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Vera J, Gomes A, Póvoas D, Seixas D, Maltez F, Pedroto I, Maia L, Mota M, Vieira MJ, Manata MJ, Ferreira P, Lino S, Pereira Guedes T, Barradas V, Marques N. Real-World Effectiveness and Safety of Glecaprevir/Pibrentasvir for the Treatment of Chronic Hepatitis C: A Prospective Cohort Study in Portugal. ACTA MEDICA PORT 2024; 37:323-333. [PMID: 38325411 DOI: 10.20344/amp.19178] [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: 12/22/2022] [Accepted: 06/02/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Information about pan-genotypic treatments for hepatitis in Portugal is scarce. We aimed to evaluate the effectiveness and safety of glecaprevir plus pibrentasvir (GLE/PIB) treatment for hepatitis C virus (HCV) infection in real-world clinical practice. METHODS An observational prospective study was implemented in six hospitals with 121 adult HCV patients who initiated treatment with GLE/PIB between October 2018 and April 2019, according to clinical practice. Eligible patients had confirmed HCV infection genotype (GT) 1 to 6 and were either treatment-naïve or had experience with interferon-, ribavirin- or sofosbuvir-based regimens, with or without compensated cirrhosis. Baseline sociodemographic and safety data are described for the total population (N = 115). Effectiveness [sustained virologic response 12 weeks after treatment (SVR12)] and patient-reported outcomes are presented for the core population with sufficient follow-up data (n = 97). RESULTS Most patients were male (83.5%), aged < 65 years (94.8%), with current or former alcohol consumption (77.3%), illicit drug use (72.6%), and HCV acquisition through intravenous drug use (62.0%). HIV co-infection occurred in 22.6% of patients. The prevalence of each GT was: GT1 51.3%, GT2 1.7%, GT3 30.4%, GT4 16.5%, and GT5.6 0%. Most patients were non-cirrhotic (80.9%) and treatment-naïve (93.8%). The SVR12 rates were 97.9% (95% CI: 92.8 - 99.4), and > 95% across cirrhosis status, GT, illicit drug use, alcohol consumption, and HCV treatment experience. The adverse event rate was 2.6%, and no patient discontinued treatment due to adverse events related to GLE/PIB. CONCLUSION Consistent with other real-world studies and clinical trials, treatment with GLE/PIB showed high effectiveness and tolerability overall and in difficult-to-treat subgroups (ClinicalTrials.gov: NCT03303599).
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Affiliation(s)
- José Vera
- Centro Hospitalar Barreiro-Montijo. Barreiro. Portugal
| | | | - Diana Póvoas
- Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Diana Seixas
- Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | | | | | - Luís Maia
- Centro Hospitalar Universitário Porto. Porto. Portugal
| | - Margarida Mota
- Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | | | | | | | - Sara Lino
- Centro Hospitalar Lisboa Central. Lisboa. Portugal
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Cabrera JA, Mota M. Same Pathogen, Different Manifestations: A Case of Extrapulmonary Tuberculosis. Cureus 2023; 15:e50436. [PMID: 38222214 PMCID: PMC10785197 DOI: 10.7759/cureus.50436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Tuberculosis (TB) remains the most prevalent contagious disease worldwide and a significant cause of morbidity, ranking as the second most deadly disease globally. The transmission of the disease occurs through aerosols via the respiratory route, predominantly affecting pulmonary tissue. However, the pathogen can disseminate and infect any organ within the body. Up to 15% of patients exhibit extrapulmonary involvement. The case involves a 59-year-old male who presented to the emergency department complaining of abdominal pain and subfebrile episodes, without any other significant symptoms or findings on physical examination. Laboratory investigations revealed elevated inflammatory markers and abnormal liver biochemistry parameters. A computed tomography (CT) scan showed a neoformative lesion in the liver - a collection with a vascularized, thick, irregular wall. This raised the possibility of a potentially hypervascular hepatic neoformation or an encysted inflammatory lesion. The patient was started on empirical broad-spectrum antibiotics and was admitted to the Internal Medicine ward for further investigation. Later, the patient began to exhibit a decline in overall condition, a slowed and less complex speech pattern, loss of balance, and distal tremors in the upper limbs, as well as a symmetric and distal reduction in strength in all four limbs. A cerebral CT scan revealed no significant abnormalities, and a lumbar puncture yielded no immediate notable findings. Simultaneously, a repeated abdominal CT scan showed the previously known hepatic lesion, albeit with features more indicative of a multiloculated collection. An aspirative biopsy of the hepatic abscess was conducted. From the extensive analysis conducted, a positive PCR result for mycobacterium tuberculosis was identified in both the pus from the hepatic abscess and the cerebrospinal fluid. This led to the conclusion that the case presented was an instance of extrapulmonary TB involving the liver and the central nervous system. Following the identification of the causative agent, the patient commenced antibacterial therapy comprising rifampicin, ethambutol, and isoniazid with adjunctive dexamethasone. Despite targeted treatment and instituted supportive therapy, the patient exhibited an unfavorable progression and eventually succumbed 57 days after diagnosis. This case highlights an unusual manifestation of a patient with disseminated extrapulmonary TB, emphasizing the importance of early diagnostic suspicion for clinicians. The unfavorable disease progression despite appropriate targeted treatment prompts reflection on whether the delay in diagnosis and provision of anti-TB drugs may have played a major role in the prognosis of the patient.
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Affiliation(s)
- Joana A Cabrera
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Margarida Mota
- Infectious Diseases, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Marques D, Costa AL, Mansinho A, Quintela A, Pratas E, Brito-da-Silva J, Cruz J, Félix J, Rodrigues J, Mota M, Teixeira AR, Dâmaso S, Pinheiro S, Andreozzi V, Costa L, Barros AG. The REWRITE Study - REal-WoRld effectIveness of TrifluridinE/tipiracil in Patients with Previously Treated Metastatic Colorectal Cancer. Clin Oncol (R Coll Radiol) 2023; 35:665-672. [PMID: 37487914 DOI: 10.1016/j.clon.2023.07.004] [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: 11/24/2022] [Revised: 05/31/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
AIMS In the pivotal RECOURSE trial, trifluridine/tipiracil improved survival outcomes in refractory metastatic colorectal cancer (mCRC), while demonstrating an acceptable toxicity profile. Routine clinical practice evidence is important to support the ongoing value of recently approved medicines. Our objective was to assess the utilisation patterns and real-world effectiveness of trifluridine/tipiracil in previously treated mCRC patients. MATERIALS AND METHODS This was a retrospective observational study including consecutive patients who started trifluridine/tipiracil between 1 April 2018 and 30 September 2019 in the medical oncology departments of three major public hospitals in Portugal. The primary outcome measure was overall survival. Associations between overall survival and patient and tumour characteristics were assessed using multivariate Cox regression analyses. RESULTS In total, 111 patients were included in the study, with a mean age of 64 years. From these, 45.9% received two prior lines of treatment, 47.8% had three or more previous lines of treatment and 83.6% had Eastern Cooperative Oncology Group (ECOG) performance status 0-1 at baseline. The median duration of trifluridine/tipiracil treatment was 3.7 cycles (95% confidence interval 3.4-4.1). Most patients (80.4%) remained on their planned dose throughout the trifluridine/tipiracil treatment period, fulfilling 100% relative dose intensity. The median overall survival in the total study cohort was 7.9 months (95% confidence interval 6.4-9.8) and the median progression-free survival was 3.4 months (95% confidence interval 3.2-3.9). The median overall survival was significantly higher in patients with a normal serum lactate dehydrogenase (LDH) level (median overall survival 11.2 months for [135, 205] IU/l LDH [95% confidence interval 8.2-NR] and 13.6 months for [205, 251] IU/l LDH [95% confidence interval 8.2-NR]) and in better fitted (ECOG = 0-1) patients (median overall survival 8.0 months; 95% confidence interval 6.7-10.0). The median time to worsening performance status was 6.2 months (95% confidence interval 5.0-8.0). Treatment discontinuation due to adverse events was low (3.1%). CONCLUSION Our study confirms the effectiveness of trifluridine/tipiracil in real-life mCRC patients. Overall survival and progression-free survival outcomes are consistent with the efficacy profile reported in the earlier randomised RECOURSE clinical trial. Like other real-world studies, we found no additional safety concerns in the use of trifluridine/tipiracil.
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Affiliation(s)
- D Marques
- Department of Medical Oncology, Portuguese Oncology Institute, Porto, Portugal
| | - A L Costa
- Department of Medical Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - A Mansinho
- Department of Medical Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - A Quintela
- Department of Medical Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - E Pratas
- Department of Medical Oncology, University Hospital of Coimbra, Coimbra, Portugal
| | - J Brito-da-Silva
- Department of Medical Oncology, Portuguese Oncology Institute, Porto, Portugal
| | - J Cruz
- Department of Medical Oncology, University Hospital of Coimbra, Coimbra, Portugal
| | - J Félix
- Exigo Consultores, Lisbon, Portugal
| | - J Rodrigues
- Department of Medical Oncology, University Hospital of Coimbra, Coimbra, Portugal
| | - M Mota
- Exigo Consultores, Lisbon, Portugal
| | - A R Teixeira
- Department of Medical Oncology, Portuguese Oncology Institute, Porto, Portugal
| | - S Dâmaso
- Department of Medical Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - S Pinheiro
- Department of Medical Oncology, University Hospital of Coimbra, Coimbra, Portugal
| | | | - L Costa
- Department of Medical Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - A G Barros
- Department of Medical Oncology, University Hospital of Coimbra, Coimbra, Portugal
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Cabrera JA, Silva LP, Mota M. Sudden Undulating Movements of the Abdominal Wall: An Exuberant Case of Belly Dancer Syndrome. Am J Gastroenterol 2023; 118:1318. [PMID: 36881433 DOI: 10.14309/ajg.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023]
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Cabrera JA, Monteiro R, Pinho I, Presa Ramos J, Mota M. A Rare and Difficult Diagnosis: A Case of Hepatoid Carcinoma of the Gallbladder. Cureus 2023; 15:e43901. [PMID: 37746379 PMCID: PMC10512190 DOI: 10.7759/cureus.43901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Extrahepatic metastasis of hepatocellular carcinoma is usually associated with extensive intrahepatic lesions. Hepatoid adenocarcinoma is a rare variant of extrahepatic malignant adenocarcinoma that exhibits remarkable histological and immunohistochemical similarity to hepatocellular carcinoma, which can result in an underestimated diagnosis. This case report describes a patient with a newly found gallbladder polyp. Following cholecystectomy, the initial histological and immunohistochemical evaluation suggested a metastasis of hepatocellular carcinoma. However, after multiple scans, no primary intrahepatic lesion was found. A subsequent review of the gallbladder specimens showed negative staining for CK7 and CK19, leading to a diagnosis of hepatoid carcinoma of the gallbladder.
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Affiliation(s)
- Joana A Cabrera
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Renata Monteiro
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Inês Pinho
- Internal Medicine, Liver Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - José Presa Ramos
- Internal Medicine, Hepatology Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
| | - Margarida Mota
- Infectious Diseases, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Fidalgo M, Salvado CA, Carmo F, Gil PC, Mota M. Gonococcal Infection: Case Report of Bacteremia and Brief Review of a Series of Cases. Cureus 2023; 15:e40095. [PMID: 37425543 PMCID: PMC10328378 DOI: 10.7759/cureus.40095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Neisseria (N) gonorrhoeae is the microorganism responsible for the second-most reported sexually transmitted disease in the world, commonly infecting mucosal surfaces such as the endocervix, urethra, and pharynx. Gonococcal disease is generally non-symptomatic or pauci-symptomatic, but if untreated, it can progress to a more serious disease with joint, cardiac, or nervous system involvement. Disseminated gonococcal infection occurs in 0.5 to 3% of patients with gonorrhea and can present with purulent arthritis or a combination of dermatitis, tenosynovitis, and migratory polyarthralgia. This article presents the case of a 45-year-old woman examined in the emergency room for fever and acute pain in her right shoulder and knee. A few days later, the patient developed petechiae and vesiculopustular lesions on her right hand. Blood analysis showed elevated inflammation markers, and cultures yielded gram-negative diplococcus identified as N. gonorrhoeae. The patient was successfully treated with ceftriaxone, with complete remission of signs and symptoms of infection. The article then examines a series of 42 cases of gonococcal disease diagnosed in a tertiary hospital, their microbiologic susceptibilities, and the antibiotics chosen to treat them.
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Affiliation(s)
- Mariana Fidalgo
- Internal Medicine, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova Gaia, PRT
| | - Catarina A Salvado
- Internal Medicine, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova Gaia, PRT
| | - Francisca Carmo
- Internal Medicine, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova Gaia, PRT
| | - Pedro C Gil
- Internal Medicine, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova Gaia, PRT
| | - Margarida Mota
- Internal Medicine, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova Gaia, PRT
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Cabrera JA, Mota M, Pais C, Morais A. Deprescription in Palliative Care. Cureus 2023; 15:e39578. [PMID: 37378207 PMCID: PMC10292863 DOI: 10.7759/cureus.39578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Individuals with limited life expectancy represent a significant proportion of healthcare consumers and are usually patients with multiple diseases and high levels of frailty. Polypharmacy and the prescription of long lists of drugs are frequent in patients with reduced life expectancy and often, as the patient's health status deteriorates, the list of drugs increases substantially as new medications are introduced to address new symptoms or complications. A key priority for healthcare professionals managing the care of these patients should be balancing the pharmacological approach to chronic diseases with the palliation of acute symptoms and complications. An important element of this process is to ensure that the benefit of any prescription decision outweighs potential risks. We reviewed the pros and cons of deprescribing drugs in individuals with limited life expectancy, how to identify the expected disease trajectory, which drugs are to be discontinued, identified some models trying to achieve rigorous deprescribing criteria, and the psychosocial effects of deprescribing in late phases of life. Deprescribing is not a one-time event but rather a continuous process that requires ongoing evaluation and monitoring. It is vital to continuously monitor and evaluate the pharmacological and non-pharmacological prescriptions for patients with chronic illnesses to align them with their goals of care and life expectancy.
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Affiliation(s)
- Joana A Cabrera
- Internal Medicine, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Margarida Mota
- Infectious Diseases, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Carmen Pais
- Internal Medicine, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Anabela Morais
- Internal Medicine, Centro Hospitalar de Trás os Montes e Alto Douro, Vila Real, PRT
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Soares Da Costa I, Mota M. Neurodevelopmental disorders and gender dysphoria: a fertile relationship? Eur Psychiatry 2022. [PMCID: PMC9567677 DOI: 10.1192/j.eurpsy.2022.2085] [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
Development of gender identity is a complicated process. During this process it is thought that many factors play a role. Gender dysphoria is a condition where there is a mismatch between the assigned gender at birth and gender identity. Although scarce, literature shows that compared to cisgender individuals, transgender and gender-diverse individuals have higher rates of autism, other neurodevelopmental and psychiatric diagnoses.
Objectives
To describe posible relations and overlap between gender dysphoria and neurodevelopmental disorders.
Methods
Literature search in Pubmed and other similar platforms. Articles considered relevant under this theme were included.
Results
Autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) can compromise health and may be more prevalent amongst individuals with gender dysphoria (GD). Symptoms such as attention difficulties, deficits in communication and social skills, obsessional interests, and stereotyped behaviour can significantly impact assessment of GD and the appropriate clinical care. With some overlapping symptoms, the potential for misdiagnosis is possible. Data about prevalence of this conditions in transgender community is of low quality, but ASD is more prevalent, ranging from 6-26%.
Conclusions
Studies demosntrate that neurodevelopmental disorders and other psychiatric conditions are more common in transgender and gender-diverse individuals. It is important that future studies focus on exploring the mental health outcomes of neurodevelopmental-trans individuals.
Disclosure
No significant relationships.
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Timofticiuc DP, Vladu I, Stefan A, Forțofoiu M, Mitrea A, Fortofoiu M, Mota M. STOP-BANG QUESTIONNAIRE - AN EASY TOOL FOR IDENTIFYING OBSTRUCTIVE SLEEP APNEA SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Acta Endocrinol (Buchar) 2022; 18:49-57. [PMID: 35975264 PMCID: PMC9365405 DOI: 10.4183/aeb.2022.49] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) have a higher risk of developing obstructive sleep apnea (OSA) compared to the general population. Our study aims to analyze the usefulness of the STOP-BANG score, tool which was not yet validated in patients with diabetets, as a tool that estimates the severity of OSA, in patients with T2DM. METHODS 120 patients, who answered the STOP-BANG questionnaire and underwent polysomnography, were included in the study. The patients were divided into 3 groups, depending on the severity of OSA, defined by the apnea/hypopnea index (AHI). RESULTS A significant percentage of participants (42.1%) had a severe form of OSA (AHI ≥30) and a high percentage of subjects had a STOP-BANG score ≥5 (58.7%), equivalent to a severe form of the disease. The STOP-BANG score increased proportionally with AHI (p<0.001). The area under the ROC curve for the STOP-Bang score indicated an optimal cut-off value of 4.5, with a sensitivity of 88.2% and a specificity of 62.9% (p <0.001), STOP-BANG score ≥5 being an independent predictor for severe OSA in patients with T2DM. CONCLUSIONS The STOP-BANG score can be used in patients with diabetes to detect severe OSA in order to establish appropriate therapeutic measures.
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Affiliation(s)
- D.C. Protasiewicz Timofticiuc
- University of Medicine and Pharmacy of Craiova, Doctoral School, Craiova, Romania
- County Clinical Emergency Hospital of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
| | - I.M. Vladu
- County Clinical Emergency Hospital of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
- University of Medicine and Pharmacy of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, Craiova, Craiova, Romania
| | - A.G. Stefan
- Calafat Municipal Hospital, Calafat, Craiova, Romania
| | - M.C. Forțofoiu
- University of Medicine and Pharmacy of Craiova, Faculty of Medicine, Department of Medical Semiology, Craiova, Romania
- Clinical Municipal Hospital “Philanthropy” of Craiova, Department of Internal Medicine, Craiova, Romania
| | - A. Mitrea
- University of Medicine and Pharmacy of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, Craiova, Craiova, Romania
- Clinical Municipal Hospital “Philanthropy” of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
| | - M. Fortofoiu
- University of Medicine and Pharmacy of Craiova, Faculty of Medicine, Department of Emergency Medicine, Craiova, Romania
- Clinical Municipal Hospital “Philanthropy” of Craiova, Department of Emergency, Craiova, Romania
| | - M. Mota
- University of Medicine and Pharmacy of Craiova, Doctoral School, Craiova, Romania
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Costa R, Silva L, Monteiro R, Santos F, Mota M. Kaposi Sarcoma as Presentation of HIV - A Clinical Case. Cureus 2021; 13:e18936. [PMID: 34812320 PMCID: PMC8604423 DOI: 10.7759/cureus.18936] [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] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
Kaposi sarcoma (KS) is the most common neoplasm of people with human immunodeficiency virus (HIV) infection. Although, in the antiretroviral therapy (ART) era, KS is a rare form of presentation of HIV/acquired immunodeficiency syndrome. The authors present a case of disseminated KS in a 23-year-old male. Just after the diagnosis the patient started ART and then chemotherapy with placlitaxel with clinical improvement. This case is highly representative of the complexity of HIV. The authors aim to bring awareness of an unusual form of presentation of HIV, and recall the severity and the necessity of an early diagnosis and treatment.
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Affiliation(s)
- Rita Costa
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Leonor Silva
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Renata Monteiro
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Filipa Santos
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Margarida Mota
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Ferreira PM, Rato IR, Rigor J, Mota M. Hansen's disease - a forgotten disease? JRSM Open 2021; 12:20542704211035995. [PMID: 34484802 PMCID: PMC8411470 DOI: 10.1177/20542704211035995] [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] [Indexed: 11/24/2022] Open
Abstract
Hansen's disease, also known as leprosy, is an infection caused by the bacteria
Mycobacterium leprae. The authors present the case of a 52-year-old man, born in Tondela
and living in Espinho, with no pathological antecedents. The clinical picture began in
April 2017, when macular lesions appeared in the lower limbs and rapidly progressed to the
trunk and upper limbs, associated with complaints of pruritus but without alterations in
the analytical study. After several topical and systemic treatments with glucocorticoids,
antifungals, antibacterials and unsuccessful antihistamines, he was referred to an
external consultation of Dermatology. He performed a biopsy of one of the lesions that
revealed the definitive diagnosis: “Lepromatous Leprosy”. After the biopsy result, he
started triple treatment with rifampicin, clofazimine and dapsone with improvement of the
condition.
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Affiliation(s)
| | - Inês Rueff Rato
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Internal Medicine, Portugal
| | - Joana Rigor
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Internal Medicine, Portugal
| | - Margarida Mota
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Internal Medicine, Portugal
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Barbosa D, Ramos B, Covelo V, Mota M. Third generation cognitive-behavioral therapies and genital pain. Eur Psychiatry 2021. [PMCID: PMC9475736 DOI: 10.1192/j.eurpsy.2021.1459] [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
IntroductionGenital pain is a heterogeneous chronic pain condition and the relationship between biological, psychological and social factors sets a complex clinical challenge. The importance of negative thoughts and emotions has opened up an opportunity for the role of third generation cognitive-behavioral therapies (CBT). While the majority of evidence revolves around female sexual desire and arousal problems, research on genital pain disorders is beginning to take shape.ObjectivesTo review the evidence of third generation CBT on genital pain disorder.MethodsReview of literature using the Pubmed platform.ResultsWe identified 21 publications. Evidence shows that mindfulness-based CBT (MbCBT) improves reduction of fear linked to sexual activity, pain acceptance, catastrophizing and decentering. MbCBT shows significant improvements on secondary outcomes (overall sexual function, sexual satisfaction, depression and anxiety) while reduction of genital pain has yielded contradictory results. Acceptance and commitment therapy (ACT) has been studied for chronic pain disorders with improvements on pain acceptance, psychological flexibility, anxiety, depression and functioning. Compassion-focused therapy (CFT) has yielded favorable results on pain distress and intensity, self-efficacy, self-acceptance, anxiety and depression. Self-compassion may be a promising protective factor in genital pain. Both ACT and CFT have not yet been studied specifically for genital pain.ConclusionsThird generation CBT are most commonly used for depressive, anxiety and chronic pain disorders which signals the logical role that these interventions may have in genital pain. While MbCBT has started to present favorable results in treating genital pain (as well other sexual problems), ACT and CFT require more research.
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Barbosa D, Almeida B, Mota M. Revisiting hysterical psychosis: A case report. Eur Psychiatry 2021. [PMCID: PMC9479780 DOI: 10.1192/j.eurpsy.2021.2029] [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
IntroductionHoliender and Hirsch defined hysterical psychosis in 1964 and, while hysteria has a contemporary equivalent in somatoform/dissociation disorder, hysterical psychosis remains set adrift in the nosological understanding of psychiatric disorders.ObjectivesTo present a case report of a hysterical psychosis and to review this nosological construct.MethodsClinical interview, consultation of clinical records and review of literature using the Pubmed platform.ResultsThe authors present a case of a 38 year-old woman, admitted in a psychiatric emergency department for bizarre behavior, restlessness, auditory (pseudo)hallucinations and emotional lability, starting 1 week after a personal development retreat. This is the second episode of this nature, the first being a 15-day hospitalization 7 years ago, with rapid stabilization, extensive examination and restitium ad integrum. The patient initiated Olanzapine and was referred to an outpatient clinic, with rapid stabilization and restitium ad integrum throughout follow-up. Given the episode and patient characteristics, a hysterical psychosis diagnosis may be accurate, taking into account the acute onset and course, the pleomorphic nature of symptoms and the presence of a disturbing life event. The authors propose reviewing the concept of hysterical psychosis regarding its clinical implications and debating its therapeutic and prognostic utility.ConclusionsHysterical psychosis may not be a mere historic footnote and encompasses an entity with distinctive diagnostic, prognostic and therapeutic characteristics. While its etiology may not be understood, its clinical implications ensure the need for future research.DisclosureNo significant relationships.
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Barbosa D, Sousa A, Machado A, Moreira R, Mota M. Looking beyond electroconvulsive therapy: A case report. Eur Psychiatry 2021. [PMCID: PMC9470387 DOI: 10.1192/j.eurpsy.2021.2068] [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: 12/01/2022] Open
Abstract
Introduction Electroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions. Objectives To present a case report of a patient with psychotic depression with partial response to ECT. Methods Clinical interviews and review of literature using the Pubmed platform. Results The authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases. Conclusions ECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes. Disclosure No significant relationships.
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Barbosa D, Mota M. Immunotherapy and psychosis: It there a risk? Eur Psychiatry 2021. [PMCID: PMC9528415 DOI: 10.1192/j.eurpsy.2021.669] [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 Over the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%). Objectives
To review the effects of monoclonal antibodies on psychosis. Methods Review of literature using PubMed database. A total of 16 studies were included. Results The targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy. Conclusions The available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.
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Guerra AM, Lira A, Lameirão A, Selaru A, Abreu G, Lopes P, Mota M, Novais Â, Peixe L. Multiplicity of Carbapenemase-Producers Three Years after a KPC-3-Producing K. pneumoniae ST147-K64 Hospital Outbreak. Antibiotics (Basel) 2020; 9:E806. [PMID: 33202755 PMCID: PMC7696612 DOI: 10.3390/antibiotics9110806] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/16/2022] Open
Abstract
Carbapenem resistance rates increased exponentially between 2014 and 2017 in Portugal (~80%), especially in Klebsiella pneumoniae. We characterized the population of carbapanemase-producing Enterobacterales (CPE) infecting or colonizing hospitalized patients (2017-2018) in a central hospital from northern Portugal, where KPC-3-producing K. pneumoniae capsular type K64 has caused an initial outbreak. We gathered phenotypic (susceptibility data), molecular (population structure, carbapenemase, capsular type) and biochemical (FT-IR) data, together with patients' clinical and epidemiological information. A high diversity of Enterobacterales species, clones (including E. coli ST131) and carbapenemases (mainly KPC-3 but also OXA-48 and VIM) was identified three years after the onset of carbapenemases spread in the hospital studied. ST147-K64 K. pneumoniae, the initial outbreak clone, is still predominant though other high-risk clones have emerged (e.g., ST307, ST392, ST22), some of them with pandrug resistance profiles. Rectal carriage, previous hospitalization or antibiotherapy were presumptively identified as risk factors for subsequent infection. In addition, our previously described Fourier Transform infrared (FT-IR) spectroscopy method typed 94% of K. pneumoniae isolates with high accuracy (98%), and allowed to identify previously circulating clones. This work highlights an increasing diversity of CPE infecting or colonizing patients in Portugal, despite the infection control measures applied, and the need to improve the accuracy and speed of bacterial strain typing, a goal that can be met by simple and cost-effective FT-IR based typing.
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Affiliation(s)
| | - Agostinho Lira
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Angelina Lameirão
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Aurélia Selaru
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Gabriela Abreu
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Paulo Lopes
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Margarida Mota
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Ângela Novais
- UCIBIO, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal;
| | - Luísa Peixe
- UCIBIO, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal;
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Silva JC, Ponte A, Mota M, Pinho R, Vieira N, Oliveira R, Mota-Carvalho N, Gomes AC, Afecto E, Carvalho J. Fecal microbiota transplantation in the intestinal decolonization of carbapenamase-producing enterobacteriaceae. Rev Esp Enferm Dig 2020; 112:925-928. [PMID: 33118360 DOI: 10.17235/reed.2020.7150/2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS fecal microbiota transplantation (FMT) is effective for recurrent Clostridium difficile infection (CDI). Intestinal decolonization of carbapenamase-producing enterobacteriaceae (CPE) can prevent transmission and infection by these agents. The aim of this study was to assess CPE decolonization after FMT. METHODS this was a case-series study that consecutively included all CPE-carriers that underwent FMT between 2014 and 2019. The indications included refractory/recurrent CDI and CPE-decolonization. RESULTS out of 21 CPE-carriers, eight were excluded due to incomplete post-FMT testing. CPE decolonization was confirmed in 76.9 % (n = 10). The median decolonization time was 16-weeks (IQR-23) and ranged from two to 53 weeks. CONCLUSION FMT may be used in the clinical practice for CPE-decolonization as an alternative to combined antibiotic regimens.
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Affiliation(s)
| | - Ana Ponte
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Margarida Mota
- Infection Control Group, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Rolando Pinho
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Nuno Vieira
- Infection Control Group, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Rosa Oliveira
- Infection Control Group, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Nelson Mota-Carvalho
- Centre of Biotechnology and Fine Chemistry, Faculty of Biotechnology. Catholic University of Portugal
| | - Ana Catarina Gomes
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Edgar Afecto
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - João Carvalho
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
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de Lacerda N, Mota M. P-06-16 Dealing With the Intersection Between Intellectual Disability and Gender Dysphoria. A Case of Female-to-Male Civil Identity Change. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.359] [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: 10/24/2022]
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Rigor J, Ferreira PM, Murteira F, Figueiredo C, Vieira N, Oliveira R, Couto R, Mota M. Antibiotic Clinic: Two Years' Experience in Outpatient Parenteral Antimicrobial Therapy in a Portuguese Hospital. ACTA MEDICA PORT 2019; 32:576-579. [PMID: 31493360 DOI: 10.20344/amp.11730] [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: 12/23/2018] [Accepted: 03/12/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Outpatient antimicrobial therapy programs have been in place for more than four decades. They provide safe and effective treatment for a selected group of patients while reducing costs. In Europe in general, and in Portugal in particular, these programs are still a relatively new phenomenon. The aim of this study is to describe our center's two years' experience with such a program (Antibiotic Clinic). MATERIAL AND METHODS The cohort of treatments administered by the Antibiotic Clinic in its first two years of existence (September 12th 2016 to September 11th 2018) was analyzed and data pertaining to patients, infections, infectious agents, antimicrobials and outcomes (infection resolution, adverse events and death) were characterized. RESULTS The Antibiotic Clinic treated 231 patients in 250 episodes, providing a total of 2357 days of antibiotic treatment. The urinary tract was the most common site (39.2%) and Enterobacteriaceae the most common agents (63.7% of isolates). Infections were resolved in 90.8% of treatments (95.6% of patients), adverse events were few (1.2%) and direct mortality was not found. The dropout rate was 1.6%. DISCUSSION Infection resolution and adverse event rates were comparable to other centers. High treatment and low dropout rates point to high physician and patient acceptance. CONCLUSION Our experience with this program suggests it is a safe and effective alternative to inpatient admission. This is in line with current literature which suggests efforts should be made to expand this treatment modality.
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Affiliation(s)
- Joana Rigor
- Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Paula Marques Ferreira
- Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Fábio Murteira
- Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Cristóvão Figueiredo
- Unidade de Doenças Infeciosas. Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Nuno Vieira
- Grupo Coordenador Local. Programa de Prevenção e Controlo de Infeções e Resistência aos Antimicrobianos. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Rosa Oliveira
- Grupo Coordenador Local. Programa de Prevenção e Controlo de Infeções e Resistência aos Antimicrobianos. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Raquel Couto
- Unidade de Doenças Infeciosas. Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Margarida Mota
- Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Unidade de Doenças Infeciosas. Serviço de Medicina Interna. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Grupo Coordenador Local. Programa de Prevenção e Controlo de Infeções e Resistência aos Antimicrobianos. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
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Almeida MC, Antunes D, Silva BMA, Rodrigues L, Mota M, Borges O, Fernandes C, Gonçalves T. Early Interaction of Alternaria infectoria Conidia with Macrophages. Mycopathologia 2019; 184:383-392. [PMID: 31183740 DOI: 10.1007/s11046-019-00339-6] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
Fungi of the genus Alternaria are ubiquitous indoor and outdoor airborne agents, and individuals are daily exposed to their spores. Although its importance in human infections and, particularly in respiratory allergies, there are no studies of how Alternaria spp. spores interact with host cells. Our aim was to study the early interaction of Alternaria infectoria spores with macrophages, the first line of immune defense. RAW 264.7 macrophages were infected with A. infectoria conidia, and the internalization and viability of conidia once inside the macrophages were quantified during the first 6 h of interaction. Live cell imaging was used to study the dynamics of this interaction. TNF-α production was quantified by relative gene expression, and the concentration of other cytokines (IL-1α, IL-1β, IL-6, IL-4, IL-10, IL-17, GM-CSF and INF-γ) and a chemokine, MIP-1α, was quantified by ELISA. Conidia were rapidly internalized by macrophages, with approximately half internalized after 30 min of interaction. During the first 6 h of interaction, macrophages retained the ability to mitotically divide while containing internalized conidia. The classical macrophage-activated morphology was absent in macrophages infected with conidia, and TNF-α and other cytokines and chemokines failed to be produced. Thus, macrophages are able to efficiently phagocyte A. infectoria conidia, but, during the first 6 h, no effective antifungal response is triggered, therefore promoting the residence of these fungal conidia inside the macrophages.
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Affiliation(s)
- M C Almeida
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.
| | - D Antunes
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - B M A Silva
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - L Rodrigues
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Mota
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - O Borges
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FFUC - Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - C Fernandes
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - T Gonçalves
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Ramos B, Marques-Pinto A, Dias-Amaral A, Barbosa D, Covelo V, Mota M. PO-01-065 Psychopathology in sexual dysfunction: Experience in a Portuguese outpatient clinic. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.211] [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: 11/29/2022]
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Delabays N, Grogg A, Mota M, Piantini U. Selection of plant species for permanent ground cover in vineyards: Looking for an agronomic and environmental optimum. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191501007] [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
The installation of a permanent ground cover in vineyards offers numerous agronomic (soil protection, soil fertility) and environmental (reduced leaching of nutrients and of plant protection products, reduced use of herbicides, biodiversity) benefits. Nevertheless, such ground covers are not always free of drawbacks (competition for water and nitrogen, increased risk of frost, management). For the growers, the challenge is to manage the green ground covers in such a way as to preserve their advantages while limiting these drawbacks. Among the tools available to the winegrower is the sowing of a seed mixture composed of selected species: a choice depending of the soil and climatic conditions of the parcel, but also of the different, and sometime contradictory, objectives of the grower. This paper lists the agronomic and environmental issues addressed by the installation of a permanent ground cover in vineyards. It describes two concrete situations – ground cover for vineyards integrated in agro-ecological networks and green cover on the row of vines (as alternative to glyphosate) – for which, according to the objectives and the impacts, a choice of plant species is proposed. At last, it presents the trials now carried out to validate and optimize those selections, as well as the first observations and results gathered to date.
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Ponte A, Pinho R, Mota M, Silva J, Vieira N, Oliveira R, Rodrigues J, Sousa M, Sousa I, Carvalho J. Fecal microbiota transplantation in refractory or recurrent Clostridium difficile infection: a real-life experience in a non-academic center. Rev Esp Enferm Dig 2018; 110:311-315. [PMID: 29411989 DOI: 10.17235/reed.2018.5099/2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM this study aimed to describe the efficacy and safety of fecal microbiota transplantation (FMT) for the treatment of refractory and recurrent Clostridium difficile infection (CDI). METHODS this was an observational study of patients with refractory or recurrent CDI treated with FMT between June 2014 and January 2017. Primary and secondary outcomes were the resolution of diarrhea without CDI recurrence within two months after one or more FMT. A descriptive analysis was performed. RESULTS thirty-four FMT were performed in 28 patients, 88.2% (n = 30) using an upper route with a gastroscopy and 11.8% (n = 4) with colonoscopy; 50% (n = 17) of FMT were due to recurrent CDI and 50% (n = 17) were due to refractory CDI. The overall cure rate of upper FMT was 87.5% (21/24) and 100% (4/4) when colonoscopy was performed. A cure was achieved after one FMT in 88% (22/25) of cases and after two or more FMT in 8% (2/25) of cases, resulting in an overall cure rate of 96% (24/25). No severe adverse events were reported. CONCLUSION FMT constitutes an effective and safe approach for the management of refractory and recurrent CDI, with an overall cure rate of 96% and no reported severe adverse events.
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Affiliation(s)
- Ana Ponte
- Gastrenterologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Rolando Pinho
- Department of Gastroenterology and Hepatology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal, Portugal
| | | | - Joana Silva
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Portugal
| | - Nuno Vieira
- Centro Hospitalar de Vila Nova de Gaia/Espinho
| | | | - Jaime Rodrigues
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Mafalda Sousa
- Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho
| | | | - João Carvalho
- Gastroenterology and Hepatology department, Centro Hospitalar de Gaia/Espinho
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Zetu C, Popa S, Popa A, Munteanu R, Mota M. LONG-TERM IMPROVEMENT OF GLUCOSE HOMEOSTASIS AND BODY COMPOSITION IN PATIENTS UNDERGOING LAPAROSCOPIC SLEEVE GASTRECTOMY. Acta Endocrinol (Buchar) 2018; 14:477-482. [PMID: 31149300 PMCID: PMC6516409 DOI: 10.4183/aeb.2018.477] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Laparoscopic sleeve gastrectomy (SG) has gained popularity as a metabolic procedure, but its long-term effectiveness for Romanian patients remains unclear. OBJECTIVES To assess the long-term efficacy of SG for Romanian patients and to evaluate the differences between 5 years and 1 year follow-up. DESIGN A longitudinal, prospective analysis of collected data from 68 patients undergoing SG between 2009 and 2014 was performed. Long-term outcomes at 5 years were analyzed in terms of total weight loss (%TWL), excess weight loss (%EWL), body composition and glucose homeostasis. SUBJECTS AND METHODS All patients meeting the standard criteria for SG before inclusion were prospectively enrolled in the study. Of the 68 patients, eight were lost to follow-up, therefore, 60 patients (41.7±12.5 years, baseline body mass index [BMI] 44.6±9.9Kg/m2) were analyzed. RESULTS The BMI decreased at 12 months with 30.7% from the preoperative BMI (p<0.001) and subsequently stabilized at 5 years.TWL and EWL were 30.6% and 83.1%, respectively at 1 year, with a slightly increase at 5 years.Therapeutic success rate (%EWL≥50) and diabetes remission rate (Buchwald criteria) were 93.3% and respectively 63.6% at 5 years. Insulin sensitivity index and metabolic clearance rate of glucose increased with 92.5% and 60.1% respectively, in the third month from baseline (p<0.001), while estimated second phase of insulin secretion decreased with 7.9% in the first month postoperatively (p=0.04), remaining stable afterwards. CONCLUSIONS SG was effective in terms of %EWL, body composition and glucose homeostasis improvement for Romanian patients, the outcomes stabilizing after 1 year follow-up.
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Affiliation(s)
- C. Zetu
- “N.C. Paulescu” National Institute for Diabetes, Nutrition and Metabolic Diseases, Diabetes 1, Craiova, Romania
| | - S.G. Popa
- University of Medicine and Pharmacy, Craiova, Romania
| | - A. Popa
- Emergency Clinical Hospital, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
| | - R. Munteanu
- Euroclinic Hospital, Department of Surgery, Bucharest, Craiova, Romania
| | - M. Mota
- University of Medicine and Pharmacy, Craiova, Romania
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Dias C, Duarte-Ribeiro F, Pipa S, Barbosa AR, Mota M, Rosas Vieira F. Hepatocellular carcinoma after direct-acting antiviral therapy for chronic HCV infection: Is it a real risk? IDCases 2018; 14:e00450. [PMID: 30191133 PMCID: PMC6125765 DOI: 10.1016/j.idcr.2018.e00450] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 01/05/2023] Open
Abstract
The newer oral treatments for chronic hepatitis C virus infection are one of the greatest revolutions in modern medicine. These drugs promise to eradicate the infection, showing high cure rates even in difficult to treat populations with very few side effects. Nevertheless, some cases of recurrence and de novo hepatocellular carcinoma after treatment with these drugs have been reported. We describe two cases of patients treated with direct-acting antiviral agents that developed hepatocarcinoma during follow-up post-treatment.
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Affiliation(s)
- Cátia Dias
- Corresponding author at: Rua Dr.º Francisco Sá Carneiro, 1228 1º esquerdo, São Cosme, 4420-132 Gondomar, Porto, Portugal.
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Abstract
The diagnosis of acute hepatitis C (HCV) infection is rare since the majority of cases are asymptomatic, which makes the infection usually detected in a chronic phase, most of the time using serological tests. The main route of HCV transmission is percutaneous, with sexual transmission occurring more often in men who have sex with men. The analytical alterations of acute hepatitis C are varied but usually present with ALT elevation higher than AST, very rarely with hepatic insufficiency. We report a case of a patient with a clinical and analytical picture compatible with toxic acute hepatitis, accompanied by hepatic insufficiency, with negative serology for hepatotropic viruses and with no history compatible with the use of substances with hepatic toxicity other than alcohol. During the diagnostic investigation it was concluded that the patient had acute HCV hepatitis and that the transmission route was heterosexual.
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Affiliation(s)
- Cátia Dias
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Sara Pipa
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
| | - Margarida Mota
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal
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Dias C, Pipa S, Duarte-Ribeiro F, Mota M. Fecal microbiota transplantation as a potential way to eradicate multiresistant microorganisms. IDCases 2018; 13:e00432. [PMID: 30140609 PMCID: PMC6105750 DOI: 10.1016/j.idcr.2018.e00432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/21/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022] Open
Abstract
Multiresistant microorganism infection often can produce a life-threatening situation. We report two cases in which fecal microbiota transplantation used for the treatment of recurrent Clostridium difficile infection were effective in eradicating colonization by carbapenemase-producing Enterobacteriaceae. The presented cases illustrate the potential benefit of fecal microbiota transplantation in resolution of asymptomatic carrier states of multiresistant microorganisms, suggesting the need for further investigations with a view to their applicability in this area.
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Affiliation(s)
- Cátia Dias
- Corresponding author at: Rua Dr.° Francisco Sá Carneiro, 1228 1° esquerdo, São Cosme, 4420-132 Gondomar, Porto, Portugal.
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Rosu MM, Popa SG, Mota E, Popa A, Manolache M, Guja C, Bala C, Mota C, Mota M. CARDIOVASCULAR RISK ASSESSMENT IN THE ADULT (AGED 40-79 YEARS) ROMANIAN POPULATION. Acta Endocrinol (Buchar) 2018; 14:227-234. [PMID: 31149262 DOI: 10.4183/aeb.2018.227] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Atherosclerotic Cardiovascular Diseases are the leading cause of death worldwide. Aim To estimate the prevalence of cardiovascular risk (CVR) categories in the adult population (aged 40-79 years) of Romania. Design The present study was part of the epidemiological, cross-sectional PREDATORR study (PREvalence of DiAbeTes mellitus, prediabetes, overweight, Obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romania). Subjects and Methods Exclusion criteria: age <40/or>79 years old and diagnosis of ischemic vascular disease. The CVR was evaluated using charts developed by the World Health Organization/ International Society of Hypertension (WHO/ISH) available for Europe B (epidemiological sub-region where Romania was included). The CVR was divided into 5 categories: <10%, 10-20%, 20-30%, 30-40%, > 40%. Results A total of 1631 subjects (57.0±10.7 years, 45.1% males) were included in the present study.The age and sex-adjusted prevalence of CVR >40% was 2.9% (95%CI 2.8-3.1%), CVR 30-40% was 1.85% (95%CI 1.8-1.9%), CVR 20-30% was 5.8% (95%CI 5.6-6.0%) and 13.0% (95%CI 12.8-13.3%) of the adult Romanian population has a 10-20% CVR, these CVR categories being more frequent in male and older age. Diabetes, overweight/obesity and smoking were associated with high CVR categories. Conclusion Romania is one of the countries with high CVR, requiring CVD prevention measures.
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Affiliation(s)
- M M Rosu
- Clinical County Emergency Hospital Craiova, Romania, Dept. of Diabetes, Nutrition and Metabolic Diseases, Craiova University of Medicine and Pharmcy, Romania
| | - S G Popa
- Dept. of Diabetes, Nutrition and Metabolic Diseases, Romania
| | - E Mota
- Dept. of Nephrology, Romania
| | - A Popa
- Clinical Emergency Hospital, Department of Diabetes, Nutrition and Metabolic Diseases - Craiova, Romania
| | | | - C Guja
- "N.C. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases - Bucharest, Romania
| | - C Bala
- "Iuliu Hatieganu" University of Medicine and Pharmacy - Diabetes, Nutrition and Metabolic Diseases - Cluj-Napoca, Romania
| | - C Mota
- "Iuliu Hatieganu" University of Medicine and Pharmacy - Diabetes, Nutrition and Metabolic Diseases - Cluj-Napoca, Romania
| | - M Mota
- Dept. of Diabetology, Romania.,Clinical Emergency Hospital, Department of Diabetes, Nutrition and Metabolic Diseases - Craiova, Romania
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Abstract
Summary Background. Antiretroviral therapy (ART) may be responsible for hypersensitivity reactions varying in severity, clinical manifestations and frequency. Case report. We report the case of a 47-year-old woman with HIV infection who developed a delayed mucocutaneous reaction after treatment with ART. Hypersensitivty reaction (HR) to emtricitabine and tenofovir was considered probable based on positive patch tests (PT) and hypersensitivity reaction to nevirapine was confirmed by drug provocation test. Discussion. The diagnosis of HR to ART remains a diagnostic challenge, partly due to unknown mechanism and the absence of validated diagnostic tools. Patch testing may represent a useful method for confirming hypersensitivity. Further investigation in this area is required, so that successful management strategies can be offered, preventing loss of potent and viable antiretroviral agents.
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Affiliation(s)
- M J Sousa
- Immunoallergology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - S Cadinha
- Immunoallergology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Mota
- Infectious Diseases, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - T Teixeira
- Infectious Diseases, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - D Malheiro
- Immunoallergology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J P Moreira da Silva
- Immunoallergology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Duarte-Ribeiro F, Dias C, Mota M. Bronchopleural and pleurocutaneous fistula in HIV patient with pulmonary tuberculosis. IDCases 2017; 9:82-84. [PMID: 28725561 PMCID: PMC5506868 DOI: 10.1016/j.idcr.2017.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/19/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 12/03/2022] Open
Abstract
We present a 37-year-old man intravenous drug user, with HIV/HCV/HBV co-infection, lymph node tuberculosis 10 years before (completed 12 months of treatment), and left lobar pneumonia 4 years earlier complicated by empyema (treated with left lower lobectomy with a persistent bronchopleural fistula) who was admitted to the emergency department with caseous-purulent drainage and exteriorization of air from an orifice in the chest wall. Acid-fast bacilli were identified in this drainage. A pleurocutaneous fistula was evident on the chest computed tomography scan. He was admitted to the Infectious Diseases Unit and started on antituberculous therapy with a favorable outcome.
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Affiliation(s)
- Filipa Duarte-Ribeiro
- Centro Hospitalar Vila Nova de Gaia/Espinho – Internal Medicine Department, Portugal
- Corresponding author.
| | - Cátia Dias
- Centro Hospitalar Vila Nova de Gaia/Espinho – Internal Medicine Department, Portugal
| | - Margarida Mota
- Centro Hospitalar Vila Nova de Gaia/Espinho – Internal Medicine Department, Infectious Diseases Unit, Portugal
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Ponte A, Pinho R, Mota M. Fecal microbiota transplantation: Is there a role in the eradication of carbapenem-resistant Klebsiella pneumoniae intestinal carriage? Rev Esp Enferm Dig 2017; 109. [DOI: 10.17235/reed.2017.4425/2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Castro A, Komora N, Ferreira V, Lira A, Mota M, Silva J, Teixeira P. Prevalence of Staphylococcus aureus from nares and hands on health care professionals in a Portuguese Hospital. J Appl Microbiol 2016; 121:831-9. [PMID: 27206682 DOI: 10.1111/jam.13186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 03/07/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
Abstract
AIMS The main goal was to estimate the prevalence of methicillin-resistant Staphylococcus aureus on hands and in nose of health care professionals. METHODS AND RESULTS Detection of Staph. aureus on hands or in the nose of 169 individuals was performed. Nasal and hand carriage was found in 39·6 and in 8·9% respectively. About 17·2% of the individuals were carriers of methicillin-resistant Staph. aureus (MRSA) in the nose and 4·7% on hands. The majority of nasal MRSA were resistant to β-lactams, erythromycin and ciprofloxacin. All nasal MRSA were SCCmec type IV and Panton-Valentine leukocidin (PVL) negative. One MRSA isolated from hand was SCCmec type V. About 75·6% of MRSA isolates presented the same or closely related restriction patterns. Sixty per cent of Staph. aureus from hands and from noses from the same individual were the same strain. CONCLUSIONS MRSA nasal carriage was high considering healthy health care professionals but in accordance with high level of MRSA infection in Portugal. Isolates recovered in this study seemed to be different from major clones previously isolated in other Portuguese hospitals. SIGNIFICANCE AND IMPACT OF THE STUDY These findings may have implications on the knowledge of healthy health care workers as vehicles of MRSA infections among the community. Presence of several virulence factors may contribute to increased pathogenesis in case of infection.
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Affiliation(s)
- A Castro
- Escola Superior de Biotecnologia, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Universidade Católica Portuguesa, Porto, Portugal
| | - N Komora
- Escola Superior de Biotecnologia, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Universidade Católica Portuguesa, Porto, Portugal
| | - V Ferreira
- Escola Superior de Biotecnologia, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Universidade Católica Portuguesa, Porto, Portugal
| | - A Lira
- Clinical Pathology Unit, Gaia Hospital Centre - Oporto University, Vila Nova de Gaia, Portugal
| | - M Mota
- Infectious Diseases Unit, Gaia Hospital Centre - Oporto University, Vila Nova de Gaia, Portugal
| | - J Silva
- Escola Superior de Biotecnologia, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Universidade Católica Portuguesa, Porto, Portugal
| | - P Teixeira
- Escola Superior de Biotecnologia, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Universidade Católica Portuguesa, Porto, Portugal
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Abstract
In this paper, we investigate the geometric growth of homogeneous multitype Markov chains whose states have nonnegative integer coordinates. Such models are considered in a situation similar to the supercritical case for branching processes. Finally, our general theoretical results are applied to a class of controlled multitype branching process in which the control is random.
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Abstract
In this paper, we introduce a bisexual Galton-Watson branching process with mating function dependent on the population size in each generation. Necessary and sufficient conditions for the process to become extinct with probability 1 are investigated for two possible conditions on the sequence of mating functions. Some results for the probability generating functions associated with the process are also given.
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Amaral A, Ferraz I, Mota M. A journey across perversions history – from Middle Age to DSM. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionPsychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.AimsTo review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.MethodsPubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.ResultsThroughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.ConclusionA progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Fontes-Carvalho R, Mancio J, Marcos A, Sampaio F, Mota M, Rocha Gonçalves F, Gama V, Azevedo A, Leite-Moreira A. HIV patients have impaired diastolic function that is not aggravated by anti-retroviral treatment. Cardiovasc Drugs Ther 2015; 29:31-9. [PMID: 25749869 DOI: 10.1007/s10557-015-6573-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Recent studies have shown that HIV infection is independently associated with heart failure. Diastolic dysfunction (DD) is frequent in HIV patients, but it is unclear whether this is an effect of the HIV infection itself or of the anti-retroviral therapy (ART). Our aim was to compare diastolic function in HIV treatment-naïve, HIV-ART patients and controls. METHODS We prospectively enrolled 206 consecutive patients with HIV-1 infection and 30 controls, selected by frequency matching for age and sex. HIV patients were divided in two subgroups: ART-naïve (n = 88) and ART (n = 118). Diastolic function was assessed and graded by echocardiography, according to modern consensus criteria and using tissue Doppler analysis. RESULTS Compared to controls, ART-naïve patients had lower E' velocities (E' septal: 10.2 ± 2.4 vs 11.9 ± 2.6 cm/s, p = 0.02), higher E/E' ratio (7.8 ± 1.9 vs 6.9 ± 1.6,p = 0.02) and higher prevalence of DD (19 % vs 3.3 %,p = 0.05). HIV patients under ART also had worse diastolic function compared to controls (E' septal: 10.3 ± 2.5 cm/s;p < 0.01; E/E'ratio: 8.0 ± 2.0,p < 0.01; DD prevalence: 23 %;p = 0.01), but no significant differences were found between ART-naïve and ART HIV subgroups. In multivariable logistic regression analysis, age and body mass index were the only independent predictors of reduced diastolic reserve in HIV patients. Regarding systolic function, there were no significant differences in ejection fraction or S' velocities between controls and HIV subgroups. CONCLUSIONS HIV treatment-naïve patients have reduced diastolic reserve that is not worsened by ART. These data reinforce the association of diastolic dysfunction with the HIV infection itself and not with the anti-retroviral therapy.
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Affiliation(s)
- Ricardo Fontes-Carvalho
- Cardiology Department, Gaia Hospital Center, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal,
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Mendes G, Vieira P, Lanceros-Méndez S, Kluskens L, Mota M. Transformation of Escherichia coli JM109 using pUC19 by the Yoshida effect. J Microbiol Methods 2015; 115:1-5. [DOI: 10.1016/j.mimet.2015.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
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Bao M, Roura A, Mota M, Nachón D, Antunes C, Cobo F, MacKenzie K, Pascual S. Macroparasites of allis shad (Alosa alosa) and twaite shad (Alosa fallax) of the Western Iberian Peninsula Rivers: ecological, phylogenetic and zoonotic insights. Parasitol Res 2015; 114:3721-39. [DOI: 10.1007/s00436-015-4601-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
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Bao M, Mota M, Nachón DJ, Antunes C, Cobo F, Garci ME, Pierce GJ, Pascual S. Anisakis infection in allis shad, Alosa alosa (Linnaeus, 1758), and twaite shad, Alosa fallax (Lacépède, 1803), from Western Iberian Peninsula Rivers: zoonotic and ecological implications. Parasitol Res 2015; 114:2143-54. [PMID: 25810220 DOI: 10.1007/s00436-015-4403-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 12/01/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
Spawning individuals of allis shad, Alosa alosa (Linnaeus, 1758), and twaite shad, Alosa fallax (Lacépède, 1803), were sampled from three rivers on the Atlantic coast of the Iberian Peninsula (Ulla, Minho, Mondego) during 2008 to 2013 to assess the presence of the zoonotic marine parasite Anisakis spp. larvae. The results revealed that both shad species were infected by third-larval stage Anisakis simplex s.s. and Anisakis pegreffii. The latter is reported in mixed infections in both shad species of Western Iberian Peninsula for the first time. In A. alosa, the prevalence of Anisakis infection can reach 100%, while in A. fallax, prevalence was up to 83%. Infected individuals of the former species also often contain much higher number of parasites in theirs internal organs and flesh: from 1 to 1138 Anisakis spp. larvae as compared to 1 to 121 larvae, respectively. In general, numbers of A. pegreffii were higher than those of A. simplex s.s. Our results suggest that in the marine environment of the Western Iberian Peninsula, both anadromous shad species act as paratenic hosts for A. simplex s.s. and A. pegreffii, thus widening the distribution of the infective nematode larvae from the marine to the freshwater ecosystem. This finding is of great epidemiological relevance for wildlife managers and consumers, considering the zoonotic and gastroallergic threats posed of these parasites.
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Affiliation(s)
- M Bao
- ECOBIOMAR, Instituto de Investigaciones Marinas (CSIC), Eduardo Cabello 6, 36208, Vigo, Spain,
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Ferraz I, Ramos I, Coelho T, Mota M. First Faster Then Slower. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)32100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Massa AF, Campos M, Osório Ferreira E, Tente D, Cabeçadas J, Mota M, Coelho H, Baptista A. Cutaneous Epstein-Barr virus-associated lymphoproliferative polymorphic disease - AIDS presenting manifestation. J Eur Acad Dermatol Venereol 2015; 30:554-6. [PMID: 25623621 DOI: 10.1111/jdv.12958] [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: 11/28/2022]
Affiliation(s)
- A F Massa
- Department of Dermatology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - M Campos
- Department of Dermatology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - E Osório Ferreira
- Department of Dermatology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - D Tente
- Department of Pathology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - J Cabeçadas
- Department of Pathology, IPO Lisboa, Lisboa, Portugal
| | - M Mota
- Infectious Disease Unit, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - H Coelho
- Department of Haematology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - A Baptista
- Department of Dermatology, Centro Hospitalar de V.N.Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
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Ponte A, Pinho R, Mota M, Silva J, Vieira N, Oliveira R, Pinto-Pais T, Fernandes C, Ribeiro I, Rodrigues J, Lopes P, Teixeira T, Carvalho J. Initial experience with fecal microbiota transplantation in Clostridium difficile Infection Transplant protocol and preliminary results. Rev Esp Enferm Dig 2015; 107. [DOI: 10.17235/reed.2015.3767/2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Affiliation(s)
- Maria Sousa
- Allergy DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoPortugal
| | - Susana Cadinha
- Allergy DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoPortugal
| | - Margarida Mota
- Infectious Diseases DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoPortugal
| | - Tiago Teixeira
- Infectious Diseases DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoPortugal
| | - Daniela Malheiro
- Allergy DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoPortugal
| | - JP Moreira Silva
- Allergy DepartmentCentro Hospitalar Vila Nova de Gaia/EspinhoPortugal
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Vanikar AV, Trivedi HL, Dave SD, Kute VB, Rawal MN, Patel HV, Gumber MR, Afghahi H, Pirouzifard M, Svensson AM, Eliasson B, Svensson MK, Dumann K, Horrmann B, Lammert A, Rheinberger M, Gorski M, Kramer BK, Heid IM, Boger CA, Demirtas L, Akbas EM, Timuroglu A, Ozcicek F, Turkmen K, Fernandez-Fernandez B, Sanchez-Nino MD, Martin-Cleary C, Izquierdo MC, Elewa U, Ortiz A, Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Gluhovschi C, Velciov S, Bob F, Vlad D, Popescu R, Petrica M, Jianu DC, Milas O, Izvernari O, Ursoniu S, Makino Y, Konoshita T, Nyumura I, Babazono T, Yoshida N, Uchigata Y, Handisurya A, Kerscher C, Tura A, Werzowa J, Heinzl H, Ristl R, Kautzky-Willer A, Pacini G, Saemann M, Schmidt A, Halbesma N, Metcalfe W, Bulum T, Prka in I, Blaslov K, Zibar K, Duvnjak L, Idorn T, Knop FK, Jorgensen MB, Christensen M, Holst JJ, Hornum M, Feldt-Rasmussen B, Naess H, Hartmann A, Jenssen TG, Holdaas H, Horneland R, Grzyb K, Bitter J, Midtvedt K, Yoshida N, Babazono T, Uchigata Y, Timar R, Gluhovschi G, Gadalean F, Velciov S, Petrica L, Timar B, Gluhovschi C, Soro-Paavonen A, Fleming T, Forsblom C, Gordin D, Tolonen N, Harjutsalo V, Nawroth PP, Groop PH, Tsuda A, Ishimura E, Uedono H, Yasumoto M, Nakatani S, Ichii M, Ohno Y, Ochi A, Mori K, Fukumoto S, Emoto M, Inaba M, Rheinberger M, Hormann B, Lammert A, Dumann K, Gorski M, Heid IM, Kramer BK, Boger CA, Siddaramaiah NH, Tez DK, Linker NJ, Bilous M, Winship S, Marshall SM, Bilous RW, Lampropoulou IT, Papagianni A, Stangou M, Didangelos T, Iliadis F, Efstratiadis G, Esposito P, Debarbieri G, Mereu R, Ditoro A, Montagna F, Groop PH, Bernardi L, Dal Canton A, Garland JS, Holden R, Morton R, Ross R, Adams M, Pruss C, Akbas EM, Demirtas L, Timuroglu A, Ozcicek F, Turkmen K, Bulum T, Prka in I, Blaslov K, Zibar K, Duvnjak L, Theodoridis M, Panagoutsos S, Bounta T, Roumeliotis S, Kantartzi K, Pouloutidis G, Passadakis P, Polaina Rusillo M, Borrego Utiel FJ, Ortega Anguiano S, Liebana Canada A, Gaber EW, Abdel Rehim WM, Ibrahim NA, Mahmoud BF, Silva AP, Fragoso A, Tavares N, Silva C, Santos N, Camacho A, Neves P, Rodriguez R, Porrini E, Gonzalez-Rinne A, De Vries A, Torres A, Salido E, Kato S, Makino H, Uzu T, Koya D, Nishiyama A, Imai E, Ando M, Jorgensen MB, Knop FK, Idorn T, Holst JJ, Hornum M, Feldt-Rasmussen B, Vaduva C, Popa S, Mitrea A, Mota M, Mota E, Theodoridis M, Panagoutsos S, Roumeliotis S, Bounta T, Kriki P, Roumeliotis A, Passadakis P, Ogawa T, Okazaki S, Hatano M, Hara H, Inamura M, Kiba T, Iwashita T, Shimizu T, Tayama Y, Kanozawa K, Kato H, Matsuda A, Hasegawa H, Elewa U, Fernandez B, Egido J, Ortiz A, Rottembourg J, Guerin A, Diaconita M, Dansaert A, Chakraborty J, Prabhu R, Nagaraju SP, Bairy M, Satyamoorthy K, Kosuru S, Parthasarathy R, Tomilina N, Zhilinskaya T, Stolyarevich E, Silva AP, Fragoso A, Guilherme P, Silva C, Santos N, Rato F, Camacho A, Neves P, Pasko N, Strakosha A, Toti F, Dedej T, Marku N, Petrela E, Zekollari E, Kacorri V, Thereska N, Roumeliotis SK, Roumeliotis AK, Theodoridis M, Tavridou A, Panagoutsos S, Passadakis P, Vargemezis V, Kim IY, Lee SB, Lee DW, Kim MJ, Shin MJ, Rhee H, Yang BY, Song SH, Seong EY, Kwak IS, Celebi K, Sengul E, Cekmen MB, Yilmaz A, Sonikian M, Dona A, Skarakis J, Miha T, Trompouki S, Karaitianou A, Spiliopoulou C, Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Kanellos IE, Fotiadis SD, Didaggelos TP, Savopoulos CG, Hatzitolios AI, Grekas DM, Hsu YH, Huang MC, Chang HY, Shin SJ, Wahlqvist ML, Chang YL, Hsu KC, Hsu CC, Miarka P, Grabowska-Polanowska B, Faber J, Skowron M, Pietrzycka A, Walus-Miarka M, Sliwka I, Sulowicz W. DIABETES CLINICAL. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu169] [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: 11/13/2022] Open
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Guerra C, Coelho T, Torres C, Correia R, Moreira R, Silva A, Mota M. EPA-0596 – Catatonia and electroconvulsive therapy: are there patients that need a higher number of sessions? Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)77983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Fernandes C, Mota M, Veloso R, Pinho R, Dias V. [Symptomatic acute hepatitis C: the importance of diagnosis]. Acta Gastroenterol Latinoam 2013; 43:308-311. [PMID: 24516958] [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: 06/03/2023]
Abstract
Chronic infection by the hepatitis C virus (HCV) is one of the leading causes of chronic liver disease with an estimate worldwide prevalence of over 200 million people. Acute hepatitis C infection is usually asymptomatic and rarely identified in clinical practice, leading to chronic infection in about 80% of all cases. However, when symptomatic, only about 50% of acute infections progress to chronicity. Correctly identifying acute HCV infection is of paramount importance once it presents itself as an unique treatment opportunity with sustained virological response of about 90%, which is very distant from the 30% to 80% of sustained virological response achieved with standard chronic HCV treatment. The authors present four cases of acute HCV infection. There was spontaneous viral clearance in two pa- tients at week 12 of follow-up. In one case viral RNA was positive at week 12 but sustained virological response was eventually achieved after peginterferon alpha2a monotherapy.
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Affiliation(s)
- Carlos Fernandes
- Serviço de Medicina Interna, Centro hospitalar de Vila Nova de Gaia/espinho EP.E., Portugal.
| | - Margarida Mota
- Serviço de Medicina Interna, Centro hospitalar de Vila Nova de Gaia/espinho EP.E., Portugal
| | - Ricardo Veloso
- Serviço de Gastrenterologia, Centro hospitalar de Vila Nova de Gaia/espinho EP.E., Portugal
| | - Rolando Pinho
- Serviço de Gastrenterologia, Centro hospitalar de Vila Nova de Gaia/espinho EP.E., Portugal
| | - Vitor Dias
- Serviço de Medicina Interna, Centro hospitalar de Vila Nova de Gaia/espinho EP.E., Portugal
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