José Manuel Romãozinho

Hospitais da Universidade de Coimbra, Coímbra, Coimbra, Portugal

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Publications (44)91.62 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Outcome of Helicobacter pylori (H. pylori) infection results from interaction of multiple variables including host, environmental and bacterial-associated virulence factors.
    Digestive Diseases and Sciences 08/2014; · 2.26 Impact Factor
  • Nuno Veloso, Pedro Amaro, Manuela Ferreira, José Manuel Romãozinho, Carlos Sofia
    Gastroenterologia y hepatologia. 05/2014;
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    ABSTRACT: Helicobacter pylori (H. pylori) resistance to antimicrobial agents is steadily increasing. It is extremely important to be aware of the local prevalence of antibiotic resistance in order to adjust treatment strategies. During this single-centre, prospective study, we aimed to determine primary and secondary resistance rates of H. pylori to antibiotics as well as host and bacterial factors associated with this problem. Overall 180 patients (131 female; mean age 43.4 ± 13.5 years; primary resistance – 103; secondary resistance – 77) with positive 13C-urea breath test were submitted to upper endoscopy with gastric biopsies. H. pylori was cultured and antimicrobial susceptibility was determined by Etest and molecular methods. Clinical and microbiological characteristics associated with resistance were evaluated by logistic regression analysis. Among the 180 isolates 50% were resistant to clarithromycin (primary–21.4%; secondary–88.3%), 34.4% to metronidazole (primary–29.1%; secondary–41.6%), 33.9% to levofloxacin (primary–26.2%; secondary–44.2%), 0.6% to tetracycline and 0.6% to amoxicillin. Female sex was an independent predictor of resistance to clarithromycin and metronidazole. Previous, failed, eradication treatments were also associated with a decrease in susceptibility to clarithromycin. History of frequent infections, first-degree relatives with gastric carcinoma and low education levels determined increased resistance to levofloxacin. Mutations in 23S rRNA and gyrA genes were frequently found in isolates with resistance to clarithromycin and levofloxacin, respectively. This study revealed that resistance rates to clarithromycin, metronidazole and levofloxacin are very high and may compromise H. pylori eradication with first- and second-line empiric triple treatments in Portugal.This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 05/2014; · 4.58 Impact Factor
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    ABSTRACT: Helicobacter pylori resistance to antibiotics is steadily increasing and multidrug-resistant strains are common and difficult to eliminate, mainly in countries where bismuth, tetracycline, furazolidone, and rifabutin are unavailable. To evaluate the efficacy and safety of a triple therapy with proton-pump inhibitor (PPI), amoxicillin, and doxycycline in patients with multidrug-resistant H. pylori. This prospective study involved 16 patients (13 females; mean age - 50 ± 11.3 years) infected by H. pylori with known resistance to clarithromycin, metronidazole, and levofloxacin, but susceptibility to amoxicillin and tetracycline. All patients were previously submitted to upper endoscopy with gastric biopsies for H. pylori culture and susceptibility testing by Etest. Mutations in 23S rRNA and gyrA genes were determined by real-time PCR. A 10-day eradication regimen with PPI (double-standard dose b.i.d.), amoxicillin (1000 mg b.i.d.), and doxycycline (100 mg b.i.d.) was prescribed after pretreatment with PPI during 3 days. Eradication success was assessed by (13) C-urea breath test 6-10 weeks after treatment. Compliance and adverse events were determined through phone contact immediately after treatment and specific written questionnaires. Only one patient did not complete treatment due to adverse events. Another four patients experienced mild side effects not affecting compliance. The control (13) C-urea breath test was positive in all patients. Per-protocol and intention-to-treat eradication rates were 0%. Although safe, a triple-therapy protocol with high-dose PPI, amoxicillin, and doxycycline is useless for multidrug-resistant H. pylori eradication.
    Helicobacter 02/2014; · 3.51 Impact Factor
  • José Manuel Romãozinho
    GE Jornal Português de Gastrenterologia. 01/2014; 21(1):3–4.
  • Isabel Pedroto, Pedro Amaro, José Manuel Romãozinho
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    ABSTRACT: The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, requires their admission in hospital units with conveniently equipped facilities, as is done for heart attack and stroke patients. Little information of gastroenterology emergencies as a function of structure, processes and outcome is available at the organizational level. Surveys that have been conducted in different countries just assess local treatment outcome and question the organizational structure and existing resources but its impact on the outcome is not clear. Most studies address the problem of upper gastrointestinal bleeding and the out-of-hours endoscopy services in the hospital setting. The demands placed on emergency (part of the overall continuum of care) are obvious, as are the needs for the efficient use of resources and processes to improve the quality of care, meaning data must cover the full care cycle. Gastrointestinal emergencies, namely gastrointestinal bleeding, must be incorporated into the overall emergency response as is done for heart attack and stroke. This chapter aims to provide a review of current literature/evidence on organizational health system models towards a better management of gastroenterology emergencies and proposes a research agenda.
    Best practice & research. Clinical gastroenterology 10/2013; 27(5):819-27. · 2.48 Impact Factor
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    ABSTRACT: Abstract Background. CARD15 is involved in the innate immune response and mutations of this gene have been linked with increased risk of Crohn's disease and colorectal cancer. The relation between CARD15 mutations and gastric cancer (GC) remains controversial. Aims. To assess whether CARD15 mutations are risk factors for GC in Portugal and whether there are genotype-phenotype correlations in these patients. Methods. The 3 main CARD15 mutations (3020insC, R702W and G908R) were searched in 150 patients with GC and in 202 healthy controls. Results. Overall, CARD15 mutations were found in 28 patients (18.7%) and in 27 controls (13.4%) (p = 0.176). Individually, the incidence of 3020insC was significantly higher in patients than in controls (6.0% vs. 1.0%, p = 0.021). This polymorphism was linked with an increased risk for the intestinal-type of GC (p = 0.002), while no association was found with the diffuse and/or mixed types. Genotype frequencies for R702W (10.0% vs. 7.9%) and G908R (4.0% vs. 4.0%) were not statistically different between the two groups. Similarly, no significant associations were detected between these two polymorphisms and the different histological GC types. No correlations were observed between CARD15 mutations and family history, mean age at diagnosis or GC stage. Conclusions. The CARD15 3020insC variant is a risk factor for intestinal GC in Portugal. CARD15 variants are not correlated with age of diagnosis or family aggregation of the disease neither with the GC stage.
    Scandinavian Journal of Gastroenterology 10/2013; 48(10):1188-97. · 2.33 Impact Factor
  • Maria João França Pereira, José Manuel Romãozinho, Carlos Sofia
    Case Reports 01/2013; 2013(jul23_1).
  • Rosa Ferreira, Pedro Amaro, Manuela Ferreira, José Manuel Romãozinho
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    ABSTRACT: Gastrointestinal bleeding due to suture line ulceration has been attributed to use of non‑absorbable silk sutures. We report a case of a 63‑year‑old male with gastrointestinal bleeding due to gastric suture line ulceration after splenectomy performed 11 years ago. Emergent upper endoscopy revealed a small gastric ulcer with a visible vessel and raised the suspicion of gastric varices. An endoscopic ultrasound was performed, showing a gastric hyperechogenic area in the mucosa layer with an acoustic shadow. Upper endoscopy with a transparent cap was repeated and a mobile foreign body in the ulcer´s bed was found. It was successfully removed by forceps. After the procedure a silk suture line of 3.5 cm was identified.
    Jornal Português de Gastrenterologia. 02/2012; 19(2):105-107.
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    ABSTRACT: Obscure gastrointestinal bleeding is responsible for 2-10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage.
    Case reports in gastrointestinal medicine. 01/2012; 2012:186065.
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    ABSTRACT: The emergency liver transplantation criteria for acute liver failure (ALF) due to Amanita phalloides (A. phalloides) intoxication are not consensual. The aims of this study were to evaluate the clinical outcomes, and to assess the accuracy of the current and specific criteria for emergency liver transplantation in predicting fatal outcome in ALF induced by A. phalloides. Ten patients admitted with ALF induced by A. phalloides in a Gastroenterology Intensive Care Unit were studied. Indications for liver transplant were based on Clichy and/or King's College criteria. Specific criteria of Ganzert and Escudié were tested retrospectively. A. phalloides intoxication represented 11.6% of all admissions for ALF. Patients were admitted at a mean time of 60 ± 20.4 h after ingestion. Eight patients met the Clichy and/or King's College criteria for emergency liver transplantation, seven of these patients were listed for transplant and only six patients were transplanted. Four (40%) patients died in a mean time of 4.8 ± 0.74 days after ingestion. When applied retrospectively, Escudié's criteria showed 100% of accuracy for predicting fatal outcome, whereas, King's College, Clichy's and Ganzert's criteria had an accuracy of 90, 80 and 70%, respectively. A prothrombin index of less than 10% at day 3 after ingestion showed a positive predictive value of 100% and a negative predictive value of 60%. Escudié's criteria show the best accuracy for emergency liver transplant in ALF induced by A. phalloides. The assessment of these criteria at day 3 after ingestion shows a maximum positive predictive value, although with a decline in its negative predictive value.
    European journal of gastroenterology & hepatology 09/2011; 23(12):1226-32. · 1.66 Impact Factor
  • Jornal Português de Gastrenterologia. 07/2011; 18(4):179-185.
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    Inflammatory Bowel Diseases 06/2011; 17(6):E64-5. · 5.12 Impact Factor
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    ABSTRACT: Background: prognostic scores have been validated in cirrhotic patients admitted to general Intensive Care Units. No assessment of these scores was performed in cirrhotics admitted to specialized Gastroenterology Intensive Care Units (GICUs). Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients. Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APACHE II, SAPS II, SOFA, MELD and CPT scores, respectively. Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2011; 103(4):177-183. · 1.65 Impact Factor
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    ABSTRACT: INTRODUCTION: Cirrhotic patients admitted in Intensive Care Units (ICU) have a poor prognosis. The prognosis of these patients can be evaluated with general scores (SOFA, APACHE, SAPS) or with specific scoring systems for liver disease (MELD, Child-Pugh). AIMS: To evaluate the prognostic value of general scores (SOFA, APACHE and SAPS) and of liver-specific scores (MELD and Child-Pugh) in patients with liver cirrhosis admitted to general ICUs or to Gastroenterology Intensive Care Units (GICU). MATERIAL AND METHODS: The authors present a literature review on the assessment of the prognosis of cirrhotic patients admitted to ICUs and also report your experience on this issue in the context of a specialized GICU including the analysis of 124 admissions. RESULTS: In several studies on patients with liver cirrhosis admitted to general ICUs, both general and liver-specific scores showed good discrimination, with an area under receiver operating characteristic curve (>AUC) > 0.7. Considering the six most representative studies, the mean value of AUC on SOFA, APACHE II, APACHE III, MELD and Child-Pugh scores was 0.86, 0.74, 0.81, 0.79 and 0.77, respectively. The study of 124 consecutive cirrhotic admissions to a GICU showed that patients who died belonged exclusively to the class C of Child-Pugh and had average values of SOFA, APACHE II, SAPS II and MELD scores significantly higher than those of the patients who survived (10.1, 22.0, 47.5 and 30.7 in those who died and 3.5, 13.6, 25.3 and 18.0 in those who survived, respectively; p < 0.05). CONCLUSIONS: Both general scores and liver-specific scores have prognostic value in the risk assessment of patients with liver cirrhosis admitted to general ICUs or to GICUs. In the ICUs the general scores, and particularly the SOFA score, have better prognostic ability than the liver-specific scores.
    Jornal Português de Gastrenterologia. 03/2011; 18(2):73-80.
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    [Show abstract] [Hide abstract]
    ABSTRACT: prognostic scores have been validated in cirrhotic patients admitted to general Intensive Care Units. No assessment of these scores was performed in cirrhotics admitted to specialized Gastroenterology Intensive Care Units (GICUs). to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients. the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5,18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5,respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686,0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APA-CHE II, SAPS II, SOFA, MELD and CPT scores, respectively. in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 03/2011; 103(4):177-83. · 1.65 Impact Factor
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    P Freire, J M Romãozinho, P Amaro, M Ferreira, C Sofia
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    ABSTRACT: Several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs). To assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU. Retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II. in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 10/2010; 102(10):596-601. · 1.65 Impact Factor
  • P. Freire, J. M. Romãozinho, P. Amaro, M. Ferreira, C. Sofia
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    ABSTRACT: Background: several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs). Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU. Methods: retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Results: overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II. Conclusions: in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction.
    Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 10/2010; 102(10):596-601. · 1.65 Impact Factor
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    Gastroentérologie Clinique et Biologique 01/2009; 33(1 Pt 1):80-2. · 1.14 Impact Factor
  • Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 10/2008; 100(9):600-1. · 1.65 Impact Factor

Publication Stats

132 Citations
91.62 Total Impact Points

Institutions

  • 2013–2014
    • Hospitais da Universidade de Coimbra
      • Department of Gastroenterology
      Coímbra, Coimbra, Portugal
    • Centro Hospitalar do Porto
      Oporto, Porto, Portugal
  • 1997–2012
    • University of Coimbra
      • Department of Surgery
      Coímbra, Coimbra, Portugal
  • 2008
    • Instituto Português de Oncologia
      Oporto, Porto, Portugal
  • 2006
    • Hospital Garcia de Orta
      Almada, Setúbal, Portugal