se essencial. ABSTRACT The prevalence of the childhood obesity through the last decades is increasing, with significant comorbidities and major health consequences. Obesity is associated with illness, such as cardiovascular disease, hypertension, type 2 diabetes mellitus and dislipidemia, and premature death. It is also associated with orthopedic complications, hepatic steatosis, sleep apnea, pseudotumor cerebri and poor self-esteem. Prevention is essential as treatment is usually frustrating. Treatment plan should include reasonable weight-loss goals, dietary and physical activity management, behavior modification and family involvement.
- A influência da osteoartrose e da artroplastia da anca sobre a atividade laboral em doentes em idade ativaPublication . Aido, R.; Sousa, M.; Pereira, A.; Ramos, J.; Coelho, R.; Lemos, R.O impacto da artroplastia total da anca sobre a atividade laboral em doentes jovens com coxartrose é um tema pouco explorado na literatura. Com o objetivo de avaliar a dimensão do problema e reconhecer os fatores clínicos que influenciam o retorno ao emprego nesta população, revimos 81 doentes com uma média etária de 47 anos, submetidos a artroplastia entre 2006 e 2010 (98 ancas). O estudo revelou que antes do procedimento 27 doentes já se encontravam aposentados e que mais 17 se reformaram depois da cirurgia. Os números finais demonstram que apenas 37 dos 81 doentes operados (45,6%) se mantêm a trabalhar depois da intervenção, sendo que o regresso ao trabalho acontece em média 6,7 meses depois da cirurgia. Existem fatores que favorecem positivamente o regresso ao trabalho: sexo masculino, juventude, coxartrose idiopática, prontidão na realização da cirurgia, unilateralidade, hastes metafisárias, postos de chefia e trabalho fisicamente pouco exigente. Apesar da elevada satisfação na resolução dos sintomas conseguido com a artroplastia, existe uma taxa de reforma em idade ativa de 54,4%. Sendo o problema do emprego multifatorial, os médicos sempre tiveram uma palavra sobre o retorno ao trabalho, a qual ainda se encontra baseada na experiência artroplástica do passado. A imergência de novos implantes dotados de maior resistência ao desgaste, aliada ao aprimoramento das técnicas cirúrgicas bem como as condições sociais que se atravessam, devem em nossa opinião introduzir a questão se não será tempo de reformular as restrições medicamente impostas aos pacientes jovens com artroplastia da anca.