45 results on '"Freitas, João Pedro"'
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2. Des scores élevés d’évaluation globale par le patient en cas de polyarthrite rhumatoïde en rémission ne reflètent pas une inflammation infraclinique
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Brites, Luisa, Rovisco, João, Costa, Flávio, de Freitas, João Pedro Dinis, Jesus, Diogo, Eugénio, Gisela, Serra, Sara, Duarte, Cátia, Ferreira, Ricardo J.O., and Pereira da Silva, José António
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- 2022
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3. High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation
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Brites, Luisa, Rovisco, João, Costa, Flávio, Freitas, João Pedro Dinis de, Jesus, Diogo, Eugénio, Gisela, Serra, Sara, Duarte, Cátia, Ferreira, Ricardo J.O., and da Silva, José António Pereira da
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- 2021
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4. Pancreatite Aguda - uma revisão abrangente sobre a etiologia e fisiopatologia, classificação, manifestações clínicas, diagnóstico, complicações, tratamento, prognóstico e prevenção
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Lopes, Milena Dutra, primary, Nogueira, Fernanda Bedin, additional, Freitas, João Pedro Berbert, additional, Ritti, Larissa de Almeida, additional, Guimarães, Manuela Ferreira, additional, Dias, Laura Poema de Barros Oliveira, additional, Lanna, Lívia Vecchi, additional, Sales, Victor Hugo Cubiça Tostes, additional, Nogueira, Vitor Bedin, additional, and Rezende Júnior, William Roberto de Oliveira, additional
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- 2023
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5. HÉRNIA DIAFRAGMÁTICA COMPLICADA NO PÓS-PARTO
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Firmino, Giulia de Carvalho, primary, Castaldelli, Gabriel Bezerra, additional, Freitas, João Pedro Cavalcante, additional, Arrais, Nicole Leopoldino, additional, Rodrigues, Sarah Linhares de Aragão, additional, and Rodrigues, Francisco Régis de Aragão, additional
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- 2019
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6. Automatic multi-view pose estimation in focused cardiac ultrasound
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Freitas, João Pedro Aarão Videiros, Fonseca, Jaime C., Queirós, Sandro, and Universidade do Minho
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Análise de imagens médicas ,Engenharia e Tecnologia::Engenharia Médica ,Determinação automática da pose ,Synthetic image generation ,Cardiac ultrasound ,Medical image analysis ,Ultrassonografia cardíaca ,Geração sintética de imagem ,Deep learning ,Automatic pose estimation - Abstract
Dissertação de mestrado integrado em Engenharia Biomédica, A ecocardiografia point-of-care (do inglês focused cardiac ultrasound, FoCUS) permite a avaliação das estruturas cardiovasculares e da sua função, por meio da imagem ultrassonográfica, na mod alidade point-of-care. Em situações de emergência e cuidados intensivos, o FoCUS é fundamental para acelerar a avaliação e o diagnóstico da função cardíaca, vital em situações críticas. No entanto, quando comparado com o exame de ecocardiografia convencional, o FoCUS difere no equipamento utilizado (qualidade inferior), no alcance do exame (conjunto limitado de vistas) e no operador (ger almente menos experiente), aspetos que fazem do FoCUS um exame essencialmente qualitativo. Com o objetivo de explorar o potencial do FoCUS na avaliação quantitativa da função cardíaca em ambiente tridimensional, esta tese focou no desenvolvimento de um algoritmo que estime automat icamente a relação espacial entre as cinco vistas cardíacas padrão de um exame de FoCUS. A pose relativa entre estas permitiria representar todas no mesmo espaço tridimensional, mitigando assim a principal barreira para a aplicação de métodos de análise 3D a este tipo de exames. No entanto, uma limitação inerente ao desenvolvimento deste tipo de algoritmos encontra-se relacionada com a falta de datasets cardíacos que contemplem imagem e respetiva pose 3D. Para ultrapassar esta limitação, uma pipeline para a geração de um dataset de FoCUS realista, com a imagem e a sua respetiva pose, foi desenvolvida com a utilização de um simulador de ultrassom e um método baseado em redes generativas adversárias para translação de imagem para imagem. Com o recurso ao dataset gerado, uma framework para estimação da pose foi desenvolvida, sendo constituída por três módulos. O primeiro propõe o uso de redes neuronais convolucionais para a regressão de mapas de calor, os quais representam as áreas mais prováveis de interseção entre as imagens de entrada. No segundo módulo, linhas representativas destas interseções são extraídas com recurso a um algoritmo de procura em grelha. Por fim, estas linhas são usadas para criar um sistema de equações não-lineares, cuja solução traduz a pose relativa 3D entre as vistas de interesse. Após provar a viabilidade da pipeline proposta para a geração de imagens realistas de FoCUS, incluindo a presença de ruído speckle e artefactos de sombra, um conjunto de testes foi realizado para validar a framework proposta. No geral, o método de regressão de mapas de calor provou ser viável e preciso, superando as baselines em todas as métricas de avaliação. De igual forma, o método de posicionamento de vistas em 3D demonstrou a sua viabilidade para a estimação da pose. Em suma, estes resultados demonstram o potencial da framework desenvolvida em contexto clínico., Focused cardiac ultrasound (FoCUS) allows the assessment of cardiovascular structures and their function using ultrasound imaging, in a point-of-care modality. In emergency and intensive care departments, FoCUS is seen as a key tool to accelerate evaluation and diagnosis of patients’ cardiac function, vital in critical situations. However, compared to a conventional echocardiography exam, FoCUS differs in the equipment used (inferior quality), in the examination scope (limited set of views) and in the operators (usually less experienced), which make FoCUS a primarily qualitative exam. Aiming to ultimately explore FoCUS’ potential to assess cardiac function quantitatively and three dimensionally, the focus of this thesis was to develop an algorithm that automatically estimates the spatial relationship between five standard FoCUS cardiac views. The relative pose between views would allow to represent all in the same three-dimensional (3D) coordinate system, thus mitigating the major barrier towards the application of 3D cardiac image analysis methods to FoCUS exams. However, a first drawback in the development of said algorithm is the lack of datasets that con template both FoCUS images and their 3D pose. To first tackle this limitation, an automatic pipeline for the generation of realistically looking (synthetic) FoCUS datasets, with both image and pose data, was developed using an ultrasound simulator and an image-to-image translation method. Leveraging of the created dataset, a novel framework for pose estimation contemplating three stages was implemented. In the first stage, a convolutional neural network based on an encoder decoder architecture is proposed to regress line-based heatmaps representing the most likely areas of intersection between input images. In the second stage, the lines that best fit the regressed heatmaps are extracted through a multi-resolution grid search algorithm. In the final stage, the previously identified lines are used to create a system of non-linear equations, whose solution traduces the relative 3D pose between all input views. After proving the feasibility of the proposed pipeline for the generation of images with realistic appearances, including US-specific features like speckle noise and shadowing artifacts, a set of ex periments were performed to validate the proposed framework. Overall, the developed heatmap regression method proved to be feasible and accurate, outperforming the implemented baselines in all evaluation metrics. Similarly, the 3D view positioning method showed its feasibility for pose estim ation. Altogether, the results for the developed framework are promising, suggesting its usefulness in a future clinical context., The work present in this project was performed in the Life and Health Sciences Research Institute (ICVS, School of Medicine) and in Centro ALGORITMI (School of Engineering), University of Minho. Financial support was provided by National funds, through the Foundation for Science and Technology (FCT) - project PTDC/EMD-EMD/1140/2020.
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- 2022
7. Schnitzler Syndrome: A Dramatic Response to Anakinra
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Gouveia, Ana Isabel, Micaelo, Manuela, Pierdomenico, Francesca, and Freitas, João Pedro
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- 2016
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8. Aplicativos de relacionamento: A rejeição de corpos no ambiente digital
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De Oliveira, Anita Borges, De Freitas, João Pedro Azambuja, Tommaselli, Guilherme Costa Garcia, and Pereira, Gilmar Ribeiro
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- 2022
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9. Schnitzler syndrome: Prompt response to treatment with anakinra: 1792
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Gouveia, Ana Isabel, Micaelo, Manuela, Pierdomenico, Francesca, and Freitas, João Pedro
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- 2015
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10. Linear Immunoglobulin A Bullous Dermatosis
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Gouveia, Ana Isabel, Teixeira, Ana, Freitas, João Pedro, Soares-de-Almeida, Luís, Filipe, Paulo, and Sacramento-Marques, Manuel
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- 2016
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11. Appearance of de novo dysplastic spitzoid compound naevus in an adalimumab-treated psoriatic patient: Case report and review of the possible causal relationship with TNF-α blockers
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Sousa, Marisa, Freitas, João Pedro, Antunes, Joana, Soares-de-Almeida, Luís, and Filipe, Paulo Leal
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- 2014
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12. Os determinantes da manipulação de resultados, evidência empírica em empresas não-cotadas
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Freitas, João Pedro Oliveira Fernandes de, Dias, Paulo Jorge Varela Lopes, and Laureano, Raúl Manuel Silva
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Auditoria -- Audit ,Determinantes de manipulação de resultados ,Accruals discricionários ,Earnings manipulation determinants ,Discretionary accruals ,Manipulação de resultados ,Earnings manipulation ,Ciências Sociais::Economia e Gestão [Domínio/Área Científica] - Abstract
Este estudo analisa e procura estabelecer uma relação entre potenciais determinantes de manipulação de resultados e a manipulação de resultados. Nos últimos anos, tem-se presenciado enormes problemas financeiros como consequência de manipulações e fraudes financeiras, quer a nível global, quer a nível nacional pelo que, é fulcral a investigação deste tema para evitar problemas do mesmo foro futuramente. Com este estudo espera-se incentivar uma divulgação de informação financeira mais transparente e contribuir de forma positiva com um estudo que possa ser útil a todos os utilizadores das demonstrações financeiras assim como, a profissionais de auditoria e entidades reguladoras. O objetivo deste estudo é relacionar as potenciais variáveis com os accruals discricionários indicativos de manipulação de resultados e para tal, usou-se quatro modelos teóricos para estimar os accruals: Original Jones, Modified Jones, Cashflow Jones e Performance Jones. O presente estudo empírico baseia-se em dados de empresas cotadas e não-cotadas em Portugal, com referência ao período compreendido entre 2009- 2016. Os resultados obtidos proporcionam evidências da relação encontrada entre as variáveis determinantes de manipulação e a manipulação de resultados e também, da concordância entre os modelos quanto aos determinantes de manipulação. Assim conclui-se que estes resultados apresentam um contributo na atual discussão de manipulação de resultados e os seus determinantes. This study analyses and looks to find a correlation between potential earnings manipulation variables and earnings manipulation. In the last years, we have been facing serious problems as consequence of earnings manipulation and financial fraud. Whether the problem is global or local, it is highly important to investigate this subject in order to, avoid future problems related to this matter. With this study, it is expected to encourage a more transparent reporting of financial information as well as, to provide a positive contribution, with an empirical analysis that can be useful for all financial statement´s users, audit professionals and regulatory authorities. The objective of this study is to relate potential earnings manipulation determinants and discretionary accruals indicative of earnings manipulation for such It was used four theoretical models to estimate the accruals: Original Jones, Modified Jones, Cash-flow Jones and Performance Jones. The present study uses data based on listed and unlisted firms from Portugal, for the period from 2009 until 2016. The results show evidence of a relation between the selected determinants and earnings manipulation, as well as, the agreement of the different theoretical accrual models regarding the earnings manipulation determinants. Therefore, it is concluded that these results present a positive contribute in the current discussion of earnings manipulation and its determinants.
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- 2020
13. Identificação de propriedades elásticas da madeira à escala dos anéis de crescimento por um método de elementos finitos iterativo
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Freitas, João Pedro Faria de, Xavier, José Manuel Cardoso, and Morais, José Joaquim Lopes
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Madeira ,Método dos elementos finitos - Abstract
Dissertação de Mestrado em Engenharia Mecânica
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- 2019
14. Sun Exposure: Beyond the Risks
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Queirós, Catarina Soares, primary and Freitas, João Pedro, additional
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- 2019
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15. Clinical and Laboratory Factors Associated with Prolonged Hospital Stay among Patients with Cellulitis/Erysipelas
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Roda, Ângela, Pinto, Ana Marcos, Filipe, Ana Rita, Travassos, Ana Rita, Freitas, João Pedro, Filipe, Paulo, and Repositório da Universidade de Lisboa
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Hospitalization ,Erysipelas ,C-Reactive Protein ,Leukocytosis ,Celulite ,Erisipela ,Hospitalização ,Leucocitose ,Proteína C-Reactiva ,Cellulitis - Abstract
Copyright © Ordem dos Médicos 2019., Introduction: Cellulitis and erysipelas represent the most frequent cause of hospitalization in the dermatology department of Santa Maria Hospital in Lisbon, Portugal. The aim of this study was to investigate whether patient demographics, comorbidities, previous episodes of cellulitis/erysipelas, the presence of complications, laboratory markers at admission, microbial isolation or previous use of antibiotics, are associated with prolonged stays. Material and methods: Retrospective analysis, including patients admitted with cellulitis/erysipelas in the inpatient dermatology department of Santa Maria Hospital between July 1st 2012 and June 30th 2017. Results: There were 372 admissions, corresponding to 348 patients. The median length of stay was 11 days. Increased age (p = 0.002, OR 1.03, 95% CI 1.01 - 1.04), previous episode of cellulitis/erysipelas requiring hospitalization (p = 0.005, OR 4.81, 95% CI 1.63 - 14.23), the presence of cellulitis/erysipelas-associated complications (p = 0.001, OR 3.28, 95% CI 1.63 - 6.59), leukocytosis (p = 0.049, OR 1.81, 95% CI 1.00 - 3.30), high levels of C-reactive protein (p = 0.035, OR 1.03, 95% CI 1.00 - 1.06) and a positive culture result (p = 0.002, OR 2.59, 95% CI 1.41 - 4.79) were associated with prolonged hospitalization. Discussion: Prolonged hospitalization for cellulitis/erysipelas is associated with higher costs, additional clinical investigation, invasive treatments, prolonged courses of antibiotic therapy, risk of nosocomial infections, and delayed return to activities of daily living. Thus, the investigation of clinical-laboratory factors associated with prolonged hospitalization for cellulitis / erysipelas is essential and may be useful for the construction of a severity score. Conclusion: The knowledge of the characteristics that are associated with prolonged stay among patients with cellulitis/erysipelas may be relevant to improve health care, by reducing the length of hospital stay and associated risks and costs., Introdução: A celulite e a erisipela constituem a causa mais frequente de internamento no Serviço de Dermatologia do Hospital Santa Maria. Este estudo teve como objetivo investigar se as características demográficas, as comorbilidades, a existência de episódios prévios de celulite/erisipela, a presença de complicações associadas, os parâmetros laboratoriais na admissão, o isolamento de microrganismo em cultura ou o uso prévio de antibióticos estão associados a internamentos prolongados. Material e Métodos: Estudo retrospetivo, incluindo os doentes internados no Serviço de Dermatologia do Hospital Santa Maria com o diagnóstico de celulite/erisipela, entre 1 de julho de 2012 e 30 de junho de 2017. Resultados: Existiram 372 internamentos, correspondendo a 348 doentes. A mediana do tempo de internamento foi de 11 dias. A idade ( p = 0,002, OR 1,03, 95% IC 1,01 – 1,04), a existência de internamento prévio por celulite/erisipela (p = 0,005, OR 4,81, 95% IC 1,63 – 14,23), a presença de complicações associadas à celulite/erisipela (p = 0,001, OR 3,28, 95% IC 1,63 – 6,59), a leuco- citose (p = 0,049, OR 1,81, 95% IC 1,00 – 3,30), valores elevados de proteína C reativa (p = 0,035, OR 1,03, 95% IC 1,00 - 1,06) e o isolamento de microrganismo em cultura (p = 0,002, OR 2,59, 95% IC 1,41 – 4,79) estiveram associados a internamentos prolongados. Discussão: A par dos maiores custos associados, o internamento prolongado por celulite/erisipela está frequentemente associado à necessidade de investigação clínica adicional, a tratamentos invasivos, a cursos prolongados de antibioterapia, ao risco de infeções nosocomiais e ao atraso no retorno às atividades da vida diária. Assim, o estudo dos fatores clínico-laboratoriais associados ao inter- namento prolongado por celulite/erisipela é fundamental e poderá ser útil para a construção de um score de gravidade. Conclusão: O conhecimento de características clínicas e laboratoriais associadas ao internamento prolongado poderá ser relevante para melhorar os cuidados de saúde, através da redução dos tempos de internamento e dos seus riscos e custos associados.
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- 2019
16. Syncope Diagnosis
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Oliveira, Tiago dos Santos and Freitas, João Pedro Pinto
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Monitorização Ambulatorial ,Syncope/diagnosis ,Monitoring, Ambulatory ,Diagnosis, Computer-Assisted ,Síncope/diagnóstico ,Diagnóstico por Computador - Abstract
No diagnóstico de pacientes com síncope é fundamental que a etiologia seja determinada corretamente. Desta forma, na avaliação destes doentes é essencial uma abordagem multifacetada, combinando uma história clínica meticulosa com um exame físico e exames auxiliares de diagnóstico adequados. No entanto, mesmo com uma correta abordagem inicial, muitos pacientes são mal diagnosticados ou permanecem sem diagnóstico, tornando-se assim candidatos a um seguimento prolongado. O implantable loop recorder (ILR) é um aparelho de pequenas dimensões que permite uma monitorização prolongada (até 3 anos) da atividade elétrica cardíaca, aumentando a probabilidade de detetar uma correlação entre eventuais alterações do ritmo cardíaco e os sintomas do paciente. Assim, os ILR têm assumido um interesse crescente nesta área dado que permitem detetar a etiologia cardíaca (arrítmica) de muitas síncopes que até então permaneciam de causa desconhecida. As guidelines atuais recomendam o uso dos ILRs na fase precoce da avaliação de pacientes com síncopes recorrentes de causa desconhecida, após avaliação inicial, na ausência de critérios de alto risco e na avaliação de pacientes de alto risco com síncope após avaliação inicial negativa. Este artigo é uma revisão sistemática que resume o conhecimento atual sobre a utilidade e a precisão dos ILRs no diagnóstico de síncope de causa desconhecida após uma abordagem diagnóstica convencional, tal como a sua utilidade em diversas situações específicas (na epilepsia, na população pediátrica, em idosos, na fibrilação auricular e no AVC criptogénico). In the diagnosis of patients with syncope it is important that the aetiology is correctly determined. Thus, a multidisciplinary approach is essential in the evaluation of these patients, combining a meticulous clinical history with an appropriate physical examination and auxiliary diagnostic tests. However, even with a correct initial approach, many patients are misdiagnosed or remain undiagnosed, becoming then candidates for a prolonged follow-up. The implantable loop recorder (ILR) is a small device that allows prolonged monitoring (up to 3 years) of the electric cardiac activity, increasing the likelihood of detecting a correlation between any cardiac rhythm alterations and the patient's symptoms. Thus, ILRs have assumed an increasing interest in this area since they allow the detection of cardiac (arrhythmic) aetiology of much syncope that until then remained with an unknown cause. The current guidelines recommend the use of ILRs in the early phase of the evaluation of patients with recurrent syncope of unknown cause, after initial evaluation, in the absence of high risk criteria and in the evaluation of high risk patients with syncope after initial negative evaluation. This article is a systematic review that summarizes the current knowledge about the utility and accuracy of ILR in the diagnosis of syncope of unknown cause after a conventional diagnostic approach; as well as its utility in many specific situations (epilepsy, paediatrics, elderly, atrial fibrillation and cryptogenic stroke).
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- 2019
17. Operational transconductor amplifier fully diferential with high linearity and common mode feedback compensation
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Freitas, João Pedro Gonçalves, Barúqui, Fernando Antônio Pinto, Souza, Márcio Nogueira de, and Soares, Carlos Fernando Teodósio
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Folded flipped voltage follower ,Offset diferencial ,ENGENHARIAS::ENGENHARIA ELETRICA [CNPQ] ,Operational transconductor amplifier - Abstract
Submitted by Paloma Arruda (palomaoliiveira75@gmail.com) on 2021-02-20T03:53:14Z No. of bitstreams: 1 JoaoPedroGoncalvesFreitas.pdf: 6986068 bytes, checksum: 9658e9530bdd23260bf4c9885820c92c (MD5) Approved for entry into archive by Moreno Barros (moreno@ct.ufrj.br) on 2021-04-05T01:59:08Z (GMT) No. of bitstreams: 1 JoaoPedroGoncalvesFreitas.pdf: 6986068 bytes, checksum: 9658e9530bdd23260bf4c9885820c92c (MD5) Made available in DSpace on 2021-04-05T01:59:08Z (GMT). No. of bitstreams: 1 JoaoPedroGoncalvesFreitas.pdf: 6986068 bytes, checksum: 9658e9530bdd23260bf4c9885820c92c (MD5) Previous issue date: 2019-03 Apresenta-se, nesta dissertção, o projeto de um Operational Transconductor Amplifier (OTA) totalmente diferencial de alta linearidade, baseado na topologia de um Folded Flipped Voltage Follower. Este foi desenvolvido e aplicado em um filtro passa-baixas de 3a ordem, baseado na aproximação de Chebyshev do tipo Gm −C, com frequência de corte de 300 kHz. Além disso, o OTA possui baixo offset diferencial e é integrado a um circuito de controle de modo comum para eliminar a tensão de modo comum dos terminais de saída. O projeto foi realizado para a tecnologia Complementary Metal-Oxide-Semiconductor (CMOS) de 0,35 µm e as tensões de alimentação do circuito serão + −1,5 V. In this work, we present the design of a fully differential Operational Transconductor Amplifier (OTA) with high linearity, based on the Folded Flipped Voltage Follower (FFVF) Topology. This structure was developed and applied on a 3a order low-pass Gm − C filter, based on the Chebyshev’s aproximation with a cutoff frequency of 300 kHz. Besides that, the OTA has low differential offset and it is integrated with a common mode feedback compensation circuit, to eliminate the common mode voltage at the output nodes. The project was implemented in a 0.35 µm Complementary Metal-Oxide-Semiconductor (CMOS) technology and operates at a + −1.5 V power supply.
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- 2019
18. A user perspective on online business modelling
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Freitas, João Pedro Martins and Bohnsack, René
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Online business model development tools ,Web-based usability ,Usability ,Usabilidade ,Software para desenvolvimento de modelos de negócios ,Business model innovation ,Usability evaluation ,Mensuração da usabilidade ,Ciências Sociais::Economia e Gestão [Domínio/Área Científica] ,Inovação em modelos de negócio - Abstract
Submitted by Isabel Gomes (itg@lisboa.ucp.pt) on 2019-02-20T13:53:59Z No. of bitstreams: 1 A User Perspective on Online Business Modeling.pdf: 1467204 bytes, checksum: 155ab3dbe9ed9cb7411dff388218dbbe (MD5) Approved for entry into archive by Isabel Gomes (itg@lisboa.ucp.pt) on 2019-02-20T13:54:41Z (GMT) No. of bitstreams: 1 A User Perspective on Online Business Modeling.pdf: 1467204 bytes, checksum: 155ab3dbe9ed9cb7411dff388218dbbe (MD5) Made available in DSpace on 2019-02-20T13:54:41Z (GMT). No. of bitstreams: 1 A User Perspective on Online Business Modeling.pdf: 1467204 bytes, checksum: 155ab3dbe9ed9cb7411dff388218dbbe (MD5) Previous issue date: 2019-02-01
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- 2019
19. REFRACTORY ERYTHRODERMA: CASE REPORT (JUST PSORIASIS OR PSYCHIATRIC DISORDER?): P2785
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Gouveia, Carolina, Garcia, Carlos, Reis, Miguel-Duarte, and Freitas, João Pedro
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- 2005
20. ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS: REVIEW OF 6 CLINICAL CASES: P515
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García, Carlos Miguel Ruiz, Reis, Miguel, and Freitas, João Pedro
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- 2005
21. Genes e Melanoma
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Mendonça Sanches, Maria, Soares de Almeida, Luís, and Freitas, João Pedro
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Genes ,OncogenesSignal Transduction ,Oncogenes ,Melanoma ,Transdução de Sinais - Published
- 2018
22. Reorganização de um armazém de materiais de construção e melhoria dos seus processos de arrumação e picking
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Freitas, João Pedro Viegas de, Telhada, José, and Universidade do Minho
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Standardization of processes ,Normalização de processos ,Logística ,Layout ,Engenharia e Tecnologia::Outras Engenharias e Tecnologias ,Outras Engenharias e Tecnologias [Engenharia e Tecnologia] ,Storage management ,Logistics ,Gestão do armazenamento ,Picking - Abstract
Dissertação de mestrado em Engenharia de Sistemas, A presente dissertação aplica princípios e métodos científicos para o desenvolvimento de ações de melhoria na organização e gestão de um armazém de materiais de construção que funciona como o elo principal na cadeia de abastecimento das obras do Grupo dst. A atual organização e gestão dos processos do armazém de materiais apresentam claras deficiências que manifestamente geram desperdícios, condicionam a produtividade e o nível de serviço prestado aos clientes, apesar de o sistema contar com a dedicação de gestores e colaboradores experientes e com a utilização do ERP SAP. O estudo tem duas vertentes. Uma das vertentes incide no desenvolvimento de ações de melhoria dos diversos processos logísticos realizados no armazém, iniciando com o levantamento minucioso das operações realizadas, medição dos tempos de execução e mapeamento através da metodologia DMAIC. Ainda com esta metodologia, pretende-se normalizar os processos e aumentar a respetiva eficiência. A segunda vertente do estudo incide, em particular, na análise do layout e arrumação do armazém, e da atividade de picking. A intervenção passa pela proposta de um novo sistema de identificação das estantes e prateleiras, aliado a uma gestão visual eficaz, uma redefinição dos locais reservados ao armazenamento de cada um dos materiais e a uma redefinição do modelo de lista de picking. Com as melhorias propostas, estimam-se ganhos de produtividade e eficiência, com base na projeção da redução de 50% do tempo médio despendido no processo de aditamento, na redução de 32,8% do tempo médio de ocupação diário da equipa de trabalho do armazém com a inserção de um Gestor de Stock, uma coordenação entre o fornecedor e o armazém através do horário definido, controlar o nível e minimizar o stock dos materiais, a automatização de algumas operações dos respetivos processos, a fiabilidade dos dados em SAP, a redução do número de deslocações e distância no picking dos materiais e melhor método de arrumação e organização dos materiais. Ao nível de ganhos qualitativos estima-se uma melhor gestão visual dos materiais e locais de armazenamento no armazém de materiais., The present dissertation applies principles and scientific methods to promote improvement actions for organizations and management of a warehouse with materials for construction that works has a connection between the supply chain of the dst Group. The actual management and organization of the processes to the materials warehouses show great deficiency that generate waste, condition the productivity and the level of service provided to the clients, despite the fact that the system accounts with the dedication of the experienced managers and collaborator and the use of the of the ERP SAP. This study has two strands. One strand focuses in the development of the improvement actions of the diverse logistics processes used in the warehouse, starting with the survey scrutiny of the operations carried out, time measurements of the executions and mapping with the methodology DMAIC. Still with this methodology, it’s pretended to normalize the processes and increase the respective efficiency. The second strand of the study focuses, in particular, in the analysis of the layout and the storage of the warehouse, and the picking activity. This intervention involves the proposal of a new identification system for shelves and racks, allied to an effective visual management, a redefinition of preserved locations to the storage of each material and a redefinition to the model of the picking list. With the improvement propositions, its estimated to gain productivity and efficiency, in particular on the level of the projection made, the reduction of 50% average time spent on the aditamento process, the reduction by 32,8% of the average daily time spent by the warehouse work team with the insertion of a Stock Manager, a coordination between the provider and the warehouse through a set schedule, a level control and minimize the stock of materials, the automation of some operations of the respective processes, the reliability of data in SAP, the reduction of the number of travelling and the distance in picking materials and the best method of storage and organization of materials. At the level of qualitative gains, it’s estimated a better visual management of the materials and storage locations.
- Published
- 2018
23. Fatores Clínico-Laboratoriais Associados ao Internamento Prolongado em Doentes com Celulite/Erisipela
- Author
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Roda, Ângela, primary, Pinto, Ana Marcos, additional, Filipe, Ana Rita, additional, Travassos, Ana Rita, additional, Freitas, João Pedro, additional, and Filipe, Paulo, additional
- Published
- 2019
- Full Text
- View/download PDF
24. Cutaneous Manifestations of Diabetes Mellitus and Prediabetes
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Sanches, Maria Mendonça, primary, Roda, Ângela, additional, Pimenta, Rita, additional, Filipe, Paulo Leal, additional, and Freitas, João Pedro, additional
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- 2019
- Full Text
- View/download PDF
25. Púrpura de Henoch-Schönlein (Vasculite por IgA) no Adulto
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Gouveia, Ana Isabel, Lopes, Leonor, and Freitas, João Pedro
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Adult ,Vasculitis ,Leukocytoclastic ,Cutaneous ,Vasculite Leucocitoclástica Cutânea ,Adulto ,Schoenlein-Henoch ,Imunoglobulina A ,Purpura ,Púrpura Henoch-Schönlein ,Immunoglobulin A - Published
- 2016
26. Ulcerated Necrobiosis Lipoidica
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Pimenta, Rita, primary, Roda, Ângela, additional, and Freitas, João Pedro, additional
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- 2018
- Full Text
- View/download PDF
27. ‘Stony’ shoulder: an exuberant case of glenohumeral synovial chondromatosis with extra-articular extension
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Costa, Flávio, primary, Freitas, João Pedro, additional, Coutinho, Margarida, additional, and Malcata, Armando, additional
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- 2018
- Full Text
- View/download PDF
28. Utilização do 'cheque-dentista' por parte de crianças de 10 e 13 anos no ano letivo 2013/2014 em duas escolas no agrupamento de Vizela
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Freitas, João Pedro da Silva Castro Faria de and Neves, Helena
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Programa Nacional de Promoção de Saúde Oral ,Crianças ,Health ,Ciências Médicas::Medicina Clínica [Domínio/Área Científica] ,Oral Health ,National Program of Oral Health Promotion ,Saúde Oral ,Saúde ,Cheque-dentista ,Children ,Dentist-check - Abstract
Introdução: Uma grande parte de todas as consultas de medicina dentária realizadas em Portugal ocorre em prestadores de natureza privada, consequentemente a acessibilidade, principalmente entre os estatutos socioeconomicamente mais desfavorecido é dificultada. As crianças e os jovens são um grupo especial da população que necessita de particular atenção e proteção por parte dos serviços governamentais, investir na sua saúde e no seu bem‐estar garante ganhos de saúde ao longo das suas vidas. Tendo isto em conta, foi criado o Programa Nacional de Promoção de Saúde Oral (PNPSO). Os objetivos principais deste programa consistem na redução da incidência de doenças orais, melhoria dos conhecimentos e comportamentos sobre saúde oral e a promoção da equidade na prestação de cuidados de saúde oral. Desta forma são emitidos cheques-dentista para determinados grupos populacionais, sendo eles crianças e jovens com idade inferior a 16 anos, gravidas a ser seguidas no SNS, beneficiários do complemento solidário para idosos, portadores de Sida/VIH, e consultas no âmbito da prevenção do cancro oral. Participantes e Métodos: Realizou-se um estudo observacional transversal onde a população em análise foi constituída pelos responsáveis dos alunos de 10 e 13 anos abrangidos pelo PNPSO que no ano letivo 2013/2014 frequentaram o Colégio de Vizela e o Instituto Silva Monteiro. A recolha de dados foi feita através de um inquérito realizado por escrito com questões relativas à utilização dos documentos no âmbito do PNPSO. Em ambas as situações esteve presente o consentimento informado e garantiu-se a total confidencialidade dos dados. Os dados recolhidos neste estudo foram submetidos a uma análise estatística recorrendo ao software IBM SPSS Statistics v22. Resultados: Na população analisada quando questionados “O seu educando já tinha tido alguma consulta de medicina dentária?” 88,5% responderam “sim”, desses a maioria referiu que o médico dentista onde essas consultas foram realizadas estava incluído no programa (81,5%). Uma grande parte dos inquiridos referiu a escola como fator que lhes deu a conhecer o programa (sendo que 90,2% incluíram essa opção nas suas respostas). Quando questionados se fizeram tratamentos fora do programa 54,9% responderam que não. Em relação à utilização do(s) cheque(s)-dentista a que tiveram direito, 86,1% dos beneficiários referiu ter utilizado, desses, 67,6% mencionou a conclusão dos tratamentos com as consultas no âmbito do programa. Quando questionados o que os levou a escolher o consultório onde os tratamentos incluídos no PNPSO foram realizados, 57,9% do total de respostas foram para o “conhecimento prévio do médico dentista”. Na opinião de grande parte dos inquiridos (97,5%), o cheque-dentista é um incentivo para cuidados de saúde oral. No futuro, 99,2% dos beneficiários referiram que irão realizar os tratamentos a que tenham direito com o PNPSO. Conclusão: Com este estudo foi possível observar que grande parte dos beneficiários analisados utilizou o(s) cheque(s)-dentista a que tiveram direito. É possível observar que a maioria dos utentes referiram ter beneficiado com o programa, e afirmam que este constitui um meio de promoção e prevenção de doenças orais futuras e um incentivo para os cuidados de saúde oral. O processo de divulgação do PNPSO foi na sua maioria realizado pelas escolas, em que ambas se revelaram competentes a dar a conhecer o programa aos beneficiários. Introduction: In Portugal the major part of professional dental care occurs on the private sector making the access difficult, especially among the part of the population with low socioeconomically status. Children and young people are a special group of the population that needs particular attention and protection by government services, investments in their health and well-being ensures health gains throughout their lives. In response to those problems, the National Program of Oral Health Promotion (PNPSO) was created. The main objective of this program consists in the decrease of oral disease incidence and also improving the knowledge and behavior about oral health and promoting equity in oral health care and services. So certain population groups are entitled to “dental checks” (vouchers), those groups are: children and teenagers under the age of 16, pregnant women, elderly people, patients with AIDS / HIV, and patients that need dental services related to oral cancer prevention. Participants and Methods: A cross-sectional observational study where the population under review was represented by the guardians of students from 10 to 13 years old covered by PNPSO that in the academic year of 2013/2014 attended the College of Vizela and Silva Monteiro Institute. The data collection was done through a survey conducted in writing concerning the use of documents within the PNPSO. Total confidentiality was assured by an informed consent. The data collected in this study was submitted to statistical analysis using the IBM SPSS v22 software. Results: In the study sample when asked "your son or daughter had already had some dental consultation?"85.5% answered "yes", from that group, most mentioned that the dentist where the consultations were held was included in the program (88, 5%). A large proportion of respondents referred the school as the factor who gave them the knowledge about the program (90.2% included this option in their responses). When asked if they made treatments not included in the program, 54.9% said no. Regarding the use of the vouchers to which they were entitled, 86.1% of beneficiaries reported having used them, from those, 67.6% mentioned the conclusion of treatments with the services under the program. When asked what led them to choose the clinic where the treatments included in PNPSO were performed, 56.9% of the responses were for "prior knowledge of the dentist." In the view of most respondents (97.5%), the dentist-check is an incentive to oral health care. In the future, 99.2% of beneficiaries said they will perform the treatments they are entitled with the program. Conclusion: In this study was observed that most of the analyzed beneficiaries used the vouchers to which they were entitled. The majority of users reported having benefited with the program, and claim that it is a means of promotion and prevention of oral diseases and a further incentive for oral health care. The PNPSO disclosure process was mostly conducted by schools, where both have proved competent in publicizing the program to the beneficiaries.
- Published
- 2015
29. Genes & Melanoma
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Sanches, Maria Mendonça, primary, Soares-de-Almeida, Luis, additional, and Freitas, João Pedro, additional
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- 2017
- Full Text
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30. Reestruturação interna e organização dos serviços municipais
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Freitas, João Pedro Gonçalves, Gomes, Maria Cristina Sousa, and Mota, José Carlos Baptista da
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Serviço público ,Serviços públicos ,Organigramas ,Administração pública ,Divisão dos Recursos Humanos ,Reforma administrativa ,Reestruturação ,Serviços municipais - Ovar (Portugal) ,Reforma - Abstract
Mestrado em Administração e Gestão Pública O presente relatório de estágio pretende explicar e analisar a reforma, e consequente melhoria, dos serviços Municipais de Ovar assim como as atividades que foram realizadas durante o mesmo e que, de certa forma, sofreram alterações e foram influenciadas pela recente reforma. A Divisão dos Recursos Humanos teve um papel muito importante na integração e condução de todo este processo de reforma. Este relatório está essencialmente dividido em três partes: a primeira parte é um enquadramento teórico de base acerca do tema da Administração Pública; a segunda parte contém uma exposição do tema e do local de estágio e, para terminar, a terceira parte que tem a enumeração das atividades realizadas e as considerações finais, quer das atividades efetuadas, quer de todo o relatório. This internship report aims to explain and analyze the reform and consequent improvement of Ovar municipal services as well as the activities performed during the same and that, somehow, have changed and were influenced by this recent reform. The Human Resources division had a very important role in integrating and conducting this reform process. This report is essentially divide into three parts: the first part is a basic theoretical framework regarding the subject of the Public Administration; the second part comprises the presentation of the theme and internship site and, finally, the third part that has a list of all the activities that were performed during the internship and the final considerations of the entire report.
- Published
- 2014
31. O caminho para uma nova agenda securitária- contributos do neorrealismo
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Freitas, João Pedro Lopes Teixeira de and Ferreira, Marcos Farias
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Lógica Sistémica-Bipartida ,Hobbes ,Binómio-de-Segurança ,Spykman ,Praxis Securitária ,Geopolítica ,Reformismo-Teórico ,Anarquia Estrutural ,Waltz ,Ameaças Emergentes ,Segurança-Humana ,Neorrealismo - Abstract
Dissertação de Mestrado em Relações Internacionais - Especialização em Segurança e Informações Para compreendermos a construção de uma Nova Agenda Securitária, e os respectivos potenciais contributos que o neorrealismo e, por acréscimo, que o realismo neoclássico têm a oferecer na mesma, devemos entender e apreender novos conceitos como, por exemplo, o da Segurança Humana, como processos analíticos descritivos e conceitos prescritivos ao mesmo tempo; como duas imagens sobrepostas. O Século XXI é marcado por uma materialização de diversos paradigmas que incorporam não só uma evolução complexa a nível de consciência social e política a nível internacional como integram também, em conjugação com essa evolução de consciência, diversos avanços técnicos e tecnológicos que eram apenas imaginados pela criatividade de alguns escritores há meros 20 anos. Estes paradigmas trouxeram e trazem alterações indeléveis à dinâmica interna e externa dos estados e às suas respectivas projecções securitárias. Seja no que concerne à análise, resposta ou doutrina, a digitalização da ameaça, em junção com a compreensão alargada e percepção unificada da existência efectiva de ameaças ecosistémicas (como exemplificado por Peter Stoett), levou a um novo e aprofundado entendimento multidimensional da Segurança. Este novo entendimento deve levar forçosamente a uma reforma, ou actualização, da Segurança (o conceito) e das propostas materiais (a praxis securitária) que esta deve conter. Achamos, assim, que o neorrealismo (e, de certa forma, o realismo neoclássico) tem um contributo de inegável relevo a oferecer nesta transformação e reavaliação, tanto teórica como prática, das prioridades securitárias e da agenda que estas devem ocupar. Estabelecendo-se um binómio analítico entre o modelo clássico de Segurança e o modelo de Segurança Humana, ascende-se a um desenvolvimento subsequente de agendas securitárias mais adaptáveis e moldadas à realidade hodierna transnacional, que eventualmente garantirão condições de crescimento e desenvolvimento de novas relações de interdependência; reduzindo talvez as tendências hostis (maximalistas, de guerra portanto) mesmo no contexto da estrutura anárquica do sistema internacional – ao momento considerado, possivelmente, como sistema transnacional. Tal significa que a segunda componente da realização securitária holística teorizada por Thomas Hobbes poderá ser aproximada, elevando os estados a um novo patamar de Agendas, ou políticas públicas, de Segurança. Tudo consistindo num processo e entendimento neorrealistas, de base Waltziana mas dotados de reformas teóricas adequadas, a exercer o aproveitamento de conceptualizações das teorias críticas e a integrar parte das suas postulações na lógica sistémica bipartida proposta nesta Tese. Desta forma, integramos também a formulação de agendas securitárias num processo analítico e prescritivo tipicamente geopolítico – essencial a uma adaptabilidade das agendas à natureza volátil (e estrutural) das ameaças emergentes que abordaremos em detalhe na Tese. N/A
- Published
- 2013
32. Frei Luís de Sousa e o desenvolvimento de competências orais
- Author
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Freitas, João Pedro Botelho de, Silva, António Carvalho da, and Universidade do Minho
- Subjects
806.90:372.88 ,372.88 [806.90] ,372.88:806.90 ,806.90 [372.88] - Abstract
Relatório de estágio de mestrado em Ensino de Português e de Línguas Clássicas no 3º Ciclo do Ensino Básico e no Ensino Secundário, O ensino/aprendizagem da oralidade na disciplina de Português sofreu no passado algum esquecimento face a outros domínios, como a leitura e a escrita. Tal aconteceu devido a determinados preconceitos que o senso comum difunde no que às competências orais concerne: que estas são inatas, sendo, por isso mesmo, desnecessário canalizar os estudos para a sua melhoria; que, sendo um domínio de cariz espontâneo, as lacunas ao nível da organização do discurso, raciocínio e sintaxe são desculpáveis. No entanto, numa leitura atenta ao Programa de Português (Seixas et al., 2002), e recorrendo a autores como Emília Amor (1993) ou Hilário de Sousa (2006), compreendemos que a atividade linguística contempla quatro aptidões a serem trabalhadas em complementaridade, sendo estas o ler, o escrever, o ouvir e o falar – e apenas este trabalho holístico permite dotar os alunos de uma real competência comunicativa. Neste enquadramento, decidimos que o nosso projeto de estágio - integrado no Mestrado em Ensino de Português e de Línguas Clássicas - incidiria na questão da oralidade, a ser trabalhada através de duas perspetivas: promovendo, por um lado, a sua exercitação (concretizada a partir de apresentações orais e do incentivo à participação, evitando as aulas de cariz expositivo e praticando estratégias para falar em público) e, por outro, dotando os alunos de conhecimentos e competências que lhes permitam proceder a uma planificação e execução de enunciados orais formais e informais, desenvolvendo para isso a noção de discurso adequado. Como base de toda a intervenção que aqui se descreve esteve a obra de Almeida Garrett Frei Luís de Sousa que, por se tratar de uma obra dramática, nos pareceu, de entre as restantes incluídas no programa da disciplina, a mais adequada e que mais versatilidade nos traria, já que permitiu refletir sobre os diferentes registos discursivos das personagens e, também, proceder a exercícios como, a título de exemplo, leituras encenadas. Aliando conteúdos programáticos a exercícios que requerem uma participação mais ativa (planificada ou não) por parte dos alunos, conseguimos despertá-los para a noção de discurso adequado e dotá-los de competências para a elaboração de apresentações e intervenções orais, ao mesmo tempo que fomentávamos a sua capacidade de raciocínio e de sistematização – exigidos no momento de esquematizar as apresentações orais., The teaching / learning of orality in the discipline of Portuguese suffered, in the past, some neglect over other areas, such as reading and writing. This happened due to certain prejudices that common sense diffuses in regards to oral skills: they are innate, and, therefore, it is unnecessary their improvement; it’s spontaneous nature might excuse the gaps related to the organization of speech, reasoning and syntax. However, a careful reading of the Portuguese Program (Seixas et al., 2002), and by using authors as Emília Amor (1993) and Hilário de Sousa (2006), we understand that the linguistic activity comprises four skills to be complementarily worked on , these being the reading, writing, listening and speaking - and only this holistic work can provide students with a real communicative competence. In this framework, we decided that our intervention - integrated into the Master of Teaching Portuguese and Classical Languages - would focus on the issue of orality, to be worked through two perspectives: promoting, in one hand, its drilling (taken from oral presentations and encouraging participation, avoiding classes with expository nature and strategies for practicing public speaking) and, second, providing the students with knowledge and skills to undertake the planning and execution of formal and informal statements, developing the notion of appropriate speech. The basis of all the intervention described here was Almeida Garrett’s Frei Luís de Sousa. As it is a dramatic work, it seemed, among others included in the Program of Portuguese Language (Seixas et al., 2002), the most appropriate and versatility for us, as it allowed the reflection on the character’s different discursive registers and also conduct exercises as, for example, staged readings. Combining exercises that require more active participation (planned or not) by the students, we can awaken them to the notion of appropriate speech and equip them with skills to prepare presentations and public speeches, while instigate their ability for reasoning and systematization - obligatory for oral presentations.
- Published
- 2013
33. Cutaneous Manifestations of Systemic Lupus Erythematosus
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Uva, Luís, Miguel, Diana, Pinheiro, Catarina, Freitas, João Pedro, Marques Gomes, Manuel, and Filipe, Paulo
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Article Subject ,immune system diseases ,skin and connective tissue diseases - Abstract
Systemic lupus erythematosus (SLE) is a multiorgan autoimmune disease of unknown etiology with many clinical manifestations. The skin is one of the target organs most variably affected by the disease. The American College of Rheumatology (ACR) established 11 criteria as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individuals and do not do well in that capacity. Cutaneous lesions account for four of these 11 revised criteria of SLE. Skin lesions in patients with lupus may be specific or nonspecific. This paper covers the SLE-specific cutaneous changes: malar rash, discoid rash, photosensitivity, and oral mucosal lesions as well as SLE nonspecific skin manifestations, their pathophysiology, and management. A deeper thorough understanding of the cutaneous manifestations of SLE is essential for diagnosis, prognosis, and efficient management. Thus, dermatologists should cooperate with other specialties to provide optimal care of SLE patient.
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- 2012
- Full Text
- View/download PDF
34. Síndromas de intolerância ortostática. Contributo para o seu esclarecimento
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Freitas, João Pedro Pinto de Almeida
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Medicina ,education ,Medicine ,Porto - Abstract
Medicina Doctoral Programme in Medicine
- Published
- 2009
35. Oxidative Stress in Chronic Hepatitis C: The Effect of Interferon Therapy and Correlation with Pathological Features
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Serejo, Fátima, primary, Emerit, Ingrid, additional, Filipe, Paulo Manuel, additional, Fernandes, Afonso Camilo, additional, Costa, Maria Adília, additional, Freitas, João Pedro, additional, and de Moura, Miguel Carneiro, additional
- Published
- 2003
- Full Text
- View/download PDF
36. A THOUSAND PLATELET - A CASE REPORT.
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Freitas, João Pedro, Costa, Flávio Campos, Rovisco, João, Silva, Jorge, and Malcata, Armando
- Abstract
Introduction: Primary Sjogren syndrome (pSS) is considered a chronic inflammatory disease. The most common clinical feature of pSS is xerostomia and xerophthalmia, but rare complications can occur such as autoimmune cytopenias. Case Report: 50 old women with stablished pSS according ACR criteria: positive Anti-SSA/Ro and Schirmer's test < 5mm/5 minutes in both eyes presented to emergency ward with bruising, gingival hemorrhage and fatigue for the past week. She had a dubious medical history of allergy to prednisolone. The physical examination besides multiple bruising's was normal. Laboratory investigations revealed Haemoglobin 11.5 g/dL, white cell count 7200/L, platelet count 1000/L and Erythrocyte Sedimentation Rate 57mm/h. Previous blood analysis showed positive ANA (1:360 titer), and both SSA and SSB antibodies were strongly positive and C3/C4 were normal. Cryoglobulin screening was negative. Antibodies against double-stranded DNA (dsDNA), lupus anticoagulant (LA), anti-p2-glycoprotein-I and anticardiolipin antibodies were pending. She initiated treatment with IVIg 400mg/kg/day. Her platelet count responded, and within 72 hours, her platelet count had raised to 88 000 U/L. On day 4 she develops a thrombophlebitis in her right arm, and cephalic vein thrombosis in her left arm and starts empiric treatment with Vancomicine, cefalozine and enoxaparin. On day 5 she develops acute respiratory failure and hemoptysis. Her platelet count had dropped to 22 000 U/L and a Thorax CT-Scan showed "crazy paving pattern" suggestive of alveolar haemorrage. Intensive care with ventilation was required and she was treated with high-dose steroids. Platelet count normalized and our patient started azathioprine (AZA), after discharged from Intensive Care. Discussion: This clinical case presents with several challenges. Firstly, the emergence of commencing an effective treatment regarding the values of severe thrombocytopenia, on the other hand the therapeutic caution for the presumed allergy to corticosteroids. Immunosuppressive drugs, such as methotrexate (MTX), AZA, rituximab (RTX) and cyclophosphamide (CYP), have all been used with wavering degrees of success in cytopenias. With corticosteroids seeming to be the mainstay of treatment (1). Based on data available from RTX efficacy in autoimmune cytopenias, we can extrapolate that it may be useful in the treatment of cytopenias associated with pSS. Several weeks are expected before response, however the urgency of the case would not allow it (2). CYP, MTX and AZA have been used in cases of thrombocytopenia associated with pSS, however, CYP due to its adverse effects and MTX and AZA, due to its late response, were precluded (3). IVIG has been tried in agranulocytosis complicating pSS and is a first line treatment to immune thrombocytopenia. An increase in platelet count is typically expected within 24 to 48 hours (4,5). This was the treatment of choice. However, the onset of tromboflebites and thrombosis, poses the doubt of antiphospholipid antibody syndrome as antibodies results were still pending. The decision to start enoxaparin at platelet safe levels is made. Another complication yet occurred, alveolar haemorrage, with the patient ventilated the decision for high dose corticosteroids is finally made. Antibodies against dsDNA, LA, anti-β2-glycoprotein-I, anticardiolipin and heparin antibodies came out negative. Before discharge AZA was used as a corticosteroid sparing, due to its relative safety profile. The patient has had no further relapses for 2 years now. [ABSTRACT FROM AUTHOR]
- Published
- 2019
37. DERMATOMYOSITIS AND HEAR LOSS: TWO MANIFESTATIONS OF ONE DISEASE?
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Costa, Flávio Campos, Freitas, João Pedro, and L., Ines
- Abstract
Introduction: Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by features of proximal skeletal muscle weakness, evidence of muscle inflammation and characteristic skin manifestations. Caucasian male 18 years, previously healthy, was referred to our department due to a history with 5 months of evolution of proximal muscular weakness (especially in upper limbs). The patient reported fatigue, difficulty climbing stairs and difficulty swallowing. Simultaneously mentioned height loss (10kg in 3 months), and photosensitive erythema over face, neck, dorsum of metacarpalphalangeal (MCF) and proximal interphalangeal (PIP) joints. In the physical examination it stands out periorbital heliotrope rash and Gottron's papules over the dorsal PIP and MCP. In the neurological examination, muscle strength was 3/5 proximal at upper limbs, Growers sign was present. No arthritis was identified. Blood analysis exhibited a discrete elevation of creatine phosphokinase: 181 U/L, aldolase: 7.8 U/L (Normal< 7,6). The inflammatory markers, antinuclear antibody, myositis-specific, and myositis-associated autoantibody were negative. Electromyography presented lesion of muscular fibers. The diagnosis of DM was made, and the patient started 60mg/day of prednisolone. A muscular biopsy confirmed the diagnosis of DM (muscle with lesions of inflammatory myopathy). During the following period, the patient showed clinical improvement (improvement of muscle strength was 5/5 proximal at upper limbs, Growers sign was negative, allowing reduction of dosage of prednisolone. After 4 months of treatment, the patient presented bilateral hearing loss. An MRI was made which revealed «presence of an expansive formation centered on the posterior wall of the oropharynx, obliterating the nasopharynx, exerting a mass effect on the adjacent structures». A biopsy of the lesion was executed by otorhinolaryngologist, and histology revealed EBV-associated non-keratinizing epidermoid carcinoma whose staging was T2N2M0. The patient started radiotherapy with chemotherapy with cisplatin 100mg/m2, remaining in treatment with clinical improvement. Conclusion: The association between malignancy and inflammatory myopathy has been supported by numerous epidemiologic studies, with the strongest association occurring in those with DM2. The clinical implications of this association, irrespective of the pathophysiologic mechanisms involved, are that it is imperative to screen for tumors in patients with DM, particularly if the symptoms do not respond to conventional immunosuppressive treatment. The types of malignancies vary and include not only hematologic malignancies such as lymphoma but also solid tumors such3. Ethnic backgrounds should be considered in screening, because cancer types vary according to race, with lung and nasopharyngeal cancers being more frequent in Asians than Caucasians. The authors highlight this case due to the rarity of the association between DM and nasopharyngeal cancer especially in a young Caucasian patient. [ABSTRACT FROM AUTHOR]
- Published
- 2019
38. PAGET'S DISEASE-EXPERIENCE OF A TERTIARY CENTER.
- Author
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Brites, Luisa, Prata, Ana Rita, Sousa, Marlene, Luis, Mariana, Freitas, João Pedro, Salvador, Maria João, and Santiago, Mariana
- Abstract
Background: Paget's disease is a chronic progressive metabolic bone disorder that can affect one or multiple sites, but with a predilection for the axial skeleton. The majority of patients with Paget disease of bone are asymptomatic and the diagnosis is usually made incidentally. The prevalence of the disease in Portugal is unknown. Objectives: To report and describe the presentation and clinical characteristics of a rarely diagnosed rheumatic disease. Methods: Retrospective study of patients with a diagnosis of Paget's disease with follow up in the rheumatology department in a tertiary center. The demographic data, clinical features, investigation results and treatment of the cases were analyzed from medical records. Results: We identified 7 patients with Paget's disease of the bone (3 women and 4 men; mean diagnosis age 59.1±7.0 years). Four patients had bone pain at the affected site and three had unspecific arthralgias and presented as an incidental finding during the diagnostic investigation. All but one had raised serum alkaline phosphatase level with normal serum calcium levels. The majority of the patients (71.4%, n=5) had a monostotic disease and the most commonly involved site was the pelvis. All of them had hypercaption of the radiopharmaceutical agent at bone scintigraphy and alterations that were suggestive of pagetic bones at the radiographs. All of them were treated with bisphosphonates (intravenous pamidronate (n=2), oral alendronate (n= 3), oral risedronate (n=1), intravenous zoledronate (n=1)). The two patients treated with one administration of intravenous pamidronate were then treated with zoledronate or alendronate. After one year of treatment, the serum alkaline phosphatase levels have decreased in all patients. None of the patients had related complications (musculoskeletal, neurologic, and cardiovascular problems). Conclusion: The patients included are mainly men with bone pain at the site involved. The majority was a monostotic disease. All of them were treated with bisphosphonates with good clinical results. [ABSTRACT FROM AUTHOR]
- Published
- 2019
39. THE LEVEL OF AGREEMENT BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY IN EARLY ARTHRITIS.
- Author
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Costa, Flávio Campos, Brites, Luisa, Freitas, João Pedro, Serra, Sara, Rovisco, João, Santiago, Mariana, Coutinho, Margarida, da Silva, JAP, and Duarte, Cátia
- Abstract
Introduction: Over the past decades, Early Arthritis Clinics (EAC) have been created to identify early arthritis and institute appropriate treatment as soon as possible. In Rheumatoid Arthritis (RA) many studies show that ultrasonography (US) is superior to clinical exam for the detection of synovitis and has good correlation with clinical findings and markers of inflammation and can be used to improve the certainty of a diagnosis of RA. [1] However, few studies address the agreement between the US with the clinical examination in patients with early arthritis. Objective: To evaluate the agreement between clinical examination and US findings of metacarpophalangeal and proximal interphalangeal joints of patients with early arthritis Methods: Patients from the EAC of our department with suspect arthralgia were included. Patients were submitted to clinical evaluation by a rheumatologist to identify tender and swollen joints. They were then submitted to an US examination of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, by an experienced sonographer oblivious of the previous examination. Each joint was scored for the presence of synovial hypertrophy (SH) and Power Doppler (PD) signal. Based on OMERACT guidance, we defined synovitis as: ≥ grade 1 grey scale synovitis (hypoechoic SH regardless of the presence of effusion) and £ grade 1 power-Doppler. The diagnostic value of clinical evaluation was assessed through sensitivity, specificity, Negative predictive value (NPV) and Positive predictive value (PPV), assuming the US synovitis as gold standard. Clinical arthritis was defined by joint swelling. Cohen's kappa coefficient was used to analyse concordance between joint swelling appreciated by clinical exam and HS, PD and the presence of US synovitis. Kappa values < 0 were considered poor, 0-0.20 slight, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 good and 0.81-1.00 excellent. [2] Statistical significance was defined as p<0.05. Statistical analysis was performed using IBM SPSS Statistics, version 21.0. Results: 77 consecutive patients were included (53.2% female) with a mean age of 53.8±19.1 years. We evaluated 770 MCP and 770 PIP joints. The sensitivity and specificity of clinical examination in relation to US synovitis was respectively 71% and 60% for MCP and 54.5% and 43.9% for PIP. The NPV and PPV for MCP were 87.8% and 33.3% respectively, and for PIP were 85.3% and 13.9%. The level of agreement between joint swelling and HS, PD and the presence of synovitis is show on Table I. Conclusion: The clinical evaluation of MCP showed a better performance than clinical evaluation of IFP. The high NPV of clinical examination makes its suitable to be used to rule out MCP and PIP involvement in patients with early arthritis. The performance of the two assessment strategies on the same day may increase agreement and diagnostic certainty. [ABSTRACT FROM AUTHOR]
- Published
- 2019
40. "STRIATAL HANDS" MIMICKING RHEUMATOID ARTHRITIS.
- Author
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Campos Costa, Flávio, Luis, Mariana, Freitas, João Pedro, Coutinho, Margarida, and Malcata, Armando
- Abstract
Introduction: Recognition of advanced Rheumatoid Arthritis (RA) is usually facilitated by the presence of chronic deformities such as ulnar deviation, metacarpals radial shift and interosseous atrophy. Although being considered typical, these deformities are not pathognomonic of RA and other conditions must be ruled out, especially when the clinical picture is not clear. The authors present 2 clinical cases of RA-like hand deformities. Case 1: A 73-year-old female was referred from the Neurology Department because of suspicion of RA. The patient complained of polyarthralgias involving shoulders, elbows, wrists, PIP, hips, and knees. She also complained of mechanical low back pain and muscle stiffness lasting all day long. She had been diagnosed with Parkinson Disease (PD) 25 years ago and was being treated with ropinirole 8 mg per day and carbidopa/levodopa 25/250mg (6 times per day). Rheumatologic examination revealed the presence of Heberden's and Bouchard's nodes, interosseous atrophy, metacarpals radial shift, reducible ulnar deviation, and kyphosis but no signs of arthritis were present. Rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA) and acute phase markers were negative. Spine radiographs showed old fractures of dorsal and lumbar spine. Proximal interphalangeal (PIP) and distal interphalangeal joint space narrowing with subchondral sclerosis and osteophytosis were seen on hands radiographs. Diagnosis of multifocal osteoarthritis and osteoporosis were made and the patient was started on pain relievers, vitamin D, calcium supplementation and bisphosphonate. The patient was kept on regular follow up, but arthritis was never observed. Case 2: A 73-year-old female presented with a 10-year history of mechanical polyarthralgias (affecting shoulders, elbows, wrists, PIP, hips, knees, and feet) with 30 minutes of morning stiffness. She had an 11-year history of PD, under carbidopa/levodopa 25/100mg (3 times per day), and osteoporosis (with several lumbar osteoporotic fractures). On rheumatologic examination, stood out a reducible ulnar deviation of the left hand and a marked kyphosis. There were no clinical signs of arthritis. RF and ACPA were negative and acute phase markers were normal. Radiographs of the hands and feet showed radiographic generalized osteopenia, without joint space narrowing, erosions or any other typical feature of RA. The patient was diagnosed with osteoporosis and treatment with pain relievers, bisphosphonate and calcium and vitamin D supplementation was started. The patient was kept on regular follow-up, once again, without any signs of arthritis. Conclusion: Both patients showed chronic hand deformities suggestive of advanced RA. However, no clinical evidence of the disease was found in neither case. Interestingly both patients have been suffering from long-standing PD, with osteoporosis. The deformities observed in both these patients hands are named striatal hands and have been reported in 10% of patients with untreated, advanced PD1. Unlike RA, local signs of joint involvement, such as pain, tenderness, heat and swelling are absent in striatal hands. Also, RA tends to occur bilaterally and deformaties are not reducible, whereas focal dystonia before PD tends to be unilateral, with tremor, rigidity, and bradykinesia developing on the ipsilateral side. [ABSTRACT FROM AUTHOR]
- Published
- 2019
41. Sistemas de informação geográfica aplicados à gestão de resíduos sólidos urbanos e industriais: caso de estudo do Concelho de Ferreira do Zêzere
- Author
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Ferreira, Maria do Céu, Anastácio, Rita Ferreira, and Freitas, João Pedro Frias
- Subjects
Gestão Integrada de Resíduos Sólidos ,Sistemas Informação Geográfica ,Engenharia e Tecnologia::Outras Engenharias e Tecnologias [Domínio/Área Científica] ,Gestão de Resíduos Urbanos e industriais ,Concelho de Ferreira do Zêzere - Abstract
As Políticas Nacionais e Europeias no âmbito da Gestão dos Resíduos têm como objetivos prioritários evitar e reduzir a produção de resíduos, bem como reduzir o risco para a saúde humana e para o ambiente, tendo como finalidade uma gestão integrada e sustentável dos mesmos. Nos últimos anos, com o aumento da densidade populacional nas zonas urbanas, e adaptação a novos hábitos e exigências, tem-se verificado um aumento progressivo da produção de resíduos urbanos e industriais, que foi motivado por falta de civismo e educação ambiental. Grande parte deles é depositada ao ar livre, ignorando qualquer sensibilidade e respeito pelo meio ambiente e ecossistemas envolventes, bem como os resultados que podem surgir desse tipo de ações. O Concelho de Ferreira do Zêzere tem uma grande preocupação com esta temática e tem vindo a dar ao longo dos anos especial atenção à mesma, com destaque para a qualidade ambiental dos recursos existentes e os respetivos ecossistemas. Neste sentido se justifica o tema de estágio que tem por objetivo caracterizar, partindo de um levantamento cartográfico, os Resíduos Tóxicos e não Tóxicos depositados ao ar livre, sistematizando as suas características numa Base de Dados Geográfica. Os mesmos foram categorizados segundo a sua localização, altimetria, classe de declives, geologia tendo em conta a permeabilidade dos solos, a proximidade às linhas de água e ribeiras, proximidade à rede viária, classe de uso do solo, classe de ordenamento, segundo o Plano Diretor Municipal, que inclui as condicionantes, Reserva Agrícola Nacional, Reserva Ecológica Nacional e Rede Natura 2000. O modelo proposto permitiu avaliar o risco de contaminação destes locais, assim como identificar segundo os mesmos critérios as áreas mais sensíveis aos depósitos de resíduos e à sua contaminação, de forma a definir medidas de intervenção no âmbito da recolha e posterior monitorização. Dos 611 locais em estudo 207 estão em área de Elevado Risco de Contaminação, 340 em áreas de Médio Risco e apenas 64 com áreas de Baixo Risco. Com base nos resultados obtidos propõem-se medidas de intervenção.
- Published
- 2019
42. Shear-Wave Elastography Evaluation of Major Salivary Glands in Primary Sjögren's Syndrome.
- Author
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Prata AR, Freitas JP, Marques ML, Costa F, Santiago M, Serra S, Coutinho M, Santiago T, Rovisco J, and Pereira da Silva JA
- Subjects
- Humans, Cross-Sectional Studies, Prospective Studies, Reproducibility of Results, Salivary Glands diagnostic imaging, Sjogren's Syndrome diagnosis, Elasticity Imaging Techniques methods
- Abstract
Objectives: Salivary glands ultrasonography has recently been shown to be useful in the diagnosis of Primary Sjögren's Syndrome (pSS). Shear-wave elastography (SWE) is a promising tool for the quantitative assessment of tissues stiffness, but studies evaluating its role in pSS diagnosis are limited. This study aimed at investigating the diagnostic performance of SWE in pSS., Materials and Methods: Cross-sectional study including patients fulfilling the 2016 ACR/EULAR classification criteria for pSS and healthy subjects. The four major salivary glands were assessed using SGUS. B-mode scans were rated using the Hočevar score, and shear-wave velocity (SWV) values were obtained using SWE. Intraclass-correlation coefficient (ICC) estimates were used to assess reliability. Cut-off values for differentiating pSS patients from healthy subjects were calculated using Receiver-Operating Characteristics (ROC) curves., Results: We included 50 pSS and 25 healthy subjects. Inter-rater reliability of SWE was moderate (ICC=0.64) and intra-rater reliability was moderate to good (ICC= 0.73 to 0.83). Total SWV (2.09 m/s (0.32); p < 0.001), parotid SWV (2.25 m/s (0.40)) and submandibular SWV (1.92 m/s (0.38)) were significantly higher in pSS patients. Total and parotid SWV presented good diagnostic performance for pSS diagnosis (AUROC= 0.80 and 0.81, respectively). The Hočevar score demonstrated excellent diagnostic performance (AUROC= 0.98) and combining it with total SWV did not result in statistically significant improvement (p=0.301)., Conclusions: SWE may contribute to the diagnosis of pSS. Large prospective studies including sicca and secondary SS patients, as well as the standardisation of SWE protocols, are warranted to assess the role of SWE in pSS management.
- Published
- 2022
43. Assessment of the vaccination status in rheumatic disease patients treated with disease-modifying antirheumatic drugs.
- Author
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Brites L, Costa F, Freitas JP, Silva S, Duarte C, and Santiago M
- Abstract
Patients with rheumatic diseases are at a higher risk for infections associated to the underlying pathology and immunosuppressive therapy. This fact leads to an increased morbidity and/or mortality. Effective vaccination is essential for the prevention of a significant number of these infections, namely influenza and pneumococcal vaccination. In our cohort, and despite current recommendations, vaccination rates are still low among patients with autoimune diseases, which is in agreement with the available literature. A greater effort from all physicians is required to improve these results and to make the difference.
- Published
- 2019
44. Portuguese Recommendations for the use of biological therapies in patients with rheumatoid arthritis- 2016 update.
- Author
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Duarte C, Sousa-Neves J, Águeda A, Ribeiro P, Daniel A, Eugénio G, Serra S, Araújo F, Barcelos A, Filipe B, Bernardes M, Canhão H, Cerqueira M, Capela S, Cordeiro A, Costa F, Costa L, Cruz M, Cunha Miranda L, Duarte C, Falcão S, Faria D, Figueira R, Freitas JP, Gonçalves MJ, Madruga Dias J, Melo Gomes J, Mourão AF, Neto A, Oliveira Ramos F, Pimenta S, Pinto P, Polido-Pereira J, Ponte C, Ramos J, Rodrigues A, Santos H, Santos MJ, Sepriano A, Silva C, Tavares Costa J, Teixeira F, Teixeira V, Valente P, Vieira-Sousa E, Barros R, Abreu P, and Fonseca JE
- Abstract
Objective: To update the recommendations for the treatment of Rheumatoid Arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheumatology (SPR)., Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting the 10 recommendations were discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations., Results: These recommendations cover general aspects as shared decision, prospective registry in Reuma.pt, assessment of activity and RA impact and treatment objective. Consensus was also achieved regarding specific aspects as initiation of biologic therapy, assessment of response, switching and definition of persistent remission., Conclusion: These recommendations may be used for guidance of treatment with biological therapies in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated.
- Published
- 2017
45. Mucocutaneous manifestations of Behçet's disease.
- Author
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Uva L, Miguel D, Pinheiro C, Filipe P, and Freitas JP
- Subjects
- Behcet Syndrome drug therapy, Behcet Syndrome etiology, Humans, Mucous Membrane, Behcet Syndrome complications, Behcet Syndrome diagnosis, Skin Diseases etiology
- Abstract
Behçet's disease is a relapsing multisystem polysymptomatic disease with exacerbations and remissions defined by the presence of the major symptom, recurrent oral aphthous ulcers, plus two of the following: recurrent genital ulceration, eye lesions, skin lesions or a positive pathergy test. Mucocutaneous manifestations like oral and genital ulcers, and cutaneous lesions (papulopustular lesions, erythema nodosum-like lesions, cutaneous ulcers, superficial thrombophlebitis), are considered the \"fingerprint\" of the disease, being the most common and often the first signs to appear. Although the exact etiopathogenesis is still not known, genetic predispose and environmental factors may influence and contribute to the development of this disease. Diagnosis is based in the International Study Group criteria. During the last years, this disease has been largely studied and new immunological data and treatment strategies have been postulated. Despite that, further studies and attention to new data are needed.
- Published
- 2013
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