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Canhão BT, Trigo A, Madeira JI, Simão A, Madaleno J. Prolonged arthralgias in Whipple's disease - A common but often overlooked symptom of a rare disease. J R Coll Physicians Edinb 2024; 54:41-43. [PMID: 38606805 DOI: 10.1177/14782715241237283] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Whipple's disease is a multisystemic chronic infectious condition caused by Tropheryma whipplei (T. whipplei). Though characterised often by insidious weight loss, diarrhoea, and arthralgia, three other distinct manifestations can be observed, namely localised disease, acute infection and asymptomatic carriage. The diagnosis relies on histopathological examination of duodenal biopsies and polymerase chain reaction analysis of the 16S rRNA gene for T. whipplei. We report the case of a middle-aged man admitted for etiologic investigation of prolonged, migrating, and inflammatory arthralgias and subsequent development of gastrointestinal symptoms. Despite its reputation as a great mimicker of many different illnesses, the difficulty in diagnosis probably lies with its rarity rather than its masking.
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Affiliation(s)
- Bernardo Tourais Canhão
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - André Trigo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Inês Madeira
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adélia Simão
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Madaleno
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Canhão B, Cipriano A, Carvalho A, Simão A, Madaleno J. Autoimmune Hepatitis on a Living Liver Donor: An Unexpected Long-Term Complication. ACG Case Rep J 2024; 11:e01289. [PMID: 38463495 PMCID: PMC10923377 DOI: 10.14309/crj.0000000000001289] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024] Open
Abstract
In Western countries, deceased donor liver transplantation remains the standard of care for patients with end-stage liver disease. Living donor liver transplantation is a viable and feasible strategy for patients with end-stage liver disease designed to mitigate the deceased organ shortage. Donor safety is the primary concern because liver donors, ideally, should not have any complication. We report a case of middle-aged woman without a history of chronic liver disease who developed autoimmune hepatitis more than 20 years after live liver donation. Changes in these patients' liver enzymes should prompt swift referral to an hepatologist for initial liver disease work-up.
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Affiliation(s)
- Bernardo Canhão
- Liver Disease Unit-Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Augusta Cipriano
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Liver Disease Unit-Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Adélia Simão
- Liver Disease Unit-Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Madaleno
- Liver Disease Unit-Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Terziroli Beretta-Piccoli B, Buescher G, Dalekos G, Zachou K, Geerts A, Semmo N, Kolev M, De Martin E, Janik MK, Madaleno J, Lalosevic Stojkovic M, Dumortier J, Vanwolleghem T, Schregel I, Steinmann S, Lacaille F, Sebode M. Hepatic safety and efficacy of immunomodulatory drugs used in patients with autoimmune hepatitis. J Autoimmun 2023; 140:103113. [PMID: 37716078 DOI: 10.1016/j.jaut.2023.103113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/28/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND AND AIMS There is little data on the hepatic efficacy and safety of immunomodulatory drugs used in patients with autoimmune hepatitis (AIH), despite their established use in dermatology, rheumatology and inflammatory bowel diseases (IBD). Our aim was to collect real-life data on the experience of expert centres in treating AIH patients with these drugs, considered unconventional for AIH management. METHODS Online survey among hepatology centres being part of the European Reference Network on Hepatological Diseases (ERN RARE-LIVER). RESULTS 25 AIH patients have been reported. Ten were female, median age at diagnosis was 28 years; median follow-up was 17 months. All had initially received AIH-standard treatment. AIH-unconventional treatment was initiated for concomitant autoimmune diseases in 15 cases: nine for IBD (five vedolizumab and four ustekinumab), and one each for following diseases: autoinflammatory syndrome (tocilizumab), chronic urticaria (omalizumab), rheumatoid arthritis (abatacept), psoriasis (guselkumab), psoriatric arthritis (secukinumab, followed by ustekinumab) and alopecia (ruxolitinib). Three patients were treated with immunomodulatory drugs for side effects of previous treatments, including two patients with IBD treated with vedolizumab and ustekinumab, respectively, and one treated with belimumab. At the end of follow-up, 13 patients were in complete biochemical response, the patient on omalizumab had a relapse, and four patients with concomitant IBD had insufficient response. Seven patients were treated for lack of biochemical remission, of whom six with belimumab, all initially reaching complete biochemical response, but five relapsing during follow-up; and one with secukinumab, having concomitant rheumatoid arthritis and ankylosing spondylitis, reaching complete biochemical response. Only the patient on abatacept received unconventional treatment as monotherapy. Side effects were reported in two patients on belimumab: one recurrent soft tissue infections, one fatigue and arthralgia. CONCLUSION Among 25 AIH patients who were treated with immunomodulatory drugs for different reasons, the majority had a fovorable course, relapse was frequent in difficult-to-treat patients who received belimumab, and four with concomitant IBD had insufficient response.
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Affiliation(s)
- Benedetta Terziroli Beretta-Piccoli
- Epatocentro Ticino, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; MowatLabs, Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, UK.
| | - Gustav Buescher
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - George Dalekos
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Kalliopi Zachou
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Centre in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Anja Geerts
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Gastroenterology and Hepatology, University Hospital of Ghent, Belgium
| | - Nasser Semmo
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Mirjam Kolev
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Eleonora De Martin
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Hépatologie et Transplantation Hépatique, Hôpital Paul Brousse, Villejuif, France
| | - Maciej K Janik
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; . Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - João Madaleno
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Liver Disease Unit, Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Milica Lalosevic Stojkovic
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; University Clinical Center of Serbia, Belgrade, Serbia
| | - Jérôme Dumortier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Hôpital Edouard Herriot, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Vanwolleghem
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Department of Gastroenterology and Hepatology Antwerp University Hospital, Antwerp, Belgium; Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Antwerp, Belgium
| | - Ida Schregel
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Silja Steinmann
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Florence Lacaille
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; Hôpital Necker-Enfants Malades, Paris, France
| | - Marcial Sebode
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany; I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Walmsley M, Tornai D, Cazzagon N, Leburgue A, Mrzljak A, Lenzen H, Carbone M, Madaleno J, Lleo A, Junge N, Schramm C, Bergquist A. Patient-reported quality of care in primary sclerosing cholangitis. Liver Int 2023; 43:1654-1662. [PMID: 37312635 DOI: 10.1111/liv.15650] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Management and follow-up strategies for primary sclerosing cholangitis (PSC) vary. The aim of the present study was to assess patient-reported quality of care to identify the most important areas for improvement. METHODS Data were collected via an online survey hosted on the EU Survey platform in 11 languages between October 2021 and January 2022. Questions were asked about the disease, symptoms, treatment, investigations and quality of care. RESULTS In total, 798 nontransplanted people with PSC from 33 countries responded. Eighty-six per cent of respondents reported having had at least one symptom. Twenty-four per cent had never undergone an elastography, and 8% had not had a colonoscopy. Nearly half (49%) had never undergone a bone density scan. Ursodeoxycholic acid (UDCA) was used in 90-93% in France, Netherlands and Germany, and 49-50% in the United Kingdom and Sweden. Itch was common (60%), and 50% of those had received any medication. Antihistamines were taken by 27%, cholestyramine by 21%, rifampicin by 13% and bezafibrate by 6.5%. Forty-one per cent had been offered participation in a clinical trial or research. The majority (91%) reported that they were confident with their care although half of the individuals reported the need for more information on disease prognosis and diet. CONCLUSION Symptom burden in PSC is high, and the most important areas of improvement are disease monitoring with more widespread use of elastography, bone density scan and appropriate treatment for itch. Personalised prognostic information should be offered to all individuals with PSC and include information on how they can improve their health.
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Affiliation(s)
- Martine Walmsley
- PSC Support, Oxford, UK
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Dávid Tornai
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nora Cazzagon
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Azienda Ospedale - Università Padova, Padova, Italy
| | - Angela Leburgue
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Albi, Association pour la Lutte contre les maladies inflammatoires du foie et des voies biliaires, Versailles, France
| | - Anna Mrzljak
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Department of Medicine, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Henrike Lenzen
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Marco Carbone
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Division of Gastroenterology, University of Milano-Bicocca, Milan, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - João Madaleno
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Liver Disease Unit, Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Lleo
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Norman Junge
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- I. Medizinische Klinik und Poliklinik, and Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Hamburg Center of Translational Immunology, Hamburg, Germany
| | - Annika Bergquist
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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Silva E, Marques S, Leal B, Canhão B, Madaleno J, Simão A, Carvalho A. Occult hepatitis C infection identified in injection drug users with direct antiviral agents therapy and spontaneous resolution of hepatitis C virus infection. Virus Res 2023; 329:199104. [PMID: 37003528 DOI: 10.1016/j.virusres.2023.199104] [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: 12/12/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Occult hepatitis C infection (OCI) is characterized by the detection of hepatitis C virus (HCV) RNA in hepatocytes and in peripheral blood mononuclear cells (PBMCs) without detection in serum. We aimed to evaluate OCI in drug and no drug users who achieved sustained virological response (SVR) after therapy with direct-acting antivirals (DAAs) and with HCV spontaneous resolution. METHODS Twenty-four patients in the AVP group (who achieved a SVR after DAAs therapy), 13 in the NAVP group (with HCV spontaneous resolution) and 7 HCV-RNA positive patients (CPP, control positive group) were included in the study. HCV/OCI-RNA was screened in serum and PBMCs samples of the patients by ddPCR for OCI patients' identification. Plasma and red blood cells (RBCs) samples of the patients were also evaluated for HCV/OCI-RNA detection by ddPCR. RESULTS OCI was presented in injection drug users (IDUs) in the AVP (20.8%) and NAVP (23.1%) groups by ddPCR with a higher statistically significant percentage detected in RBCs samples of the patients in the AVP group comparatively to NAVP (p<0.01) and CPP (p < 0.05) groups. CONCLUSION OCI was identified in IDUs patients of the AVP and NAVP groups by ddPCR. These results suggest that OCI patients in the AVP group might not be entirely cured, and that OCI patients in the NAVP group were not identified at clinical evaluation time when just serum samples were analysed. A higher percentage of HCV/OCI-RNA was detected in RBCs samples. Overall results recommends that HCV/OCI identification in patients with DAAs therapy and spontaneous resolution of HCV infection should be studied more accurately in future and in larger patient groups if possible. Additionally, suggest also PBMCs and RBCs samples as predictors for HCV/OCI diagnosis and management.
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Affiliation(s)
- Eliane Silva
- Research Center in Biodiversity and Genetic Resources (CIBIO/InBIO), University of Porto, Vairão, Portugal; School of Medicine and Biomedical Sciences of the University of Porto (ICBAS-UP), Porto, Portugal.
| | - Sara Marques
- Research Center in Biodiversity and Genetic Resources (CIBIO/InBIO), University of Porto, Vairão, Portugal
| | - Bárbara Leal
- Unit for Multidisciplinary Research in Biomedicine (UMIB) at 2School of Medicine and Biomedical Sciences of the University of Porto (ICBAS-UP), Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Bernardo Canhão
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Hospital and University Center (CHUC), Coimbra, Portugal
| | - João Madaleno
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Hospital and University Center (CHUC), Coimbra, Portugal
| | - Adélia Simão
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Hospital and University Center (CHUC), Coimbra, Portugal
| | - Armando Carvalho
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Hospital and University Center (CHUC), Coimbra, Portugal
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Borges-Rosa J, Oliveira-Santos M, Silva R, Mendes J, Madaleno J, Teixeira R, Ferreira MJ, Gonçalves L. [ 18F]FDG PET-CT in the diagnosis of bacterial pericarditis. J Nucl Cardiol 2022; 29:3611-3614. [PMID: 34228340 DOI: 10.1007/s12350-021-02706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 01/18/2023]
Affiliation(s)
- João Borges-Rosa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Manuel Oliveira-Santos
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - Rodolfo Silva
- Nuclear Medicine Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Jorge Mendes
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - João Madaleno
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - Maria João Ferreira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
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Canhão B, Trigo A, Madaleno J. Extrapyramidal dysfunction in cirrhosis: Is hepatic encephalopathy the only answer? Eur J Intern Med 2022; 99:99-100. [PMID: 35153122 DOI: 10.1016/j.ejim.2022.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Bernardo Canhão
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - André Trigo
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Madaleno
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Liver Transplant Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal
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Mendes JB, Gomes JF, Gonçalves T, Canhão B, Madaleno J. Encephalitis: A rare complication of mediterranean spotted fever. IDCases 2021; 24:e01136. [PMID: 34026533 PMCID: PMC8122166 DOI: 10.1016/j.idcr.2021.e01136] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022] Open
Abstract
Mediterranean spotted fever (MSF) is an emerging zoonosis caused by Rickettsia conorii. The MSF typically presents with a triad of fever, generalized cutaneous rash and inoculation eschar, but its clinical spectrum may range from a mild febrile illness to a potentially life-threatening condition, being central nervous system involvement highly rare. We report the clinical case of a 63-year-old male patient with MSF complicated by acute encephalitis and multi-organic failure.
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Affiliation(s)
| | - João Filipe Gomes
- Internal Medicine in Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Tatiana Gonçalves
- Internal Medicine in Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Bernardo Canhão
- Internal Medicine in Centro Hospitalar e Universitário de Coimbra, Portugal
| | - João Madaleno
- Internal Medicine in Centro Hospitalar e Universitário de Coimbra, Portugal
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Madaleno J, Fernandes A, Cochicho J, Silva N, Carvalho A. Immune thrombocytopenia associated with pleural and pericardial tuberculosis: case report. Rev Bras Hematol Hemoter 2016; 38:163-5. [PMID: 27208577 PMCID: PMC4877611 DOI: 10.1016/j.bjhh.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/07/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- João Madaleno
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | | | - Joana Cochicho
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; School of Medicine, Universidade de Coimbra, Coimbra, Portugal
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Madaleno J, Fernandes A, Silva N. A cause for craniocervical pain. Eur J Intern Med 2016; 29:e1-2. [PMID: 26563935 DOI: 10.1016/j.ejim.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/14/2015] [Accepted: 11/01/2015] [Indexed: 11/20/2022]
Affiliation(s)
- João Madaleno
- Internal Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - António Fernandes
- Internal Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Silva
- Internal Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Cochicho J, Madaleno J, Louro E, Simão A, Carvalho A. Polymyositis and the Spectrum of Scleroderma Disorders. Eur J Case Rep Intern Med 2015; 3:000346. [PMID: 30755854 PMCID: PMC6346825 DOI: 10.12890/2015_000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/29/2015] [Accepted: 12/12/2015] [Indexed: 11/20/2022] Open
Abstract
Polymyositis (PM) is usually associated to other autoimmune or connective tissue diseases. The authors report the case of a 59-year-old man with pulmonary fibrosis, who presented with constitutional symptoms and gradually developed proximal muscle weakness, Raynaud phenomenon, and dysphagia. Besides creatine kinase (CK) elevation, he had positive anti-Polymyositis-Scleromyositis (PM-Scl) and anti-Sjögren’s-syndrome A (SSA) antibodies. Nailfold capillaroscopy showed a scleroderma pattern and muscle biopsy revealed necrosis, regeneration of muscle fibers, and inflammatory infiltrate. Prednisolone was started, with great improvement. Taking into account the overlap features between PM and systemic sclerosis sine scleroderma, it is important to closely monitor the patient for signs of pulmonary and cardiac decompensation.
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Affiliation(s)
- Joana Cochicho
- Internal Medicine Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - João Madaleno
- Internal Medicine Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Emília Louro
- Internal Medicine Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Adélia Simão
- Internal Medicine Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Armando Carvalho
- Internal Medicine Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
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Simão A, Madaleno J, Silva N, Rodrigues F, Caseiro P, Costa JN, Carvalho A. Plasma osteopontin is a biomarker for the severity of alcoholic liver cirrhosis, not for hepatocellular carcinoma screening. BMC Gastroenterol 2015; 15:73. [PMID: 26122937 PMCID: PMC4487194 DOI: 10.1186/s12876-015-0307-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/24/2015] [Indexed: 12/11/2022] Open
Abstract
Background Implementation of surveillance programs for at-risk populations and identification of biomarkers for early hepatocellular carcinoma (HCC) detection are a major public health goal. Recently, osteopontin (OPN) has attracted attention as a promising biomarker, with some potential advantages compared to alpha-fetoprotein (AFP), but its role in the context of alcoholic cirrhosis has never been assessed. The aims of this study are to assess the utility of plasma OPN in the diagnosis of HCC in alcoholic cirrhotic patients and to investigate whether increased values are due to the tumor or underlying liver disease severity. Methods A total of 90 consecutively alcoholic cirrhosis patients, observed between Jun 2013 and May 2014 at a Liver Disease Unit, were included and divided into two groups: 45 without (group I) and 45 with HCC (group II). Plasma levels of OPN (ELISA, Immuno-Biological Laboratories, Gunma, Japan) and AFP (IMMULITE® 2000 AFP, Siemens Healthcare Diagnostics, Tarrytown, New York) were assessed. The diagnostic accuracy of each marker was evaluated using Receiver-Operating Characteristic (ROC) curve analysis (AUC) and its 95 % Confidence Interval (CI). Results Plasma OPN levels in group I patients (1176.28 +/–744.59 ng/mL) weren’t significantly different from those of group II (1210.75 +/–800.60 ng/mL) (p = 0.826). OPN levels significantly increased with advancing BCLC tumor stage and with advancing Child-Pugh class, in both groups. Comparing the two groups, AUC for OPN and AFP were 0.51 (95 % CI: 0.39–0.63) and 0.79 (95 % CI: 0.70–0.89), respectively. Based on the ROC analysis, there were no satisfactory cut-off values for OPN that would distinguish patients with from those without tumour. Conclusions Despite having a correlation with BCLC stage, the same was observed with progressive deterioration of underlying liver function in terms of Child-Pugh class and MELD score, and isn’t a useful diagnostic biomarker for HCC in alcoholic cirrhotic patients, particularly in the early stages. AFP confirms the performance evidenced in other studies, being superior to OPN. Searching more specific biomarkers for early diagnosis of HCC in alcoholic cirrhosis is still warranted.
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Affiliation(s)
- Adélia Simão
- Internal Medicine A-Centro Hospitalar e Universitário de Coimbra, Portugal, and University of Coimbra, Faculty of Medicine, Coimbra, Portugal, Av. Bissaya Barreto e Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - João Madaleno
- Internal Medicine A-Centro Hospitalar e Universitário de Coimbra, Portugal, and University of Coimbra, Faculty of Medicine, Coimbra, Portugal, Av. Bissaya Barreto e Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Nuno Silva
- Internal Medicine A-Centro Hospitalar e Universitário de Coimbra, Portugal, and University of Coimbra, Faculty of Medicine, Coimbra, Portugal, Av. Bissaya Barreto e Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Fernando Rodrigues
- Clinical Pathology-Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Paula Caseiro
- Clinical Pathology-Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - José Nascimento Costa
- Internal Medicine A-Centro Hospitalar e Universitário de Coimbra, Portugal, and University of Coimbra, Faculty of Medicine, Coimbra, Portugal, Av. Bissaya Barreto e Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Armando Carvalho
- Internal Medicine A-Centro Hospitalar e Universitário de Coimbra, Portugal, and University of Coimbra, Faculty of Medicine, Coimbra, Portugal, Av. Bissaya Barreto e Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
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Sargento-Freitas J, Felix-Morais R, Ribeiro J, Gouveia A, Nunes C, Duque C, Madaleno J, Silva F, Machado C, Cordeiro G, Cunha L. Different locations but common associations in subcortical hypodensities of presumed vascular origin: cross-sectional study on clinical and neurosonologic correlates. BMC Neurol 2014; 14:24. [PMID: 24495346 PMCID: PMC3917903 DOI: 10.1186/1471-2377-14-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/03/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Subcortical hypodensities of presumed vascular etiology (SHPVO) are a clinical, radiological and neuropathological syndrome with a still largely unexplained pathophysiology. Parallel to the clinical heterogeneity, there is also recognised cerebral topographical diversity with undetermined etiological implications. Our aim is to assess clinical and neurosonological predictors of SHPVO according to their location. METHODS Cross sectional analysis of consecutive patients that underwent neurosonologic evaluation and head CT within one month, during a one year period. We excluded patients with absent temporal sonographic window, any pathology with a possible confounding effect on cerebral arterial pulsatility, atrial fibrillation and other etiologies of white matter diseases. The mean pulsatility index (PI) of both middle cerebral arteries was measured in the middle third of the M1 segment; intima media thickness was evaluated in the far wall of both common carotid arteries. SHPVO were rated by analysis of head CT in deep white matter (DWMH), periventricular white matter (PVWMH) and basal ganglia (BGH). We conducted a multivariate ordinal logistic regression model including all clinical, demographic and ultrasonographic characteristics to determine independent associations with SHPVO. RESULTS We included 439 patients, mean age 63.47 (SD: 14.94) years, 294 (67.0%) male. The independent predictors of SHPVO were age (OR = 1.067, 95% CI: 1.047-1.088, p < 0.001 for DWMH; OR = 1.068, 95% CI: 1.049-1.088, p < 0.001 for PVWMH; OR = 1.05, 95% CI: 1.03-1.071, p < 0.001 for BGH), hypertension (OR = 1.909, 95% CI: 1.222-2.981, p = 0.004 for DWMH; OR = 1.907, 95% CI: 1.238-2.938, p = 0.003 for PVWMH; OR = 1.775, 95% CI: 1.109-2.843, p = 0.017 for BGH) and PI (OR = 17.994, 95% CI: 6.875-47.1, p < 0.001 for DWMH; OR = 5.739, 95%CI: 2.288-14.397, p < 0.001 for PVWMH; OR = 11.844, 95% CI: 4.486-31.268, p < 0.001 for BGH) for all locations of SHPVO. CONCLUSIONS Age, hypertension and intracranial pulsatility are the main independent predictors of SHPVO across different topographic involvement and irrespective of extracranial atherosclerotic involvement.
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Affiliation(s)
- João Sargento-Freitas
- Neurosonology Laboratory, Coimbra University and Hospital Centre, Coimbra 3000-075, Portugal.
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Leite L, Ferreira R, Moura J, Lazaro S, Madaleno J, Soares FC, Baptista R, Silva N, Elvas L, Pego M. Manchester triage system in acute pulmonary embolism: can it predict the mortality? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leite L, Moura J, Ferreira R, Lazaro S, Madaleno J, Moreira N, Baptista R, Silva N, Elvas L, Pego M. LDH as a predictor of in-hospital and late mortality in acute pulmonary embolism. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lazaro S, Ferreira AR, Moura Ferreira J, Leite L, Martins H, Madaleno J, Silva N, Baptista R, Ramos D, Pego M. Beyond arterial gases: the role of lactates in risk stratification in pulmonary embolism. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1149] [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: 11/14/2022] Open
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Moura Ferreira J, Moura Ferreira S, Ferreira A, Madaleno J, Silva N, Baptista R, Leite L, Mendes S, Ferreira MJ, Pego M. Platelet size deviation width measured at hospital admission predicts in-hospital mortality and all cause mortality at follow up after discharge in acute pulmonary embolism. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1148] [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: 11/13/2022] Open
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