Browsing by Author "Martins, I"
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- Behavioral response to headache: a comparison between migraine and tension-type headache.Publication . Martins, I; Parreira, EOBJECTIVE: To compare patients with migraine and tension-type headache in their behavior during the attacks and the maneuvers used to relieve the pain. BACKGROUND: Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis. METHODS: One hundred consecutive patients with either migraine (n = 72 ) or tension-type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared. RESULTS: Patients with migraine tended to perform more maneuvers than individuals with tension-type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension-type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs). CONCLUSIONS: The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.
- Cluster headache without autonomic symptoms: why is it different?Publication . Martins, I; Gouveia, R; Parreira, EBACKGROUND: Some patients with otherwise typical cluster headache (CH) have persistent attacks free of cranial autonomic symptoms (CAS). The factors responsible for this atypical presentation are not known. OBJECTIVES: To identify factors associated to the absence of CAS in patients with CH. METHODS: A prospective series of 157 patients with the diagnosis of CH was analyzed, comparing 148 typical CH patients with 9 CH patients without CAS. RESULTS: Patients without CAS reported significantly less intense attacks (P = .003) when compared to those with CAS. There was also a tendency (not reaching statistical significance) for a higher frequency of females and chronic CH among those without CAS. Otherwise, there were no differences between the two groups (in age, duration of illness, follow-up time, attack duration or frequency, nor side or site of pain). A logistic regression analysis showed that only pain intensity could explain the difference between the two groups, since the other explanatory variables were also associated with different intensity of attacks. CONCLUSIONS: These results support the hypothesis that CH without cranial autonomic symptoms represents a milder form of CH.
- Direct Gaze Partially Overcomes Hemispatial Neglect and Captures Spatial AttentionPublication . Rato, M; Mares, I; Sousa, D; Senju, A; Martins, IDirect gaze has been shown to be a particularly important social cue, being preferentially processed even when unconsciously perceived. Results from several visual search tasks further suggest that direct gaze modulates attention, showing a faster orientation to faces perceived as looking toward us. The present study aimed to analyze putative modulation of spatial attention by eye gaze direction in patients with unilateral neglect. Eight right hemisphere stroke patients with neglect performed a target cancelation paradigm. Patients were instructed to cross all open-eyed pictures amidst closed eyed distractors. Target images were either in direct or averted gaze. Participants performed significantly better when observing targets with direct gaze supporting the hypothesis that this gaze direction captures attention. These findings further suggest that perception of direct gaze is able to diminish the visuospatial impairment seen in neglect patients.
- High resolution mass spectrometry-based methodologies for identification of Etravirine bioactivation to reactive metabolites: In vitro and in vivo approaches.Publication . Godinho, A; Martins, I; Nunes, J; Charneira, C; Grilo, J; Silva, D; Pereira, S; Soto, K, et al.Drug bioactivation to reactive metabolites capable of covalent adduct formation with bionucleophiles is a major cause of drug-induced adverse reactions. Therefore, elucidation of reactive metabolites is essential to unravel the toxicity mechanisms induced by drugs and thereby identify patient subgroups at higher risk. Etravirine (ETR) was the first second-generation Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) to be approved, as a therapeutic option for HIV-infected patients who developed resistance to the first-generation NNRTIs. Additionally, ETR came into market aiming to overcome some adverse effects associated with the previously used efavirenz (neurotoxicity) and nevirapine (hepatotoxicity) therapies. Nonetheless, post-marketing reports of severe ETR-induced skin rash and hypersensitivity reactions have prompted the U.S. FDA to issue a safety alert on ETR. Taking into consideration that ETR usage may increase in the near future, due to the possible use of the drug for coinfection with malaria and HIV, the development of reliable prognostic tools for early risk/benefit estimations is urgent. In the current study, high resolution mass spectrometry-based methodologies were integrated with MS3 experiments for the identification of reactive ETR metabolites/adducts: 1) in vitro incubation of the drug with human and rat liver S9 fractions in the presence of Phase I and II co-factors, including glutathione, as a trapping bionucleophile; and 2) in vivo, using urine samples from HIV-infected patients on ETR therapy. We obtained evidence for multiple bioactivation pathways leading to the formation of covalent adducts with glutathione and N-acetyl-L-cysteine. These results suggest that similar reactions may occur with cysteine residues of proteins, supporting a role for ETR bioactivation in the onset of the toxic effects elicited by the drug. Additionally, ETR metabolites stemming from amine oxidation, with potential toxicological significance, were identified in vitro and in vivo. Also noteworthy is the fact that new metabolic conjugation pathways of glucuronide metabolites were demonstrated for the first time, raising questions about their potential toxicological implications. In conclusion, these results represent not only a contribution towards the elucidation of new metabolic pathways of drugs in general but also an important step towards the elucidation of potentially toxic ETR pathways, whose understanding may be crucial for reliable risk/benefit estimations of ETR-based regimens.
- Kinesiophobia in migrainePublication . Martins, I; Gouveia, R; Parreira, EPain aggravation by movement and avoidance of movement (kinesiophobia) is often reported by patients during migraine attacks. Yet its specific contribution to migraine diagnosis is undetermined. To characterize the frequency and severity of kinesiophobia during migraine and its role in the diagnosis of primary headaches, we questioned 150 patients (126 women and 24 men, average age 38.5 yrs) with migraine (n = 111) or tension-type headache (TTH) (n = 39) about aggravation of pain by bending forward, brisk head movements (jolt), and avoidance of movement during the attacks. The degree of pain worsening by each stimulus was measured through a visual analog scale and compared to worsening produced by other sensory stimuli such as light, sound, and smell. The discrimination power of kinesiophobia between migraine and TTH was calculated, using the International Classification of Headache Disorders criteria as gold standard. Sensitivity/specificity of studied symptoms was high in differentiating the 2 headache types: bending forward: 98%/85.7%; jolt: 96.3%/81.6%; and immobility during the attacks: 100%/70%. The degree of kinesiophobia was identical to photo- and phonophobia in migraine patients. We conclude that kinesiophobia discriminates between migraine and TTH. Bending forward and jolt may be useful additional questions to ask patients for the differentiation of headache attacks. PERSPECTIVE: This article evaluates the specific role of movement (movement-induced pain aggravation and avoidance of movement) in primary headaches. Kinesophobia is an easy symptom to screen, explained by migraine pathophysiology, and proved to be a sensitive and specific measure to identify migraine attacks when compared to tension-type headache.
- Obstipação crónica – Novos agentes farmacológicosPublication . Martins, I; Figueiredo, LA obstipação crónica idiopática (OCI), uma doença frequente no âmbito da gastrenterologia, tem sofrido grandes desenvolvimentos nos últimos anos no que diz respeito à sua abordagem terapêutica. Actualmente, antes da instituição de uma terapêutica em “cascata”, preconiza-se a descontinuação, se possível, de fármacos potencialmente causadores de obstipação. Posteriormente está preconizado o início da utilização de laxantes e, quando necessário, até mesmo associá-los. Na tentativa de uma maior eficácia terapêutica, têm sido desenvolvidos novos fármacos, dos quais destacamos o prucalopride (procinético), a lubiprostona e a linaclotida (agentes secretores). O prucalopride foi aprovado no tratamento da OCI, mas ainda não se encontra disponível em Portugal. A lubiprostona foi aprovada no tratamento da OCI e do Síndrome do Intestino Irritável com Obstipação (SII-O), porém, também não se encontra disponível em Portugal. A linaclotida foi aprovada para o tratamento da OCI (mas não na Europa) e da SII-O (na Europa, incluindo Portugal).
- Risk factors for bronchopulmonary dysplasia in five portuguese neonatal intensive care unitsPublication . Guimarães, H; Rocha, G; Vasconcellos, G; Proença, E; Carreira, ML; Sossai, MR; Morais, B; Martins, I; Rodrigues, T; Severo, MThe pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc. AIM: To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns. MATERIAL AND METHODS: 256 very low birth weight infants with gestational age (GA) <30 weeks and/or birthweight (BW) <1250 g admitted in five Portuguese NICUs, between 2004 and 2006 were studied. A protocol was filled in based on clinical information registered in the hospital charts. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. RESULTS: BPD prevalence was 12.9% (33/256). BPD risk decreased 46% per GA week and of 39% per 100g BW. BPD risk was significantly higher among newborns with low BW (adj OR= 0.73, 95% CI=0.57- 0.95), severe hyaline membrane disease (adj OR= 9.85, 95% CI=1.05-92.35), and those with sepsis (adj OR=6.22, 95% CI=1.68-23.02), those with longer duration on ventilatory support (42 vs 3 days, respectively in BPD and no BPD patients, p <0.001) and longer duration of FiO2>0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p <0.001). COMMENTS: The most relevant risk factors were low birth weight, severe hyaline membrane disease, duration of respiratory support and oxygen therapy, and nosocomial sepsis. The implementation of potentially better practices to reduce lung injury in neonates must be addressed to improve practices to decrease these risk factors.