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- New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature reviewPublication . Costa, Diogo Alpuim; Costa, Tiago Porfírio; Netto, Eduardo Carlinhos; Joaquim, Natércia; Ventura, Isabel; Pratas, Ana Cristina; Winckler, Patricia; Silva, Inês Pires; Pinho, Ana Catarina; Sargento, Isabel Goulão; Guerreiro, Francisco Gamito; Moreira, António RitaOver the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. (C) 2016 Wiley Periodicals, Inc.
- Risk factors for severity and recurrence of colonic diverticular bleedingPublication . Joaquim, Natércia; Caldeira, Paulo; Antunes, Artur; Eusébio, Marta; Guerreiro, HoracioBackground: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined. Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding. Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate. Results: Seventy-four patients were included, with a mean age of 75.7 +/- 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (<= 11 g/dL; OR 18.8), older age (>= 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population. Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.
- Systematic review of the prevalence, predictors, and treatment of insomnia in palliative carePublication . Nzwalo, Isa; Aboim, Maria Ana; Joaquim, Natércia; Marreiros, Ana; Nzwalo, HipólitoIntroduction: The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care is scarce. Methodology: Literature review about the prevalence, predictors, and treatment options of insomnia in palliative care patients. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in identified articles and selected reviews. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 65 studies were included in the review. Most studies had acceptable /good quality. The prevalence of insomnia in the included studies ranged from 2.1% to 100%, with a median overall prevalence of 49.5%. Sociodemographic factors such as age; clinical characteristics such as functional status, disease stage, pain, and use of specific drugs, including opioids; psychological factors such as anxiety/depression; and spiritual factors such as feelings of well-being were identified as predictors. The treatment options identified were biological (pharmacological and nonpharmacological), psychological (visualization, relaxation), and spiritual (prayer). Conclusions: The systematic review showed that the prevalence of insomnia is high, with at least one in 3 patients affected in most studies. Insomnia's risk factors and treatment in palliative care are both associated to physical, psychological, social, and spiritual factors, reflecting its true holistic nature.
- Dimensões da qualidade de vida e apoio social dos pacientes hospitalizados nas unidades de assistência à saúde do AlgarvePublication . Duarte, António; Joaquim, Natércia; Nunes, CristinaThis study assessed the relations between quality of life and social support network of patients in continuing care units in Algarve, using WHOQOL-BREF and ASSIS. Participants were 92 users of ages between 34-101 years: very elderly (40.2%), female (58.7%), widows (40.2%), upper-middle class (46.8%), cohabiting with spouse (43.2%), and partly dependent (72.5%). Emotional, tangible and informational support networks were mainly composed by family. We found significant associations between informative social support and physical domains, social relations and environment of quality of life (p< 0.05). The results suggest middle levels in self-perception and satisfaction with health, and lower levels in physical domain. Informational support needs were negatively associated with psychological and social relations dimensions of quality of life.
- Irreversible hypersomnolence after bilateral thalamic infarctionPublication . Mogildea, Mihail; Varela, Miguel; Martins, Cristiana; Joaquim, Natércia; Soleiro, Jose; Nzwalo, Hipolito
- Evaluation of health-related quality of life in a physically active senior populationPublication . Fontes, Ana Paula; Joaquim, Natércia; Pereira, TâniaBackground: Physical activity (PA) is a strong determinant of health and one of the most important predictors of healthy aging and health-related quality of life (HRQoL). The aim of the study was to understand the HRQoL of a senior population practicing PA and its association with some socio-demographic characteristics, the levels of PA, and functional independence. Methods: This is a correlational study with a sample of 376 individuals of both sexes. The data collection instruments were a socio-demographic and health questionnaire, the international PA questionnaire (IPAQ)-short version, the Katz index, the Lawton and Brody index, and the WHOQOL-OLD and WHOQOL-BREF questionnaires. Results: The sample revealed a good perception of HRQoL, especially in the “psychological” and “social relations” domains. Sex showed a greater association with quality of life (QoL) than age. Multiple linear regression revealed that the variables with the most significant influence on the individuals’ QoL were related to health (“Presence of chronic disease” and “habitual use of medication”). The QoL related to "social relationships" is the domain with more predictors, with a markedly socio-demographic focus. Conclusions: Practicing PA proved to be a HRQoL predictor, where “sensory function” and HRQoL related to “social relations” are included. Despite PA practice and socio-demographic characteristics being able to predict some HRQoL domains, health-related variables showed a more robust presence in this prediction.
- Establishment of an induced pluripotent cell line (ABCRIi001-A) from an elderly female for ageing researchPublication . Esteves, Filipa; Vilhena Catarino Brito, David; Rajado, Ana Teresa; Silva, Nádia; Apolónio, Joana; Roberto, Vânia; Andrade, Raquel; Calado, Sofia; Faleiro, Maria Leonor; Albuquerque Andrade de Matos, Carlos Adriano; Marques, Nuno; Marreiros, Ana; Nzwalo, Hipólito; Pais, Sandra; Palmeirim, Isabel; Simãoa, Sónia; Joaquim, Natércia; Miranda, Rui; Pêgas, António; Raposo, Daniela Marques; Sardo, Ana; Araújo, Inês; Nóbrega, Clévio; Castelo-Branco, Pedro; Bragança, JoséHuman induced pluripotent stem cells (hiPSCs) hold promises to model and understand human diseases, including those associated with ageing. Here, we describe ABCRIi001-A, a hiPSC line generated from peripheral blood mononuclear cells (PBMCs) of a 79-year-old female enrolled in a study for development of an ageing score (ALFA Score). PBMCs were reprogrammed using three Sendai virus-based reprogramming vectors (hKOS, hc-Myc, and hKlf4). ABCRIi001-A showed normal morphology and karyotype, viral clearance, absence of genomic aberrations, and their pluripotency was confirmed by expression of pluripotency-related markers and their ability to differentiate into the three germ layers. ABCRIi001-A is valuable for ageing-related studies.