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Porto, Portugal

PURPOSE:: To evaluate choroidal morphology and thickness at the posterior pole of individuals affected by multisystemic autoimmune diseases and without known ophthalmologic manifestations. METHODS:: Retrospective cross-sectional study including 75 patients with autoimmune diseases (divided according to their specific disease) and 80 healthy controls. A spectral-domain optical coherence tomography using enhanced depth imaging was performed and choroidal thickness was measured in the center of fovea and at 500 μm intervals along a horizontal section. RESULTS:: Lupus patients presented a thicker subfoveal choroid than controls (408.624 vs. 356.536, P < 0.001) and in all the other measurements (P < 0.001 to P = 0.003). Rheumatoid arthritis and other autoimmune diseases had an overall thinner choroid than controls (297.867 vs. 356.536 subfoveally, P = 0.004; P = 0.005–0.019 in other measurements). Results were adjusted for the covariates age (P = 0.007), spherical equivalent (P < 0.001), and systemic steroids dose (P = 0.004). Hypertension (P = 0.102), diabetes mellitus (P = 0.672), time since the beginning of therapy with hydroxychloroquine (P = 0.104) and its cumulative dose (P = 0.307), or use of other immunosuppressives (P = 0.281) had no influence on the mean choroidal thickness. No morphologic abnormalities were found. CONCLUSION:: The choroid may be subclinically involved in autoimmune diseases. However, the choroidal response seems to differ depending on the autoimmune disease. Infiltrative mechanisms specific for lupus may justify the thickened choroid found in these patients. © 2016 by Ophthalmic Communications Society, Inc.

Silveira C.,Hospital de Sao Joao | Silveira C.,University of Sfax | Marques-Teixeira J.,Laboratory of Psychophysiology | De Bastos-Leite A.J.,University of Porto
Journal of Nervous and Mental Disease | Year: 2012

Schizophrenia is a very complex psychiatric disorder of unknown etiology, and there is controversy as to whether its name is even appropriate to describe the associated variety of clinical presentations and symptoms. Currently, the diagnosis is essentially based on clinical criteria. These enable a clinical profile to be recognized as encompassing positive symptoms, negative symptoms, disorganization of thinking and behavior, cognitive impairment, mood abnormalities, motor abnormalities, chronic clinical course, and incomplete remissions. The concept has evolved during the past century, and schizophrenia is currently questioned as a single disease entity. Established diagnostic criteria do not mirror the heterogeneity of the disorder. A strategy to deal with clinical heterogeneity in schizophrenia is, perhaps, the adoption of a classification system based on dimensions and stages. An additional strategy to deal with etiological and pathophysiological heterogeneity is to try to identify biomarkers, namely, on the basis of intermediate phenotypes. Despite extensive biological research, the biomarkers for schizophrenia are still lacking. Copyright © 2012 by Lippincott Williams & Wilkins.

Ribeiro C.,Centro Hospitalar Of Vila Nova Of Gaia Espinho | Campelos S.,Centro Hospitalar Of Vila Nova Of Gaia Espinho | Moura C.S.,Hospital de Sao Joao | Moura C.S.,University of Porto | And 3 more authors.
Annals of Oncology | Year: 2013

Background: Well-differentiated papillary mesothelioma (WDPM) is a rare variant of epithelioid mesothelioma and is considered to be associated with good prognosis due to its clinically indolent behavior and long survival. Most reported cases involve the peritoneum of women at reproductive age with no history of exposure to asbestos, with pleural involvement being less common. The optimal management, including the role of chemotherapy in the treatment of WDPM, remains unsettled. Patients and methods: The authors describe two cases of WDPM in women of the same family (siblings); the elder with WDPM of the pleura and peritoneum with a 12-year survival period and the younger with a WDPM of the peritoneum diagnosed in 2011 and uveal melanoma diagnosed in 2012. Neither patient had any known exposure to asbestos fibers or any other mineral carcinogens. Results: After the concurrent diagnosis of WDPM and uveal melanoma, genetic diagnosis was carried out taking into consideration that these two malignancies were recently associated with hereditary BAP1 gene mutations and it was positive for both the patients. Conclusions: To our knowledge, this is the first description of WDPM in two siblings who also presented with a germline BAP1 mutation. This article provides evidence of the wide clinical spectrum of cancer susceptibility associated with a BAP1 germline mutation. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Moreira R.,Hospital de Sao Joao | Moreira R.,University of Porto
Clinical Drug Investigation | Year: 2011

Major depressive disorder (MDD) is a highly recurrent condition associated with a substantial burden of disease. Antidepressants alone or in combination with psychotherapy are the mainstay of treatment. Evidence demonstrates that antidepressant agents are significantly more efficacious than placebo in treating MDD, and antidepressants of different types have similar efficacies. However, not all patients respond to initial pharmacologica treatment, suggesting the need for antidepressants with different mechanisms of action. Bupropion is a second-generation antidepressant, with a mechanism of action different from most antidepressants, in that it is a dopamine and norepinephrine reuptake inhibitor. Bupropion has demonstrated efficacy in the treatment of MDD, measured by Hamilton depression rating scale total and clinical global impressions severity and improvement scores, the proportion of responders, the proportion of patients in remission of disease, the prevention of relapse and beneficial effect on a range of healthrelated quality of life measures. With an efficacy that is at least similar to most other common antidepressants, including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and other secondgeneration drugs, bupropion has a favourable acceptability and tolerability profile. In particular, it has a minimal effect on sexual function, comparable or lower rates of somnolence than placebo, and is associated with lower rates of weight gain and sedation than some other commonly used antidepressants. Combination therapy of bupropion with other second-generation antidepressants has been shown to improve outcomes in patients failing antidepressant monotherapy. Bupropion is approved for the treatment of MDD in the USA, Canada and many countries in Europe, and current evidence-based guidelines reinforce its place as an efficacious and well-tolerated treatment option in the pharmacological management of MDD. © 2011 Adis Data Information BV.

Teixeira J.F.,Hospital de Sao Joao
Transplantation Proceedings | Year: 2014

The appropriate clinical management of the integrated process of Donation and Transplantation implies the participation of the Transplant Coordinator. The aim of this article is to present the process of Certification of Transplant Coordinators in Europe since 2001, in accordance with the Council of Europe Recommendations and the evolving model implemented in 2008 under the auspices of the UEMS, reporting the longest running European standardized assessment of Transplant Coordination skills and knowledge. It includes the rationale for development of a certification process, how the examinations were developed and updated, eligibility to take the examination, and relationship with standards of practice for Transplant Coordinators. A total of 455 healthcare professionals were certified in two phases: 1st ETCO certification since 2001 to 2007 (390) and 2nd ETCO/UEMS certification from 2008 to 2011 (65). © 2014 by Elsevier Inc. All rights reserved.

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