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Porto L.,Centro Hospitalar Tondela Viseu
BMJ case reports | Year: 2013

Paraneoplastic syndromes are indirect manifestations of cancer due to functional peptides/hormones produced by a tumour, or due to cross reactivity between tumour and host antigens. Here the case of a 58-year-old woman presenting with ataxia, paraesthesia and subacute and progressive loss of vision is reported. The patient exhibited strong serum positivity for anti-Hu and anti-CV2 antibodies, and a chest CT scan showed a hypodense nodule in proximity of the right upper lobe bronchus and an enlarged ipsilateral paratracheal lymph node that was not visible on a lung x-ray. Histopathological examination of a biopsy specimen from this lymph node showed that small cell carcinoma of the lung was present. The patient's deficits were subsequently diagnosed as three coexisting paraneoplastic neurological syndromes (PNSs): subacute cerebellar ataxia, sensory neuropathy and retinopathy, respectively. Although rare, PNSs can be the first manifestations of cancer, and their rapid recognition facilitates an early treatment.


Franco D.G.,University of Beira Interior | Franco D.G.,Centro Hospitalar Tondela Viseu | Cardoso J.,Instituto Superior Of Ciencias Da Saude Egas Moniz | Neto I.,University of Beira Interior
Sexuality and Disability | Year: 2012

The acceptance of sexuality and its manifestations has changed in recent decades to being considered a normal feature of the identity of each individual. However, the person with intellectual disability have not benefited from this change in attitude. Their sexuality remains shrouded in myths and prejudices. The study population consisted of 454 students from the University of Beira Interior, from the Medicine, Psychology and Architecture majors. The data was collected using a questionnaire specifically drafted for this research. Most surveyed students consider sexuality an important part of life for every human being. From the responses to the questionnaire, psychology students were those with a more positive attitude towards sexuality and affectivity of the individual with intellectual disability, but the variability of the distribution of student responses from the three majors did not differ significantly. A positive attitude is characteristic of those who have acquired sufficient knowledge, females and of those who have frequent contact with individuals with intellectual disability. © Springer Science+Business Media, LLC 2012.


Santos M.I.,Centro Hospitalar Tondela Viseu | Limbert C.,Centro Hospitalar Lisbon Central | Marques F.C.,Centro Hospitalar Lisbon Ocidental | Rosario F.,Unidade de Cuidados de Saude Personalizados Tomaz Ribeiro | Lopes L.,Centro Hospitalar Lisbon Central
Journal of Pediatric Endocrinology and Metabolism | Year: 2015

Background: Serum thyroid stimulating hormone (TSH) levels are frequently elevated in obese children and are most likely to be associated with insulin resistance. However, clinical relevance of this association remains unclear. Objectives: To assess the prevalence of hyperthyrotropinemia; to analyze the relationship between TSH and homeostasis model assessment-insulin resistance (HOMA-IR); and to verify whether TSH levels and HOMA-IR vary with weight loss in obese children. Subjects and Methods: Retrospective longitudinal study with data from baseline and 1 year after lifestyle intervention in a pediatric obese group (344 children were recruited and 100 among them completed follow-up). For postintervention analysis, three groups were considered according to body mass index-standard deviation score (BMI-SDS) variations: ≤-0.5 (significant weight loss); 0.5-0 (weight loss); and >0 (weight gain). Statistical analysis was performed using SPSS 19.0®. Results: The prevalence of increased TSH levels was 9.3%. At baseline TSH (p=0.007), fT4 (p=0.006), and HOMA-IR (p<0.001) were positively correlated to BMI-SDS (n=344). Weight reduction was verified in 67 out of 100 cases but significant loss was present in only 21 cases. Decreases in both TSH and BMI-SDS were independently associated with decreases in HOMA-IR (p=0.005 and p=0.016, respectively). There was no correlation between TSH and BMI-SDS variation. Significant decreases in the HOMA-IR (p=0.006) were only achieved in the significant weight loss group. Conclusions: The prevalence of hyperthyrotropinemia was lower than previously reported. However, cutoff values were adjusted to pubertal stage, suggesting an over report in other studies. Insulin resistance and TSH were positively correlated, independent of body status. Although weight loss was not associated with TSH variation, a decrease in TSH levels was independently associated with decreases in HOMA-IR. © 2015 by De Gruyter.


Freitas F.,University of Porto | Freitas F.,Fernando Pessoa University | Freitas F.,Centro Hospitalar Tondela Viseu | Machado E.,University of Porto | And 5 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014

We investigated the occurrence, diversity and molecular epidemiology of genes coding for acquired AmpC β-lactamases (qAmpC) among clinical isolates of Enterobacteriaceae lacking inducible chromosomal AmpCs in Portugal. A total of 675 isolates non-susceptible to broad-spectrum cephalosporins obtained from four hospitals and three community laboratories during a 7-year period (2002-2008) were analysed. The presence of genes coding for qAmpC was investigated by phenotypic criteria, polymerase chain reaction (PCR) and sequencing. Bacterial identification, antibiotic susceptibility testing, conjugation assays and clonal analysis were performed by standard procedures. The presence of bla qAmpC genes was detected in 50 % (50/100; 41 Klebsiella pneumoniae, 5 Escherichia coli, 4 Klebsiella oxytoca) of the presumptive qAmpC producers. DHA-1, detected in those species, was the most prevalent qAmpC (94 %, 47/50), being identified since 2003 and throughout the studied period in different institutions. Despite the high clonal diversity observed, three DHA-1-producing Klebsiella spp. clones were more frequently identified. CMY-2 (6 %, 3/50) was observed in B1-E. coli clones. Conjugative transfer was only observed in one (2 %) CMY-2-producing isolate. Most qAmpC producers (94 %, 47/50) co-expressed SHV-type and/or OXA-1 or CTX-M-32 extended-spectrum β-lactamases (ESBLs). To the authors' knowledge, this is the first description of the molecular epidemiology and the long-term dissemination of qAmpC-producing Enterobacteriaceae in Portuguese clinical settings, highlighting an evolution towards a more complex epidemiological situation regarding cephalosporin resistance in Portugal. © 2013 Springer-Verlag.


Porto L.,Centro Hospitalar Tondela Viseu
BMJ case reports | Year: 2013

A 51-year-old man presented with a 3 month history of progressive right visual loss. On examination, the only abnormal findings were a right visual acuity of 4/10 and a swollen right optic disc. The patient had previously undergone MRI that had been reported as being normal and a trial of corticosteroids under the care of the referring ophthalmologist. An extensive battery of blood tests was normal apart from a rapid plasmatic reagin titre of 1:64. ELISA revealed elevated levels of total and immunoglobulin M antibodies against Treponema pallidum. Cerebrospinal fluid analysis revealed a mild leucocytosis and mildly elevated protein content. The patient was treated with a 5 week course of penicillin. Three months after starting treatment, his right visual acuity had improved to 8/10 and his right optic disc swelling had resolved.

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