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De Azevedo SM, Pichel RC, Freitas E, Campar A, Marinho A, Mendonça T. Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature. Rom J Intern Med 2023; 61:212-215. [PMID: 37671719 DOI: 10.2478/rjim-2023-0021] [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: 03/23/2023] [Indexed: 09/07/2023]
Abstract
Calcium pyrophosphate crystal deposition disease (CPPD), also known as pseudogout, with spinal involvement, is associated with clinical manifestations of acute nerve compression or chronic spinal stenosis. Precipitation of crystals of calcium pyrophosphate dihydrate in connective tissues can lead to acute inflammatory arthritis, degenerative chronic arthropathies, and radiographic evidence of cartilage calcification. We present a case of an 87-year-old woman, with unstudied chronic polyarthralgia and symptomatic orthostatic hypotension. It were documented acute calcium pyrophosphate deposition wrist arthritis, and cervical CT and MRI was suggestive of spinal involvement of CPPD. Workup excluded other causes of OH. Surgical approach could be indicated to minimize the symptoms, but it was contra-indicated due to the patient's performance status, so histological diagnosis was not possible. Muscle atrophy played an important part in the rapid progression of this insidious chronic disease. Conservative and symptomatic treatment achieve scarce short-term clinical improvement. Spinal involvement of CPPD was thought to be rare but recent studies show a higher prevalence than expected. We call for attention to the extent of structural changes that may occur when not early diagnosed nor treated. High clinical suspicion is required and this is, to our knowledge, the first report of orthostatic hypotension as a presentation of CPPD.
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Affiliation(s)
- Sofia Moura De Azevedo
- Internal Medicine Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Rita Carrilho Pichel
- Medical Oncology Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Egídio Freitas
- Dermatology Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Ana Campar
- Clinical Immunology Unit, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - António Marinho
- Clinical Immunology Unit, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
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Caley L, Campar A, Mendonça T, Farinha F. Aortic Dissection in a Patient with Novel Frameshift COL5A1 Variant of Classical Ehlers-Danlos Syndrome. Eur J Case Rep Intern Med 2023. [DOI: 10.12890/2023_003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Classical Ehlers-Danlos syndrome (cEDS) is one of the 13 subtypes of Ehlers-Danlos syndrome, which has the major clinical criteria of hyperextensibility skin, atrophic scars, and generalised joint hypermobility. The occurrence of aortic dissection has been described in some subtypes of Ehlers-Danlos, but it has a rare association with the cEDS subtype. This case report discusses a 39-year-old female with a past medical history of transposition of great arteries with a Senning repair at the age of 18 months and controlled hypertension with medication, who presents a spontaneous distal aortic dissection. The diagnosis of cEDS was made using the major criteria, and a novel frameshift mutation in COL5A1 was discovered. The reported case emphasises that in patients with cEDS, vascular fragility may be a complication.
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Affiliation(s)
- Lídia Caley
- Internal Medicine Department, Centro Hospitalar Médio Tejo, Abrantes, Portugal
| | - Ana Campar
- nternal Medicine Department, Centro Hospitalar Universitário do Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
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Taborda F, Ferreira DA, Mendonça T, Farinha F. Not so Mutually Exclusive Diseases: A Case of Co-occurrence of Inflammatory Spondyloarthritis and Diffuse Skeletal Hyperostosis in a Young Patient. Eur J Case Rep Intern Med 2023; 10:003721. [PMID: 36819656 PMCID: PMC9930877 DOI: 10.12890/2023_003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axial SpA) are differential diagnoses of lower back pain. While the latter is considered to be an inflammatory disease, DISH is thought to be a metabolic condition. The authors report a case of a 34-year-old man who presented with a one-year history of axial lower back pain associated to migratory polyarthritis, buttock and heel pain. Imaging revealed contiguous calcification of the anterior longitudinal ligament of the cervical segment, meeting major criteria for DISH. However, he also exhibited signs of bilateral sacroiliitis highly suggestive of axial SpA for which he initiated biological therapy. LEARNING POINTS Although the most used criteria for diffuse idiopathic skeletal hyperostosis (DISH) were designed to exclude radiographic signs of spondyloarthritis (SpA), both conditions can be present simultaneously.There are only few case reports in the literature that demonstrate the association of the two diseases.Overlap and misperception of SpA and DISH could result in undertreatment of individual patients and have a negative impact on prognosis.
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Affiliation(s)
- Filipa Taborda
- Internal Medicine Department, Hospital de Cascais, Alcabideche, Portugal
| | | | - Teresa Mendonça
- Internal Medicine Department, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal,Clinical Immunology Unit, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Fátima Farinha
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
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Silva AS, Guimarães J, Sousa C, Mendonça L, Soares-Dos-Reis R, Mendonça T, Abreu P, Sequeira L, Sá MJ. Metabolic syndrome parameters and multiple sclerosis disease outcomes: A Portuguese cross-sectional study. Mult Scler Relat Disord 2023; 69:104370. [PMID: 36401965 DOI: 10.1016/j.msard.2022.104370] [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: 05/04/2022] [Revised: 05/31/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metabolic syndrome and multiple sclerosis [MS] share the presence of chronic inflammation in their pathogenic mechanisms. This study aimed to estimate the prevalence of metabolic syndrome parameters in MS and their association with disease disability, cognitive function, and Neurofilament Light chain [NfL] levels. METHODS Clinical, analytical, and magnetic resonance imaging data were obtained through medical records. Disease disability was measured by the Expanded Disability Status Scale [EDSS], the MS Severity Scale [MSSS] along with cognitive impairment by the Brief International Cognitive Assessment for MS [BICAMS] and Word List Generation test [WLG]. Metabolic syndrome parameters were evaluated by fasting blood glucose, triglycerides, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol, total cholesterol, blood pressure, and waist circumference [WC]. We also analysed serum leptin and ghrelin and cerebrospinal fluid NfL. RESULTS Our sample included 51 people with MS, 34 (66.7%) females, mean age of 38.20±12.12 years and median disease duration of 3 years (P25=2.0, P75=5.0). Multivariate linear regression analysis confirmed that WC correlates with EDSS (β=0.04, p=.001) and MSSS (β=0.07, p=.002) as well as Brief Visuospatial Memory Test-Revised (β=-0.29, p=.008), WLG (β=-0.20, p=.039). NfL is also negatively associated with HDL-C (β=-4.51, p=.038). CONCLUSIONS Waist circumference is associated with disability and deficits in cognitive tests. A decrease in HDL-C is associated with an increase in NfL. This suggests metabolic syndrome might be an important factor in MS disease course.
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Affiliation(s)
- Ana Sofia Silva
- Faculty of Medicine of the University of Porto, Al. Prof. Hernâni Monteiro, Porto 4200-319, Portugal.
| | - Joana Guimarães
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Portugal; Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Portugal
| | - Cláudia Sousa
- Neuropsychological Unit, Department of Psychology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Liliana Mendonça
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ricardo Soares-Dos-Reis
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Portugal; i3S, University of Porto, Portugal
| | - Teresa Mendonça
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Pedro Abreu
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Portugal
| | - Lucinda Sequeira
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Maria José Sá
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
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Caley L, Campar A, Mendonça T, Farinha F. Aortic Dissection in a Patient with Novel Frameshift COL5A1 Variant of Classical Ehlers-Danlos Syndrome. Eur J Case Rep Intern Med 2023; 10:003698. [PMID: 36970158 PMCID: PMC10035622 DOI: 10.128f90/2023_003698] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/07/2023] [Indexed: 03/29/2023] Open
Abstract
Classical Ehlers-Danlos syndrome (cEDS) is one of the 13 subtypes of Ehlers-Danlos syndrome, which has the major clinical criteria of hyperextensibility skin, atrophic scars, and generalised joint hypermobility. The occurrence of aortic dissection has been described in some subtypes of Ehlers-Danlos, but it has a rare association with the cEDS subtype. This case report discusses a 39-year-old female with a past medical history of transposition of great arteries with a Senning repair at the age of 18 months and controlled hypertension with medication, who presents a spontaneous distal aortic dissection. The diagnosis of cEDS was made using the major criteria, and a novel frameshift mutation in COL5A1 was discovered. The reported case emphasises that in patients with cEDS, vascular fragility may be a complication. LEARNING POINTS Classical Ehlers-Danlos is a rare autosomal dominant inherited connective disorder.Arterial dissections are rarely found in cEDS patients.Association of cEDS and vascular fragility can result from new type V collagen mutation.
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Affiliation(s)
- Lídia Caley
- Internal Medicine Department, Centro Hospitalar Médio Tejo, Abrantes, Portugal
| | - Ana Campar
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto, Portugal
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Gaudêncio AMPAF, Lameiras AC, Mendonça T. IgA Vasculitis and C3 Glomerulonephritis: One Patient... Various Autoimmune Diseases. Gaz Med 2022. [DOI: 10.29315/gm.v1i1.537] [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: 01/01/2023] Open
Abstract
Leucocytoclastic vasculitis refers to a small vessel vasculitis caused by immune complexes, infections and medications. IgA or IgM/IgG immune complexes can be found in direct immunofluorescence studies suggesting specific forms of leucocytoclastic vasculitis. Some authors suggested that IgA vasculitis and IgA nephropathy were two clinical mani- festations of the same disease. From a histological point of view, it is not possible to distinguish a glomerulonephritis as part of an IgA vasculitis from an IgA nephropathy.The authors present a case of a 50-year-old woman diagnosed with vitiligo ad immune thrombocytopenic purpura (ITP). ITP was diagnosed 2 years before the present case. She presented to the autoimmune diseases’ appointment with a pruriginous rash of the lower extremities over the last 3 months. Skin biopsy was suggestive of leukocytoclastic vasculitis, revealing deposits of C3, IgG (less intensity) and IgA. IgA vasculitis was then assumed. After a few weeks, she kept peripheral edema, but an increasing decline in renal function was detected. Therefore, a renal biopsy was performed, which revealed endocapilar proliferative glomerulonephritis and predominantly C3 mesangial deposits, with IgA and vestigial IgM. These results were compatible with a C3 glomerulonephritis. The patient was started on systemic steroid treatment with prednisolone 1 mg/kg/day and ramipril 2.5 mg/day with progressive normalization of renal function.With this case, the authors emphasize the possibility that all these manifestations could be part of the same disease spectrum, but also, the importance of complement activation. So, this case may constitute additional evidence of the complement activation in pathogenesis of this vasculitis, however, further investigation is need, particularly to understand C3 glomerulonephritis, a rare kidney disease.
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Gaudêncio M, Mendonça T. Eosinophilic Gastroenteritis: An Unusual Disease of Gastrointestinal Tract. Gaz Med 2022. [DOI: 10.29315/gm.v1i1.536] [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: 01/01/2023] Open
Abstract
Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal disease characterized by generalized abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding and weight loss. The etiology and pathogenesis are not well understood and mostly based on case reports. Clinical presentation may vary depending on sites and depth of involvement of the gastrointestinal tract. The diagnosis is usually confirmed by histology that shows eosinophilic infiltration and the absence of secondary cause of eosinophilia.The authors present a case report of a 47-year-old woman that was diagnosed with dyslipidemia, obesity and allergic rhinitis. She had no significant family history. She was admitted in internal medicine department with 2 weeks of abdominal pain, nausea, vomiting, diarrhea and weight loss (> 10%). Further study revealed increased eosinophil count, normocytic anemia, elevated erythrocyte sedimentation rate and normal Ig E levels. Digestive endoscopic study was performed, and multiple biopsy specimens showed moderate eosinophilic infiltration in stomach and duodenal mucosa.The patient was started on prednisolone, with clinical improvement. Follow-up go the patient twenty years after the beginning of this treatment showed stabilization of clinical symptoms and laboratory tests.So, eosinophilic gastroenteritis is characterized by three criteria - presence of gastrointestinal symptoms, histologic evidence of eosinophilic infiltration and exclusion of other causes of tissue eosinophilia. The treatment is based on the severity of symptoms. Corticosteroids are the mainstay of therapy, so the usual dose of prednisolone/prednisone is 20-40 mg daily for two weeks with tapering thereafter. In the literature, the use of montelukast and biologic agents have been reported.
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Ferreira DA, Taborda F, Mendonça T, Farinha F. Pregnancy and lactation-associated osteoporosis in a Systemic Lupus Erythematosus patient. Lupus 2022; 31:1829-1833. [DOI: 10.1177/09612033221136102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pregnancy and lactation-associated osteoporosis (PLO) is a rare disease that occurs in late pregnancy or early postpartum and is associated with multiple vertebral fractures. We present a case of a 34-year-old woman with a history of Systemic Lupus Erythematosus and Antiphospholipid Syndrome, who started postpartum back pain. After an ineffective response to analgesic escalation, she performed imaging exams with evidence of multiple dorsal and lumbar vertebral fractures. After an exhaustive etiological study, PLO represented the most likely diagnosis. Early diagnosis, interruption of breastfeeding, and initiation of targeted anti-osteoporotic therapy are essential for symptomatic control, increase the quality of life of these patients, and prevent new fractures in the future.
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Affiliation(s)
| | - Filipa Taborda
- Internal medicine, Hospital de Cascais Dr Jose de Almeida, Alcabideche, Portugal
| | - Teresa Mendonça
- Internal medicine, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Fátima Farinha
- Internal medicine, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
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Oliveira J, Sala I, Freitas J, Tavares J, Santos S, Campos A, Lascasas JS, Mendonça T, Cabrita A. Refractory diffuse podocytopathy. J Nephropathol 2022. [DOI: 10.34172/jnp.2022.17314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- João Oliveira
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
| | - Inês Sala
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
| | - Joana Freitas
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
| | - Joana Tavares
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
| | - Sofia Santos
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
| | - Andreia Campos
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
| | | | - Teresa Mendonça
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, Portugal
| | - António Cabrita
- Department of Nephrology, Centro Hospitalar Universitário do Porto, Portugal
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Mendonça T, Bienboire-Frosini C, Chabaud C, Arroub S, Menuge F, Pageat P. Serotonin assays in clinical practice. Do sex and activity play a role in serotonin concentrations in equine plasma? J Vet Behav 2022. [DOI: 10.1016/j.jveb.2021.06.027] [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: 10/19/2022]
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Menuge F, Marcet-Rius M, Chabaud C, Teruel E, Berthelot C, Kalonji G, Bienboire-Frosini C, Mendonça T, Lascar E, Pageat P. Repeated separations between a future guide dog and its foster family modify stress-related indicators and affect dog’s focus. Appl Anim Behav Sci 2021. [DOI: 10.1016/j.applanim.2021.105486] [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: 11/30/2022]
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Santos E, Rocha AL, Oliveira V, Ferro D, Samões R, Sousa AP, Figueiroa S, Mendonça T, Abreu P, Guimarães J, Sousa R, Melo C, Correia I, Durães J, Sousa L, Ferreira J, de Sá J, Sousa F, Sequeira M, Correia AS, André AL, Basílio C, Arenga M, Mendes I, Marques IB, Perdigão S, Felgueiras H, Alves I, Correia F, Barroso C, Morganho A, Carmona C, Palavra F, Santos M, Salgado V, Palos A, Nzwalo H, Timóteo A, Guerreiro R, Isidoro L, Boleixa D, Carneiro P, Neves E, Silva AM, Gonçalves G, Leite MI, Sá MJ. Neuromyelitis optica spectrum disorders: A nationwide Portuguese clinical epidemiological study. Mult Scler Relat Disord 2021; 56:103258. [PMID: 34583213 DOI: 10.1016/j.msard.2021.103258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/14/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits. OBJECTIVE To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics. METHODS This was a nationwide multicenter study. Twenty-four Portuguese adult and 3 neuropediatric centers following NMOSD patients were included. RESULTS A total of 180 patients met the 2015 Wingerchuk NMOSD criteria, 77 were AQP4-antibody positive (Abs+), 67 MOG-Abs+, and 36 seronegative. Point prevalence on December 31, 2018 was 1.71/100,000 for NMOSD, 0.71/100,000 for AQP4-Abs+, 0.65/100,000 for MOG-Abs+, and 0.35/100,000 for seronegative NMOSD. A total of 44 new NMOSD cases were identified during the two-year study period (11 AQP4-Abs+, 27 MOG-Abs+, and 6 seronegative). The annual incidence rate in that period was 0.21/100,000 person-years for NMOSD, 0.05/100,000 for AQP4-Abs+, 0.13/100,000 for MOG-Abs+, and 0.03/100,000 for seronegative NMOSD. AQP4-Abs+ predominated in females and was associated with autoimmune disorders. Frequently presented with myelitis. Area postrema syndrome was exclusive of this subtype, and associated with higher morbidity/mortality than other forms of NMOSD. MOG-Ab+ more often presented with optic neuritis, required less immunosuppression, and had better outcome. CONCLUSION Epidemiological/clinical NMOSD profiles in the Portuguese population are similar to other European countries.
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Affiliation(s)
- Ernestina Santos
- Neurology Service, Department of Neurosciences, Hospital de Santo António/Centro Hospitalar Universitário do Porto; Multidisciplinary Biomedical Research Unit, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto.
| | | | - Vanessa Oliveira
- Neurology Service, Department of Neurosciences, Hospital de Santo António/Centro Hospitalar Universitário do Porto
| | - Daniela Ferro
- Neurology Service, Centro Hospitalar Universitário São João
| | - Raquel Samões
- Neurology Service, Department of Neurosciences, Hospital de Santo António/Centro Hospitalar Universitário do Porto; Multidisciplinary Biomedical Research Unit, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto
| | - Ana Paula Sousa
- Neurology Service, Department of Neurosciences, Hospital de Santo António/Centro Hospitalar Universitário do Porto
| | - Sónia Figueiroa
- Neuropediatrics Service, Centro Materno-Infantil do Norte/Centro Hospitalar Universitário do Porto
| | | | - Pedro Abreu
- Neurology Service, Centro Hospitalar Universitário São João
| | | | - Raquel Sousa
- Neuropediatrics Unit, Pediatrics Service, Centro Hospitalar Universitário São João
| | - Cláudia Melo
- Neuropediatrics Unit, Pediatrics Service, Centro Hospitalar Universitário São João
| | - Inês Correia
- Neurology Service, Centro Hospitalar Universitário de Coimbra
| | - Joao Durães
- Neurology Service, Centro Hospitalar Universitário de Coimbra
| | - Lívia Sousa
- Neurology Service, Centro Hospitalar Universitário de Coimbra
| | - João Ferreira
- Neurology Service, Centro Hospitalar Universitário de Lisboa Norte
| | - João de Sá
- Neurology Service, Centro Hospitalar Universitário de Lisboa Norte
| | | | | | | | - Ana Luísa André
- Neurology Service, Centro Hospitalar Universitário do Algarve
| | - Carlos Basílio
- Neurology Service, Centro Hospitalar Universitário do Algarve
| | - Marta Arenga
- Neurology Service, Centro Hospitalar e Universitário da Cova da Beira
| | | | | | - Sandra Perdigão
- Neurology Service, Hospital de Viana do Castelo/Unidade Local de Saúde do Alto Minho
| | | | - Ivânia Alves
- Neurology Service, Centro Hospitalar Tâmega e Sousa
| | | | | | | | | | - Filipe Palavra
- Centro de Desenvolvimento da Criança - Neuropediatria, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra
| | - Mariana Santos
- Neurology Service, Hospital Fernando da Fonseca/Amadora Sintra
| | - Vasco Salgado
- Neurology Service, Hospital Fernando da Fonseca/Amadora Sintra
| | | | | | | | | | - Luís Isidoro
- Neurology Service, Centro Hospitalar de Tondela e Viseu
| | - Daniela Boleixa
- Departamento de Ensino, Formação e Investigação, Centro Hospitalar Universitário do Porto
| | - Paula Carneiro
- Multidisciplinary Biomedical Research Unit, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto; Immunology Service, Hospital de Santo António/Centro Hospitalar Universitário do Porto
| | - Esmeralda Neves
- Multidisciplinary Biomedical Research Unit, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto; Immunology Service, Hospital de Santo António/Centro Hospitalar Universitário do Porto
| | - Ana Martins Silva
- Neurology Service, Department of Neurosciences, Hospital de Santo António/Centro Hospitalar Universitário do Porto; Multidisciplinary Biomedical Research Unit, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto
| | - Guilherme Gonçalves
- Multidisciplinary Biomedical Research Unit, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Radcliffe Hospital, Oxford University
| | - Maria José Sá
- Neurology Service, Centro Hospitalar Universitário São João; Faculdade de Ciências da Saúde, Universidade de Fernando Pessoa
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Nascimento S, Simião H, Mendonça T, Silva M. Ekbom syndrome - a case report. Eur Psychiatry 2021. [PMCID: PMC9475586 DOI: 10.1192/j.eurpsy.2021.1437] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Delusional parasitosis/infestation or Ekbom syndrome is an uncommon psychotic disorder characterized by a false belief that there is a parasitic infestation of the skin - the delusion that insects are crawling underneath the skin. Objectives This work aims to summarize and evaluate the currently available evidence regarding Delusional parasitosis, and for this purpose, we will illustrate a case report of a patient admitted in the emergency room. Methods The authors have conducted online research in PubMed with the words “Delusional parasitosis” “delusional infestation”, “Ekbom syndrome”, from the outcome, the articles considered to be relevant were collected and analyzed. Results Delusional parasitosis can be classified into primary delusional parasitosis without other psychiatric or organic disorders present, secondary – functional (secondary to several mental disorders such as schizophrenia, depression, dementia, anxiety, and phobia), and organic forms (associated with hypothyroidism, anaemia, vitamin B12 deficiency, hepatitis, diabetes, infections (e.g., HIV, syphilis), and cocaine abuse. It is most commonly seen in middle-aged women. The patients became frequently socially isolated, prone to the development of depression symptoms. Conclusions This syndrome often presents a high level of psychosocial morbidity. Patients often seek dermatologists help in the first place, although there is no medical evidence. Psychiatrists play a major role in the diagnosis and treatment of these patients. Psychopharmacological therapy is quite challenging because of the patient’s belief that they have a parasitic infestation and not a psychiatric condition.
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Sousa FC, Figueiras M, Parente AR, Santos S, Miranda M, Teixeira M, Mendonça T. Dystrophic calcinosis cutis associated with systemic lupus erythematosus: a case report. Pan Afr Med J 2021; 40:258. [PMID: 35251452 PMCID: PMC8856974 DOI: 10.11604/pamj.2021.40.258.28215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Calcinosis cutis is a rare and potentially disabling condition characterized by calcium deposition in soft tissues. When associated with autoimmune connective tissue diseases, calcinosis cutis is classified as Dystrophic Calcinosis Cutis (DCC), being its occurrence in systemic lupus erythematosus (SLE) patients fairly uncommon. We report a case of DCC in a 49 years old woman with eleven years evolution SLE that presented with a two years history of multiple painful skin lesions, some of them ulcerated and exhibiting a chalky white-yellow floor, in both hands, forearms, thighs, buttocks, abdomen and left breast. The pelvic X-ray showed soft tissue calcifications and the skin biopsy confirmed the diagnosis of DCC. The patient was treated with diltiazem 240mg/day and a significant regression of the lesions and associated pain was observed. Dystrophic calcinosis cutis is often a painful and disrupting condition in which timely diagnosis and treatment may be quite challenging.
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Affiliation(s)
- Filipa Costa Sousa
- Department of Clinical Immunology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Corresponding author: Filipa Costa Sousa, Department of Clinical Immunology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Mariana Figueiras
- Department of Clinical Immunology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Rita Parente
- Department of Clinical Immunology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sónia Santos
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Mafalda Miranda
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Mónica Teixeira
- Department of Internal Medicine, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Teresa Mendonça
- Department of Clinical Immunology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Machado B, Matos AR, Mendonça T, Farinha F. Um Caso Clínico de Sarcoidose Cutânea, Pulmonar, Esplénica e Neurosarcoidose. Gaz Med 2020. [DOI: 10.29315/gm.v7i1.304] [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
A sarcoidose é uma doença granulomatosa que pode afetar qualquer órgão de etiologia desconhecida. Apresentamos o caso de um homem, de 49 anos, com antecedentes pessoais de um episódio de eritema nodoso. O estudo imagiológico do tórax mostrou múltiplas adenopatias mediastínicas e justa-hilares bilaterais, apesar de não apresentar queixas respiratórias. O lavado broncoalveolar revelou uma relação de células CD4/CD8 de 9,98 e o estudo analítico revelou uma enzima conversora da angiotensina elevada, sem outros achados. O doente iniciou corticoterapia verificando-se uma melhoria das manifestações cutâneas. Após dois anos, apresenta-se na consulta de Medicina Interna com queixas de emagrecimento, anorexia, fadiga, hipoacusia, síndrome vertiginosa e hipostesia dorsal em banda. Este caso mostra o envolvimento multissistémico da sarcoidose, tendo como ponto de partida para o seu diagnóstico uma manifestação cutânea e realça a importância da vigilância e do tratamento destes doentes a fim de um controlo atempado da doença.
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Urzal J, Cimbron M, Mendonça T, Farinha F. Eosinophilic fasciitis (Shulman's disease): review and comparative evaluation of seven patients. Reumatologia 2019; 57:85-90. [PMID: 31130746 PMCID: PMC6532118 DOI: 10.5114/reum.2019.84813] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/09/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Eosinophilic fasciitis (EF) was described in 1974 by Shulman as a rare fibrosing connective tissue disease of unknown etiology. An undetermined trigger is thought to lead to the degranulation of eosinophils that interact with fibroblasts and express fibrogenic cytokines including the transforming factor of tumor growth a and b and interleukins 1 and 6. The purpose of this study was to summarize seven cases of EF in a central hospital. MATERIAL AND METHODS This was a retrospective and descriptive study of a population with EF of a central hospital. All patients diagnosed with EF in a hospital unit were admitted to the study between January 1, 2005, and April 30, 2018. RESULTS A total of seven patients diagnosed with EF were analyzed. The median age of the population at the time of diagnosis was 56 years, and 57% of the patients were women. All patients had elevated peripheral eosinophilia and sedimentation rate, and only one patient had hypergammaglobulinemia. All patients had edema and cutaneous thickening of the limbs, 57% had constitutional symptoms, and 57% had inflammatory arthritis with joint contracture. Prednisolone (PDN) therapy was initiated in all patients, and only in two was the association of PDN with methotrexate (MTX) initially performed. In one patient triple therapy of PDN, MTX, and cyclosporine was required. At the time of this publication, only one patient maintains active disease, and tocilizumab has been initiated. CONCLUSIONS Recent studies show a more favorable response from the combination of PDN and MTX than from PDN alone. Considering the rarity of the disease, more long-term studies are needed regarding the etiopathogenetics, progression, recurrence of EF, and new effective therapies.
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Affiliation(s)
- Joana Urzal
- Department of Internal Medicine, Hospital Professor Doutor Fernando Fonseca, Portugal
| | - Miriam Cimbron
- Department of Internal Medicine, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Teresa Mendonça
- Medicine Department, University Hospital Center of Porto, Portugal
| | - Fátima Farinha
- Medicine Department, University Hospital Center of Porto, Portugal
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Nogueira FN, Mendonça T, Rocha P. Positive state observer for the automatic control of the depth of anesthesia-Clinical results. Comput Methods Programs Biomed 2019; 171:99-108. [PMID: 27647647 DOI: 10.1016/j.cmpb.2016.08.019] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 07/06/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
The depth of anesthesia (DoA) is a crucial feature in general anesthesia. Nowadays the DoA is usually evaluated by the bispectral index (BIS). According to the surgical procedure, different reference levels for the BIS may be clinically required. This can be achieved by the simultaneous administration of an analgesic (e.g. remifentanil) and an hypnotic (eg propofol). As a contribution to the effort of automating the processes of drug delivery in general anesthesia, in this paper, a positive state observer is designed for the implementation of a control scheme proposed for the automatic administration of propofol and of remifentanil, in order to track a desired level for the BIS. It is proved and illustrated by simulations that the controller-observer scheme has a very good performance. This scheme was implemented, tested and evaluated both by means of simulations and for a set of patients during surgical procedures.
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Affiliation(s)
- Filipa N Nogueira
- CTAC-The Center for Territory, Environment and Construction, School of Engineering of University of Minho, 4800-048 Guimarães, Portugal.
| | - T Mendonça
- Faculdade de Ciências da Universidade do Porto, 4169-007 Porto, Portugal; SYSTEC-Research Center for Systems & Technologies, Porto, Portugal
| | - P Rocha
- SYSTEC-Research Center for Systems & Technologies, Porto, Portugal; Faculdade de Engenharia da Universidade do Porto, 4200-465, Porto, Portugal
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Cação G, Calejo M, Alves JE, Medeiros PB, Vila-Cha N, Mendonça T, Taipa R, Silva AM, Damásio J. Clinical features of hypertrophic pachymeningitis in a center survey. Neurol Sci 2018; 40:543-551. [PMID: 30588552 DOI: 10.1007/s10072-018-3689-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypertrophic pachymeningitis (HP) is characterized by cranial and/or spinal thickening of the dura mater with or without associated inflammation. Neuroimaging studies reveal dura mater thickening and focal or diffuse contrast enhancement. It is described in association with trauma, infections, tumors, autoimmune/inflammatory diseases, and cerebrospinal fluid hypotension syndrome, with some cases remaining idiopathic. METHODS A retrospective study was conducted with patients' identification through a key terms search within MRI reports in the period of July 2008 to September 2015. Clinical files, MRI, laboratory, and pathology data were reviewed. RESULTS Fifty-three patients were identified and 20 were excluded because they did not meet the inclusion criteria. Of the 33 included, 19 were female, with a mean age at symptoms onset of 51.2 ± 17.6 years. The most common presenting symptoms were headache and cranial nerves palsy, followed by seizures, delirium, lumbar pain, cognitive decline, motor deficit, and language impairment. In 17 patients, a neoplastic etiology was identified; in eight, inflammatory/autoimmune; in six, infectious; and two were classified as idiopathic. Of the eight patients with inflammatory/autoimmune etiology, four had possible IgG4-related disease (IgG4-RD) and the remaining had granulomatosis with polyangiitis, sarcoidosis, rheumatoid arthritis, and Tolosa-Hunt syndrome. Treatment was directed according to the underlying etiology. DISCUSSION In the described series, a female predominance was identified, with symptoms' onset in the 5th decade. Although headache was the most common symptom, clinical presentation was varied, emphasizing the role of MRI in HP diagnosis. The underlying etiologies were diverse, with only a few cases remaining idiopathic, also reflecting the contribution of the recently described IgG4-RD.
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Affiliation(s)
- Gonçalo Cação
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Margarida Calejo
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - José Eduardo Alves
- Neuroradiology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Nuno Vila-Cha
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Martins Silva
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Joana Damásio
- Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
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Furtado I, Pinheiro G, Campar A, Mendonça T. Association of severe and therapy-refractory systemic lupus erythematosus and neuromyelitis optica: a management challenge. BMJ Case Rep 2018; 2018:bcr-2017-222139. [PMID: 29866760 DOI: 10.1136/bcr-2017-222139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder. Neuromyelitis optica (NMO) is an infrequent neuroinflammatory disorder, whose association with SLE remains rare. The authors report the case of an 18-year-old woman, with SLE refractory to multiple immunosuppressive therapies and novel biological agents. Under immunosuppressive therapy, the patient presented with transverse myelitis with contiguous spinal cord lesions and urinary incontinence, having been diagnosed with seropositive NMO, which was also proven to be refractory to common treatments. Partial recovery of the neurological deficits occurred with plasmapheresis, although not averting the brain involvement by NMO that ensued. The patient was listed nationally for allogeneic bone marrow transplant, but, unfortunately, no match was found and the patient died of severe cerebral NMO flare with coma due to brain swelling and consequent respiratory failure. Although the association of SLE and NMO is very rare, early diagnosis is crucial to facilitate initiation of immunosuppressive therapy.
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Affiliation(s)
- Inês Furtado
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Guiomar Pinheiro
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Campar
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
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Furtado I, Pinheiro G, Campar A, Mendonça T. Association of severe and therapy-refractory systemic lupus erythematosus and neuromyelitis optica: a management challenge. BMJ Case Rep 2018. [PMID: 29866760 DOI: 10.1136/bcr-2017-222139"] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder. Neuromyelitis optica (NMO) is an infrequent neuroinflammatory disorder, whose association with SLE remains rare. The authors report the case of an 18-year-old woman, with SLE refractory to multiple immunosuppressive therapies and novel biological agents. Under immunosuppressive therapy, the patient presented with transverse myelitis with contiguous spinal cord lesions and urinary incontinence, having been diagnosed with seropositive NMO, which was also proven to be refractory to common treatments. Partial recovery of the neurological deficits occurred with plasmapheresis, although not averting the brain involvement by NMO that ensued. The patient was listed nationally for allogeneic bone marrow transplant, but, unfortunately, no match was found and the patient died of severe cerebral NMO flare with coma due to brain swelling and consequent respiratory failure. Although the association of SLE and NMO is very rare, early diagnosis is crucial to facilitate initiation of immunosuppressive therapy.
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Affiliation(s)
- Inês Furtado
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Guiomar Pinheiro
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Campar
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
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Rocha C, Mendonça T, Silva ME, Gambús P. Erratum to: Individualizing propofol dosage: a multivariate linear model approach. J Clin Monit Comput 2016; 31:239. [PMID: 26861640 DOI: 10.1007/s10877-016-9834-8] [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: 10/22/2022]
Affiliation(s)
- Conceição Rocha
- Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 4169-007, Porto, Portugal. .,Center for Research & Development in Mathematics and Applications (CIDMA), Aveiro, Portugal.
| | - Teresa Mendonça
- Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 4169-007, Porto, Portugal.,Center for Research & Development in Mathematics and Applications (CIDMA), Aveiro, Portugal
| | - Maria Eduarda Silva
- Center for Research & Development in Mathematics and Applications (CIDMA), Aveiro, Portugal.,Faculdade de Economia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-464, Porto, Portugal
| | - Pedro Gambús
- Systems Pharmacology Effect Control and Modeling (SPEC-M) Research Group, Department of Anesthesia, Hospital CLINIC de Barcelona and Neuroimmunology Research Group, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Anesthesia and Perioperative Care, University of California San Francisco (UCSF), San Francisco, CA, USA
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Andrade C, Mendonça T, Farinha F, Correia J, Marinho A, Almeida I, Vasconcelos C. Alveolar hemorrhage in systemic lupus erythematosus: a cohort review. Lupus 2015; 25:75-80. [DOI: 10.1177/0961203315605365] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare but potentially catastrophic manifestation with a high mortality. Among rheumatologic diseases, it occurs most frequently in patients with systemic lupus erythematosus (SLE) and systemic vasculitis. Despite new diagnostic tools and therapies, it remains a diagnostic and therapeutic challenge. The aim of this work was to characterize the SLE patients with an episode of alveolar hemorrhage followed in our Clinical Immunology Unit (CIU). A retrospective chart review was carried out for all patients with SLE followed in CIU between 1984 and the end of 2013. We reviewed the following data: demographic characteristics, clinical and laboratory data, radiologic investigations, histologic studies, treatment, and outcome. We identified 10 episodes of DAH, corresponding to seven patients, all female. These represent 1.6% of SLE patients followed in our Unit. The age at DAH attack was 42.75 ± 18.9 years. The average time between diagnosis of SLE and the onset of DAH was 7.1 years. Three patients had the diagnosis of SLE and the DAH attack at the same time. Disease activity according to SLEDAI was high, ranging from 15 to 41. All patients were treated with methylprednisolone, 37.5% cyclophosphamide and 28.6% plasmapheresis. The overall mortality rate was 28.6%.
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Affiliation(s)
- C Andrade
- Internal Medicine, Hospital Pedro Hispano, Matosinhos, Portugal
| | - T Mendonça
- Clinical Immunology Unit, Centro Hospitalar do Porto and UMIB, ICBAS, Universidade do Porto, Portugal
| | - F Farinha
- Clinical Immunology Unit, Centro Hospitalar do Porto and UMIB, ICBAS, Universidade do Porto, Portugal
| | - J Correia
- Clinical Immunology Unit, Centro Hospitalar do Porto and UMIB, ICBAS, Universidade do Porto, Portugal
| | - A Marinho
- Clinical Immunology Unit, Centro Hospitalar do Porto and UMIB, ICBAS, Universidade do Porto, Portugal
| | - I Almeida
- Clinical Immunology Unit, Centro Hospitalar do Porto and UMIB, ICBAS, Universidade do Porto, Portugal
| | - C Vasconcelos
- Clinical Immunology Unit, Centro Hospitalar do Porto and UMIB, ICBAS, Universidade do Porto, Portugal
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Pereira C, Ribeiro S, Lopes V, Mendonça T. Rhodotorula mucilaginosa Fungemia and Pleural Tuberculosis in an Immunocompetent Patient: An Uncommon Association. Mycopathologia 2015; 181:145-9. [DOI: 10.1007/s11046-015-9942-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022]
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Da Silva Domingues V, Da Silva Domingues V, Neves I, Garrido S, Ferreira I, Mendonça T. Chylous Ascites in Systemic Lupus Erythematosus (SLE) Patients. Eur J Case Rep Intern Med 2015. [DOI: 10.12890/000229] [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: 11/05/2022] Open
Affiliation(s)
- Vital Da Silva Domingues
- Hospital de Santo António, Centro Hospitalar do Porto Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
| | - Vital Da Silva Domingues
- Hospital de Santo António, Centro Hospitalar do Porto Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
| | - Isabel Neves
- Hospital de Santo António, Centro Hospitalar do Porto Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
| | - Susana Garrido
- Hospital de Santo António, Centro Hospitalar do Porto Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
| | - Inês Ferreira
- Hospital de Santo António, Centro Hospitalar do Porto Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
| | - Teresa Mendonça
- Hospital de Santo António, Centro Hospitalar do Porto Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
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Nogueira FN, Mendonça T, Rocha P. Controlling the depth of anesthesia by a novel positive control strategy. Comput Methods Programs Biomed 2014; 114:e87-e97. [PMID: 24468159 DOI: 10.1016/j.cmpb.2013.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 02/18/2013] [Revised: 11/18/2013] [Accepted: 12/23/2013] [Indexed: 06/03/2023]
Abstract
In this paper a positive control law is designed for multi-input positive systems that ensures asymptotic tracking of a desired output reference value. This control law can be viewed as a generalization of another one proposed in the literature for the control of the total mass in SISO compartmental systems, but is suitable for a wider class of positive systems. The controller proposed here is applied to the control of the depth of anesthesia (DoA), by means of the administration of propofol and remifentanil, when using a parameter parsimonious Wiener model recently introduced in the literature. Its performance is illustrated by realistic simulations.
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Affiliation(s)
- F N Nogueira
- Faculdade de Engenharia da Universidade do Porto, Porto, Portugal; CIDMA - Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Portugal.
| | - T Mendonça
- Faculdade de Ciências da Universidade do Porto, Porto, Portugal; CIDMA - Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Portugal
| | - P Rocha
- Faculdade de Engenharia da Universidade do Porto, Porto, Portugal; CIDMA - Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Portugal
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Gomes AO, Ribeiro S, Neves J, Mendonça T. Uncommon aetiologies of chylothorax: superior vena cava syndrome and thoracic aortic aneurysm. Clin Respir J 2014; 9:185-8. [PMID: 24520817 DOI: 10.1111/crj.12122] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 02/26/2014] [Accepted: 02/06/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chylothorax, an uncommon cause of pleural effusion, results from the accumulation of lymph in the pleural space due to damage or obstruction of the thoracic duct. The high content of triglycerides and the presence of chylomicrons in the pleural fluid sets the diagnosis. OBJECTIVE To present a case report of a chylothorax due to superior vena cava compression or a thoracic aortic aneurysm, discuss the particularities, the investigation of chylothorax as well as its treatment options. METHODS A review of the literature on chylothorax was performed using PubMed to assess the different aetiologies, investigation and treatments usually performed. CONCLUSION Chylothorax is usually secondary to malignancy, trauma, congenital diseases and infections. However, less common causes are also described, as the ones described in our case report. The gold standard for diagnosis is the identification of chylomicrons in the pleural fluid. Conservative management is recommended in most cases of chylothorax.
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Affiliation(s)
- Ana O Gomes
- Department of Internal Medicine, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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Barata C, Ruela M, Mendonça T, Marques JS. A Bag-of-Features Approach for the Classification of Melanomas in Dermoscopy Images: The Role of Color and Texture Descriptors. Series in BioEngineering 2014. [DOI: 10.1007/978-3-642-39608-3_3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Rocha C, Mendonça T, Silva ME, Gambús P. Individualizing propofol dosage: a multivariate linear model approach. J Clin Monit Comput 2013; 28:525-36. [PMID: 24072471 DOI: 10.1007/s10877-013-9510-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/04/2013] [Indexed: 12/19/2022]
Abstract
In the last decades propofol became established as an intravenous agent for the induction and maintenance of both sedation and general anesthesia procedures. In order to achieve the desired clinical effects appropriate infusion rate strategies must be designed. Moreover, it is important to avoid or minimize associated side effects namely adverse cardiorespiratory effects and delayed recovery. Nowadays, to attain these purposes the continuous propofol delivery is usually performed through target-controlled infusion (TCI) systems whose algorithms rely on pharmacokinetic and pharmacodynamic models. This work presents statistical models to estimate both the infusion rate and the bolus administration. The modeling strategy relies on multivariate linear models, based on patient characteristics such as age, height, weight and gender along with the desired target concentration. A clinical database collected with a RugLoopII device on 84 patients undergoing ultrasonographic endoscopy under sedation-analgesia with propofol and remifentanil is used to estimate the models (training set with 74 cases) and assess their performance (test set with 10 cases). The results obtained in the test set comprising a broad range of characteristics are satisfactory since the models are able to predict bolus, infusion rates and the effect-site concentrations comparable to those of TCI. Furthermore, comparisons of the effect-site concentrations for dosages predicted by the proposed Linear model and the Marsh model for the same target concentration is achieved using Schnider model and a factorial design on the factors (patients characteristics). The results indicate that the Linear model predicts a dosage profile that is faster in leading to an effect-site concentration closer to the desired target concentration.
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Affiliation(s)
- Conceição Rocha
- Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, 4169-007, Porto, Portugal,
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30
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Silva MM, Lemos JM, Coito A, Costa BA, Wigren T, Mendonça T. Local identifiability and sensitivity analysis of neuromuscular blockade and depth of hypnosis models. Comput Methods Programs Biomed 2013; 113:23-36. [PMID: 24252467 DOI: 10.1016/j.cmpb.2013.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 06/22/2013] [Accepted: 07/20/2013] [Indexed: 06/02/2023]
Abstract
This paper addresses the local identifiability and sensitivity properties of two classes of Wiener models for the neuromuscular blockade and depth of hypnosis, when drug dose profiles like the ones commonly administered in the clinical practice are used as model inputs. The local parameter identifiability was assessed based on the singular value decomposition of the normalized sensitivity matrix. For the given input signal excitation, the results show an over-parameterization of the standard pharmacokinetic/pharmacodynamic models. The same identifiability assessment was performed on recently proposed minimally parameterized parsimonious models for both the neuromuscular blockade and the depth of hypnosis. The results show that the majority of the model parameters are identifiable from the available input-output data. This indicates that any identification strategy based on the minimally parameterized parsimonious Wiener models for the neuromuscular blockade and for the depth of hypnosis is likely to be more successful than if standard models are used.
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Affiliation(s)
- M M Silva
- Departamento de Matemática, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal; Division of Systems and Control, Department of Information Technology, Uppsala University, Box 337, SE-751 05 Uppsala, Sweden; Center for Research and Development in Mathematics and Applications (CIDMA), Universidade de Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
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31
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Ribeiro S, Domingues V, Faria RM, Mendonça T. Invasive pneumococcal disease complicated by cerebral vasculitis, transient diabetes insipidus and spondylodiscitis. BMJ Case Rep 2013; 2013:bcr-2013-010336. [PMID: 23960149 DOI: 10.1136/bcr-2013-010336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Invasive pneumococcal disease (IPD) is a potential life-threatening situation that requires immediate recognition and treatment. Cerebrovascular complications are uncommon and have been reported less frequently in adults than in children. We report a case of 59-year-old man with IPD complicated by cerebral vasculitis, transient central diabetes insipidus and spondylodiscitis. Each of these complications is rare and needs specific approach. Their association is even rarer and to the best of our knowledge this is the first case reported.
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Affiliation(s)
- Sofia Ribeiro
- Department of Medicine, Hospital Santo António, Porto, Portugal.
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Marques JS, Barata C, Mendonça T. On the role of texture and color in the classification of dermoscopy images. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2012:4402-4405. [PMID: 23366903 DOI: 10.1109/embc.2012.6346942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper addresses the detection of melanoma lesions in dermoscopy images, using texture and color features. Although melanoma detection has been studied in several works, using different types of texture, color and shape features, it is not always clear what is the role of each set of features and which features are most discriminative. This papers aims at clarifying the role of texture and color features. Furthermore, the proposed systems is based on features which can be easily implemented and tested by other researchers. It is concluded that both types of features achieve good detection scores when used alone. The best results (SE=94.1%, SP=77.4%) are achieved by combining them both.
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Affiliation(s)
- Jorge S Marques
- Instituto Superior Tecnico and Institute for Systems and Robotics, Lisbon, Portugal.
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33
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Leitão T, Rodrigues T, Soares C, Silva R, Garcia R, Martinho D, Romão A, Sandul A, Mendonça T, Pereira S, Varela J, Lopes T. UP-02.124 A Prospective Randomized Trial of Prostate Biopsy Protocols Comparing the Vienna Nomogram and a Standard 10-Core Biopsy Scheme. Urology 2011. [DOI: 10.1016/j.urology.2011.07.942] [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: 10/16/2022]
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Dias V, Cabral S, Anjo D, Vieira M, Antunes N, Carvalheiras G, Gomes C, Meireles A, Mendonça T, Torres S. Successful management of Listeria monocytogenes pericarditis: case report and review of the literature. Acta Cardiol 2011; 66:537-8. [PMID: 21894816 DOI: 10.1080/ac.66.4.2126608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Listeria monocytogenes, although an uncommon cause of illness in the general population, is feared principally because of the morbidity and mortality associated with CNS infections. Cardiovascular involvement with L. monocytogenes is very rare, and has been limited to endocarditis. We describe a case of Listeria pericarditis, which occurred in a 60-year-old man with Child-Pugh B cirrhosis who presented to the emergency department with asthenia, anorexia, and respiratory distress. The echocardiogram showed severe pericardial effusion and after pericardiocentesis, L. monocytogenes was isolated in the culture of pericardial fluid. After surgical pericardiectomy with draining of the pericardial effusion and antibiotic treatment with ampicillin, the patient experienced a slow, but full recovery. Documentation of L. monocytogenes pericarditis is an extremely rare entity with very scarce reports in medical literature, and is usually associated with a very poor prognosis. A case report is presented together with a review of the literature.
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Affiliation(s)
- Vasco Dias
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Sofia Cabral
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Diana Anjo
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Miguel Vieira
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Nuno Antunes
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Graziela Carvalheiras
- Departments of Medicine, Santo António General Hospital - Oporto Hospital Centre, Porto, Portugal
| | - Catarina Gomes
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Ana Meireles
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
| | - Teresa Mendonça
- Departments of Medicine, Santo António General Hospital - Oporto Hospital Centre, Porto, Portugal
| | - Severo Torres
- Departments of Cardiology and Internal - Oporto Hospital Centre, Porto, Portugal
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Mendes A, Mendonça T, Sousa A, Moreira G, Carvalho M. Stroke secondary to aortic dissection treated with a thrombolytic: a successful case. Neurol Sci 2011; 33:107-10. [DOI: 10.1007/s10072-011-0616-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
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Carvalheiras G, Vita P, Marta S, Trovão R, Farinha F, Braga J, Rocha G, Almeida I, Marinho A, Mendonça T, Barbosa P, Correia J, Vasconcelos C. Pregnancy and systemic lupus erythematosus: review of clinical features and outcome of 51 pregnancies at a single institution. Clin Rev Allergy Immunol 2010; 38:302-6. [PMID: 19603147 DOI: 10.1007/s12016-009-8161-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is mainly a disease of fertile women and the coexistence of pregnancy is by no means a rare event. How SLE and its treatment affects pregnancy outcome is still a matter of debate. Assessment of the reciprocal clinical impact of SLE and pregnancy was investigated in a cohort study. We reviewed the clinical features, treatment, and outcomes of 43 pregnant SLE patients with 51 pregnancies followed from 1993 to 2007 at a tertiary university hospital. The age of patients was 28.7 +/- 5.4 years and SLE was diagnosed at age of 23.0 +/- 6.1 years. Previous manifestations of SLE included lupus nephritis (14 patients) and secondary antiphospholipid syndrome (11 patients). Thirty-five pregnant patients (69%) were in remission for more than 6 months at the onset of pregnancy. Patients were being treated with low doses of prednisone (29), hydroxychloroquine (20), azathioprine (five), acetylsalicylic acid (51), and low molecular weight heparin (13). Sixteen pregnancy-associated flares were documented, mainly during the second trimester (42%) and also in the following year after delivery (25%). Renal involvement was found in 11 cases (68%). Spontaneous abortion occurred in 6%, 16% had premature deliveries, and 74% were delivered at term. No cases of maternal mortality occurred. No cases of fetal malformation were recorded. There was one intrauterine fetal death and one neonatal death at 24 gestational weeks. Pregnant women with SLE are high risk patients, but we had a 90% success rate in our cohort. A control disease activity strategy to target clinical remission is essential.
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Affiliation(s)
- Graziela Carvalheiras
- Serviço de Medicina, Centro Hospitalar do Porto, Hospital Santo António, Porto, Portugal.
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Carvalheiras G, Anjo D, Mendonça T, Vasconcelos C, Farinha F. Hemophagocytic syndrome as one of the main primary manifestations in acute systemic lupus erythematosus - case report and literature review. Lupus 2009; 19:756-61. [DOI: 10.1177/0961203309354906] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemophagocytic syndrome is an unusual but fatal disorder characterized by pancytopenia and activation of macrophages. We describe one case of acute systemic lupus erythematosus with an unusual presentation of hemophagocytic syndrome not related to infection. The patient presented with pancytopenia related to increasing hemophagocytic activity of histiocytes in the bone marrow. Concomitant class IV World Health Organization lupus nephritis, serositis, high titer of antinuclear factor and positive test for anti-DNA antibody fitted the diagnostic criteria of systemic lupus erythematosus. She also presented with alveolar hemorrhage and lupus myocarditis. She underwent immunosuppressive therapy with recovery from the hemophagocytic syndrome. Therefore, diagnosis of acute lupus hemophagocytic syndrome was made. The clinical presentation, laboratory diagnosis, and management of the patient are discussed and the literature was reviewed and presented, with emphasis on a possible distinct lupus subset, which includes a more aggressive systemic disease with heart involvement.
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Affiliation(s)
- G. Carvalheiras
- Internal Medicine, Centro Hospitalar do Porto, Hospital Santo António, Porto, Portugal,
| | - D. Anjo
- Cardiology, Centro Hospitalar do Porto, Hospital Santo António, Porto, Portugal
| | - T. Mendonça
- Internal Medicine, Centro Hospitalar do Porto, Hospital Santo António, Porto, Portugal, Clinic Immunology, Centro Hospitalar do Porto-Hospital de Santo Antonio, Porto, Portugal
| | - C. Vasconcelos
- Internal Medicine, Centro Hospitalar do Porto, Hospital Santo António, Porto, Portugal, Clinic Immunology, Centro Hospitalar do Porto-Hospital de Santo Antonio, Porto, Portugal
| | - F. Farinha
- Internal Medicine, Centro Hospitalar do Porto, Hospital Santo António, Porto, Portugal, Clinic Immunology, Centro Hospitalar do Porto-Hospital de Santo Antonio, Porto, Portugal
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Vasconcelos C, Carvalho C, Leal B, Pereira C, Bettencourt A, Costa PP, Marinho A, Barbosa P, Almeida I, Farinha F, Mendonça T, Correia JA, Mendonça D, Martins B. HLA in Portuguese Systemic Lupus Erythematosus Patients and Their Relation to Clinical Features. Ann N Y Acad Sci 2009; 1173:575-80. [DOI: 10.1111/j.1749-6632.2009.04873.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alonso H, Lemos JM, Mendonça T. A target control Infusion method for neuromuscular blockade based on hybrid parameter estimation. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2008:707-10. [PMID: 19162753 DOI: 10.1109/iembs.2008.4649250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The paper presents a new method for target control infusion (TCI) for neuromuscular blockade (NMB) level control of patients subject to general anaesthesia. The method combines an inversion of the pharmacokinetic/pharmacodynamic (PK/PD) model with a hybrid parameter estimation method that uses on-line data from the initial bolus response to estimate the model parameters. Although atracurium is considered as relaxant, the newly proposed method may be applied to other drugs for which the PK/PD model is available. Simulation results on a bank of 100 patient models are presented to demonstrate the achievable performance.
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Affiliation(s)
- H Alonso
- FCUP, R. do Campo Alegre 687, 4169-007 Porto, Portugal.
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Ferreira S, Vasconcelos J, Marinho A, Farinha F, Almeida I, Correia J, Barbosa P, Mendonça T, Vasconcelos C. [CD4 lymphocytopenia in systemic lupus erythematosus]. Acta Reumatol Port 2009; 34:200-206. [PMID: 19474774] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is an inflammatory chronic disease characterized by the presence of autoantibodies, immunocomplex production and organ injury. Several alterations of the immune system have been described, namely of CD4 T cells, with particular focus on regulatory subgroup. OBJECTIVE Quantify peripheral CD4 T cells in a population of patients with SLE and correlate it with lupus activity, affected organs, therapeutics and infections. METHODS Retrospective study involving all SLE patients seen in the clinical immunology outpatient clinic of the Hospital Geral Santo António, Porto that has done some peripheral blood flow cytometry study. RESULTS Twenty-nine patients have been evaluated, 16 were taking glucocorticoids and six immunossupressors. The mean SLEDAI at the study time was nine and the ECLAM was three. Thirty-one percent of the patients had leukopenia, 76% lymphocytopenia and the same number CD4 depletion. Fifty-five percent of the patients had CD4 levels lower than 500/mm3, 31% lower than 200/mm3. All patients with SLEDAI > or = 20 and ECLAM > or = 4 had CD4 counts inferior to 500/mm3 and all patients with inactive disease had CD4 superior to 500/mm3. There have been three opportunistic infections: cryptococcal meningitis, pulmonary aspergilosis, Pneumocystis jirovecii pneumonia, all in patients with CD4 counts lower than 500/mm3. CONCLUSION Decreased CD4 T cells counts have been very common in this study population. There is an inverse relation between CD4 cells counts and disease activity. Opportunistic infections occurred in patients with severe CD4 depletion.
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Affiliation(s)
- Sofia Ferreira
- Serviço de Medicina, Hospital Geral de Santo António, Centro Hospitalar do Porto, 4150-571 Porto.
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Alonso H, Mendonça T, Rocha P. A hybrid method for parameter estimation and its application to biomedical systems. Comput Methods Programs Biomed 2008; 89:112-122. [PMID: 18083269 DOI: 10.1016/j.cmpb.2007.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 10/11/2007] [Accepted: 10/29/2007] [Indexed: 05/25/2023]
Abstract
A general version of a hybrid method for parameter estimation is presented with a theoretical support and an illustrative example of application. This method consists of a curve fitting algorithm that takes the initial estimate of the parameterization from an artificial neural network. The idea is to improve the convergence of the algorithm to the sought parameterization using a close initial estimate. The motivation arises from biomedical problems where one is interested in obtaining a meaningful estimate so that it can be used for both description and prediction purposes. Two strategies are proposed for the application of the hybrid method: one is of general applicability, the other is intended for systems defined by the series connection of various blocks. The feasibility of the method is illustrated with a case study related to the neuromuscular blockade of patients undergoing general anaesthesia.
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Affiliation(s)
- Hugo Alonso
- Departamento de Matemática Aplicada, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre 687, Porto, Portugal.
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Magalhães H, Lemos JM, Mendonça T, Rocha P, Esteves S, Gaivão J. Observer design in switching control of neuromuscular blockade: clinical cases. Conf Proc IEEE Eng Med Biol Soc 2007; 2006:5436-9. [PMID: 17946305 DOI: 10.1109/iembs.2006.259492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper concerns the application of multiple model switched methods to the control of neuromuscular blockade of patients undergoing anaesthesia. Since the model representing the neuromuscular blockade process is subject to a high level of uncertainty due both to inter-patient variability and time variations, switched methods provide the adaptation capability needed to achieve the desired performance. The paper contributions are twofold: first, it is shown that, for the type of process control problem considered, the design of the associated observer must be carefully performed. Guidelines are provided for adequate selection of the characteristic polynomial defining the observer error dynamics. Second, clinical results using atracurium as blocking agent are reported in order to illustrate the use of the proposed control structure in actual clinical practice.
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Nunes CS, Mendonça T, Lemos JM, Amorim P. Control of depth of anesthesia using MUSMAR--exploring electromyography and the analgesic dose as accessible disturbances. Annu Int Conf IEEE Eng Med Biol Soc 2007; 2007:1574-1577. [PMID: 18002271 DOI: 10.1109/iembs.2007.4352605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The problem of controlling the level of depth of anesthesia measured by the Bispectral Index (BIS) of the electroencephalogram of patients under general anesthesia, is considered. It is assumed that the manipulated variable is the infusion rate of the hypnotic drug propofol, while the drug remifentanil is also administered for analgesia. Since these two drugs interact, the administration rate of remifentanil is considered as an accessible disturbance in combination with the level of electromyography (EMG) that also interferes with the BIS signal. In order to tackle the high uncertainty present on the system, the predictive adaptive controller MUSMAR is used. The performance of the controller is illustrated by means of simulation with 45 patient individual adjusted models, which incorporate the effect of the drugs interaction on BIS. This controller structure proved to be robust to the EMG and remifentanil disturbances, patient variability, changing reference values and noise.
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Affiliation(s)
- Catarina S Nunes
- Faculdade de Ciências da Universidade do Porto, Departamento de Matemática Aplicada, Rua do Campo Alegre 687, 4169-007 Porto, Portugal.
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Abstract
The problem of embedding sensor fault tolerance in feedback control of neuromuscular blockade is considered. For tackling interruptions of feedback measurements, a structure based upon Bayesian inference as well as a predictive filter is proposed. This algorithm is general and can be applied to different situations. Here, it is incorporated in an adaptive automatic system for feedback control of neuromuscular blockade using continuous infusion of muscle relaxants. A significant contribution consists in the experimental clinical testing of the algorithm in patients undergoing surgery.
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45
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Abstract
OBJECTIVE Development of an automatic system (software package Hipocrates) for the control of neuromuscular blockade by continuous infusion of the non-depolarising types of muscle relaxant drugs presently used in anaesthesia, namely atracurium, cisatracurium, vecuronium and rocuronium. METHODS Hipocrates incorporates control strategies based upon classical, adaptive and robust control, as well as a wide range of noise reduction techniques and on-line adaptation to patient-specific characteristics. Therefore, the system provides strong robustness to inter- and intra-individual variability of the patients responses or unexpected circumstances and adaptation to the individual requirements. RESULTS The control system is easy to set up and to use in a clinical environment. It consists of a portable PC computer, a Datex AS/3 NMT sensor and a B/Braun compact perfusion pump. In the simulation mode the software package incorporates sophisticated generation of pharmacokinetic/pharmacodynamic models driven by simulated drug administration regimes (bolus, continuous infusion and a combination of both). CONCLUSIONS Hipocrates is an advanced standalone application for the control of neuromuscular blockade with a friendly graphic interface. It has been extensively validated, and it can be used on patients undergoing surgery as well as for simulation studies. Therefore Hipocrates also provides an excellent environment for education and training purposes.
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Affiliation(s)
- Teresa Mendonça
- Departamento de Matemática Aplicada, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre 687, 4169-007 Porto, Portugal.
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46
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Affiliation(s)
- Natividade Rocha
- Department of Dermatology, Hospital Geral de Santo António, Oporto, Portugal
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