Browsing by Author "Dias, C."
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- 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.
- Caso dermatológicoPublication . Dias, C.; Maia, A.; Selores, M.ABSTRACT Glomuvenous malformations, also known as glomangiomas, are tumor-like malformations or hamartomas of the glomus body. They can be sporadic or inherited as an autosomal dominant disease. Glomuvenous malformations tend to resemble hemangiomas. Clinical distinction between these entities is important due to their different therapeutic approaches. Surgical excision is the treatment of choice for isolated, painful glomuvenous malformations. We describe a case of a 7-year-old girl with multiple glomuvenous malformations.
- 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.
- Criança em risco - estudo multicêntricoPublication . Vale, M.J.; Borges, T.; Alexandrino, A.; Gesta, C.; Casanova, C.; Lunet, N.; Dias, C.Objectivos: Caracterizar as crianças em risco ou maltratadas identificadas nos hospitais da região Norte de Portugal e conhecer os mecanismos de protecção à criança existentes nessas instituições. Material e Métodos: Foram avaliadas as crianças com idade inferior a 18 anos, referenciadas ao Serviço Social em 2005, através da consulta retrospectiva dos processos clínicos/sociais. Foi calculada a proporção de crianças classificadas como estando em risco ou tendo sido maltratadas. Compararam-se as características dos indivíduos em que se observaram os diferentes tipos de mau trato e risco através da prova do χ2 ou do teste exacto de Fisher. Resultados: Participaram no estudo quinze hospitais; cinco tinham Núcleo de Apoio à Criança e Jovem em Risco. Das 804 crianças, 53,2% eram do sexo masculino e 68,3% tinham menos de 3 anos. Os motivos de sinalização foram: risco (79,4%), negligência (20,5%), mau trato físico (5,4%), mau trato psicológico (3,7%), abandono (5,6%) e abuso sexual (3,5%); 25% das crianças já tinham sido referenciadas ao Serviço Social. Foi pedido o acompanhamento da Comissão Protecção Crianças Jovens em Risco em 30,1% e do Tribunal de Menores e outras instâncias judiciais em 14,5% dos casos sinalizados. Os casos de maus tratos ou risco foram mais frequentemente perpetrados pela mãe (88,2%) e pelo pai (55,2%). Comparativamente com outras formas de mau trato, o abuso sexual foi mais frequente em crianças do sexo feminino (6,3% vs 1,2%, p<0,001) e mais frequentemente perpetrado por Desconhecidos (31,6% vs 2,8% p<0,001) ou Outros (27,5% vs 1,9% p<0,001). Conclusão: A elevada percentagem de crianças sinalizadas por risco traduz uma maior preocupação dos profissionais de saúde com esta problemática, embora seja necessário uniformizar os critérios de referenciação e protocolar a recolha de informação referente à criança, família e caracterização do mau trato. Urge melhorar o funcionamento das equipas de intervenção social e permitir que as medidas de protecção instituídas sejam cumpridas. ABSTRACT Objectives: The aims of the present study were to characterize the children at risk or maltreated identified in hospitals from the north of Portugal and to describe the child protection mechanisms available in these institutions. Material and methods: All children aged 0 to 17 years evaluated by the Social Services during 2005, were eligible for this study. Data was obtained from retrospective consultation of the social and medical files. The proportion of children abused or at risk of maltreatment was calculated. The characteristics of individuals suffering different types of abuse or at risk of maltreatment were compared using χ2 and Fisher exact tests. Results: Fifteen hospitals participated in this study; five of them had Children Protective Comittees (Nucleo de Apoio à Criança e Jovem em Risco). Information was obtained for 804 children (53.2% male; 68.3% aged less than 3 years). Referral to Social Services was due to: risk of maltreatment (79.4%), child neglect (20.5%), physical abuse (5.4%), emotional abuse (3.7%), abandonment (5.6%) and sexual abuse (3.5%); 25% had had a previous referral to the Social Services. Follow-up by Children Protective Services and Family Court were solicited in 30.1% and 14.5% of the cases respectively. The mother (88.2%) and the father (55.2%) were the most usual perpetrators of child abuse or risk of maltreatment. Compared to other types of abuse/maltreatment, sexual abuse was more frequent among females (6.3% vs 1.2%, p<0,001), and more frequently perpetrated by strangers or other persons besides the parents (27.5% vs 1.9% p<0,001). Conclusion: The high detection of children at risk of maltreatment probably reflects the health professionals concern about this subject. However it’s necessary to establish uniform referral criteria to the Social Services to standardize procedures and to maintain records regarding reports and families. It’s urgent to improve the coordination of Children Protective Services, law enforcement, schools, mental health and other institutions.
- Genes, Crianças e PediatrasPublication . Soares, G.; Dias, C.; Martins, M.; Fortuna, A.; Reis-Lima, M.; Álvares, S.
- Genes, Crianças e Pediatras 2005 IIPublication . Dias, C.; Martins, M.; Rocha, M.; Soares, G.; Pinto-Basto, J.; Gonçalves, S.; Carrilho, I.; Fortuna, A.; Reis-Lima, M.
- Genes, Crianças e Pediatras IIPublication . Pinto-Basto, J.; Soares, G:; Dias, C.; Martins, M.; Fortuna, A.; Barbot, J.; Reis-Lima, M.
- Genes, Crianças e Pediatras IIIPublication . Dias, C.; Soares, G.; Pinto-Basto, J.; Fortuna, A.; Martins, M.; Reis-Lima, M.; Fonseca, F.
- Genes, Crianças e Pediatras IVPublication . Soares, G.; Pimentel, I.; Dias, C.; Pinto-Basto, J.; Martins, M.; Fortuna, A.; Reis-Lima, M.
- Genes, Crianças e Pediatras, 2005 IPublication . Pinto-Basto, J.; Martins, T.; Soares, G.; Dias, C.; Rocha, M.; Martins, M.; Fortuna, A.; Reis-Lima, M.