UIC - Unidade de Imunologia Clínica
Permanent URI for this community
Browse
Browsing UIC - Unidade de Imunologia Clínica by Issue Date
Now showing 1 - 10 of 38
Results Per Page
Sort Options
- Monitorização do Consumo de Antibióticos nos Serviços de Cirurgia e de Ortopedia de Seis Hospitais SAPublication . Caldeira, L.; Teixeira, I.; Vieira, I.; Batel-Marques, F.; Santiago, L.; Rodrigues, V.; Fonseca, A.; Varanda, J.; Bicó, A.; Vasconcelos, C.; Polónia, J.; Brochado, J.; Faria, V.; Mota, A.; Ramalheira, E.; Capão-Filipe, M.; Marques, M.; Martins, M.; Carmo, E.; Martins, F.; Contente, H.; Lobo, M.; Gloria, P.; Pereira, L.; Faria, D.A monitorização do consumo de antimicrobianos é um instrumento de interesse indiscutível e tem merecido uma atenção particular nos últimos anos, devido às crescentes preocupações com a emergência de estirpes microbianas multi-resistentes. Os objectivos do presente estudo consistiram, por um lado, na monitorização do consumo e na avaliação do impacto económico da prescrição hospitalar de antimicrobianos, em serviços de cirurgia e ortopedia. Por outro lado, pretendeu-se estudar e a relação indicação-prescrição terapêutica e profilática. Tendo presentes estes objectivos realizou-se um estudo-piloto longitudinal, com recolha de dados durante o mês de Maio de 2004, em seis Hospitais SA, incidindo numa amostra total de 1.122 doentes internados. Verificámos uma taxa de incidência de prescrição de 76,9%, com dispensa de 1.154 antimicrobianos, dos quais 71,2% se destinaram, em média, à profilaxia da infecção pós-cirúrgica, atestando a adesão geral à prática da profilaxia da infecção no local cirúrgico. O custo médio da antibioterapia foi mais elevado nos casos de “suspeita de infecção” (€9,09) ou “infecção declarada” (€8,74) e mais baixo quando utilizados para “profilaxia” (€5,67), facto relacionado com a menor duração média dos episódios de profilaxia. Os regimes de profilaxia utilizados apresentaram variações consideráveis entre os diferentes hospitais no que respeita ao tipo de antibiótico utilizado e uma duração média de 2,61 dias, com cerca de metade dos episódios de profilaxia prolongando-se por mais de 24 horas, sugerindo uma implementação insuficiente das actuais recomendações quanto ao tipo de fármaco a utilizar para esta prática, o que aponta para o necessidade duma avaliação da existência nas unidades hospitalares, de recomendações claras para a profilaxia da infecção do local cirúrgico, bem como da adesão dos clínicos a estas.
- Mutations in STAT3 and IL12RB1 impair the development of human IL-17 – producing T cellsPublication . Beaucoudrey, L.; Puel, A.; Filipe-Santos, O.; Cobat, A.; Ghandil, P.; Chrabieh, M.; Feinberg, J.; Bernuth, H.; Samarina, A.; Jannière, L.; Fieschi, C.; Stéphan, J.; Boileau, C.; Lyonnet, S.; Jondeau, G.; Cormier-Daire, V.; Merrer, M.; Hoarau, C.; Lebranchu, Y.; Lortholary, O.; Chandesris, M.; Tron, F.; Gambineri, E.; Bianchi, L.; Rodriguez-Gallego, C.; Zitnik, S.; Vasconcelos, J.; Guedes, M.; Vitor, A.; Marodi, L.; Chapel, H.; Reid, B.; Roifman, C.; Nadal, D.; Reichenbach, J.; Caragol, I.; Garty, B.; Dogu, F.; Camcioglu, Y.; Gülle, S.; Sanal, O.; Fischer, A.; Abel, L.; Stockinger, B.; Picard, C.; Casanova, J.Abstract The cytokines controlling the development of human interleukin (IL) 17--producing T helper cells in vitro have been difficult to identify. We addressed the question of the development of human IL-17--producing T helper cells in vivo by quantifying the production and secretion of IL-17 by fresh T cells ex vivo, and by T cell blasts expanded in vitro from patients with particular genetic traits affecting transforming growth factor (TGF) beta, IL-1, IL-6, or IL-23 responses. Activating mutations in TGFB1, TGFBR1, and TGFBR2 (Camurati-Engelmann disease and Marfan-like syndromes) and loss-of-function mutations in IRAK4 and MYD88 (Mendelian predisposition to pyogenic bacterial infections) had no detectable impact. In contrast, dominant-negative mutations in STAT3 (autosomal-dominant hyperimmunoglobulin E syndrome) and, to a lesser extent, null mutations in IL12B and IL12RB1 (Mendelian susceptibility to mycobacterial diseases) impaired the development of IL-17--producing T cells. These data suggest that IL-12Rbeta1- and STAT-3--dependent signals play a key role in the differentiation and/or expansion of human IL-17-producing T cell populations in vivo.
- LINFOPENIA T CD4 NO LUPUS ERITEMATOSO SISTÉMICOPublication . Ferreira, S.; Vasconcelos, J.; Marinho, A.; Farinha, F.; Almeida, I.; Correia, J.; Barbosa, P.; Mendonça, T.; Vasconcelos, C.Abstract: Background: Systemic Lupus Erythematosus (SLE) is an inflammatory chronic disease characterized by the presence of autoantibodies, immunocomplex production and organ injury. Several alterations of the immune system have been described, namely of CD4 T cells, with particular focus on regulatory subgroup. Objective: Quantify peripheral CD4 T cells in a population of patients with SLE and correlate it with lupus activity, affected organs, therapeutics and infections. Methods: Retrospective study involving all SLE patients seen in the clinical immunology outpatient clinic of the Hospital Geral Santo António, Porto that has done some peripheral blood flow cytometry study. Results: Twenty-nine patients have been evaluated, 16 were taking glucocorticoids and six immunossupressors. The mean SLEDAI at the study time was nine and the ECLAM was three. Thirty-one percent of the patients had leukopenia, 76% lymphocytopenia and the same number CD4 depletion. Fifty-five percent of the patients had CD4 levels lower than 500/mm3, 31% lower than 200/mm3. All patients with SLEDAI ?20 and ECLAM ?4 had CD4 counts inferior to 500/mm3 and all patients with inactive disease had CD4 superior to 500/mm3. There have been three opportunistic infections: cryptococcal meningitis, pulmonary aspergilosis, Pneumocystis jirovecii pneumonia, all in patients with CD4 counts lower than 500/mm3. Conclusion: Decreased CD4 T cells counts have been very common in this study population. There is an inverse relation between CD4 cells counts and disease activity. Opportunistic infections occurred in patients with severe CD4 depletion. Keywords: Systemic Lupus Erythematosus; CD4 T Lymphocytes; Lymphocytopenia; SLE Activity; Opportunistic infections
- Low frequency of CD4+CD25+ Treg in SLE patients: a heritable trait associated with CTLA4 and TGFbeta gene variants.Publication . Barreto, M.; Ferreira, R.; Lourenço, L.; Moraes-Fontes, M.; Santos, E.; Alves, M.; Carvalho, C.; Martins, B.; Andreia, R.; Viana, J.; Vasconcelos, C.; Mota-Vieira, L.; Ferreira, C.; Demengeot, J.; Vicente, A.Abstract BACKGROUND: CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females. RESULTS: To investigate the involvement of Treg in SLE pathogenesis, we determined the frequency of CD4+CD25+CD45RO+ T cells, which encompass the majority of Treg activity, in the PBMC of 148 SLE patients (76 patients were part of 54 families), 166 relatives and 117 controls. SLE patients and their relatives were recruited in several Portuguese hospitals and through the Portuguese Lupus Association. Control individuals were blood donors recruited from several regional blood donor centers. Treg frequency was significantly lower in SLE patients than healthy controls (z = -6.161, P < 0.00001) and intermediate in the relatives' group. Remarkably, this T cell subset was also lower in females, most strikingly in the control population (z = 4.121, P < 0.001). We further ascertained that the decreased frequency of Treg in SLE patients resulted from the specific reduction of bona fide FOXP3+CD4+CD25+ Treg. Treg frequency was negatively correlated with SLE activity index (SLEDAI) and titers of serum anti-dsDNA antibodies. Both Treg frequency and disease activity were modulated by IVIg treatment in a documented SLE case. The segregation of Treg frequency within the SLE families was indicative of a genetic trait. Candidate gene analysis revealed that specific variants of CTLA4 and TGFbeta were associated with the decreased frequency of Treg in PBMC, while FOXP3 gene variants were associated with affection status, but not with Treg frequency. CONCLUSION: SLE patients have impaired Treg production or maintenance, a trait strongly associated with SLE disease activity and autoantibody titers, and possibly resulting from the inability to convert FOXP3+CD25- into FOXP3+CD25+ T cells. Treg frequency is highly heritable within SLE families, with specific variants of the CTLA4 and TGFbeta genes contributing to this trait, while FOXP3 contributes to SLE through mechanisms not involving a modulation of Treg frequency. These findings establish that the genetic components in SLE pathogenesis include genes related to Treg generation or maintenance.
- Development and use of touch-screen computer-assisted self interviewing in Portuguese patients with chronic immune diseases: Evaluation of an electronic version of SF-36v2Publication . Ribeiro, C.; Moreira, L.; Silveira, A.; Silva, I.; Gestal, J.; Vasconcelos, C.Abstract Aim:The major purpose of this study was to evaluate alternative automated methods of collecting data on health related quality of life (HR-QoL). In order to achieve this, we developed a study with the following objectives: (1) to evaluated the feasibility of electronic version in patients with different chronic pathologies of the immune system using Short Form 36version2 (SF-36v2), (2) to evaluate the construct validity of SF-36v2 using the electronic data capture, and (3) to compare electronic version questionnaires with paper questionnaires in terms of patients ´ acceptance, data quality, and reliability. Methods:Out-patients with chronic immune diseases (HIV infection, lupus, scleroderma, rheumatoid arthritis, Behçet and Sjögren), were randomly selected to completed electronic and paper SF- 36v2 (n=50) before consultation in Clinical Immunology Unit, in Hospital Santo António-Centro Hospitalar do Porto (CI-HGSA). Results: There were very high correlations in SF- 36v2 responses (p< .001) between the paper and electronic forms. Internal reliability coefficients (Cronbach’s a) showed good internal consistency for all reported responses in either, computer and paper. There were no missing data in electronic version or paper. About 84% of the patients prefer to use the computer version in future. Conclusion: The electronic HR-QoL assessment is technically possible and it can provide reliable and valid clinically significant information which can either be used in routine care appointments.
- Photodynamic therapy as adjunctive therapy for morpheaform basal cell carcinomaPublication . Torres, T.; Fernandes, I.; Costa, V:; Selores, M.The authors decided to evaluate the possible use of methyl-aminolevulinate photodynamic therapy (MAL-PDT) as adjunctive therapy for morpheaform basal cell carcinoma prior to standard surgical excision in order to reduce tumor size and volume and to facilitate surgical treatment. It was observed that MAL-PDT may be an option as an adjunctive therapy prior to standard surgical excision of morpheaform basal cell carcinoma, leading to less invasive surgery
- From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected PatientsPublication . Nery, F.; França, M.; Almeida, I.; Vasconcelos, c.Background Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural history of PML infection in a population of HIV patients. Methods We retrospectively reviewed, from 1992 to 2009, PML cases in a population of 724 HIV infected patients followed in our institution. Clinical, biological, imagery features and outcomes were characterized. Results Twenty-five (3.45%) patients were identified as having PML. The mean time between HIV and PML diagnosis was 20.4 months. PML was the presentation of HIV infection in 40% of the patients, and 92% had CD4 T cell count lower than 200/mm3. Paresis was the most common clinical presentation. No specific characteristics were found in cerebrospinal fluid and JCV DNA was positive in 3 of 7 patients. MRI revealed characteristic findings. Combined antiretroviral therapy was started or changed in 96% of the patients. Neurological condition got worse in 12 patients. From the 14 deaths, 5 were directly attributed to PML progression. Follow-up was lost in 8 patients. Conclusions PML was the presentation of HIV infection in more than 1/3 of patients, frequently associated with advanced immunocompromise. MRI sensitivity to PML is high, and JCV DNA determination in CSF was not revealed to be sensible. PML diagnosis should be taken into account in HIV patients presenting any neurological symptoms, and HIV infection should be suspected when radiological findings suggest PML lesions even in previously healthy individuals.
- AVALIAÇÂO DE UMA NOVA TÉCNICA DE QUIMIOLUMINESCÊNCIA PARA DETERMINAÇÃO DE ANTICORPOS ANTI-DSDNAPublication . Carneiro, P.; Figueiras, O.; Lima, S.; Neves, E.; Cerveira, C.Introdução A determinação dos anticorpos anti-dsDNA é um teste de grande importância para o diagnóstico e monitorização de doentes com Lúpus Eritematoso Sistémico (LES), fazendo parte dos critérios de classificação de LES do ACR. (American College of Rheumathology). Existem actualmente vários métodos laboratoriais disponíveis, que respondem de forma desigual na determinação destes anticorpos nos doentes, em diferentes fases de evolução da patologia. Objectivo Avaliar o desempenho do novo método automatizado de determinação dos anticorpos anti-dsDNA por técnica de quimioluminescência (CLIA), Zenit RA dsDNA (Menarini), comparando-o com os métodos de imunofluorescência indirecta (IFI) e fluoroimunoensaio (FEIA), utilizados na rotina assistencial no Serviço de Imunologia do CHP. Material e Métodos A população estudada incluiu 151 amostras seriadas de doentes com LES, 33 doentes com doença infecciosa, 28 doentes com outras patologias com envolvimento autoimune e 38 indivíduos saudáveis. Realizou-se a determinação dos anticorpos anti-dsDNA por técnica CLIA no equipamento ZENIT RA (Menarini), por técnica FEIA no equipamento ImmunoCAP 250 (Phadia) e por IFI em lâminas de Crithidia luciliae (BioRad) processadas no aparelho PhD (BioRad). Resultados Todos os testes apresentaram uma baixa sensibilidade nos doentes com LES (33,1% a 44,4%), traduzindo o facto de um grande número de doentes se encontrar em tratamento e com fraca actividade da doença. O teste CLIA apresentou uma especificidade semelhante à da IFI (93,9% vs. 95,6%), superior à observada no FEIA (85,9%). Conclusões O teste dsDNA ZENIT RA revelou uma sensibilidade inferior ao FEIA mas uma melhor especificidade e valor preditivo positivo, semelhantes aos observados na técnica de IFI. Sendo um teste totalmente automatizado e sem a subjectividade da IFI, será agora importante a sua avaliação numa população com critérios de actividade bem definidos.
- HEALTH-STATE UTILITIES IN CHRONIC IMMUNE DISEASES: PILOT STUDYPublication . Ribeiro, C.; Silveira, A.; Marques, A.; Ribeiro, C.; Santos, I.; Vasconcelos, C.HEALTH-STATE UTILITIES IN CHRONIC IMMUNE DISEASES: PILOT STUDY Claúdia Ribeiro1,2,3, Augusta Silveira4,3, Augusta Marques5, Catarina Ribeiro4, Isabel Santos6,2,3, Carlos Vasconcelos2,3 1UCP, 2HSA/CHP, 3ICBAS/UP, 4UFP, 5HPA e 6HSMF. Universidade Católica Portuguesa (UCP), Porto Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto. Universidade Fernando Pessoa (UFP), Porto. Hospital Privado da Arrábida (HPA), Porto. Hospital Santa Maria da Feira (HSMF), Porto. Background Utility scores are used to estimate Quality Adjusted Life Years (QALYs), applied in determining the cost-effectiveness of health care interventions. In studies where no preference based measures are collected, indirect methods have been developed to estimate utilities from clinical instruments. Aim The aim of this study was to evaluate a published method of estimating the Short Form-6D (SF-6D) (preference based) in patients with chronic immune diseases from Unidade de Imunologia Clínica do Hospital de Santo António - Centro Hospitalar do Porto and evaluate the impact of socio demographics economics and clinical characteristics on quality of life (QoL) and potential predictors for QoL improvements. Methods We enrolled 320 patients with chronic immune diseases (104 men and 226 women with a mean age: 45.21; 84 people living with HIV and 236 with chronic autoimmune diseases. All responders to the Portuguese SF-36 version 2.0 questionnaire can be assigned an SF-6D score provided the 11 items used in the SF-6D have been completed using a computerized administration. To assess socioeconomic status, we use the Graffer’s scale, clinical and demographic variables were assessed by a questionnaire specifically designed for the present study. Results The mean utility value was .595. Male, gender, young, single, individuals with high educational attainment level and Graffer’s scale Class high reported higher utility levels. As expected, those who takes therapeutics’ or have a higher length disease reported lower mean utility levels than those who were in a less severe stadium of the disease or without therapeutic. Conclusion This paper provides the first utilities obtained from a populations leave with chronic immune diseases. The preference-based measures used in this study distinguish patient groups with chronic immune diseases’ in terms of socio-demographics characteristics and clinical groups. The normative values can be used economic evaluation and clinical studies as they incorporate patient’s preferences and translate the value attribute to patients´ health state. Apresentador: Cláudia Ribeiro, Médica Dentista. Doutoranda, Faculdade de Medicina da Universidade de Santiago de Compostela.
- AUTOMATED COLLECTION OF QUALITY-OF-LIFE DATA: TOUCH-SCREEN COMPUTER SYSTEMS IN PATIENTS WITH IMMUNE DISEASESPublication . Ribeiro, C.; Silveira, A.; Silva, I.; Ribeiro, C.; Vasconcelos, C.AUTOMATED COLLECTION OF QUALITY-OF-LIFE DATA: TOUCH-SCREEN COMPUTER SYSTEMS IN PATIENTS WITH IMMUNE DISEASES Claúdia Ribeiro1,2,3, Augusta Silveira4,3, Isabel Silva4, Catarina Ribeiro4, Carlos Vasconcelos2,3 1UCP, 2HSA/CHP, 3ICBAS/UP, 4UFP e 5HSMF. Universidade Católica Portuguesa (UCP), Porto. Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto. Universidade Fernando Pessoa (UFP), Porto. Hospital Santa Maria da Feira (HSMF), Porto. Background The increase of technological knowledge and methodology has allowed the practice of redirecting epidemiological research, particularly in the field of chronic disease. Although capable of controlling the accumulation of events and constraints imposed by the treatment can lead to a drastic change in quality of life (QoL) of subjects progressed to varying degrees of disability and death. In this perspective the Quality of Life Related to Health (HRQOL) has taken a leading role and its evaluation is indispensable in Medicine. Aim The aims of this study were (1) analyze the importance of HRQOL assessment as a tool for health promotion and a way of measuring the effectiveness of interventions in daily practice in patients with coexisting chronic immune system (PCSI), (2) evaluation of alternative methods for the automated collection of data on HRQOL and development of an electronic interface in sample of 320 patients, (3) creating a database to ascertain the epidemiological profile of PCSI, and identification of socio-economic, demographic and clinical data of these individuals, (4) using the QoL indicator as a predictor in decision treatment and use the preferences of patients. Methods A total of 473 patients with chronic diseases of the immune system, which were applied Graffar Index, SF-36v2, a demographic questionnaire and identification of clinical variables. Results The results of this investigation suggest that the demographic, socio-economic and clinics are associated with significant differences in QoL cumulative and chronic complications associated with different pathologies. The results verified the existence of significant correlations between the different diagnoses, duration of disease and therapy. In general, patients who have chronic diseases of the immune system such as rheumatoid arthritis, lupus, scleroderma, Bechet's disease, Sjögren's syndrome or infection with human immunodeficiency virus 1 or 2 showed a worse QoL than the general population. The derivations of preferences from the SF-36v2 exhibit strong correlations with the preferences measured with the SF-6D. Conclusions This suggests that both the application of the SF-36v2 as the SF-6D can be important sources of preferences to implement measures in economic evaluation in healthcare. HRQL can and should be integrated into immune clinical practice. The translation of graphical results given to the clinician at the beginning of the consultation, favors the rapid analysis of global values of the patient's HRQL. This assessment can be an excellent diagnostic tool to be used routinely in clinical practice or assisting in disease management and therapeutic decision making. Apresentador: Cláudia Ribeiro, Médica Dentista. Doutoranda, Faculdade de Medicina da Universidade de Santiago de Compostela.