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Lopes-Lima M, Geist J, Egg S, Beran L, Bikashvili A, Van Bocxlaer B, Bogan AE, Bolotov IN, Chelpanovskaya OA, Douda K, Fernandes V, Gomes-Dos-Santos A, Gonçalves DV, Gürlek ME, Johnson NA, Karaouzas I, Kebapçı Ü, Kondakov AV, Kuehn R, Lajtner J, Mumladze L, Nagel KO, Neubert E, Österling M, Pfeiffer J, Prié V, Riccardi N, Sell J, Schneider LD, Shumka S, Sîrbu I, Skujienė G, Smith CH, Sousa R, Stöckl K, Taskinen J, Teixeira A, Todorov M, Trichkova T, Urbańska M, Välilä S, Varandas S, Veríssimo J, Vikhrev IV, Woschitz G, Zając K, Zając T, Zanatta D, Zieritz A, Zogaris S, Froufe E. Integrative phylogenetic, phylogeographic and morphological characterisation of the Unio crassus species complex reveals cryptic diversity with important conservation implications. Mol Phylogenet Evol 2024; 195:108046. [PMID: 38447924 DOI: 10.1016/j.ympev.2024.108046] [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] [Received: 09/17/2023] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
The global decline of freshwater mussels and their crucial ecological services highlight the need to understand their phylogeny, phylogeography and patterns of genetic diversity to guide conservation efforts. Such knowledge is urgently needed for Unio crassus, a highly imperilled species originally widespread throughout Europe and southwest Asia. Recent studies have resurrected several species from synonymy based on mitochondrial data, revealing U. crassus to be a complex of cryptic species. To address long-standing taxonomic uncertainties hindering effective conservation, we integrate morphometric, phylogenetic, and phylogeographic analyses to examine species diversity within the U. crassus complex across its entire range. Phylogenetic analyses were performed using cytochrome c oxidase subunit I (815 specimens from 182 populations) and, for selected specimens, whole mitogenome sequences and Anchored Hybrid Enrichment (AHE) data on ∼ 600 nuclear loci. Mito-nuclear discordance was detected, consistent with mitochondrial DNA gene flow between some species during the Pliocene and Pleistocene. Fossil-calibrated phylogenies based on AHE data support a Mediterranean origin for the U. crassus complex in the Early Miocene. The results of our integrative approach support 12 species in the group: the previously recognised Unio bruguierianus, Unio carneus, Unio crassus, Unio damascensis, Unio ionicus, Unio sesirmensis, and Unio tumidiformis, and the reinstatement of five nominal taxa: Unio desectusstat. rev., Unio gontieriistat. rev., Unio mardinensisstat. rev., Unio nanusstat. rev., and Unio vicariusstat. rev. Morphometric analyses of shell contours reveal important morphospace overlaps among these species, highlighting cryptic, but geographically structured, diversity. The distribution, taxonomy, phylogeography, and conservation of each species are succinctly described.
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Affiliation(s)
- M Lopes-Lima
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal.
| | - J Geist
- Aquatic Systems Biology, Technical University of Munich, TUM School of Life Sciences, Mühlenweg 22, 85354 Freising, Germany
| | - S Egg
- Aquatic Systems Biology, Technical University of Munich, TUM School of Life Sciences, Mühlenweg 22, 85354 Freising, Germany; Molecular Zoology, Technical University of Munich, TUM School of Life Sciences, Hans-Carl-von-Carlowitz-Platz 2, Freising, Germany
| | - L Beran
- Regional Office Kokořínsko - Máchův kraj Protected Landscape Area Administration, Nature Conservation Agency of the Czech Republic, Česká 149, CZ-27601 Mělnik, Czech Republic
| | - A Bikashvili
- Institute of Zoology, Ilia State University, Cholokashvili ave. 3/5, 0162 Tbilisi, Georgia
| | - B Van Bocxlaer
- CNRS, Univ. Lille, UMR 8198 - Evo-Eco-Paleo, F-59000 Lille, France
| | - A E Bogan
- North Carolina Museum of Natural Sciences, 11 West Jones Street, Raleigh, NC 27601 USA
| | - I N Bolotov
- N. Laverov Federal Center for Integrated Arctic Research of the Ural Branch of the Russian Academy of Sciences, Nikolsky Av. 20, 163020 Arkhangelsk, Russia
| | - O A Chelpanovskaya
- N. Laverov Federal Center for Integrated Arctic Research of the Ural Branch of the Russian Academy of Sciences, Nikolsky Av. 20, 163020 Arkhangelsk, Russia
| | - K Douda
- Department of Zoology and Fisheries, FAFNR, Czech University of Life Sciences Prague, Kamýcká 129, CZ-16500 Prague, Czech Republic
| | - V Fernandes
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - A Gomes-Dos-Santos
- CIIMAR/CIMAR - Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal
| | - D V Gonçalves
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal; CIIMAR/CIMAR - Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal
| | - M E Gürlek
- Burdur Vocational School of Food Agriculture and Livestock, Mehmet Akif Ersoy University, 15100 Burdur, Türkiye
| | - N A Johnson
- U.S. Geological Survey, Wetland and Aquatic Research Center, Gainesville, FL, USA
| | - I Karaouzas
- Hellenic Centre for Marine Research, Institute of Marine Biological Resources and Inland Waters, 46.7 km Athens-Sounio Av., Anavyssos 19013, Greece
| | - Ü Kebapçı
- Biology Department, Faculty of Science and Arts, Burdur Mehmet Akif Ersoy University, Burdur, Türkiye
| | - A V Kondakov
- N. Laverov Federal Center for Integrated Arctic Research of the Ural Branch of the Russian Academy of Sciences, Nikolsky Av. 20, 163020 Arkhangelsk, Russia
| | - R Kuehn
- Molecular Zoology, Technical University of Munich, TUM School of Life Sciences, Hans-Carl-von-Carlowitz-Platz 2, Freising, Germany
| | - J Lajtner
- Department of Biology, Faculty of Science, University of Zagreb, Horvatovac 102a, 10000 Zagreb, Croatia
| | - L Mumladze
- Institute of Zoology, Ilia State University, Cholokashvili ave. 3/5, 0162 Tbilisi, Georgia
| | - K-O Nagel
- Malacological Section, Senckenberg Research Institute and Natural History Museum Frankfurt/M., Senckenberganlage 25, 60325 Frankfurt am Main, Germany
| | - E Neubert
- Natural History Museum, 3005 Bern, Switzerland; Institute of Ecology and Evolution, University of Bern, 3012 Bern, Switzerland
| | - M Österling
- Institution of Environmental and Life Sciences, Karlstad University, Biology, 65188 Karlstad, Sweden
| | - J Pfeiffer
- National Museum of Natural History, Smithsonian Institution, 10th and Constitution Avenue, Washington, DC, USA
| | - V Prié
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal; Institut Systématique Evolution Biodiversité (ISYEB), Muséum national d'Histoire naturelle, CNRS, Sorbonne Université, EPHE, Université des Antilles, 57 rue Cuvier, CP 51, 75005 Paris, France
| | - N Riccardi
- CNR Water Research Institute, Largo Tonolli 50, 28922 Verbania, Italy
| | - J Sell
- Department of Genetics and Biosystematics, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - L D Schneider
- The Rural Economy and Agricultural Society, 305 96 Eldsberga, Sweden
| | - S Shumka
- Faculty Of Biotechnology and Food, Agricultural University of Tirana, Koder Kamez, Tirana 2029, Albania
| | - I Sîrbu
- Lucian Blaga University of Sibiu, Faculty of Sciences, 5-7 Dr. I. Rațiu St., 550012 Sibiu, Romania
| | - G Skujienė
- Department of Zoology, Institute of Biosciences, Life Sciences Center, Vilnius University, Saulėtekio av. 7, LT-10223 Vilnius, Lithuania
| | - C H Smith
- Department of Integrative Biology, University of Texas, Austin, TX, USA
| | - R Sousa
- CBMA - Centre of Molecular and Environmental Biology, Department of Biology, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal
| | - K Stöckl
- Bavarian Academy for Nature Conservation and Landscape Management, Seethalerstrasse 6, 83410 Laufen, Germany
| | - J Taskinen
- Department of Biological and Environmental Science, University of Jyväskylä, P.O. Box 35, 40014 University of Jyväskylä, Finland
| | - A Teixeira
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus de Santa Apolónia, 5300-253 Bragança, Portugal
| | - M Todorov
- Institute of Biodiversity and Ecosystem Research, Bulgarian Academy of Sciences, 1 Tsar Osvoboditel Blvd., 1000 Sofia, Bulgaria
| | - T Trichkova
- Institute of Biodiversity and Ecosystem Research, Bulgarian Academy of Sciences, 1 Tsar Osvoboditel Blvd., 1000 Sofia, Bulgaria
| | - M Urbańska
- Department of Zoology, Poznań University of Life Sciences, ul. Wojska Polskiego 28, 60-637 Poznań, Poland
| | - S Välilä
- Department of Biological and Environmental Science, University of Jyväskylä, P.O. Box 35, 40014 University of Jyväskylä, Finland
| | - S Varandas
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; CITAB-UTAD - Centre for Research and Technology of Agro-Environment and Biological Sciences, University of Trás-os-Montes and Alto Douro, Forestry Department, Vila Real, Portugal
| | - J Veríssimo
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - I V Vikhrev
- N. Laverov Federal Center for Integrated Arctic Research of the Ural Branch of the Russian Academy of Sciences, Nikolsky Av. 20, 163020 Arkhangelsk, Russia
| | - G Woschitz
- IFIS - Ichthyological Research Initiative Styria, 1160 Vienna, Austria
| | - K Zając
- Institute of Nature Conservation, Polish Academy of Sciences, Al. Adama Mickiewicza 33, 31-120 Kraków, Poland
| | - T Zając
- Institute of Nature Conservation, Polish Academy of Sciences, Al. Adama Mickiewicza 33, 31-120 Kraków, Poland
| | - D Zanatta
- Biology Department, Institute for Great Lakes Research, Central Michigan University, Mount Pleasant, MI 48859, USA
| | - A Zieritz
- School of Geography, University of Nottingham, University Park, Sir Clive Granger Building, Nottingham NG7 2RD, United Kingdom
| | - S Zogaris
- Hellenic Centre for Marine Research, Institute of Marine Biological Resources and Inland Waters, 46.7 km Athens-Sounio Av., Anavyssos 19013, Greece
| | - E Froufe
- CIIMAR/CIMAR - Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal
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Breder J, Breder I, Barreto J, Fernandes V, Zanchetta F, Oliveira B, Chaves F, Sposito A, Lima M. Health literacy and diabetic retinopathy. Braz J Med Biol Res 2024; 57:e13066. [PMID: 38265342 PMCID: PMC10802231 DOI: 10.1590/1414-431x2023e13066] [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] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the "Brazilian Diabetes Study" cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables.
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Affiliation(s)
- J.C. Breder
- Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - I. Breder
- Departamento de Cardiologia, Laboratório de Aterosclerose e Biologia Vascular, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - J. Barreto
- Departamento de Cardiologia, Laboratório de Aterosclerose e Biologia Vascular, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - V. Fernandes
- Departamento de Oftalmologia, Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - F. Zanchetta
- Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - B.A. Oliveira
- Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - F. Chaves
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A. Sposito
- Departamento de Cardiologia, Laboratório de Aterosclerose e Biologia Vascular, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - M.H.M. Lima
- Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brasil
- Departamento de Cardiologia, Laboratório de Aterosclerose e Biologia Vascular, Universidade Estadual de Campinas, Campinas, SP, Brasil
- Departamento de Oftalmologia, Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Campos Lopes S, Brito AI, Barbosa M, Matos AC, Lopes Pereira M, Monteiro AM, Fernandes V. Flash glucose monitoring system in gestational diabetes: a study of accuracy and usability. Hormones (Athens) 2023; 22:703-713. [PMID: 37740861 DOI: 10.1007/s42000-023-00485-z] [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: 07/24/2022] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Studies of flash glucose monitoring systems (FGMSs) in pregnancy are insufficient, especially in gestational diabetes (GD). Our aim was to evaluate Freestyle Libre's usability and accuracy (compared to self-monitoring of blood glucose [SMBG]) for GD patients in real-life conditions. METHODS This is a prospective study with pregnant women diagnosed with GD (n = 24 for the usability analysis; n = 19 for the accuracy analysis). The study duration was up to 28 days (lifetime of two sensors). Participants executed a minimum of four daily FGMS readings obtained immediately after capillary SMBG. Analytical accuracy was assessed with mean absolute relative difference (MARD) and mean absolute difference (MAD); clinical accuracy was assessed with Surveillance Error Grid (SEG). Usability was evaluated with a user acceptability questionnaire. RESULTS The mean pregestational BMI was 25.21 ± 5.15 kg/m2 (mean ± SD), the mean gestational age was 30.31 ± 2.02 weeks, and the mean glucose values were 76.63 ± 7.49 mg/dL. A total of 1339 SMBG-FGMS pairs of values were obtained. Analytical accuracy was good with an overall MARD of 14.07% and an in-target MARD of 13.79%. The number of SMBG-FMGS pairs for above-target values was low (122 of 1339) with an associated MARD of 17.95%. Clinical accuracy of the FGMS was demonstrated, with 94.4% of values in the no-risk or slight, lower risk zones of the SEG. FGMS accuracy was unaffected by pregestational BMI or gestational age. The user acceptability questionnaire showed high levels of satisfaction, with 95.8-100% preferring FGMS to SMBG. No unexpected or severe adverse effects occurred. CONCLUSION FGMS showed good performance in GD regarding accuracy and usability. Larger studies are needed to corroborate our results, verify the analytical accuracy of above-target values as this glucose range might lead to initiation or adjustment of pharmacological therapy, and ultimately establish definitive recommendations regarding prescription of FGMS for GD patients.
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Affiliation(s)
| | | | - Mariana Barbosa
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
| | | | | | | | - Vera Fernandes
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
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Fernandes V, Matos F, Oliveira J, Neves A, Godina R. Identifying strategic opportunities through the development of a roadmap for additive manufacturing: The example of Portugal. Heliyon 2023; 9:e19672. [PMID: 37809460 PMCID: PMC10558949 DOI: 10.1016/j.heliyon.2023.e19672] [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: 03/04/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Additive Manufacturing (AM) demonstrates significant potential with rapid growth and widespread industrial adoption. To support the integration and innovation of AM technologies, the development of guidance tools and support methods are crucial, and a technological roadmap can assist in this effort. Despite its widespread use in production processes, the need for further research on the potential impact of AM remains significant. The full impact of AM is still uncertain and lacks consensus, highlighting the need for increased knowledge and investment from the scientific community and organizations. While the benefits of AM are recognized, the challenges of its adoption are not entirely known. AM will bring changes in the way organizations create, distribute, and derive value. Thus, in this article, a roadmap for AM is proposed and presented as a tool to map technological knowledge on the implementation and evolution of AM and serve as a strategic guide for organizations. The methodology for its elaboration involves three phases: planning and preparation, roadmap development, and review and update. Through a literature review, database and project consultation, and questionnaires to Portuguese companies that use AM in their production process it was possible to characterize the AM technology and through the visual format, based on a time horizon, summarize in a common framework all the information about the current and future state of AM in Portugal. The results of this study show that research and development initiatives are essential to promote the evolution of knowledge of the AM technology. Throughout this study and with the development of the roadmap it is anticipated that in the near future the AM will be widely used for prototyping and manufacturing of components and may be used for direct production in the short to medium term. It was also found that the main obstacles to the implementation of AM are the economic/productivity factors and the shortage of professionals with knowledge and skills in the area.
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Affiliation(s)
- V. Fernandes
- Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica 2829-516, Portugal
| | - F. Matos
- Instituto Universitário de Lisboa (ISCTE-IUL), Centro de Estudos sobre a Mudança Socioeconómica e o Território (DINÂMIA’CET), 1649-026 Lisboa, Portugal
| | - J.P. Oliveira
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon, Caparica, Portugal
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica 2829-516, Portugal
| | - A. Neves
- Department of Mechanical Engineering, Polytechnic Institute of Viseu, 3504-510, Viseu, Portugal
| | - R. Godina
- Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica 2829-516, Portugal
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica 2829-516, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
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Barbosa M, Marques-Sá J, Carvalho C, Fernandes V. Is elevated blood glucose at admission associated with poor outcomes in hospitalized COVID-19 patients? Arch Endocrinol Metab 2023; 67:e000649. [PMID: 37364151 PMCID: PMC10661009 DOI: 10.20945/2359-3997000000649] [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] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/27/2023] [Indexed: 06/28/2023]
Abstract
Objective Hyperglycemia has been suggested as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). The aim of our work was to evaluate the association between blood glucose levels at admission (BGA) and disease outcomes in hospitalized COVID-19 patients. Subjects and methods Retrospective study including all adult COVID-19 patients admitted to a Portuguese hospital from March to August 2020 with BGA measurement. Subjects were categorized into two groups: BGA < 140 mg/dL and ≥ 140 mg/dL. Statistical analysis was performed using SPSSv26® (significance defined as p < 0.05). Results We included 202 patients: median age 74 (60-86) years; 43.1% female; 31.2% with diabetes. The median BGA was 130.5 (108-158) mg/dL. When compared to normoglycemic, patients with BGA ≥ 140 mg/dL were older (p = 0.013), more vaccinated for influenza (p = 0.025) and had more comorbidities (hypertension, heart failure and peripheral arterial disease, p < 0.05). The last group presented higher leucocyte and neutrophile count, higher procalcitonin and prothrombin time, and lower lymphocyte count. Concerning prognosis, BGA ≥ 140 mg/dL was associated with higher rates of mechanical ventilation requirement and intensive care unit admission (p < 0.001), shock (p = 0.011), in-hospital mortality (p = 0.022) and 30-day mortality (p = 0.037). Considering only non-diabetic patients (n = 139), those with hyperglycemia presented higher rates of severity indicators (polypnea, SatO2 ≤ 93% and PaO2/FiO2 ≤ 300) and an association with poor outcomes was also found, namely mechanical ventilation requirement and in-hospital/30-day mortality (p < 0.05). Conclusion Hyperglycemia at admission was associated with poor outcomes in COVID-19 patients, even in those without known pre-existing diabetes. Glycemic testing should be recommended for all COVID-19 patients.
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Affiliation(s)
- Mariana Barbosa
- Serviço de Endocrinologia, Hospital de Braga, Braga, Portugal,
| | | | - Carla Carvalho
- Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Vera Fernandes
- Serviço de Endocrinologia, Hospital de Braga, Braga, Portugal
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Antunes E, Lopes J, Silva I, Fernandes V. Pheochromocytoma: A Case Report. Cureus 2022; 14:e31409. [DOI: 10.7759/cureus.31409] [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] [Accepted: 11/12/2022] [Indexed: 11/13/2022] Open
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Soares S, Fernandes V, Rede D, Dorosh O, Moreira M, Rodrigues F, Delerue-Matos C. P12-47 Honey toxicology: from consumption to environment monitoring. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.526] [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: 10/14/2022]
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M M de Souza S, Medeiros-Ribeiro AC, Bredemeier M, Duarte A, Pinheiro M, Stadler B, Macieira JC, Ranza R, Miranda J, Valim V, Castro G, Bertolo M, Sauma MDF, Fernandes V, Botelho R, Brenol C, Da Silveira DE Carvalho HM, Studart S, Da Rocha Castelar Pinheiro G, Rocha L, De Leon de Lima H, Pereira I, Ohira Gazzeta M, Kakehasi A, Louzada P, Hayata ALS, Pina F, Alves Ferreira M, Balarini L, Silveira IG, Kowalski S, Titton D, Mendonça Da Silva Chakr R, Ranzolin A, Laurindo I, Xavier R. AB1173 INCIDENT CASES OF COVID-19 AND VACCINATION ADHERENCE IN A MULTICENTRIC COHORT OF INFLAMMATORY ARTHRITIS IN BRAZIL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4722] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe SARS-CoV-2 virus has caused a worldwide health crisis. Patients with inflammatory arthritis are at higher risk of hospitalization and death by COVID-19 due to comorbidities or immunosuppressive treatments. Vaccination is one the most important strategies to control the pandemic.ObjectivesTo evaluate the incident cases of SARS-CoV-2 infection in a multicentric cohort of inflammatory arthritis in Brazil.MethodsBiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or tsDMARD (1). The present analysis is a retrospective evaluation of adult patients with inflammatory arthritis (rheumatoid arthritis – RA, spondylarthritis -SpA and psoriatic arthritis-PsA) that were alive since the beginning of the COVID-19 pandemics in Brazil in February 2020. We evaluated the incidence and severity of COVID-19 infection and the adherence to anti- SARS-CoV-2 vaccines schedules, up to January 2022.ResultsA total of 300 patients were interviewed and 69 (23.0%) reported confirmed anti-SARS-CoV infection and 5 (1.7%) had a second infection. Among known infected patients, 18.8% need hospitalization and oxygen support, 7.2% were admitted at ICU, and 5.8% died. After COVID-19 infection, 31.8% reported worsening of disease activity but only 6.1% had modification in medication due to disease activity. Distribution of cases followed the pattern of waves observed in Brazil (Figure 1). Regarding vaccination, 285 (95%) reported to have received at least one dose of any anti-SARS-CoV-2 vaccine: 43% received the first with the adenovirus ChAdOx1 nCoV-19 (AstraZeneca) adenovirus vaccine, 32% received the Sinovac-CoronaVac inactivated vaccine, 22% received the BNT162b2 (Pfizer-BioNtech) mRNA vaccine and 3% received the BNT162b2 (Pfizer-BioNtech) adenovirus vaccine. Almost all (98.1%) of these patients had already received the second dose of vaccine and after the first and second vaccine doses, 6% and 4% of patients, respectively, reported worsening of articular disease activity, while, after the third dose, no patient reported disease activity worsening.Figure 1.ConclusionDuring the pandemics, patients with inflammatory arthritis had a pattern of distribution of cases very similar to general population. Adherence to vaccination is high and well tolerated.References[1]Bredemeier et al. J Rheumatol 2021;48:1519-27Disclosure of InterestsNone declared
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Barbosa M, Moreira Gomes P, Monteiro AM, Matos C, Lopes Pereira M, Fernandes V. Postpartum reclassification test in gestational diabetes: can the test be reduced to 1 hour? Hormones (Athens) 2022; 21:287-293. [PMID: 35288881 DOI: 10.1007/s42000-022-00359-w] [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: 09/13/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE In gestational diabetes mellitus (GDM), a postpartum oral glucose tolerance test (OGTT) is recommended. However, poor adherence to this procedure has been described, and the time required is one of the reasons. Our aims were to identify predictive factors for abnormal 2-h reclassification OGTT values, including OGTT 1-h glucose, and, if it was a factor, to determine the 1-h cutoff point that best identifies abnormal values at 2 h. METHODS This was a retrospective study of 769 patients diagnosed with GDM between 2014 and 2019 in a tertiary center. The sample was divided into two groups according to the presence/absence of abnormal 2-h reclassification values, and predictive factors were studied. To determine the 1-h glycemia cutoff point capable of identifying 2-h changes, a ROC curve was drawn and the Youden index was used. RESULTS The mean age of included women was 33.6 ± 4.95 years: 70 of them (9.1%) had an abnormal 2-h test result. Women with a history of GDM (OR = 3.41, p = .012) and higher 1-h glycemia value (OR = 1.05, p < .001) had a higher risk of developing an abnormal 2-h test result. One-hour glycemia ≥ 142 mg/dL had a sensitivity of 91.4% and specificity of 75.1% to identify changes in the test at 2 h; area under the curve to predict 2-h changes was 0.90 (CI 95%: 0.86 - 0.93). CONCLUSION Glucose measurement at 1 h predicts alterations at 2 h in the reclassification test with excellent diagnostic accuracy, and the cutoff point of ≥ 142 mg/dL presents high sensitivity. These findings could serve as a foundation for a possible future redefinition of the OGTT procedure, but further investigation is required.
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Affiliation(s)
- Mariana Barbosa
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal.
| | | | - Ana Margarida Monteiro
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Catarina Matos
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Maria Lopes Pereira
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Vera Fernandes
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
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Chakr R, Bredemeier M, Duarte A, Pinheiro M, Stadler B, Macieira JC, Ranza R, Miranda J, Valim V, Castro G, Bertolo M, Sauma MDF, Fernandes V, Medeiros-Ribeiro AC, Botelho R, Brenol C, Da Silveira De Carvalho HM, Studart S, Da Rocha Castelar Pinheiro G, Rocha L, Pereira I, De Leon de Lima H, Ohira Gazzeta M, Kakehasi A, Louzada P, Hayata ALS, Pina F, Lupo C, Balarini L, Silveira I, Schowalski S, Titton D, Ranzolin A, Laurindo I, Xavier R. POS0650 THE IMPACT OF OLD AGE ON THE PERSISTENCE AND SAFETY OF TREATMENT WITH BIOLOGIC AGENTS OR JAK INHIBITORS IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2706] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe effect of age on persistence and safety of treatment with biologic disease modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis has been a subject to research interest. Two recently published studies did not observe significantly different survival of treatment with bDMARDs among older age (≥ 65 years) individuals (1,2); incidence of serious adverse events was higher in these patients (2).Objectivesto evaluate association of the age with treatment survival and overall safety among patients receiving one or multiple courses of bDMARDs or targeted synthetic (ts-) DMARDs.MethodsBiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or tsDMARD (3). The present analysis includes RA patients recruited from Jan 2009 to Oct 2019, followed-up over one or multiple (up to six) courses of treatment necessarily involving a bDMARD or tsDMARD (latest date, Nov 19, 2019). Treatment course is defined as a period during which the medication scheme does not change, except for dose adjustments. Primary outcome was the incidence treatment interruption for any reason (except for pregnancy or disease remission), while interruption due to adverse events (AEs; including death) and due to inefficacy served as secondary outcomes. Incidence of serious adverse events (SAEs) also served as a secondary outcome. Extended (frailty) multivariate Cox proportional hazards models and negative binomial regression with generalized estimating equations (to calculate incidence rate ratios [IRRs]) were used for statistical analyses (both types of analyses including time-varying covariates over multiple courses of treatment).ResultsIn total, 1316 patients (2335 treatment courses, 6508 patient-years [PY]) were enrolled. Of these, 160 patients (643 PY; 237 treatment courses) were ≥ 65 years old, mean age at starting treatment = 71 ± 5 yrs (84% female). Old age was not significantly associated with treatment interruption for any reason, but presented higher risk of interruption due to adverse events (after multivariate adjustment) and lower risk of stopping because of inefficacy (see Table 1). Older patients presented higher incidence of SAEs than younger ones (16.0 vs 8.4/100 PY, respectively; multivariate IRR: 2.06, 95% CI: 1.51 to 2.80, P<0.001). Among old patients, tocilizumab (HR: 2.73, 95% CI: 1.13 to 6.64, P=0.026), etanercept (2.13, 1.12 to 4.07, P=0.022), and infliximab (2.39, 1.19 to 4.79, P=0.014) presented higher risk of treatment termination as compared with adalimumab. In this subgroup (age ≥65 yrs), there was no significant difference in the risk of SAEs between different bDMARDs/tsDMARDs.Table 1.Univariate and multivariate hazard ratios (HRs) of interruption of treatment course comparing older (≥65 years) versus younger patients (reference category). Results are HRs, 95% CIs, and P values.Cause of interruption (n of events)Crude analysisAdjusted covariates*Interruption - any reason (1321)0.96 (0.75 to 1.23), P=0.7601.09 (0.82 to 1.43), P=0.550Interruption - adverse events (368)1.33 (0.75 to 0.89), P=0.1601.59 (1.07 to 2.35), P=0.020Interruption - inefficacy (680)0.56 (0.39 to 0.80), P=0.0020.57 (0.38 to 0.87), P=0.009* Age, baseline DAS28, disease duration, gender, smoking, RF or anti-CCP, previous malignancy, interstitial lung disease, diabetes, hypertension, hypercholesterolemia, renal failure, ischemic cardiomyopathy, COPD, heart failure, concomitant use of each cs-, b-, and tsDMARDs, corticosteroids, starting year, osteoporosis, hepatitis B,C, treatment sequence.ConclusionThe overall risk of treatment interruption with biologic or targeted synthetic DMARDs is not higher in older patients. Higher risk of interruption due to AE was balanced by a lower risk of stopping treatment due to inefficacy. Older patients had a higher incidence of SAEs.References[1]Mathieu et al. Rheumatol Int 2021;41:879-85.[2]Freitas et al. Drugs Aging 2020;37:899-907.[3]Bredemeier et al. J Rheumatol 2021;48:1519-27.Disclosure of InterestsNone declared
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Bredemeier M, Duarte A, Pinheiro M, Stadler B, Macieira JC, Ranza R, Miranda J, Valim V, Castro G, Bertolo M, Sauma MDF, Fernandes V, Medeiros-Ribeiro AC, Botelho R, Brenol C, Da Silveira DE Carvalho HM, Studart S, Da Rocha Castelar Pinheiro G, Rocha L, De Leon de Lima H, Pereira I, Ohira Gazzeta M, Kakehasi A, Louzada P, Hayata ALS, Pina F, Alves Ferreira M, Balarini L, Silveira IG, Kowalski S, Titton D, Mendonça Da Silva Chakr R, Ranzolin A, Laurindo I, Xavier R. POS0242 THE EFFECT OF ANTIMALARIALS ON THE OVERALL SAFETY AND PERSISTENCE OF TREATMENT WITH BIOLOGIC AGENTS OR JAK INHIBITORS IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4120] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAntimalarials (AM) are frequently part of the initial scheme of conventional synthetic DMARDs in the treatment of rheumatoid arthritis (RA), and have been associated with lower incidence of diabetes and better lipid profile in these patients (1). However, the role of AM in schemes involving biologic (b-) or targeted synthetic (ts-) DMARDs has been much less extensively studied. In addition, a recent large scale study (2) and a consensus article (1) casted doubt on the long-term cardiovascular safety of AM.ObjectivesTo evaluate the association of concomitant use of AM with the overall safety and survival oftreatment course among patients receiving one or multiple courses of bDMARDs or tsDMARDsMethodsBiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or tsDMARD (3). The present analysis includes RA patients recruited from Jan 2009 to Oct 2019, followed-up over one or multiple (up to six) courses of treatment (latest date, Nov 19, 2019). A treatment course is defined as a period during which the medication scheme does not change. The primary outcome was the incidence of serious adverse events (SAEs). Total and system-specific adverse events (AEs), treatment interruption for any reason, interruption due to AEs and due to inefficacy served as secondary outcomes. Negative binomial regression with generalized estimating equations (to calculate the incidence rate ratios [ÌRRs]) and extended (frailty) Cox proportional hazards models were used for statistical analyses (both types of analyses including time-varying covariates over multiple courses of treatment).ResultsIn total, 1316 patients (2335 treatment courses, 6711 patient-years [PY]) were enrolled. The overall incidence of serious adverse events was 9.2/100 PY. AM were used over 354 courses (1254.5 PY) of therapy. The IRRs for the primary and secondary outcomes are presented in Table 1. AM were also associated with better treatment course survival (Figure 1), reducing the risk of interruption due to AEs (multivariate hazard ratio: 0.56, 95% CI: 0.39 to 0.81, P=0.002) and inefficacy (0.65, 0.48 to 0.87, P=0.003).Figure 1.Table 1.Univariate and multivariate incidence rate ratios (IRRs) of adverse events comparing use versus non-use (reference category) of antimalarials. Results are IRRs, 95% CIs, and P values.Type of adverse event (n of events)Crude analysisAdjusted covariates*Serious adverse events (617)0.60 (0.41 to 0.87), P=0.0070.51 (0.37 to 0.69), P<0.001Any adverse event (3494)0.65 (0.54 to 0.77), P<0.0010.68 (0.57 to 0.81), P<0.001Cardiovascular‡Serious (52)1.04 (0.49 to 2.20), P=0.9241.06 (0.45 to 2.50), P=0.891Total (163)0.90 (0.59 to 1.38), P=0.6420.93 (0.59 to 1.45), P=0.737InfectionsSerious (277)0.78 (0.44 to 1.39), P=0.4040.53 (0.34 to 0.83), P=0.006Total (1400)0.77 (0.61 to 0.98), P=0.0330.75 (0.60 to 0.94), P=0.014Hepatic‡Total (66)0.20 (0.07 to 0.64), P=0.0070.16 (0.04 to 0.57), P=0.005Glicemic control-relatedTotal (34)0.74 (0.29 to 1.92), P=0.5400.73 (0.26 to 2.00), P=0.535DyslipidemiaTotal (83)0.60 (0.31 to 1.13), P=0.1140.55 (0.28 to 1.06), P=0.074*Age, baseline DAS28, disease duration, gender, smoking, seropositivity (RF or anti-CCP), previous malignancy, interstitial lung disease, diabetes, hypertension, hypercholesterolemia, renal failure, ischemic cardiomyopathy, COPD, heart failure, concomitant use of each cs-, b-, and tsDMARDs, corticosteroids, starting year, osteoporosis, hepatitis B and C, and treatment sequence. ‡ Excluding infections.ConclusionAmong RA patients on treatment with bDMARDs or tsDMARDs, concomitant use of antimalarials reduced the incidence of serious and total AEs, including infections and hepatic AEs, and prolonged treatment course survival. No significant increase in the risk of cardiovascular AEs was observed.References[1]Desmarais et al. Arthritis Rheumatol 2021;73:2151-60.[2]Lane et al. Lancet Rheumatol 2020;2:e698–e711[3]Bredemeier et al. J Rheumatol 2021;48:1519-27.Disclosure of InterestsNone declared
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Barbosa M, Silva AS, Fernandes V. Lipodystrophy: Still an underdiagnosed complication of subcutaneous insulin administration. Clin Case Rep 2022; 10:e05551. [PMID: 35280102 PMCID: PMC8895884 DOI: 10.1002/ccr3.5551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/30/2021] [Revised: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 11/06/2022] Open
Abstract
Lipodystrophy is a common but often underdiagnosed complication of subcutaneous insulin injections. We present an illustrative case, aiming to remind physicians to consider lipodystrophy when evaluating a patient under insulin therapy with otherwise unexplained metabolic decompensation. A complete physical examination and patient education are crucial in this setting.
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Oliveira AC, Fino P, Fernandes V, Monteiro AM. [Primary Health Care Follow-up of Patients with Differentiated Thyroid Cancer: Are We Ready?]. ACTA MEDICA PORT 2021; 34:883-884. [PMID: 34989669 DOI: 10.20344/amp.16446] [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] [Received: 04/25/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022]
Affiliation(s)
| | - Patrícia Fino
- Unidade de Saúde Familiar Alcaides de Faria. Barcelos. Portugal
| | - Vera Fernandes
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal
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Barbosa M, Fernandes V. Rapid-onset clozapine-induced hyperglycaemia: pathways of glycaemic dysregulation. BMJ Case Rep 2021; 14:e243938. [PMID: 34518181 PMCID: PMC8438955 DOI: 10.1136/bcr-2021-243938] [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] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
Clozapine is an atypical antipsychotic used in refractory schizophrenia, also efficient in alleviating dyskinesia in Parkinson's disease. Despite its potency, this drug is associated with severe metabolic side effects, including increased risk for diabetes. We report the case of a 45-year-old overweight woman with Parkinson's disease who presented with rapid-onset hyperglycaemia within 2 months after starting clozapine for refractory dyskinaesia. She had a history of gestational diabetes. At presentation, her blood glucose level was 505 mg/dL and glycated haemoglobin 12.4%, with no catabolic symptoms. Clozapine was suspended and metformin was started, but adequate glycaemic control was achieved only with insulin therapy, along with exenatide and empagliflozin afterwards. We assume that clozapine acted as a trigger for rapid deterioration of glycaemic control through direct pathophysiological mechanisms, rather than an indirect slowly evolving weight gain-related metabolic syndrome pathway. Clinicians should be aware of this complication, enabling timely diagnosis and proper treatment.
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Affiliation(s)
| | - Vera Fernandes
- Endocrinology Department, Braga Hospital, Braga, Portugal
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Abreu M, Monticielo O, Fernandes V, Cristovão Maiorano A, Dos Santos Beserra F, Lamarao F, David N, De Veras B, Bica B, Sávio Nunes de Lima D, Maria Das Chagas Medeiros M. POS0747 MAPPING THE NATIONWIDE CLINICAL PROFILE AND PATTERNS OF CARE OF SLE IN BRAZIL – FINDINGS FROM THE MACUNAÍMA STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2421] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is an autoimmune disease with wide clinical variability. Brazil has vast regional diversity, both from an ethnic and socio-cultural point of view.Objectives:To map the clinical profile of SLE in Brazil and explore how this distribution is associated with regional disparities.Methods:This cross-sectional study (GSK Study 207353) evaluated 300 Brazilian patients ≥18 years old with SLE (American College of Rheumatology [ACR] criteria, 1997) who had been under SLE care for ≥1 year. Five SLE reference teaching facilities were selected, one in each of the following Brazilian regions: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Each region included 60 patients. Clinical and demographic characteristics, and patterns of care were measured through questionnaires completed by physicians or nurses. The SLE Disease Activity Index (SLEDAI) score described disease activity and the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) described damage accrual. To assess the potential association between regional disparities and clinical outcomes, a hospitalisation profile was described. A bootstrapping approach of logistic regression was used to explore potential factors associated with hospitalisation.Results:Overall, 92.3% of patients were female, with a mean (standard deviation; SD) age of 41.8 (12.7) years and a mean (SD) disease duration of 11.8 (7.9) years. Overall, 161 (53.7%) patients were of Latino origin; in the NO this proportion was 88%. White patients predominated in the SU (58.3%); and black patients in the SE (31.7%). The mean (SD) number of years of schooling was 11.3 (4.6), and was highest in the NO (14.2 [3.6]) and lowest in the SU (9.0 [4.0]; p<0.001). With regard to the distribution of the SLE clinical profile according to ACR criteria, arthritis was found in 221 patients and predominated in all regions (mean 73.7%), with a lower prevalence in the CO (40%; p<0.001; Figure 1A). The mean (SD) SLEDAI score was 4.33 (5.39) at the time of interview. The main contributing factors to disease activity, according to SLEDAI, were complement consumption (18%), arthritis (15.3%), and alopecia (15%). The SDI scale was scored for cataracts (15%), proteinuria (8.7%), and thrombosis (7.3%). Among the associated comorbidities, hypertension was predominant in the NO (35%; p=0.001). Smoking predominated in the SU (23%; p<0.001); obesity (27%; p=0.059) and dyslipidemia (35%; p=0.023), in the SE. Regarding patterns of care (Figure 1B), antimalarials were most frequently prescribed in the SE (88.3%) and the SU (91.7%). Corticosteroids prevailed in the NO (96.7%). The mean (SD) time between home and care facility was 4.5 (12.6) hours. Patients in the NO reported the longest transport time to reach the care facility (11.5 [25.4] hours; p<0.001). The hospitalisation rate during the study period was 21.3% across all regions, with no statistical difference between centres (p=0.651). Reasons for hospitalisation included disease activity (36 [12%]), infection (19 [6.3%]), surgery (10 [3.3%]), and management of clinical morbidities (6 [2.0%]). Hospitalisation was associated with ethnicity (p<0.016), occupational status (p<0.001), age (p=0.02), and the use of hydroxychloroquine (HCQ) or chloroquine (CQ; p<0.001).Conclusion:This nationwide study highlights ethnic, social, and patterns-of-care disparities among Brazilian patients with SLE. The modelling shows evidence that such disparities contribute to the divergent clinical spectrum observed in Brazil.Funding:GSKFigure 1.Distribution of the A) Brazilian SLE clinical profile according to the ACR Classification Criteria and B) Brazilian prescriptive profile for SLE treatment according to the use of immunosuppressive drugs, biological agents, and corticosteroids during the study (12 months)ANA, antinuclear antibodyAcknowledgements:Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared
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Abreu M, Monticielo O, Fernandes V, Cristovão Maiorano A, Dos Santos Beserra F, Lamarao F, David N, De Veras B, Bica B, Sávio Nunes de Lima D, Maria Das Chagas Medeiros M. POS1430 EPIDEMIOLOGY OF LUPUS NEPHRITIS IN BRAZIL: FINDINGS FROM THE MACUNAÍMA STUDY - A NATIONWIDE MULTICENTRIC STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2336] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lupus nephritis (LN) is one of the most serious organic manifestations of systemic lupus erythematosus (SLE). Ethnicity can contribute to disparities in the prevalence and disease activity of LN.Objectives:To assess the prevalence of LN in Brazilian patients with SLE and to determine factors associated with LN activity across the country.Methods:This cross-sectional study (GSK Study 207353) was carried out through face-to-face interviews and review of medical records (12-month study period). Adult patients with SLE (American College of Rheumatology [ACR] criteria, 1997) were included. Five SLE reference teaching centres were selected: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Patients with another disease whose morbidity surpassed SLE were excluded. LN was defined as reported in the medical record or history of confirmed renal biopsy; disease activity by pre-defined changes in SLE Disease Activity Index (SLEDAI) or the patient’s kidney disease during the study. Activity was assessed during (T0), 6 months before (T6), and 12 months before (T12) the interview. Systemic Lupus International Collaborating Clinics/ACR Damage Index score mapped damage accrual. Two pairings were performed, aiming to discriminate factors associated with LN and its activity, respectively. Matching technique was used to select similar individuals based on propensity scores, obtained from a logistic regression model. A bootstrapping method explored characteristic variables associated with the risk of progressing to LN.Results:Overall, 300 Brazilian patients with SLE were included in the study. Two groups were paired: LN group (N=150) and non-LN group (N = 141). The prevalence of LN in the paired sample (N=291) was 51.5%, with a disparity between centres (p<0.001; Figure 1A). Most patients were female (LN: 92.7%; non-LN: 94.3%) and the mean (standard deviation [SD]) age for the LN and non-LN groups was 39.46 (11.86) and 43.96 (12.18), respectively. History of serositis was associated with the presence of LN (42 [28.0%] vs 21 [14.9%] non-LN; p=0.010). Type IV histological class predominated in both groups, with no disparity between centres. Social disparities were noted between groups. Non-active workers prevailed among the LN group (115 [76.7%] vs 98 [69.5%] for non-LN, p=0.024).When pairing for disease activity at T12, 73 (50.3%) patients with LN (N=145) had active disease. There was regional disparity in terms of disease activity (Figure 1B), with a predominance of active LN in the NO (28 [68.3%]) and SU (16 [55.2%], p=0.026). Type IV histological class was the component most associated with active LN (active: 32 [43.8%]; non-active: 11 [15.3%], p<0.001). Variation in SLEDAI during the study period discriminated between active and non-active LN. The mean (SD) SLEDAI score at T12 was substantially higher in those with active LN compared with non-active LN (7.18 [4.83] vs 2.47 [4.63], p<0.001). As for the pattern of care, corticosteroids users prevailed in those with active LN (62 [84.9%] vs 45 [62.5%] for non-active LN, p=0.004). There was no disparity in the use of immunosuppressants, with the exception of cyclophosphamide use, noted among 16 (21.9%) patients with active LN and 6 (8.3%) patients with non-active LN (p=0.041). Psychotropic or anticonvulsant use was higher in patients with non-active LN (32 [44.4%] vs 17 [23.3%] patients with active LN, p=0.012). Consultation with a neurologist was verified in 15 (20.8%) patients with non-active LN and 6 (8.2%) with active LN (p=0.055). Hospitalisation occurred in 17 patients with non-active (23.6%) and active (23.3%) LN.Conclusion:Disparities in the prevalence of LN and its activity were evident between the regions across Brazil, highlighting differences in clinical factors, regional factors, and patterns of care.Funding:GSKFigure 1.Prevalence of A) LN among regional centres, comparing them to disease activity profile and prescriptive practice, and B) Active and non-active LN according to prescriptive practiceCQ, chloroquine; HCQ, hydroxychloroquine*At T12Acknowledgements:Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared
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Bredemeier M, Duarte A, Pinheiro M, Stadler B, Macieira JC, Ranza R, Miranda J, Valim V, Castro G, Bertolo M, Sauma MDF, Fernandes V, Medeiros A, Botelho R, Brenol C, Negrão Gonçalo Dias D, Carvalho H, Studart S, Da Rocha Castelar Pinheiro G, Rocha L, Pereira I, Ohira Gazzeta M, Maria Kakehasi A, Louzada P, Hayata ALS, Pina F, Lupo C, Balarini L, Silveira I, Kowalski S, Titton D, Chakr R, Ranzolin A, Laurindo I, Xavier R. POS0676 SURVIVAL OF THE FIRST COURSE OF BIOLOGIC OR JAK INHIBITOR IN RHEUMATOID ARTHRITIS: ASSOCIATION WITH THE CHOICE OF AGENT AND CONCOMITANT CONVENTIONAL SYNTHETIC DMARDS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3841] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:After failure of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) in the therapy of rheumatoid arthritis (RA), treatment may be escalated to biologic (bDMARDs) or JAK inhibitors (JAKi) (1). Analysis of drug survival can provide useful information on the effectiveness of these therapeutic schemes.Objectives:to evaluate the association of the choice of therapeutic agent with the survival of treatment course in RA patients receiving their first bDMARD or JAKi.Methods:BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients starting their first bDMARD/JAKi (2). This analysis includes RA patients recruited from Jan 2009 to Oct 2019, followed-up over the first course of treatment with a bDMARD/JAKi until censoring (latest date, Nov 19, 2019) or occurrence of the outcome of interest. A treatment course is defined as a period during which the medication scheme does not change, except for dose adjustments. The primary outcome was the interruption of treatment course for any reason (except for pregnancy or disease remission); interruption of treatment due to adverse events (AEs) or death and due to inefficacy served as secondary outcomes. Multivariate Cox proportional hazards models were used for analyses.Results:In total, 1177 patients (3800 patient-years [PY]) were enrolled. The overall incidence of treatment interruption was 17.5/100 PY. Adalimumab was the most frequently prescribed agent, followed by infliximab (n= 267). The hazards ratios (HR) of the primary and secondary outcomes are presented in Table 1. Figure 1 compares the survival of treatment curves of different bDMARDs/JAKi.Table 1.Hazard ratios (HR) of interruption of therapy course of each therapeutic agent (the reference category for bDMARDs/ JAKi is infliximab). Results are HR, 95% CIs, and P values*.Agent (number of patients)Interruption for any reason (665 events)Interruption due to adverse events or death (196 events)Interruption due to inefficacy (319 events)Adalimumab (354)0.83 (0.68 to 1.01), P= 0.0620.68 (0.48 to 0.96), P=0.0291.08 (0.80 to 1.44), P=0.621Etanercept (257)0.81 (0.66 to 1.01), P=0.0630.56 (0.37 to 0.83), P=0.0040.93 (0.68 to 1.29), P=0.674Certolizumab (80)0.74 (0.47 to 1.16), P=0.1850.33 (0.13 to 0.86), P=0.0241.32 (0.74 to 2.35), P=0.350Golimumab (53)0.86 (0.53 to 1.38), P=0.5300.46 (0.18 to 1.19), P=0.1111.07 (0.53 to 2.15), P=0.849JAKi (tofacitinib) (59)0.54 (0.30 to 0.99), P=0.0470.19 (0.04 to 0.82), P=0.0260.89 (0.41 to 1.96), P=0.779Rituximab (48)0.87 (0.55 to 1.37), P=0.5400.48 (0.20 to 1.18), P=0.1090.58 (0.26 to 1.34), P=0.205Abatacept (30)0.52 (0.25 to 1.07), P=0.0770.46 (0.14 to 1.56), P=0.2150.46 (0.14 to 1.52), P=0.203Tocilizumab (29)0.29 (0.14 to 0.63), P=0.0020.40 (0.12 to 1.30), P=0.1260.28 (0.09 to 0.90), P=0.033Methotrexate (792)0.95 (0.79 to 1.14), P=0.5610.86 (0.62 to 1.19), P=0.3620.98 (0.75 to 1.28), P=0.860Leflunomide (497)1.17 (0.99 to 1.39), P=0.0611.44 (1.06 to 1.96), P=0.0201.02 (0.80 to 1.30), P=0.856Sulfasalazine (48)1.18 (0.80 to 1.75), P=0.4011.94 (1.07 to 3.54), P=0.0300.85 (0.45 to 1.59), P=0.605Antimalarials (230)0.80 (0.65 to 0.98), P=0.0270.67 (0.45 to 0.99), P=0.0430.67 (0.50 to 0.92), P=0.011* All tests adjusted for other variables presented in the table and for age, baseline DAS28, disease duration, gender, smoking, seropositivity (RF/anti-CCP), previous malignancy, diabetes, hypertension, hypercholesterolemia, renal failure, ischemic cardiomyopathy, COPD, heart failure, use of corticosteroids, starting year, hypercholesterolemia, osteoporosis, hepatitis B and C.Conclusion:In our study, infliximab was related to an overall higher hazard of treatment course interruption than tolicizumab and tofacitinib, and higher hazard of interruption due to AEs than most other anti-TNF agents and tofacitinib. Maintaining antimalarials in patients receiving advanced therapies for RA may reduce interruption of treatment due to inefficacy and AEs.Disclosure of Interests:None declared
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Marques-Sá J, Barbosa M, Fernandes V, Santos MJ. Nearly fatal hypokalaemia due to non-hypertensive primary hyperaldosteronism in the post partum. BMJ Case Rep 2021; 14:14/3/e240018. [PMID: 33753383 PMCID: PMC7986951 DOI: 10.1136/bcr-2020-240018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A previously healthy postpartum 33-year-old woman was admitted at the emergency department after two episodes of syncope. In the waiting room, she collapsed, ventricular fibrillation was detected, and she was reanimated by electric cardioversion. At admission, she was conscient, with blood pressure of 102/74 mm Hg and heart rate of 78 bpm. In the laboratory workup, severe hypokalaemia was found (K+ 1.77 mEq/L). Abdominopelvic CT revealed a 27 mm nodule in the right adrenal gland. High aldosterone and low plasma renin levels were detected, and the diagnosis of primary hyperaldosteronism was made, although she never had hypertension. Posteriorly, a cosecretion of aldosterone and cortisol was found. Two months after admission, the patient remained stable with normal K+ levels under spironolactone and a right adrenalectomy was performed. The cure of primary hyperaldosteronism and a partial adrenal insufficiency were confirmed. K+ levels and blood pressure remained normal without treatment and 10 months after surgery hydrocortisone was suspended.
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Affiliation(s)
| | | | - Vera Fernandes
- Endocrinology Department, Braga Hospital, Braga, Portugal
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Barbosa M, Lopes S, Fernandes V, Monteiro AM. Obesity and COVID-19: A Forgotten Relationship. ACTA MEDICA PORT 2021; 34:161. [PMID: 33641710 DOI: 10.20344/amp.15423] [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] [Received: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Mariana Barbosa
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal
| | - Sara Lopes
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal
| | - Vera Fernandes
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal
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Costa D, Lourenço J, Monteiro AM, Castro B, Oliveira P, Tinoco MC, Fernandes V, Marques O, Gonçalves R, Rolanda C. Clinical Performance of Flash Glucose Monitoring System in Patients with Liver Cirrhosis and Diabetes Mellitus. Sci Rep 2020; 10:7460. [PMID: 32366878 PMCID: PMC7198519 DOI: 10.1038/s41598-020-64141-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/30/2019] [Accepted: 04/06/2020] [Indexed: 12/22/2022] Open
Abstract
Flash glucose monitoring system (FGMS) is an improved subset of continuous glucose monitoring with a recognized effectiveness on glycemic control, though validation in patients with Liver Cirrhosis (LC) is lacking. To evaluate the accuracy of FGMS in patients with Type 2 Diabetes Mellitus (DM) and LC, a prospective, case-control study was performed in 61 ambulatory patients with LC and DM (LC group, n = 31) or DM (Control group, n = 30). During 14 days, patients performed 4 assessments per day of self-monitoring of blood glucose (SMBG, reference value) followed by FGMS scanning. There were 2567 paired SMBG and FGMS values used in the accuracy analysis, with an overall mean absolute relative difference (MARD) of 12.68% in the LC group and 10.55% in the control group (p < 0,001). In patients with LC, the percentage of readings within Consensus Consensus Error Grid analysis Zone A and A + B were 80.36% and 99,26%, respectively. Sensor clinical accuracy was not affected by factors such as body mass index, age, gender, Child-Pugh score or edematoascitic decompensation. This is the first study to approach FGMS clinical accuracy in LC, revealing a potential usability of this system to monitor glycemic control in this population.
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Affiliation(s)
- Dalila Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. .,Gastroenterology Department, Braga Hospital, Braga, Portugal.
| | - Joana Lourenço
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | | | - Beatriz Castro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | | | | | - Vera Fernandes
- Endocrinology Department, Braga Hospital, Braga, Portugal
| | - Olinda Marques
- Endocrinology Department, Braga Hospital, Braga, Portugal
| | | | - Carla Rolanda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,Gastroenterology Department, Braga Hospital, Braga, Portugal
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Patita M, Nunes G, Fernandes V. Sigmoidorectal intussusception as the first manifestation of colonic neoplasia. Revista de Gastroenterología de México (English Edition) 2019. [DOI: 10.1016/j.rgmxen.2019.09.002] [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: 10/25/2022] Open
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Patita M, Nunes G, Fernandes V. Sigmoidorectal intussusception as the first manifestation of colonic neoplasia. Rev Gastroenterol Mex (Engl Ed) 2019; 84:513-514. [PMID: 31519315 DOI: 10.1016/j.rgmx.2019.03.007] [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] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/21/2019] [Indexed: 11/25/2022]
Affiliation(s)
- M Patita
- Departamento de Gastroenterología, Hospital Garcia de Orta, Almada, Portugal.
| | - G Nunes
- Departamento de Gastroenterología, Hospital Garcia de Orta, Almada, Portugal
| | - V Fernandes
- Departamento de Gastroenterología, Hospital Garcia de Orta, Almada, Portugal; Departamento de Gastroenterología, CUF Clínica Almada, Almada, Portugal
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Rodrigues C, Alfaro T, Fernandes L, Ferreira P, Silva S, Costa JC, Fernandes V, Seixas E, Viana R. Does practice follow evidence-based guidelines? Adherence to GOLD guidelines in Portugal. Pulmonology 2019; 25:177-179. [PMID: 31000443 DOI: 10.1016/j.pulmoe.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/08/2019] [Accepted: 02/24/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- C Rodrigues
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Coimbra, Portugal.
| | - T Alfaro
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra - Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - L Fernandes
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - P Ferreira
- Pulmonology Department, Centro Hospitalar do Baixo Vouga - Hospital Infante D. Pedro, Aveiro, Portugal
| | - S Silva
- Pulmonology Department, Centro Hospitalar de Leiria - Hospital de Santo André, Leiria, Portugal
| | - J C Costa
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Coimbra, Portugal
| | - V Fernandes
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra - Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - E Seixas
- Pulmonology Department, Centro Hospitalar do Baixo Vouga - Hospital Infante D. Pedro, Aveiro, Portugal
| | - R Viana
- Pulmonology Department, Centro Hospitalar de Leiria - Hospital de Santo André, Leiria, Portugal
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Matta-Coelho C, Monteiro AM, Fernandes V, Pereira ML, Souto SB. Universal vs. risk-factor-based screening for gestational diabetes-an analysis from a 5-Year Portuguese Cohort. Endocrine 2019; 63:507-512. [PMID: 30255292 DOI: 10.1007/s12020-018-1760-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/08/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus. METHODS Retrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. RISK FACTORS body mass index > 30kg/m2, history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. EXCLUSION CRITERIA lack of data concerning risk factors (n = 1563). RESULTS At least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001). CONCLUSION Almost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therapy.
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Affiliation(s)
- Claudia Matta-Coelho
- Endocrinology Department, Hospital de Braga, Braga, Portugal.
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.
| | | | - Vera Fernandes
- Endocrinology Department, Hospital de Braga, Braga, Portugal
| | | | - Selma B Souto
- Endocrinology Department, Hospital de Braga, Braga, Portugal
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Macedo Silva S, Carvalho A, Lopes-Pereira M, Fernandes V. [Subclinical Hypothyroidism on the Elderly]. ACTA MEDICA PORT 2018; 31:766-773. [PMID: 30684374 DOI: 10.20344/amp.10991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/26/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Subclinical hypothyroidism, defined as an increase of thyroid stimulating hormone levels with normal levels of thyroid hormones, could have a multiorgan impact. There seem to be differences in the elderly (over 65 years of age) which indicate that there should be a different approach in terms of diagnosis and the treatment. MATERIAL AND METHODS Electronic database search and narrative bibliographical review. RESULTS Different case studies showing the multiorgan consequences of subclinical hypothyroidism suggest that, in the elderly, there is a minor impact or even a lack of repercussion, especially in those over 80 - 85 years old. Additionally, there is evidence indicating that the levels of thyroid stimulating hormone rise with the age of the patient. The standard treatment, in the beginning, is a low dose of levothyroxine when the levels of thyroid stimulating hormone are over 10.0 mIU/L, when there are noticeable symptoms or positive anti-thyroid antibodies. However, the treatment is not consensual when the levels of thyroid stimulating hormone are between 4.5 and 10.0 mIU/L, in such a way that the TRUST study concluded that no benefits have outcome from treating these patients. DISCUSSION The non-definition of the reference range and the age gap are the key factors that contribute the most to biased results. However, there is consensus regarding non-treatment of mild thyroid dysfunctions (4.5 - 7.0 mIU/L) in the elderly, particularly above 80 years of age. Nevertheless, for positive anti-thyroid antibodies, suggestive ultrasound changes or iatrogenic side effects, the reference level should be 4.5 mIU/L. CONCLUSION The general impact of subclinical hypothyroidism is different in elderly people, meaning that an individualized therapeutic approach and long-term monitoring is the appropriate strategy.
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Affiliation(s)
| | | | | | - Vera Fernandes
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal
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Santos MJ, Fernandes V. Gestational diabetes mellitus: different management strategies should be adopted for different subsets of patients diagnosed by oral glucose tolerance test. Endocrine 2018; 62:602-610. [PMID: 30088142 DOI: 10.1007/s12020-018-1704-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/19/2018] [Accepted: 07/26/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria based on the number of OGTT diagnostic criteria, which OGTT parameters are altered and the glycemic deviation from proposed diagnostic cutoffs. METHODS Cross-sectional, multicentric study of women diagnosed with GDM between 24-28 weeks of pregnancy according to the IADPSG criteria, in Portugal, between 2012-2014. Primary outcomes: large for gestational age (LGA) and maternal glucose metabolism status after delivery. Secondary outcome: small for gestational age (SGA). RESULTS Three-thousand three-hundred fourteen patients were included; 67% had 1 OGTT altered value; 3.6% had LGA and 13% had SGA newborns; 7% had prediabetes/diabetes after delivery. Three diagnostic criteria in OGTT (OR 3.02; p < 0.001), a diagnostic value at 0 min (OR 2.09; p = 0.002) and 60 min (OR 1.70; p = 0.022) and glucose deviation at 0 min (OR 1.02; p = 0.014) were predictors of LGA. Having 2 (OR 1.94; p < 0.001) or 3 (OR 3.93; p < 0.001) diagnostic criteria in OGTT, a diagnostic value at 0 min (OR 1.76; p = 0.002), at 60 min (OR 1.57; p = 0.007) and at 120 min (OR 3.11; p < 0.001), the glucose deviation at 0 (OR 1.02; p = 0.017) and 120 min (OR 1.02; p < 0.001) were predictors of prediabetes/diabetes after delivery. Insufficient weight gain in pregnancy (OR 1.49; p < 0.001) and lower maternal BMI (OR 0.97; p = 0.024) were associated with SGA. CONCLUSION IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.
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Affiliation(s)
- Maria Joana Santos
- Endocrinology Department, Hospital de Braga, Sete Fontes-São Victor, 4710-243, Braga, Portugal.
- Harvard Medical School's Portugal Clinical Scholars Research Training Program, Lisboa, Portugal.
| | - Vera Fernandes
- Endocrinology Department, Hospital de Braga, Sete Fontes-São Victor, 4710-243, Braga, Portugal
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Monteiro AM, Fernandes V, Matta-Coelho C, Paredes S, Pereira ML, Marques O, Alves M. Iron Deficiency and Obesity - Are we Diagnosing with Appropriate Indicators? ACTA MEDICA PORT 2018; 31:478-482. [PMID: 30332371 DOI: 10.20344/amp.8916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/02/2017] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We aim to define the iron deficiency prevalence and eventual differences between obese patients with and without metabolic syndrome. MATERIAL AND METHODS Analysis of patients evaluated at multidisciplinary consultation of obesity in our institution between 2013 and 2015 (n = 260). Iron deficiency: ferritin levels < 15 ng/mL. EXCLUSION CRITERIA prior bariatric surgery; lack of ferritin or hemoglobin determinations. RESULTS We analyzed data from 215 patients (84.2% female) with a mean age of 42.0 ± 10.3 years. The median body mass index was 42.5 (40.0 - 46.8) kg/m2 and 52.1% had metabolic syndrome. Iron deficiency was present in 7.0%, with no differences between genders or between patients with or without metabolic syndrome. Hypertension was associated with lower prevalence of iron deficiency. Type 2 diabetes and hypertension patients had higher levels of ferritin. The multivariate analysis showed that metabolic syndrome and increasing body mass index were predictive of higher risk of iron deficiency while hypertension predicted lower odds of iron deficiency. DISCUSSION The prevalence of iron deficiency was similar in other published studies. Iron deficiency may be underdiagnosed if based only on ferritin concentrations. In our study, diabetes and hypertension appear to contribute to the increase in ferritin levels described in obesity. CONCLUSION Ferritin may not be a reliable index for evaluating iron stores in obese patients, particularly when associated with comorbidities such as type 2 diabetes and hypertension. Further studies are needed to guide the diagnosis and iron supplementation in these patients.
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Affiliation(s)
| | - Vera Fernandes
- Departamento de Endocrinologia. Hospital de Braga. Braga, Portugal
| | | | - Sílvia Paredes
- Departamento de Endocrinologia. Hospital de Braga. Braga, Portugal
| | - Maria Lopes Pereira
- Departamento de Endocrinologia. Hospital de Braga. Braga, Portugal; Consulta Multidisciplinar de Obesidade. Hospital de Braga. Braga. Portugal
| | - Olinda Marques
- Departamento de Endocrinologia. Hospital de Braga. Braga, Portugal
| | - Marta Alves
- Departamento de Endocrinologia. Hospital de Braga. Braga, Portugal; Consulta Multidisciplinar de Obesidade. Hospital de Braga. Braga. Portugal
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Fernandes V, Monteiro AM, Santos MJ, Pereira ML, Marques O. Síndrome de Cushing Ectópica: Um Desafio Diagnóstico e Terapêutico. Gaz Med 2018. [DOI: 10.29315/gm.v5i1.141] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUÇÃO: A síndrome de Cushing ectópica é uma entidade rara e a identificação do tumor produtor de hor-mona adrenocorticotrópica (ACTH) pode ocorrer anos após o diagnóstico da síndrome de Cushing, dificultando a orientação terapêutica destes doentes.CASO CLÍNICO: Mulher de 78 anos referenciada à consulta de Endocrinologia por síndrome de Cushing. Apresenta-va sinais e sintomas de hipercortisolismo e a investigação demonstrou síndrome de Cushing ACTH dependente, com ressonância magnética hipofisária sem alterações, cateterismo dos seios petrosos negativo e nódulo pulmonar de 8 mm. A cintigrafia com recetores da somatostatina, a PET-68Ga-SRP, a broncofibroscopia e a citologia do aspirado brônquico não revelaram alterações. Por franco agravamento clínico, iniciou-se terapêutica com metirapona, com resposta clínica e analítica muito favorável. DISCUSSÃO: Este caso revelou-se um desafio diagnóstico e terapêutico. Embora sem localização do tumor primário, atingiu-se o principal objetivo, o controlo do hipercortisolismo, com melhoria da qualidade de vida da doente.
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Ferreira L, Silva J, Garrido S, Bello C, Oliveira D, Simões H, Paiva I, Guimarães J, Ferreira M, Pereira T, Bettencourt-Silva R, Martins AF, Silva T, Fernandes V, Pereira ML. Primary adrenal insufficiency in adult population: a Portuguese Multicentre Study by the Adrenal Tumours Study Group. Endocr Connect 2017; 6:935-942. [PMID: 29089364 PMCID: PMC5712836 DOI: 10.1530/ec-17-0295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Primary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. No previous studies have characterized Portuguese patients with PAI. AIMS To characterize the clinical presentation, diagnostic workup, treatment and follow-up of Portuguese patients with confirmed PAI. METHODS This multicentre retrospective study examined PAI patients in 12 Portuguese hospitals. RESULTS We investigated 278 patients with PAI (55.8% were females), with a mean age of 33.6 ± 19.3 years at diagnosis. The most frequent presenting clinical features were asthenia (60.1%), mucocutaneous hyperpigmentation (55.0%) and weight loss (43.2%); 29.1% of the patients presented with adrenal crisis. Diagnosis was established by high plasma ACTH and low serum cortisol in most patients (43.9%). The most common aetiology of PAI was autoimmune adrenalitis (61.0%). There were 38 idiopathic cases. Autoimmune comorbidities were found in 70% of the patients, the most frequent being autoimmune thyroiditis (60.7%) and type 1 diabetes mellitus (17.3%). Seventy-nine percent were treated with hydrocortisone (mean dose 26.3 ± 8.3 mg/day) mostly in three (57.5%) or two (37.4%) daily doses. The remaining patients were treated with prednisolone (10.1%), dexamethasone (6.2%) and methylprednisolone (0.7%); 66.2% were also on fludrocortisone (median dose of 100 µg/day). Since diagnosis, 33.5% of patients were hospitalized for disease decompensation. In the last appointment, 17.2% of patients had complaints (7.6% asthenia and 6.5% depression) and 9.7% had electrolyte disturbances. CONCLUSION This is the first multicentre Portuguese study regarding PAI. The results emphasize the need for standardization in diagnostic tests and etiological investigation and provide a framework for improving treatment.
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Affiliation(s)
- Lia Ferreira
- Department of EndocrinologyCentro Hospitalar do Porto, Porto, Portugal
| | - João Silva
- Department of EndocrinologyHospital das Forças Armadas, Lisboa, Portugal
| | - Susana Garrido
- Department of EndocrinologyCentro Hospitalar Tâmega e Sousa, Porto, Portugal
| | - Carlos Bello
- Department of EndocrinologyCentro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Diana Oliveira
- Department of EndocrinologyCentro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Hélder Simões
- Department of EndocrinologyInstituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Isabel Paiva
- Department of EndocrinologyCentro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Guimarães
- Department of EndocrinologyCentro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Marta Ferreira
- Department of EndocrinologyCentro Hospitalar de Leiria, Leiria, Portugal
| | - Teresa Pereira
- Department of EndocrinologyCentro Hospitalar de Leiria, Leiria, Portugal
| | | | - Ana Filipa Martins
- Department of EndocrinologyCentro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Tiago Silva
- Department of EndocrinologyHospital Garcia da Orta, Lisboa, Portugal
| | - Vera Fernandes
- Department of EndocrinologyHospital de Braga, Braga, Portugal
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Coelho CM, Monteiro AM, Fernandes V, Manso F, Marques O, Souto SB. Hipertensão de Causa Endócrina: Hiperaldosteronismo Primário por Síndrome de Conn. Gaz Med 2017. [DOI: 10.29315/gm.v4i2.27] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
O hiperaldosteronismo primário é uma das principais causas de hipertensão secundária. Carateriza-se pela produção inapropriada e parcialmente autónoma de aldosterona pela suprarrenal. O diagnóstico pressupõe um rácio aldosterona/renina elevado e, na maioria dos casos, uma prova confirmatória positiva. O tratamento preconizado é a adrenalectomia laparoscópica ou terapêutica médica com antagonistas dos recetores dos mineralocorticoides.
Descrevemos o caso de uma doente de 55 anos com hipocaliemia e hipertensão arterial refratária à terapêutica com 16 anos de evolução. A investigação diagnóstica foi compatível com hiperaldosteronismo primário por adenoma adrenal unilateral. Foi submetida a adrenalectomia laparoscópica direita, com melhoria franca do quadro clínico. O caso clínico apresentado pretende evidenciar uma causa de hipertensão secundária cuja identificação e orientação adequada pode permitir a resolução da hipertensão.
Recebido: 10/10/2016 - Aceite: 03/06/2017
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Monteiro AM, Matta-Coelho C, Fernandes V, Marques O. Type 2 Diabetes Decompensation as the Clinical Presentation of Thyroid Storm - Cause or Consequence? Eur Endocrinol 2017; 13:99-101. [PMID: 29632616 PMCID: PMC5813473 DOI: 10.17925/ee.2017.13.02.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022]
Abstract
This case study aims to discuss the unusual forms of hyperthyroidism presentation, the nonspecific symptoms and precipitating events. A 70-year-old male was taken to the emergency department for hyperglycaemia, nausea, vomiting and altered mental status with a week of evolution. He had a past medical history of type 2 diabetes, hypertension and dyslipidemia. He had no history of any recent intercurrent illness or infection. At the emergency room, besides hyperglycaemia, ketonemia and slightly elevated C-reactive protein, the basic laboratory panel workup was normal, as was the head computed tomography. He was admitted for metabolic compensation and to study the altered neurological status. During hospitalisation, despite the good glycemic control, he had no improvements in neurological status. At day four of hospitalisation, thyrotoxicosis with thyroid storm criteria was diagnosed. He started on adequate treatment with complete clinical recovery. The associated morbidity and mortality of thyroid storm requires immediate recognition and treatment. Elderly patients are frequently misdiagnosed or diagnosed later due to fewer and less pronounced signs and symptoms.
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Affiliation(s)
| | | | - Vera Fernandes
- Endocrinology Department, Hospital de Braga, Braga, Portugal
| | - Olinda Marques
- Endocrinology Department, Hospital de Braga, Braga, Portugal
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Fernandes V, Fernandes L, Tacon K, Rodrigues F, Alves de Carvalho F, Santana Parreira S, Fachin-Martins E, Menezes R. WOULD THE DIFFERENT POSTURAL KINDS IN UPRIGHT POSITION BE RELATED WITH AGING STABILITY PARAMETERS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4026] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V. Fernandes
- UnB, Brasília, Brazil,
- UniEVANGELICA, Anápolis, Brazil
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Fernandes V, Pereira T, Eloy C. [Fine-needle Aspiration of Thyroid Nodules: Is it Worth Repeating?]. ACTA MEDICA PORT 2017; 30:472-478. [PMID: 28898614 DOI: 10.20344/amp.8215] [Citation(s) in RCA: 4] [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: 03/02/2016] [Accepted: 11/18/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results. MATERIAL AND METHODS Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule. RESULTS The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3. DISCUSSION The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases. CONCLUSION The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.
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Affiliation(s)
- Vera Fernandes
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal; ICVS - Instituto de Investigação em Ciências da Vida e Saúde. Escola de Ciências da Saúde. Universidade do Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - Tânia Pereira
- IPATIMUP Diagnósticos. Instituto de Patologia e Imunologia Molecular. Universidade do Porto. Porto. Portugal
| | - Catarina Eloy
- IPATIMUP Diagnósticos. Instituto de Patologia e Imunologia Molecular. Universidade do Porto. Porto. Portugal; Departamento de Patologia. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Falcão J, Valim V, Titton D, Ranza R, Carvalho H, Bianchi W, Stadler B, Fernandes V, Louzada P, Bertolo M, Duarte A, Macieira J, Miranda J, Castelar G, Freire M, Toledo R, Moraes J, Costa I, Pereira I, Sauma M, Castro G, Brenol C, Zandonade E, Laurindo I, Baaklini C. FRI0195 Switching from anti-TNF To Non anti-TNF Therapy Yield Better Survival in Rheumatoid Arthritis (RA): Results from Brazilian Register of Biological Agents in Rheumatic Diseases – Biobadabrasil. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4484] [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: 11/04/2022]
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Ranza R, Laurindo I, Titton D, Bertolo M, Bianchi W, Brenol C, Carvalho H, Castro G, Cecconi M, Costa I, Duarte A, Fernandes V, Freire M, Louzada P, Maciera J, Miranda J, Moraes J, Pereira I, Pinheiro G, Sauma M, Stadler B, Toledo R, Valim V, Baaklini C, Descalzo M. SAT0601 Incidence of Serious Infections in Patients with Rheumatoid Arthritis and Spondyloarthritis Exposed To a-TNF Therapy. Results from Biobadabrasil Registry. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5009] [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: 11/04/2022]
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Carvalho H, Laurindo I, Ranza R, Titton D, Bertolo M, Bianchi W, Brenol C, Castelar G, Castro G, Costa I, Duarte A, Fernandes V, Freire M, Louzada P, Macieira J, MIranda J, Moraes J, Pereira I, Sauma M, Stadler B, Toledo R, Valim V, Baaklini C. SAT0586 Herpes Zoster in The Brazilian Register -Biobadabrasil. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5238] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ranza R, Laurindo I, Titton D, Bertolo M, Bianchi W, Brenol C, Bustamante M, Carvalho H, Castro G, Costa I, Duarte A, Fernandes V, Freire M, Louzada P, Maciera J, Miranda J, Moraes J, Pereira I, Pinheiro G, Sauma M, Stadler B, Toledo R, Valim V, Baaklini C, Descalzo M. THU0631 Incidence of Serious Adverse Events in Patients with Rheumatoid Arthritis Exposed To Biologic Therapies. Results from Biobadabrasil Registry. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1560] [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: 11/03/2022]
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Fernandes V, Santos MJ, Pérez A. Statin-related myotoxicity. ACTA ACUST UNITED AC 2016; 63:239-49. [DOI: 10.1016/j.endonu.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/01/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Abstract
Giant prolactinomas are rare pituitary tumours of which management can be a challenge. A 28-year-old man presented with headaches, visual impairment and behavioural changes. Clinically, the patient was found to have hypogonadism and bitemporal hemianopsia. A MRI demonstrated a pituitary tumour 76 mm in diameter and blood tests revealed a serum prolactin of 158,700 µU/mL (reference range 58-254). Initially, a craniotomy was performed. Immunohistochemistry of the tumour identified a prolactinoma with a high proliferative index and the patient was started on treatment with a dopamine agonist. A year later, neurological symptoms worsened due to regrowth of the lesion's cystic component, and so further surgery was performed. After 10 years of treatment with dopamine agonists, the prolactin levels decreased by 96.8%, there was an effective reduction in tumour size, and the neurological signs and symptoms resolved.
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Affiliation(s)
- Vera Fernandes
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
| | | | - Rui Almeida
- Department of Neurosurgery, Hospital de Braga, Braga, Portugal Department of Pituitary Tumours Group, Hospital de Braga, Braga, Portugal
| | - Olinda Marques
- Department of Endocrinology, Hospital de Braga, Braga, Portugal Department of Pituitary Tumours Group, Hospital de Braga, Braga, Portugal
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Santos MJ, Fernandes V, Garcia FM. [Vitamin D Insufficiency in a Hospital Population: A Photograph from the Laboratory Perspective]. ACTA MEDICA PORT 2015; 28:726-734. [PMID: 26849757] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/08/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although vitamin D deficiency is increasingly recognized around the world, there are few studies on the Portuguese reality. This study aims to analyse vitamin D levels in the assays performed in our hospital and their relationship with age, genre, requesting specialty and moment of sample collection. MATERIAL AND METHODS Cross-sectional study of measurements of 25(HO)D performed in our Hospital between June 2012 and November 2014. Included variables: gender, age, requesting specialty, month of sample collection. Vitamin D status classified as: 'Deficiency' (≤ 20 ng/mL), 'Insufficiency' (21 - 29 ng/ml) and 'Sufficiency' (≥ 30 ng/mL). RESULTS We included 5 439 assays; 55.0% from women; the median age was 64.0 years. Sixty per cent had 'Deficiency', 20.7% 'Insufficiency' and 18.9% 'Sufficiency'. We found a negative correlation between age and vitamin D level (p < 0.001). We didn't find differences in vitamin D levels between genres. Nine specialties requested 98% of the assays, namely Nephrology (56.2%). We found differences between specialties based on age and vitamin D level (p < 0.001). Vitamin D levels changed throughout the year, with higher levels in the summer, followed by autumn, spring and winter (p < 0.001). Despite this seasonal fluctuation, vitamin D sufficiency was only present in a minority of assays (27.8% in summer and 9.2% in winter). DISCUSSION Vitamin D deficiency is prevalent in this population, affects individuals of all ages and is not offset by the seasonal variation of sunlight. CONCLUSION Vitamin D deficiency is a real and prevalent problem in our population that needs further attention and action, given its clinical implications.
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Affiliation(s)
| | - Vera Fernandes
- Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal
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Santos MJ, Fernandes V, Garcia FM. Carência de Vitamina D numa População Hospitalar: Uma Fotografia pela Perspetiva Laboratorial. ACTA MEDICA PORT 2015. [DOI: 10.20344/amp.6253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<strong>Introduction:</strong> Although vitamin D deficiency is increasingly recognized around the world, there are few studies on the Portuguese reality. This study aims to analyse vitamin D levels in the assays performed in our hospital and their relationship with age, genre, requesting specialty and moment of sample collection.<br /><strong>Material and Methods:</strong> Cross-sectional study of measurements of 25(HO)D performed in our Hospital between June 2012 and November 2014. Included variables: gender, age, requesting specialty, month of sample collection. Vitamin D status classified as: ‘Deficiency’ (≤ 20 ng/mL), ‘Insufficiency’ (21 - 29 ng/ml) and ‘Sufficiency’ (≥ 30 ng/mL).<br /><strong>Results:</strong> We included 5 439 assays; 55.0% from women; the median age was 64.0 years. Sixty per cent had ‘Deficiency’, 20.7% ‘Insufficiency’ and 18.9% ‘Sufficiency’. We found a negative correlation between age and vitamin D level (p < 0.001). We didn’t find differences in vitamin D levels between genres. Nine specialties requested 98% of the assays, namely Nephrology (56.2%). We found differences between specialties based on age and vitamin D level (p < 0.001). Vitamin D levels changed throughout the year, with higher levels in the summer, followed by autumn, spring and winter (p < 0.001). Despite this seasonal fluctuation, vitamin D sufficiency was only present in a minority of assays (27.8% in summer and 9.2% in winter).<br /><strong>Discussion:</strong> Vitamin D deficiency is prevalent in this population, affects individuals of all ages and is not offset by the seasonal variation of sunlight.<br /><strong>Conclusion:</strong> Vitamin D deficiency is a real and prevalent problem in our population that needs further attention and action, given its clinical implications.
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Fernandes V, Osório FL. Are there associations between early emotional trauma and anxiety disorders? Evidence from a systematic literature review and meta-analysis. Eur Psychiatry 2015; 30:756-64. [PMID: 26163920 DOI: 10.1016/j.eurpsy.2015.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 05/18/2015] [Accepted: 06/14/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous studies indicate a possible association between early emotional trauma (EET) and the development of anxiety disorders (ADs) in adult life. However, no previous studies have compiled the findings of such studies and analyzed their statistical significance. Therefore, the objective of this study was to conduct a systematic literature review and meta-analysis to determine possible associations between EET and three ADs (panic, generalized anxiety, and social anxiety disorders). METHODS A systematic search was conducted in PubMed, PsycInfo, and Scielo with no publication date limitations. A total of 2127 studies were found, 32 studies of which were selected for the systematic review and 13 studies of which were selected for the meta-analysis. RESULTS High prevalence rates of different EETs were observed among the individuals with ADs (median: 18%-45%). The results of the meta-analysis indicated that individuals with EETs were 1.9- to 3.6-fold more likely to develop ADs compared with a control group of healthy individuals. Emotional traumas were the main risk factor for social anxiety disorder. However, no specific associations were found for the other ADs. CONCLUSIONS EET is a risk factor for ADs, underscoring the importance of preventive measures to combat the development of these disorders. Moreover, the identification of EETs among patients with ADs is essential for implementing remedial measures to minimize the impact and damage arising from this association by decreasing the risk and severity of symptoms and to improve the response rate to treatment of ADs.
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Affiliation(s)
- V Fernandes
- Department of neurosciences and behavior, Medical School of Ribeirão Preto, university of São Paulo, 3900, avenida dos Bandeirantes, CEP 14048-900, Ribeirão Preto, São Paulo, Brazil
| | - F L Osório
- Department of neurosciences and behavior, Medical School of Ribeirão Preto, university of São Paulo, 3900, avenida dos Bandeirantes, CEP 14048-900, Ribeirão Preto, São Paulo, Brazil; Technology Institute (INCT, CNPq) for Translational Medicine, Brazil.
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Ranza R, Laurindo I, Titton D, Barbosa L, Bertolo M, Bertaccini J, Brenol C, Carvalho H, Castro G, Cecconi M, Costa I, Duarte A, Fernandes V, Freire M, Louzada P, Macieira J, Miranda J, Pereira I, Pinheiro G, Pinheiro M, Sauma M, Silva M, Toledo R, Valin V, Vieira W, Baaklini C, Descalzo M. SAT0362 Incidence of Adverse Events in Patients with Rheumatoid Arthritis and Spondyloarthritis Exposed to Anti-Tnf Therapy. Data from the Brazilian Registry for Monitoring of Biologic Therapies in Rheumatic Diseases (Biobadabrasil). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1572] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Agarwal C, Goel S, Jacobi A, Fernandes V, Sanz J. Cardiac MRI of a contained ascending aortic rupture extending into the pericardium. Eur Heart J Cardiovasc Imaging 2014; 16:457. [DOI: 10.1093/ehjci/jeu279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Gustafson J, Blomberg S, Martin NM, Fernandes V, Borg A, Liu Z, Chang R, Lundgren E. A high pressure x-ray photoelectron spectroscopy study of CO oxidation over Rh(100). J Phys Condens Matter 2014; 26:055003. [PMID: 24334623 DOI: 10.1088/0953-8984/26/5/055003] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We have studied the oxidation of CO over Rh(100) using high pressure x-ray photoelectron spectroscopy under CO and O2 pressures ranging from 0.01 to 1 mbar. The results show a very low or no conversion for the CO covered surface found at low temperatures, while the activity rises slightly when the temperature is high enough for some CO to desorb, exposing surface sites for dissociative O2 adsorption. As the temperature is increased further, more CO desorbs and oxygen replaces CO as the dominating species at the surface. At the same time we find a sudden increase in the reactivity, such that all CO that reaches the surface is instantly transformed into CO2. We find that the O coverage in the active state is highly dependent on the total pressure and, although we do not detect any presence of a surface oxide as in previous surface x-ray diffraction studies, the highest O coverage indicates that the surface is close to being oxidized.
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Affiliation(s)
- J Gustafson
- Division of Synchrotron Radiation Research, Lund University, Box 118, SE-221 00 Lund, Sweden
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Vinter A, Fernandes V, Orlandi O, Morgan P. Verbal definitions of familiar objects in blind children reflect their peculiar perceptual experience. Child Care Health Dev 2013; 39:856-63. [PMID: 22970938 DOI: 10.1111/cch.12002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Accepted: 04/02/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the present study was to examine to what extent the verbal definitions of familiar objects produced by blind children reflect their peculiar perceptual experience and, in consequence, differ from those produced by sighted children. METHODS Ninety-six visually impaired children, aged between 6 and 14 years, and 32 age-matched sighted children had to define 10 words denoting concrete animate or inanimate familiar objects. RESULTS The blind children evoked the tactile and auditory characteristics of objects and expressed personal perceptual experiences in their definitions. The sighted children relied on visual perception, and produced more visually oriented verbalism. In contrast, no differences were observed between children in their propensity to include functional attributes in their verbal definitions. CONCLUSIONS The results are discussed in line with embodied views of cognition that postulate mandatory perceptuomotor processing of words during access to their meaning.
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Affiliation(s)
- A Vinter
- Université de Bourgogne, LEAD-CNRS, Dijon, France
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Abelha FJ, Luís C, Veiga D, Parente D, Fernandes V, Santos P, Botelho M, Santos A, Santos C. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care 2013; 17:R257. [PMID: 24168808 PMCID: PMC4057091 DOI: 10.1186/cc13084] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/07/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Delirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients. Methods This prospective study was conducted over a 10-month period in a SICU. Postoperative delirium was diagnosed in accordance with the Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality at 6-month follow-up. Hospital mortality and becoming dependent were considered as secondary outcomes, on the basis of the evaluation of the patient’s ability to undertake both personal and instrumental activities of daily living (ADL) before surgery and 6 months after discharge from the SICU. For each dichotomous outcome - hospital mortality, mortality at 6-month follow-up, and becoming dependent - a separate multiple logistic regression analysis was performed, which included delirium as an independent variable. Another outcome analyzed was changes in health-related quality of life, as determined using short-form 36 (SF-36), which was administered before and 6 months after discharge from the SICU. Additionally, for each SF-36 domain, a separate multiple linear regression model was used for each SF-36 domain, with changes in the SF-36 domain as a dependent variable and delirium as an independent variable. Results Of 775 SICU-admitted adults, 562 were enrolled in the study, of which 89 (16%) experienced postoperative delirium. Delirium was an independent risk factor for mortality at the 6-month follow-up (OR = 2.562, P <0.001) and also for hospital mortality (OR = 2.673, P <0.001). Delirium was also an independent risk factor for becoming dependent for personal ADL (P-ADL) after SICU discharge (OR = 2.188, P <0.046). Moreover, patients who experienced postoperative delirium showed a greater decline in SF-36 domains after discharge, particularly in physical function, vitality, and social function, as compared to patients without postoperative delirium. Conclusions Postoperative delirium was an independent risk factor for 6-month follow-up mortality, hospital mortality, and becoming independent in P-ADL after SICU discharge. It was also significantly associated with a worsening in the quality of life after surgery.
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Affiliation(s)
- J Dinis Silva
- Department of Gastroenterology, Hospital do Espírito Santo de Évora EPE, Largo Senhor da Pobreza, Portugal.
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Fafá B, Valim V, Peçanha P, Laurindo I, Ranzolin A, Hayata A, Duarte Â, Brenol C, Carvalho H, Pinheiro GC, Silveira I, Pereira IA, Costa I, Macieira J, Miranda JR, Moraes JC, Barbosa LSG, Bértolo M, Sauma M, Silva M, Freire M, Scheinberg M, Júnior PL, Toledo R, Ranza R, Oliveira S, Fernandes V, Bianchi W, Titton D, Brasil B. AB0524 Biological agents survival comparisons among different rheumatic disease - brazilian register of biological agents in rheumatic diseases - biobadabrasil. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2846] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mendes LR, Silva RB, Bueno CFD, Couto FAP, Dias AN, Fernandes V, Faria Filho DE. The inclusion of coffee in commercial layer diets. Rev Bras Cienc Avic 2013. [DOI: 10.1590/s1516-635x2013000200010] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- LR Mendes
- Universidade Federal de Minas Gerais, Brazil
| | - RB Silva
- Universidade Federal de Minas Gerais, Brazil
| | - CFD Bueno
- Universidade Federal de Minas Gerais, Brazil
| | - FAP Couto
- Universidade Federal de Minas Gerais, Brazil
| | - AN Dias
- Universidade Federal de Minas Gerais, Brazil
| | - V Fernandes
- Universidade Federal de Minas Gerais, Brazil
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