Rita Gaio

Association between dietary patterns and metabolic syndrome in a sample of portuguese adults

BackgroundThere is scarce evidence regarding the association between diet and metabolic syndrome (MetS) in Portuguese population. We aim to evaluate the association between a posteriori dietary patterns (DPs) and MetS and its features.MethodsUsing random digit dialing, a sample of 2167 adults was selected between 1999 and 2003, in Porto. During a face-to-face interview, a questionnaire was applied, anthropometric measures were taken, blood pressure measured and a fasting blood sample collected. Diet was assessed using a validated food frequency questionnaire, and four DPs were identified in each sex by multivariate finite mixture models.ResultsAfter adjustment for age and daily energy intake, comparing to the “healthy” DP, women with the “low fruit and vegetables” DP had a higher odds of high waist circumference (OR = 1.88 95% CI 1.17-3.01) and low HDL-cholesterol (OR = 1.78 95% IC 1.12-2.82) and women in the “red meat and alcohol” DP had higher odds of high waist circumference (OR = 1.45 95% CI 1.01-2.07) and of MetS (OR = 1.57 95% CI 1.07-2.29); men with the “fish” DP had a higher odds of high triglycerides (OR = 1.57 95% CI 1.05-2.35). After further adjustments (education, physical activity, smoking, alcohol drinking, BMI, and menopausal status) no significant associations remained.ConclusionsFour distinct DPs were identified in a community sample of Portuguese adults and there was no association with the prevalence of MetS.

Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women.

The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1st, 2nd and 3rd trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation.

Uterine artery impedance at very early clinical pregnancy

The aim of the study was to construct gestational age‐based reference ranges for the uterine artery (UtA) mean pulsatility (PI) and resistance (RI) indices from 6 to 10 weeks of pregnancy.

Assessment of the general public's knowledge about rheumatic diseases: evidence from a Portuguese population-based survey

BackgroundTo identify incorrect beliefs and common knowledge about rheumatic diseases in the general population.MethodsParticipants were selected during the follow-up of a representative cohort of adult population of Porto, Portugal; 1626 participants completed a questionnaire that included general knowledge items about rheumatic diseases.Discrete and continuous latent variable models were used to identify knowledge flaws and the target groups. Odds ratios (OR) estimated by multinomial logistic regression, and 95% confidence intervals (95%CI) were computed to evaluate magnitude of associations.ResultsA continuous latent variable model identified two dimensions: one related to general beliefs (latent 1) and another concerning characteristics, treatment and impact of rheumatic diseases (latent 2). A 3-class latent variable model refined these results: the first class presented the lowest probabilities of correct answer for items associated with the first latent (mean of 39%), and the second class presented the lowest probabilities of correct answer for items with the second latent (mean of 62%). The third class showed the highest probability of a correct answer for almost all the items (mean of 79%). The age and sex standardized prevalence of the classes was 25.7%, 30.8% and 43.5%.Taking class 2 as reference, class 1 was positively associated with the presence of rheumatic diseases (OR = 2.79; CI95% = (2.10-3.70)), with females (OR = 1.28 CI95% = (0.99-1.67)) and older individuals (OR = 1.04; CI95% = (1.03-1.05)), and was negatively associated with education (OR = 0.84; CI95% = (0.81-0.86)); class 3 was positively associated with education (OR = 1.03; CI95% = (1.00-1.05)) and the presence of rheumatic diseases (OR = 1.29; CI95% = (0.97-1.70)).ConclusionsThere are several knowledge flaws about rheumatic diseases in the general public. One out of four participants considered false general beliefs as true and approximately 30% did not have detailed knowledge on rheumatic disease. Higher education and the presence of disease contributed positively to the overall knowledge. These results suggest some degree of effectiveness of patient education, either conducted by health professionals or self-driven.

Predictors of treatment outcome in multidrug-resistant tuberculosis in Portugal

Multidrug-resistant tuberculosis (MDR-TB) is a challenge to control programs.In these cases, treatment is more complex, more expensive and very often less successful. The purpose of this study was to analyze the factors that could influence (positively or negatively)the outcome. To examine this issue we used data from the National Tuberculosis Program in Portugal SVIG-TB.For the study,we included all MDR-TB cases reported from January 2000 to December 2008. To identify the predictive factors related to the outcome of treatment we used univariate and multiple logistic regression models with the clinical variables. During the studied period 130 patients with MDR-TB were notified, of these 94 (72,3%) were male and 36 (27,7%) female, mean age 42 years old (range 40-44). Forty-six patients (35,5%) had a previous treatment and 39 (30%) were HIV positive. Treatment success (cured or completed treatment) was observed in 80 (61,5%) patients. Susceptibility and use of pyrazinamide or ethambutol, susceptibility and use of a fluoroquinolone, the use of five or more drugs in the treatmant regimen, sputum culture conversion after 2 months of treatment were predictors of successful outcome of treatment. Treatment insucess (death, default and failure) was observed in 47 (36,1%) patients. Previous treatment, HIV co-infection, presence of cavitation on the chest radiograph, resistance of two more drugs than just isoniazid and rifampicin and positive cultures after 2 to 3 month of treatment were predictors of poor treatment outcome. Rapid diagnosis of drug resistance and an appropriate therapy for effective treatment are important conditions for the prevention of spread of resistant strains and control of MDR-TB.

Tuberculosis among the homeless: should we change the strategy?

BACKGROUND Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. OBJECTIVES To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless. DESIGN This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression. RESULTS TB incidence among the homeless was 122/100,000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection. CONCLUSION TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.

Contact screening in tuberculosis: can we identify those with higher risk?

To the Editor: Contact screening, as a strategy to identify recently infected individuals, is part of the tuberculosis (TB) elimination strategy. It follows risk stratification concerning the infectiousness of the index patient, the duration and proximity of exposure, and the susceptibility of the contact [1, 2]. For its optimisation it is important to know which risk factors are associated with Mycobacterium tuberculosis transmission in order to not over screen or lose at-risk contacts. In view of that, this study aims to identify potential risk factors for M. tuberculosis transmission among contacts of pulmonary TB patients, in a Portuguese TB reference centre. From January to December of 2011, all contacts of confirmed pulmonary TB patients, screened in the TB centre, were questioned about their exposure to the index patient through a questionnaire completed during the medical appointment. Both household and casual contacts were screened, independent of their cumulative exposure. Contacts excluded: those with exposure outdoors ( e.g. in the street); those with incomplete characterisation of exposure ( e.g. index patients for whom we did not know the symptomatic period); those non-compliant with screening ( e.g. contacts who failed tuberculin skin test (TST) reading); and those with a past history of M. tuberculosis infection or TB disease ( e.g. contact´s verbal report of previous TB disease, contact with a pulmonary TB patient or treatment for latent tuberculosis infection (LTBI)). Contacts of patients with a diagnosis of pulmonary TB were identified for screening at the moment of the index patient diagnosis. The index patient was asked to identify contacts within the family, social and work spheres. Furthermore, some other …

Effect of Isoniazid Resistance on the Tuberculosis Treatment Outcome

Tuberculosis (TB) remains a serious public health problem, and bout one-third of world’s population has active or latent TB. In urope, there are 49 new cases and 7 deaths from TB every hour.1 n Portugal, the incidence has been decreasing in recent years, and n 2014 the annual incidence was 20/1,00,000.2 Drug-resistant Mycobacterium tuberculosis has become a major hreat to the control of TB and, among all first-line drugs, resisance is greatest to isoniazid (INH).3,4 In Portugal, INH resistance as 10.5% in 2014 among TB cases in whom susceptibility testing as performed.2 In fact, there has been an increasing resistance to NH, despite the decreasing number of TB cases.2 INH is a first-line anti-TB drug because of its potent early bacteicidal activity against rapidly dividing cells.3,5 However, treatment f active TB requires multiple anti-TB drugs along with INH to revent selection and emergence of a drug-resistant population f M. tuberculosis. According to current World Health Organizaion (WHO) recommendations, INH mono-resistant TB should be reated with 6–9 months of rifampicin, ethambutol, and pyraznamide, plus or minus a fluoroquinolone.6 These are also the urrent treatment guidelines in Portugal. TB is a notifiable disease in Portugal, so clinicians report all cases o National-Tuberculosis-Surveillance-System (SVIG-TB) that has ata on patient demographics, comorbidities, risk behaviors, and linical, radiological, and microbiological information, as well as reatment outcomes.7 The objectives of this study were identify factors associated with NH mono-resistance, compare treatment outcomes of INH monoesistant patients with drug-susceptible patients and understand he causes of unsuccessful treatment among INH mono-resistance B cases. To achieve the goals, data from Portuguese SVIG-TB were retospectively analyzed from 1/January/2008 to 31/December/2014. NH mono-resistant cases were compared with drug-susceptible ases. Culture-confirmed cases tested against first-line anti-TB drugs ere included. INH mono-resistant TB cases were defined as having esistance to INH, but susceptibility to all other first-line anti-TB rugs. Drug-susceptible cases were those that had documented ensitivity to INH, rifampin, pyrazinamide, and ethambutol.

Prevalence and factors associated with diabetes mellitus among tuberculosis patients: a nationwide cohort.

The association between diabetes mellitus (DM) and tuberculosis (TB) has been a matter of study worldwide, since it is assumed that DM triples the risk of TB [1]. Recent studies have found discrepant prevalence of DM among TB patients, ranging from 5.3% in Denmark [2] to 44% in India [3]. There is an urgent need to control both epidemics in order to achieve the World Health Organization (WHO) TB elimination goal [4]. To reach this goal, an integrated approach between TB elimination strategies and control of noncommunicable diseases that perpetuate the risk for TB is fundamental [5]. In a Portuguese TB cohort, diabetes mellitus was associated with older age and no HIV infection or drug consumption http://ow.ly/10EoN1

Reference Ranges for Uterine Artery Pulsatility Index during the Menstrual Cycle: A Cross-Sectional Study

Background Cyclic endometrial neoangiogenesis contributes to changes in local vascular patterns and is amenable to non-invasive assessment with Doppler sonography. We hypothesize that the uterine artery (UtA) impedance, measured by its pulsatility index (PI), exhibits a regular pattern during the normal menstrual cycle. Therefore, the main study objective was to derive normative new day-cycle-based reference ranges for the UtA-PI during the entire cycle from days 1 to 34 according to the isolated time effect and potential confounders such as age and parity. Methods From January 2009 to December 2012, a cross-sectional study of 1,821 healthy women undergoing routine gynaecological ultrasound was performed. The Doppler flow of the right and left UtA-PI was studied transvaginally by colour and pulsed Doppler imaging. The mean right and left values and the presence or absence of a bilateral protodiastolic notch were recorded. Reference intervals for the PI according to the cycle day were generated by classical linear regression. Results The majority of patients (97.5%) presented unilateral or bilateral UtA notches. The crude 5th, 50th, and 95th reference percentile curves of the UtA-PI at 1–34 days of the normal menstrual cycle were derived. In all curves, a progressive significant decrease occurred during the first 13 days, followed by an increase and recovery in the UtA-PI. The adjusted 5th, 50th, and 95th reference percentile curves for the effects of age and parity were also obtained. These two conditions generated an approximately identical UtA-PI pattern during the cycle, except with small but significant reductions at the temporal extremes. Conclusions The median, 5th, and the 95th percentiles of the UtA-PI decrease during the first third of the menstrual cycle and recover to their initial values during the last two thirds of the cycle. The rates of decrease and recovery depend significantly on age and parity.