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Manique I, Amaral S, Rego T, Coelho A, Ponte A, Brito M, Palha A, Cortez L, Forte D, Sagarribay A, Cerqueira L, Pontinha C, Mafra M, Silva‐Nunes J. Metastatic pituitary neuroendocrine neoplasms: A case report of a malignant prolactinoma. Clin Case Rep 2024; 12:e8595. [PMID: 38645600 PMCID: PMC11031745 DOI: 10.1002/ccr3.8595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 04/23/2024] Open
Abstract
We report a rare clinical case of a malignant prolactinoma in which the exponential increase of prolactin levels with minimal tumor growth and no response to treatment led to diagnosis of abdominal, thoracic, and vertebral metastases.
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Affiliation(s)
- Inês Manique
- Endocrinology, Diabetes and Metabolism Department, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Sara Amaral
- Endocrinology, Diabetes and Metabolism Department, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Teresa Rego
- Endocrinology and Nutrition DepartmentHospital de Santo Espírito da Ilha TerceiraAzoresPortugal
| | - Andreia Coelho
- Oncology DepartmentHospital de Santo Espírito da Ilha TerceiraAzoresPortugal
| | - Andreia Ponte
- Radiation Oncology DepartmentHospital de Santo Espírito da Ilha TerceiraAzoresPortugal
| | - Margarida Brito
- Oncology DepartmentInstituto Português de OncologiaLisboaPortugal
| | - Ana Palha
- Endocrinology, Diabetes and Metabolism Department, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Luísa Cortez
- Endocrinology, Diabetes and Metabolism Department, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Dalila Forte
- Neurosurgery Department, Hospital de São JoséCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Amets Sagarribay
- Neurosurgery Department, Hospital de São JoséCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Luís Cerqueira
- Neuroradiology, Hospital de São JoséCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Carlos Pontinha
- Anatomical Pathology, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - Manuela Mafra
- Anatomical Pathology, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
| | - José Silva‐Nunes
- Endocrinology, Diabetes and Metabolism Department, Hospital Curry CabralCentro Hospitalar Universitário Lisboa CentralLisbonPortugal
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Marques P, Sagarribay A, Tortosa F, Neto L, Tavares Ferreira J, Subtil J, Palha A, Dias D, Sapinho I. Multidisciplinary Team Care in Pituitary Tumours. Cancers (Basel) 2024; 16:950. [PMID: 38473312 DOI: 10.3390/cancers16050950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The optimal care for patients with pituitary tumours is best provided in a multidisciplinary and collaborative environment, which requires the contribution of multiple medical specialties working together. The benefits and advantages of the pituitary multidisciplinary team (MDT) are broad, and all relevant international consensus and guidelines in the field recommend that patients with pituitary tumours should always be managed in a MDT. Endocrinologists and neurosurgeons are normally the leading specialties within the pituitary MDT, supported by many other specialties with significant contributions to the diagnosis and management of pituitary tumours, including neuropathology, neuroradiology, neuro-ophthalmology, and otorhinolaryngology, among others. Here, we review the literature concerning the concepts of Pituitary MDT/Pituitary Tumour Centre of Excellence (PTCOE) in terms of their mission, goals, benefits, structure, proposed models of function, and barriers, and we also provide the views of different specialists involved in our Pituitary MDT.
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Affiliation(s)
- Pedro Marques
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
- Faculty of Medicine, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Amets Sagarribay
- Pituitary Tumor Unit, Neurosurgery Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Francisco Tortosa
- Pituitary Tumor Unit, Pathology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Lia Neto
- Pituitary Tumor Unit, Radiology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Joana Tavares Ferreira
- Pituitary Tumor Unit, Ophthalmology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - João Subtil
- Pituitary Tumor Unit, Otorhinolaryngology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Ana Palha
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Daniela Dias
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Inês Sapinho
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
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Amaral S, Palha A, Bogalho P, Silva-Nunes J. Maturity-onset diabetes of the young secondary to HNF1B variants (HNF1B-MODY): a series of 10 patients from a single diabetes center. Diabetol Metab Syndr 2023; 15:21. [PMID: 36793123 PMCID: PMC9930356 DOI: 10.1186/s13098-022-00964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Maturity-Onset Diabetes of the Young (MODY) is an autosomal dominant condition and represents 1-5% of all cases of diabetes mellitus. MODY is often misdiagnosed as type 1 or type 2 diabetes. The rare subtype 5 (HNF1B-MODY) is due to hepatocyte nuclear factor 1β (HNF1B) molecular alteration and is remarkable for its multisystemic phenotypes characterized by a broad spectrum of pancreatic and extra-pancreatic clinical manifestations. METHODS Retrospective study of patients with HNF1B-MODY diagnosis followed in the Centro Hospitalar Universitário Lisboa Central (Lisbon, Portugal). Demographic data, medical history, clinical and laboratory data, follow-up and treatment procedures were obtained from electronic medical records. RESULTS We found 10 patients with HNF1B variants (7 index cases). The median age at diabetes diagnosis was 28 (IQR 24) years and the median age at HNF1B-MODY diagnosis was 40.5 (IQR 23) years. Six patients were initially misclassified as type 1 and 4 as type 2 diabetes. The average time between diabetes diagnosis and the diagnosis of HNF1B-MODY was 16.5 years. Diabetes was the first manifestation in half of the cases. The other half presented with kidney malformations and chronic kidney disease at pediatric age as the first manifestation. All these patients were submitted to kidney transplantation. Long-term diabetes complications included retinopathy (4/10), peripheral neuropathy (2/10) and ischemic cardiomyopathy (1/10). Other extra-pancreatic manifestations included liver test alterations (4/10) and congenital malformation of the female reproductive tract (1/6). History of a first-degree relative with diabetes and/or nephropathy diagnosed at a young age was present in 5 of the 7 index cases. CONCLUSIONS Despite being a rare disease, HNF1B-MODY is underdiagnosed and often misclassified. It should be suspected in patients with diabetes and CKD, especially when diabetes appears at a young age, a family history is present, and nephropathy appears before/shortly after the diagnosis of diabetes. Presence of unexplained liver disease increases the degree of suspicion for HNF1B-MODY. Early diagnosis is important to minimize complications and to allow familial screening and pre-conception genetic counseling. Trial registration not applicable due to the retrospective nature of the study, non-interventional.
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Affiliation(s)
- Sara Amaral
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
- NOVA Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Ana Palha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Paula Bogalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - José Silva-Nunes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saude de Lisboa, Lisbon, Portugal
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Amaral S, Matias A, Bouça B, Manique I, Palha A, Cortez L, Cerqueira L, Forte D, Sagarribay A, Dutra E, Cristóvão M, Pontinha C, Mafra M, Silva‐Nunes J. Pituitary metastasis as the first manifestation of lung carcinoma. Clin Case Rep 2022; 10:e6601. [PMCID: PMC9743320 DOI: 10.1002/ccr3.6601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/14/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022] Open
Abstract
Pituitary metastases are rare. Clinical presentation could range from asymptomatic to panhypopituitarism or local symptoms. We present a case report of a 43‐year‐old male patient with a new onset headache, visual disturbances, and panhypopituitarism. The investigation led to the diagnosis of pituitary metastasis as the first manifestation of underlying lung cancer. With rising incidence of breast and lung malignancy, headache/visual field disturbance or signs of pituitary hormone deficiency might be the presenting feature of pituitary metastatic disease. A rapid growth of a sellar lesion and/or the presence of diabetes insipidus along with a sellar mass should raise the suspicion for malignancy.
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Affiliation(s)
- Sara Amaral
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Alexandra Matias
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Bruno Bouça
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Inês Manique
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Ana Palha
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Luísa Cortez
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Luís Cerqueira
- Department of NeurorradiologyCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - Dalila Forte
- Department of NeurosurgeryCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - Amets Sagarribay
- Department of NeurosurgeryCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - Eduardo Dutra
- Department of Pathological AnatomyCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - Miguel Cristóvão
- Department of Pathological AnatomyCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - Carlos Pontinha
- Department of Pathological AnatomyCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - Manuela Mafra
- Department of Pathological AnatomyCentro Hospitalar Universitário Lisboa Central, Hospital de Curry CabralLisbonPortugal
| | - José Silva‐Nunes
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário Lisboa CentralLisbonPortugal,Nova Medical School/ Faculdade de Ciencias MedicasUniversidade Nova de LisboaLisbonPortugal,Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saude de LisboaLisbonPortugal
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Amaral S, Rego T, Palha A, Carrilho N, Coutinho JM, Tavares P, Silva-Nunes J. Preoperative Location Of Parathyroid Adenomas In Primary Hyperparathyroidism: The Role of Cervical Doppler Ultrasound. ACTA MEDICA PORT 2022; 36:246-253. [PMID: 36240233 DOI: 10.20344/amp.18735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
Introduction: Parathyroid adenoma is the most frequent cause of primary hyperparathyroidism. In recent years, the preoperative location of parathyroid adenomas allowed minimally invasive surgical techniques that have become preferred over the traditional bilateral neck exploration. The more recent guidelines on this subject highlight the role of nuclear medicine imaging tests. The aim of this study was to review the current role of Doppler ultrasound (US) in assessing the preoperative location of parathyroid adenomas in patients with primary hyperparathyroidism.Material and Methods: Retrospective study based on data from patients with primary hyperparathyroidism that underwent parathyroidectomy between January 2013 and January 2022 at the Centro Hospitalar Universitário Lisboa Central. Statistical analysis was performed with IBM SPSS Statistics, version 26.0.0.0®.Results: Parathyroidectomy was performed in 171 patients (77.8% females) with primary hyperparathyroidism. Cervical Doppler ultrasound was the most performed test (64.3%, n = 110) for preoperative location and detected a suspicious lesion in 98 patients (89.1%). The preoperative location of the parathyroid adenomas was assessed through the Doppler ultrasound and was compared with the surgical reports and histological findings; a correct identification was made in 76 patients (77.6%). Doppler ultrasound slightly underestimated the mean adenoma size (18.1 ± 7.7 mm preoperative versus 22 ± 8.4 mm postoperative). Calcium, parathyroid hormone levels, adenoma size and concomitant presence of thyroid nodules did not affect the accuracy of Doppler ultrasound.Conclusion: Doppler ultrasound showed high diagnostic accuracy even in patients with nodular thyroid disease regardless of calcium and parathyroid hormone levels and adenoma size. Furthermore, its safety, affordability and availability should favor its use as first line test in primary hyperparathyroidism to assess the preoperative location of parathyroid adenomas.
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Affiliation(s)
- Sara Amaral
- Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Teresa Rego
- Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. Portugal
| | - Ana Palha
- Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon.Portugal
| | - Nuno Carrilho
- Radiology Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. Portugal
| | - José Mário Coutinho
- Endocrine Surgery Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. Portugal
| | - Paula Tavares
- Endocrine Surgery Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. Portugal
| | - José Silva-Nunes
- Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon. Health and Technology Research Center. Escola Superior de Tecnologia da Saúde de Lisboa. Lisbon. Portugal
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Gaspar LM, Gonçalves CI, Fonseca F, Carvalho D, Cortez L, Palha A, Barros IF, Nobre E, Duarte JS, Amaral C, Bugalho MJ, Marques O, Pereira BD, Lemos MC. A Common Variant in the CDK8 Gene Is Associated with Sporadic Pituitary Adenomas in the Portuguese Population: A Case-Control Study. Int J Mol Sci 2022; 23:ijms231911749. [PMID: 36233050 PMCID: PMC9570112 DOI: 10.3390/ijms231911749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/21/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
The majority of pituitary adenomas occur in a sporadic context, and in the absence of known genetic predisposition. Three common variants at the NEBL (rs2359536), PCDH15 (rs10763170) and CDK8 (rs17083838) loci were previously associated with sporadic pituitary adenomas in the Han Chinese population, but these findings have not yet been replicated in any other population. The aim of this case-control study was to assess if these variants are associated with susceptibility to sporadic pituitary adenomas in the Portuguese population. Genotype and allele frequencies were determined in 570 cases and in 546 controls. The CDK8 rs17083838 minor allele (A allele) was significantly associated with sporadic pituitary adenomas, under an additive (odds ratio (OR) 1.73, 95% confidence interval (CI) 1.19–2.50, p = 0.004) and dominant (OR 1.82, 95% CI 1.24–2.68, p = 0.002) inheritance model. The NEBL rs2359536 and PCDH15 rs10763170 variants were not associated with the overall risk for the disease, although a borderline significant association was observed between the PCDH15 rs10763170 minor allele (T allele) and somatotrophinomas (dominant model, OR 1.55, 95% CI 1.02–2.35, p = 0.035). These findings suggest that the CDK8 rs17083838 variant, and possibly the PCDH15 rs10763170 variant, may increase susceptibility to sporadic pituitary adenomas in the Portuguese population.
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Affiliation(s)
- Leonor M. Gaspar
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Catarina I. Gonçalves
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Fernando Fonseca
- Serviço de Endocrinologia, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, 1050-099 Lisboa, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, Faculdade de Medicina e Instituto de Investigação e Inovação em Saúde da Universidade do Porto, 4200-319 Porto, Portugal
| | - Luísa Cortez
- Serviço de Endocrinologia, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, 1050-099 Lisboa, Portugal
| | - Ana Palha
- Serviço de Endocrinologia, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, 1050-099 Lisboa, Portugal
| | - Inês F. Barros
- Serviço de Endocrinologia, Hospital de Braga, 4710-243 Braga, Portugal
| | - Ema Nobre
- Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
| | - João S. Duarte
- Serviço de Endocrinologia, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, 1349-019 Lisboa, Portugal
| | - Cláudia Amaral
- Serviço de Endocrinologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Maria J. Bugalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
| | - Olinda Marques
- Serviço de Endocrinologia, Hospital de Braga, 4710-243 Braga, Portugal
| | - Bernardo D. Pereira
- Serviço de Endocrinologia e Nutrição, Hospital do Divino Espírito Santo de Ponta Delgada, 9500-782 Ponta Delgada, Portugal
| | - Manuel C. Lemos
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- Correspondence:
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Amaral S, Palha A, Bernardino V, Silva-Nunes J. Case Report: Artifactual Hypoglycemia: A Condition That Should Not Be Forgotten. Front Endocrinol (Lausanne) 2022; 13:951377. [PMID: 35966055 PMCID: PMC9371975 DOI: 10.3389/fendo.2022.951377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypoglycemia is uncommon in people who are not being treated for diabetes mellitus and, when present, the differential diagnosis is broad. Artifactual hypoglycemia describes discrepancy between low capillary and normal plasma glucose levels regardless of symptoms and should be considered in patients with Raynaud's phenomenon. CASE PRESENTATION A 46-year-old female patient with a history of a sleeve gastrectomy started complaining about episodes of lipothymias preceded by sweating, nausea, and dizziness. During one of these episodes, a capillary blood glucose was obtained with a value of 24 mg/dl. She had multiple emergency admissions with low-capillary glycemia. An exhaustive investigation for possible causes of hypoglycemia was made for 18 months. The 72h fasting test was negative for hypoglycemia. A Raynaud's phenomenon was identified during one appointment. CONCLUSION Artifactual hypoglycemia has been described in various conditions including Raynaud's phenomenon, peripheral arterial disease, Eisenmenger syndrome, acrocyanosis, or hypothermia. With this case report, we want to reinforce the importance of being aware of this diagnosis to prevent anxiety, unnecessary treatment, and diagnostic tests.
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Affiliation(s)
- Sara Amaral
- Department of Endocrinology, Diabetes and Metabolism; Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Nova Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
- *Correspondence: Sara Amaral,
| | - Ana Palha
- Department of Endocrinology, Diabetes and Metabolism; Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Nova Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Vera Bernardino
- Functional Unit of Internal Medicine 7.2, Centro Hospitalar Universitário Lisboa Central, , Lisbon, Portugal
| | - José Silva-Nunes
- Department of Endocrinology, Diabetes and Metabolism; Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Nova Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saude de Lisboa, Lisbon, Portugal
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8
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Martins P, Teixeira V, Teixeira FJ, Canastro M, Palha A, Fonseca JE, Ponte C. Giant cell arteritis with normal inflammatory markers: case report and review of the literature. Clin Rheumatol 2020; 39:3115-3125. [DOI: 10.1007/s10067-020-05116-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
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Ferreira AR, Palha A, Correia L, Filipe P, Rodrigues V, Miranda A, André R, Fernandes J, Gouveia J, Passos-Coelho JL, Moreira A, Brito M, Ribeiro J, Metzger-Filho O, Lin NU, Costa L, Vaz-Luis I. Treatment adoption and relative effectiveness of aromatase inhibitors compared to tamoxifen in early breast cancer: A multi-institutional observational study. Breast 2017; 37:107-113. [PMID: 29131988 DOI: 10.1016/j.breast.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/18/2017] [Accepted: 11/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Since 2005, aromatase inhibitors (AIs) have been the adjuvant treatment of choice for postmenopausal women with early breast cancer (BC). In this study we characterize the adoption of AIs in Portugal, variables associated with treatment administration, and compare its effectiveness (either in monotherapy or sequential therapy) to tamoxifen monotherapy (TAM). PATIENTS AND METHODS This was a retrospective cohort study that included postmenopausal women with stage I-III hormone receptor (HR) positive BC diagnosed from 2006 to 2008 and treated with adjuvant endocrine therapy in four participating institutions. RESULTS Of the 1283 eligible patients, 527 (41%) received an AI (16% as monotherapy, 25% as sequential therapy) and 756 (59%) TAM. Patients treated with AI had less differentiated tumors, with higher TNM stage, and were more frequently HER2-positive. Use of AI also differed by center (use range from 33% to 75%, p < 0.001). With a median follow-up of 6.3 years and controlling for clinicopathological and treatment characteristics, treatment with AI had a better overall survival (OS) when compared with TAM (adjusted-HR 0.55, 95% CI 0.37-0.81). CONCLUSION AIs were successfully introduced as adjuvant treatment for HR-positive BC in Portuguese hospitals. Its use was influenced by tumor and patient characteristics, but also center of care. In this large cohort, AI use was associated with an OS benefit.
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Affiliation(s)
- Arlindo R Ferreira
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Ana Palha
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Lurdes Correia
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Pedro Filipe
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Vasco Rodrigues
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Ana Miranda
- Registo Oncológico Regional do Sul, Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Rosário André
- Registo Oncológico Regional do Sul, Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - João Fernandes
- Hospitais CUF Lisboa, R. Mário Botas, 1998-018 Lisbon, Portugal
| | - Joaquim Gouveia
- Hospitais CUF Lisboa, R. Mário Botas, 1998-018 Lisbon, Portugal
| | | | - António Moreira
- Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Margarida Brito
- Instituto Português de Oncologia F. G. de Lisboa, R. Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Joana Ribeiro
- Fundação Champalimaud, Av. Brasília, 1400-038 Lisbon, Portugal
| | | | - Nancy U Lin
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA
| | - Luís Costa
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Inês Vaz-Luis
- Institut Gustave Roussy, Unit INSERM 981, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
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Mabunda D, Palha A, Mari J, Morais M, Pala A, Mota J, Oquendo M, Bessa J. Electroconvulsive therapy in chronic psychotic patients: the interface between perceived stress, anxiety and depression and clinical outcome. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Palha A, Cortez L, Tavares AP, Agapito A. Leydig cell tumour and mature ovarian teratoma: rare androgen-secreting ovarian tumours in postmenopausal women. BMJ Case Rep 2016; 2016:bcr-2016-215985. [PMID: 27803082 DOI: 10.1136/bcr-2016-215985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Androgen-secreting ovarian tumours are extremely rare accounting for <5% of all ovarian neoplasms. They are more frequent in postmenopausal women and should be suspected in the case of a rapid onset of androgenic symptoms. We report 4 cases of postmenopausal women who presented with signs of virilisation. All patients revealed increased serum levels of testosterone, normal dehydroepiandrosterone-sulfate and negative pelvic ultrasound for adnexal masses. An androgen-secreting ovarian tumour was suspected and all of them were submitted to bilateral oophorectomy. Histology confirmed the diagnosis of Leydig cell tumours in 3 patients and mature teratoma in 1. A successful response to surgery, which includes a decline in serum androgen levels and signs of hyperandrogenism, was observed in our patients. This case series demonstrates that androgen-secreting ovarian neoplasms may not be detectable by imaging studies, but should be considered in the differential diagnosis of all postmenopausal women with signs of hyperandrogenism.
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Affiliation(s)
- Ana Palha
- Department of Endocrinology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Luísa Cortez
- Department of Endocrinology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Paula Tavares
- Department of Surgery, Centro Hospitalar Lisboa Central, Lisbon, Portugal, Centro Hospitalar de Lisboa Central, Lisboa, Lisboa, Portugal
| | - Ana Agapito
- Department of Endocrinology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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R Ferreira A, Palha A, Correia L, Filipe P, Rodrigues V, Costa L, Miranda A, André R, Fernandes J, Gouveia J, Passos-Coelho JL, Moreira A, Brito M, Ribeiro J, Metzger-Filho O, U Lin N, Vaz-Luís I. Variation in type of adjuvant chemotherapy received among patients with stage I breast cancer: A multi-institutional Portuguese cohort study. Breast 2016; 29:68-73. [PMID: 27468923 DOI: 10.1016/j.breast.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/02/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A contemporary US study showed an increase in the use of chemotherapy in the last decade for some patients with stage-I breast cancer; with a rise in more intensive regimens, and declining use of anthracyclines. Nevertheless, there is still uncertainty on the absolute benefit of chemotherapy for these patients and the optimal regimen. In this study we compare those findings with the patterns of care among a Portuguese cohort of stage-I breast cancers. METHODS Retrospective cohort study of patients with stage-I breast cancer diagnosed from 2006 to 2008 at four Portuguese institutions. The use and type of chemotherapy was evaluated. RESULTS Among patients with stage I-III breast cancer 39.4% (n = 682) had stage I disease. Of the 595 eligible patients, 22.4% were treated with chemotherapy, 33.9% aged <55 years vs. 12.7% aged >65 years (p < 0.001). Thirteen percent of patients with hormone receptor (HR)+/HER2- tumors, 52.7% of patients with HER2+ and 66.0% of patients with HR-/HER2- received chemotherapy (p < 0.001). In addition, we found inter-institutional variability, with the use of chemotherapy ranging from 0.0% to 43.4% (p < 0.001). Eighty-five percent of patients treated with chemotherapy received less-intensive regimens with anthracycline-based regimens, such as doxorubicin and cyclophosphamide, being the most frequently used, while docetaxel and cyclophosphamide was only used in 1.5% of cases. CONCLUSIONS Overall, almost one-quarter of patients received chemotherapy with institutional variability. When treated, mostly less-intensive associations including anthracyclines were used, which contrasts with contemporary US practice. This study highlights the need for health-services research to understand local practices and tailor quality improvement interventions.
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Affiliation(s)
- Arlindo R Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
| | - Ana Palha
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Lurdes Correia
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Pedro Filipe
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Vasco Rodrigues
- Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Luís Costa
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Ana Miranda
- Registo Oncológico Regional do Sul, Lisbon, Portugal
| | - Rosário André
- Registo Oncológico Regional do Sul, Lisbon, Portugal
| | | | | | | | - António Moreira
- Instituto Português de Oncologia F. G. de Lisboa, Lisbon, Portugal
| | - Margarida Brito
- Instituto Português de Oncologia F. G. de Lisboa, Lisbon, Portugal
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Rodrigues FB, Bekerman C, Neves JB, Sousa J, Vieira J, Alves A, Palha A, Rocha J, Ramalhinho V. Her Aching Bones: Atypical Parathyroid Adenoma. Am J Med 2016; 129:260-2. [PMID: 26627542 DOI: 10.1016/j.amjmed.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Filipe Brogueira Rodrigues
- Department of Medicine, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Catarina Bekerman
- Department of Medicine, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Joana Briosa Neves
- Department of Medicine, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - João Sousa
- Department of Medicine, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Joana Vieira
- Department of Medicine, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - António Alves
- Department of Pathology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ana Palha
- Department of Pathology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Rocha
- Department of Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Vitor Ramalhinho
- Department of Medicine, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Bragança M, Marinho M, Marques J, Moreira R, Palha A, Marques-Teixeira J, Esteves M. The influence of espresso coffee on neurocognitive function in HIV-infected patients. AIDS Care 2016; 28:1149-53. [PMID: 26932511 DOI: 10.1080/09540121.2016.1153589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm(3), undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.
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Affiliation(s)
- M Bragança
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
| | - M Marinho
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
| | - J Marques
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
| | - R Moreira
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
| | - A Palha
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
| | - J Marques-Teixeira
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
| | - M Esteves
- a Department of Clinical Neurosciences and Mental Health, Faculty of Medicine , University of Porto , Porto , Portugal
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Rebelo Ferreira A, Palha A, Correia L, Filipe P, Rodrigues V, Costa L, Miranda A, André R, Fernandes J, Gouveia J, Passos Coelho J, Moreira A, Brito M, Ribeiro J, Freedman R, Metzger-Filho O, Lin N, Vaz-Luís I. 1962 The use of trastuzumab in patients with early breast cancer: A multi-institutional study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Ferreira A, Palha A, Correia L, Filipe P, Rodrigues V, Costa L, Miranda A, André R, Fernandes J, Gouveia J, Passos Coelho J, Moreira A, Brito M, Ribeiro J, Metzger-Filho O, Lin N, Vaz-Luíz I. 1965 Patterns of care and relative effectiveness of aromatase inhibitors compared to tamoxifen in patients with early breast cancer: A multi-institutional study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rebelo Ferreira A, Palha A, Correia L, Filipe P, Rodrigues V, Costa L, Miranda A, André R, Fernandes J, Gouveia J, Passos Coelho J, Moreira A, Brito M, Ribeiro J, Metzger-Filho O, Lin N, Vaz-Luís I. 1961 Variation in the chemotherapy use patterns for patients with stage I breast cancer: A multi-institutional study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Ferreira-Santos F, Silveira C, Almeida PR, Palha A, Barbosa F, Marques-Teixeira J. The auditory P200 is both increased and reduced in schizophrenia? A meta-analytic dissociation of the effect for standard and target stimuli in the oddball task. Clin Neurophysiol 2011; 123:1300-8. [PMID: 22197447 DOI: 10.1016/j.clinph.2011.11.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 11/22/2011] [Accepted: 11/28/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Conflicting reports of P200 amplitude and latency in schizophrenia have suggested that this component is increased, reduced or does not differ from healthy subjects. A systematic review and meta-analysis were undertaken to accurately describe P200 deficits in auditory oddball tasks in schizophrenia. METHODS A systematic search identified 20 studies which were meta-analyzed. Effect size (ES) estimates were obtained: P200 amplitude and latency for target and standard tones at midline electrodes. RESULTS The ES obtained for amplitude (Cz) for standard and target stimuli indicate significant effects in opposite directions: standard stimuli elicit smaller P200 in patients (d = -0.36; 95% CI [-0.26, -0.08]); target stimuli elicit larger P200 in patients (d = 0.48; 95% CI [0.16, 0.82]). A similar effect occurs for latency at Cz, which is shorter for standards (d = -0.32; 95% CI [-0.54, -0.10]) and longer for targets (d = 0.42; 95% CI [0.23, 0.62]). Meta-regression analyses revealed that samples with more males show larger ES for amplitude of target stimuli, while the amount of medication was negatively associated with the ES for the latency of standards. CONCLUSIONS The results obtained suggest that claims of reduced or augmented P200 in schizophrenia based on the sole examination of standard or target stimuli fail to consider the stimulus effect. SIGNIFICANCE Quantification of effects for standard and target stimuli is a required first step to understand the nature of P200 deficits in schizophrenia.
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Affiliation(s)
- F Ferreira-Santos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Rua do Dr Manuel Pereira da Silva, 4200-392 Porto, Portugal.
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Azevedo J, Rosas M, Esteves M, Sousa C, Vaz R, Garrett C, Palha A. Sexual Health in Parkinson’s Disease. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction:The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.Objectives:To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).Methods:Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.Results and conlusions:We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.
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Domingues I, Pedrosa R, Sousa V, Marques J, Martins A, Curral R, Palha A, Torres AR. Dayhospital of the Psychiatry Department of Hospital De São João: The Last Three and a Half Years. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Day Hospital of Hospital de São João was one of the pioneers in Portugal, and it began to work in July 1970. In those days, the main purpose was to reduce the number of full hospitalizations, and to aid the reinsertion of patients discharged from the Inpatient Unit. In a previous study, presented in the I Congresso Nacional de Psiquiatria (2005, Portugal), the first 34 years of this Day Hospital (from 1970 to 2004) were analyzed - some changes were noted during that period, namely the type of diagnosis and the hospitalization length. The main purpose of the present study was to characterize the patients that were treated in the Day Hospital of Hospital de São João during the last 3 and half years (Jan 2005- Jul 2008; n = 302), according to age, gender, diagnosis, length of hospitalization, and occupation rate. Then, these data were compared to the data of the previous study (firsts 34 years, in groups of 5 years). For this purpose, the authors used the Qui Square Test and the Kruskal - Wallis Test. It was also analyzed the distribution of the diagnosis according to gender and to length of hospitalization.
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Silveira C, Santos F, Barbosa F, Pedro A, Palha A, Marques-Teixeira J. A Preliminary Study of P200 in First-episode Patients, their Relatives and Healthy Controls: Search of New Endophenotypes. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background/Objective:Despite the well established genetic basis of schizophrenia, the relationship between genes and the disorder itself is still elusive. Individual endophenotypes, which reduce the complexity of genetic analyses, allow statistical approaches with quantitative trait methodologies. P200 abnormalities of event-related potentials have been reported in schizophrenia with conflicting results. The present study aims to characterize the P200 in first-episode patients and to compare it with that of first-degree relatives and controls.Methods:ERPs were recorded at 19 sites with an auditory oddball for 21 first-episode patients with schizophrenia (mean age=25.14; SD=6.20), 41 of their first degree relatives (mean age=47.65; SD=15.53) and 19 healthy controls (mean age=26.32; SD=7.16). Potentials were averaged for frequent stimuli and P200 amplitude and latency measures were obtained.Results:Analysis of midline electrodes revealed significant group effects for P200 peak amplitudes (F(2, 78)=3.315, p=.042), but not for peak latencies. Post-hoc analyses revealed that patients with schizophrenia present significantly lower P200 amplitudes (M=2.466; SD=1.564) than controls (M=5.037; SD=2.500) at Pz (T(38)=3.851, p=.003). No other significant differences were found.Conclusion:The results obtained do not straight-forwardly support the P200 peak amplitude nor peak latency as an endophenotype of schizophrenia. However, the trends of our results may suggest that the P200 amplitudes of relatives may present intermediate values between healthy controls (with higher amplitudes) and patients (with lower amplitudes). Further statistical analyses will be required in order to disentangle the effects of possible confounding variables.
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Domingues I, Silveira C, Curral R, Marques-Teixeira J, Palha A. Early detection of cardiovascular risk factors in schizophrenia. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Silveira C, Curral R, Norton A, Costa S, Domingues I, Barbosa F, Palha A. Executive dysfunction and insight in schizophrenic patients. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Timóteo S, Domingues I, Brandão I, Torres A, Palha A. Psychopathological characterization of morbid obese patients proposed for bariatric surgery. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Silveira C, Curral R, Norton A, Domingues I, Palha A. Use of antiepileptic drugs in psychiatry. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Domingues I, Timóteo S, Costa I, Silveira C, Curral R, Palha A. Schizoafective disorder: diagnostic difficulties – about two clinical cases. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lopes AIC, Palha A, Monteiro L, Olcastro M, Pelerito A, Fernandes A. Helicobacter pylori genotypes in children from a population at high gastric cancer risk: no association with gastroduodenal histopathology. Am J Gastroenterol 2006; 101:2113-22. [PMID: 16848806 DOI: 10.1111/j.1572-0241.2006.00732.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Both bacterial and host determinants underlying differences in histopathology and clinical outcome in H. pylori pediatric infection, as compared to adults, are still poorly documented. Pediatric studies may provide important insights on H. pylori infection immunopathogenesis, particularly in high gastric cancer risk populations. The present study concerns H. pylori genotypic diversity of isolates in children from a population with high gastric cancer risk, and its association with demographic and clinical variables, including gastroduodenal endoscopic and histopathological features. METHODS A total of 119 subjects (mean age 10.3 yr, 1.5-18.0 yr) with H. pylori infection were studied. H. pylori vacA, cagA, and iceA genotypes were determined (PCR) in antral-obtained primary cultures; histopathological evaluation was performed in corpus, antrum, and duodenum biopsy specimens. RESULTS cagA-, vacA s2m2, and iceA2 were the most prevalent genotypes. No association was observed between H. pylori genotypes and subject demographic and clinical variables, with the exception of a significant association between vacA s2 genotype and lower corpus inflammation score (p< 0.03). CONCLUSIONS In this pediatric cohort, H. pylori genotype profiles were distinct from those reported in adult subjects in the same area, with a lower prevalence of the putative more virulent genotypes. Moreover, they were not associated with clinical expression of gastroduodenal disease, suggesting the potential role of host and/or environmental factors for the development of clinical disease at a later age.
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Affiliation(s)
- Ana Isabel Costa Lopes
- Gastroenterology Unit, Paediatric Department, University Hospital Santa Maria, Lisboa, Portugal
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Lopes AI, Palha A, Lopes T, Monteiro L, Oleastro M, Fernandes A. Relationship among serum pepsinogens, serum gastrin, gastric mucosal histology and H. pylori virulence factors in a paediatric population. Scand J Gastroenterol 2006; 41:524-31. [PMID: 16638693 DOI: 10.1080/00365520500337098] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Serum pepsinogens and gastrin have been proposed as markers of gastritis, but have seldom been studied in children. In this study the aim was to identify host- and Helicobacter pylori-related factors linked to variations in serum gastrin, PGI, PGII, and to evaluate the potential of these biomarkers for diagnosing gastritis, whether H. pylori-associated or not. MATERIAL AND METHODS Ninety-two dyspeptic children referred for endoscopy (peptic ulcer exclusion) were included in the study. H. pylori status (urease, culture, histology) was assessed, and genotype determined (PCR) in H. pylori-positive subjects. Serum gastrin, PGI and PGII levels were measured by standard radioimmunoassay (RIA). RESULTS PGI and PGII levels were significantly higher in H. pylori-positive subjects (p=0.007; p=0.012, respectively). Gastrin levels were significantly higher in H. pylori-negative subjects (p=0.035). PGI and PGII were associated significantly with higher antrum inflammation scores (p=0.002; p=0.016, respectively); only PGI was associated with age, after controlling for inflammation (p=0.033) and for activity (p=0.037). The contribution of virulence factors could not be assessed owing to the low number of virulent strains. After multivariate analysis, only antrum inflammation was independently associated with PGI level (p=0.012). Receiver operating characteristic (ROC) analysis showed a low PGI and PGII discriminant power for predicting antrum inflammation. CONCLUSIONS Pepsinogen levels as measured in this study seem predominantly to reflect antral inflammation, but they are not an effective screening test for gastritis (H. pylori-positive or -negative) in dyspeptic children.
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Affiliation(s)
- Ana Isabel Lopes
- Gastroenterology Unit, Paediatric Department, University Hospital Santa Maria, Lisbon, Portugal.
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Lopes AI, Quiding-Jarbrink M, Palha A, Ruivo J, Monteiro L, Oleastro M, Santos A, Fernandes A. Cytokine expression in pediatric Helicobacter pylori infection. Clin Diagn Lab Immunol 2005; 12:994-1002. [PMID: 16085918 PMCID: PMC1182187 DOI: 10.1128/cdli.12.8.994-1002.2005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Helicobacter pylori infection is one of the most common gastrointestinal infections worldwide and almost invariably causes chronic gastritis in the infected host. A predominant Th1 profile has been demonstrated in H. pylori-infected mucosa from adults, but no previous study has evaluated in situ cytokine expression in children. We therefore examined expression of proinflammatory, anti-inflammatory, and regulatory cytokines by immunohistochemistry in cryopreserved antral biopsy specimens from 10 H. pylori-infected and 10 uninfected children and correlated expression of cytokines with histology scores. Concomitant expression of interleukin-8 (IL-8), gamma interferon (IFN-gamma), IL-4, transforming growth factor beta, and tumor necrosis factor alpha was seen in 8/10 H. pylori-infected cases and in 5/10 noninfected cases; all H. pylori-infected subjects showed staining for at least two of the cytokines. The proportion of epithelial cytokine-specific staining did not differ significantly between the groups, either in surface or glandular epithelium. Furthermore, no significant differences were noticed between intraepithelial or lamina propria lymphocyte staining in the groups. There was, however, a tendency of higher numbers of IFN-gamma- and IL-8-positive cells in the H. pylori-infected group. IFN-gamma and IL-8 lamina propria lymphocyte expression correlated significantly with antrum chronic inflammation, but there was no correlation between histology scores and epithelial cytokine expression. When the same techniques were used, the cytokine response appeared to be smaller in H. pylori-infected children than in adults, and there was no clear Th1 dominance. These results therefore suggest a different mucosal immunopathology in children. It remains to be determined whether the gastric immune response is downregulated in children with H. pylori infection and whether this is relevant to the outcome of infection.
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Affiliation(s)
- Ana I Lopes
- Gastroenterology Unit, Paediatric Department, University Hospital Santa Maria, Lisboa, Portugal.
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Gonçalves MA, Guilleminault C, Ramos E, Palha A, Paiva T. Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment. Sleep Med 2005; 6:333-9. [PMID: 15946896 DOI: 10.1016/j.sleep.2005.03.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 02/09/2005] [Accepted: 03/04/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of one month of continuous positive airway pressure (CPAP) in a subgroup of obstructive sleep apnea (OSA) patients with erectile dysfunction (ED) and compare this subgroup with age- and body mass index (BMI)-matched OSA patients without ED. PATIENTS AND METHODS Prospective general, sleep, psychiatric and sexologic evaluations were conducted. Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Sleep Disorders Questionnaire (SDQ), Quality of Life SF-36, and polysomnography were used. Seventeen OSA patients with ED were compared prior to CPAP treatment and during CPAP treatment with age- and BMI-matched OSA patients without ED. Parametric and non-parametric statistics, chi-square, Fisher exact test and multiple regression analyses were performed. RESULTS Ninety-eight men (BMI=28.8 kg/m2, apnea-hypopnea index (AHI)=49.6 events/h, ESS=14.8, BDI=8.4, and lowest SaO2=75.3%) were divided into subgroups of lowest SaO2>80% (A) and lowest SaO2< or =80% (B). (A) Forty-six men had a mean lowest SaO2 of 85.7%+/-2.9, AHI=29.5+/-17.6, age=46.3+/-9.3 years, ESS=13.6+/-4.2, BMI=25.8+/-4.8. Seven of the patients had ED. (B) Fifty-two men had a mean lowest SaO2=60.10+/-10.0%, AHI=67.4+/-24.5, BDI=9.0+/-6.9, age=47.4+/-9.4 years, ESS=16.2+/-4.4, BMI=31.4+/-5.1. Twenty-one of the patients had ED (chi2: P=0.006). Significant variables for ED were lowest SaO2 and age (r=0.17). CPAP-treated subgroup: ED subjects had significantly lower SaO2, ESS, BDI and SF-36 subscale scores than OSA controls. Nasal CPAP eliminated the differences between groups, and ED was resolved in 13 out of 17 cases. CONCLUSIONS ED in OSAS is related to nocturnal hypoxemia, and about 75% of OSAS patients with ED treated with nasal CPAP showed remission at one-month follow-up, resulting in significant improvement in quality of life.
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Abstract
BACKGROUND Data concerning the effectiveness of Helicobacter pylori eradication regimens based in antibiotic susceptibility testing are scanty in children. AIMS To identify the prevalence of antibiotic resistance in H. pylori strains isolated from Portuguese children in 1999-2003; to evaluate eradication rate after antibiotic susceptibility testing-based treatment; and to identify factors associated with resistance and eradication outcome. METHODS Included were 109 children with a gastric biopsy culture positive for H. pylori. First treatment (amoxicillin, omeprazole and clarithromycin or metronidazole) was guided by susceptibility testing (E test), and eradication was assessed by [C]urea breath test. RESULTS Strains were susceptible to amoxicillin and tetracycline; 39.4% were resistant to clarithromycin, 16.5% to metronidazole and 4.5% to ciprofloxacin. No significant association was found between resistance and sex, age, clinical status, gastritis scores, H. pylori density scores and genotype. Clarithromycin resistance was significantly associated with European origin [odds ratio (OR), 3.9], previous H. pylori empiric therapy (OR 2.8) and amoxicillin minimal inhibitory concentration, > or =0.016 (OR 6.0). Eradication rate after susceptibility-based treatment was 74.7% (59 of 79; 95% confidence interval, 65.9-82.9), and a significant association was found between eradication failure and presence of resistance to 1 or more antibiotics (P < 0.05). CONCLUSIONS The prevalence of H. pylori antibiotic resistance was high in the studied population. The modest therapeutic success of clarithromycin and metronidazole susceptibility-based regimens suggests that in addition to resistance, other factors may be involved. The need of susceptibility-based treatment studies in children and of antimicrobial resistance surveillance in high prevalence areas for H. pylori are emphasized.
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Affiliation(s)
- Ana Isabel Lopes
- Unit of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, INSA, Lisbon, Portugal.
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Lepine JP, Aschauer H, Van Den Broek WA, Ceskova E, Figueira ML, Gathmann P, Massana J, Palha A, Pelissolo A, Puech A, Saletu B, Schindler SD, Vinar O, Westenberg HG. Treatment of panic disorder: Algorithms for pharmacotherapy. Int J Psychiatry Clin Pract 1997; 1 Suppl 1:S13-5. [PMID: 24936882 DOI: 10.3109/13651509709024745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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