Loading...
13 results
Search Results
Now showing 1 - 10 of 13
- Metformin in SARS-CoV-2 infection: a hidden path - from altered inflammation to reduced mortality (a review from the literature)Publication . Pedrosa, Ana Realista; Martins, Diana Cruz; Rizzo, Manfredi; Silva-Nunes, JoséSARS-CoV-2 infection has been a major threat to human health and a huge challenge to Medicine. In only two years, COVID-19 affected >350 million people, causing >5.6 million deaths. Chronic inflammatory states, such as diabetes or obesity, are known risk factors for COVID-19 poorest outcomes, with a higher risk for disease severity and greater mortality. Metformin remains on the first line of the management of hyperglycemia in type 2 diabetes. Through its anti-inflammatory and immunomodulatory mechanisms, metformin appears as an opportunity to control the dysregulated cytokine storm secondary to SARS-CoV-2 infection. Recent studies point towards a potential protective role of metformin in the course of COVID-19, showing that current or previous treatment with metformin associates with better outcomes.
- Cross-cultural translation and validation to Portuguese of the bariatric quality of life (BQL) IndexPublication . Figueiredo, Inês Rego de; Carvalho, Miguel Vasques; Cunha, Nelson; Martins, Diana; Silva-Nunes, JoséIntroduction: Obesity is a chronic noncommunicable disease, defined by the body mass index (BMI) ≥ 30Kg/m2. Its burden is not restricted to mortality and morbidity from other noncommunicable diseases, but also from a decrease in quality of life (QoL). There are several tools for assessing QoL, from generic health-related tools to obesity-related tools. However, to assess QoL in patients undergoing bariatric surgery there was only BAROS, which has some issues. Therefore, the Bariatric Quality of Life (BQL) index was developed. We aimed to perform a cross-cultural adaptation and validation of the BQL index in the Portuguese language. Methods: A cross-sectional study was performed, by presenting two questionnaires to participants: BQL índex and EQ-5D-3L. Translation followed by forward translation, reviewing, back-translation, comparison, and pilot testing was done. A retest was performed 6 months after the baseline. The following psychometric properties were assessed: converging validity by correlation through Spearman coefficient (r>0.3) of BQL and EQ-5D-3L, internal consistency by Cronbach alfa coefficient (≥0.5), and reproducibility between test and retest through Spearman correlation (r>0.3) and intraclass correlation coefficient (≥ 0.60). Results: A total of 260 participants were included, the majority (78%) being females, mean age of 45±10 years old, and a mean BMI of 44±6.5kg/m2. The most common obesity-related conditions were osteoarticular disease (69%), anxiety/depression (60%), and hypertension (54%); the eating patterns were volume-eater (67%) and sweet-eater (62%). QoL scores were 41.3±9.3 for the BQL index, 0.35±0.19 for the EQ-5D-3L index, and 55.7±19.8 for the EQ-5D-3L VAS. The translation yielded good convergent validity (r=0.62), good internal consistency (a=0.94), and good reproducibility (r=0.62 and ICC=0.79). Conclusions: Our translation exhibited good parametric properties, with validity within the original BQL values, higher internal consistency, and suboptimal reproducibility. We can conclude that this version of the BQL index is suitable for Portuguese patients.
- Liraglutide effectiveness in type 2 diabetes: insights from a real-world cohort of Portuguese patientsPublication . Silva-Nunes, José; Nascimento, Edite; Louro, Joana; Dores, Jorge; Laginha, Teresa; Gonçalves-Ferreira, Ana; Alves, Marta; Souto, Selma B.; Cunha, Nelson; Pina, Elsa; Duarte, Rui; Raposo, João FilipeLiraglutide is a long-acting glucagon-like peptide-1 receptor agonist prescribed to diabetic patients for glycaemic control. To understand the impact of liraglutide in the real-world setting, this study analysed its effects in a Portuguese cohort of Type 2 diabetes patients. This was an observational, multicentric, and retrospective study that included 191 liraglutide-treated patients with at least 12 months of treatment. Patients' data were collected and analysed during a 24-month follow-up period. Overall, liraglutide treatment effectively reduced HbA1c levels from 8.3% to around 7.5%, after 6, 12, and 24 months (p < 0.001). In fact, 38.2%, 37.2%, and 44.8% of patients at 6, 12, and 24 months, respectively, experienced an HbA1c reduction of at least 1%. Moreover, a persistent reduction in anthropometric features was also observed, with 44.0%, 47.6%, and 54.4% of patients achieving a weight reduction of at least 3% at 6, 12, and 24 months, respectively. Finally, significant improvements were observed in the HDL-c and LDL-c levels. Our results demonstrate that liraglutide effectively promoted the reduction of HbA1c values during routine clinical practice, which was sustained throughout the study. In addition, there were significant improvements in anthropometric parameters and other cardiovascular risk factors.
- The role of the metabolome and non-coding RNA on pheochromocytomas and paragangliomas: an updatePublication . Bouça, Bruno; Bogalho, Paula; Rizzo, Manfredi; Silva-Nunes, JoséPheochromocytoma and paragangliomas (PPGL) are rare neuroendocrine tumors. In some patients they exhibit malignant behavior characterized by the presence of metastases, limiting treatment options and survival rates. Therapeutic options are limited to surgery, localized radiotherapy, and a few systemic therapies. However, in several recent studies, non-coding RNA molecules are gaining increasing attention as markers of malignancy for PPGL. The understanding of PPGL development molecular mechanisms has improved in the last years, with some of the epigenetic regulatory mechanisms such as DNA and histones methylation, being better understood than RNA-based mechanisms. Metabolome deregulation in PPGL, with increased synthesis of molecules that facilitated tumor growth, results from the activation of hypoxia signaling pathways, affecting tumorigenesis. In addition, the assessment of these metabolites can be useful for the management of these tumors. This review summarizes recent discoveries linking metabolome and non-coding RNA to PPGL and their relevance for diagnosis and therapeutics.
- Preoperative location of parathyroid adenomas in primary hyperparathyroidism: the role of cervical doppler ultrasoundPublication . Amaral, Sara; Rego, Teresa; Palha, Ana; Carrilho, Nuno; Coutinho, José Mário; Tavares, Paula; Silva-Nunes, JoséABSTRACT - Introduction: Parathyroid adenoma is the most frequent cause of primary hyperparathyroidism. In recent years, the preoperative location of parathyroid adenomas allowed minimally invasive surgical techniques that have become preferred over traditional bilateral neck exploration. The more recent guidelines on this subject highlight the role of nuclear medicine imaging tests. The aim of this study was to review the current role of Doppler ultrasound (US) in assessing the preoperative location of parathyroid adenomas in patients with primary hyperparathyroidism. Material and methods: Retrospective study based on data from patients with primary hyperparathyroidism that underwent parathyroidectomy between January 2013 and January 2022 at the Centro Hospitalar Universitário Lisboa Central. Statistical analysis was performed with IBM SPSS Statistics, version 26.0.0.0®. Results: Parathyroidectomy was performed in 171 patients (77.8% females) with primary hyperparathyroidism. Cervical Doppler ultrasound was the most performed test (64.3%, n = 110) for preoperative location and detected a suspicious lesion in 98 patients (89.1%). The preoperative location of the parathyroid adenomas was assessed through the Doppler ultrasound and was compared with the surgical reports and histological findings; a correct identification was made in 76 patients (77.6%). Doppler ultrasound slightly underestimated the mean adenoma size (18.1 ± 7.7 mm preoperative versus 22 ± 8.4 mm postoperative). Calcium, parathyroid hormone levels, adenoma size, and the concomitant presence of thyroid nodules did not affect the accuracy of the Doppler ultrasound. Conclusion: Doppler ultrasound showed high diagnostic accuracy even in patients with nodular thyroid disease regardless of calcium and parathyroid hormone levels and adenoma size. Furthermore, its safety, affordability, and availability should favor its use as a first-line test in primary hyperparathyroidism to assess the preoperative location of parathyroid adenomas.
- Psychopathological and quality of life gender differences in obese patients who were candidates for bariatric surgeryPublication . Figueiredo, Inês Rego de; Carvalho, Miguel Vasques; Cunha, Nelson; Martins, Diana; Silva-Nunes, JoséIntroduction: Gender differences in obesity go from prevalence, access to treatment, baseline characteristics, outcomes, and complications. Our aim was to access baseline differences in a bariatric surgery cohort, with an emphasis on psychopathology and quality of life (QoL). Methodology: Cross-sectional study at a bariatric surgery clinic performed by application of psychological (Y-BOCS, HAD scale, FCQ-S/T, BIS-11), and QoL (EQ-5D-3L and BQL index) questionnaires. Demographic, anthropometric, and comorbidities data was collected, as well as eating patterns, and motivation for surgery. A comparison between female and male patients was performed. Results: 244 patients were included, with similar age distribution between males (n=55) and females (n=189). Males had higher visceral fat (12.6±2.8% vs. 22.6±4.4%; p<0.001) and waist circumference (129±13cm vs. 135±14cm; p=0.02), lower total fat mass (52±4% vs. 38±4%; p<0.001), but with similar BMIs (44±5.8kg/m2 vs. 45±7.6kg/m2 ; p=ns). Hypertension, sleep apnea, and liver steatosis were more frequent in men, depression/anxiety, and venous insufficiency in women; diabetes, dyslipidemia, and osteoarticular disease were similar. Men engaged more in volume eating and females in emotional eating. Among women, issues with body image were the most usual motivation for surgery. The psychopathological profile showed a higher prevalence of anxiety in women (41% vs. 19%, p=0.02). Obsessive-compulsive traits, depression, food cravings, and impulsivity were similar. No gender differences were observed for QoL in the EQ5D-3L index and VAS and BQL index. However, there were differences in the following EQ-5D-3L health profiles of usual activities (p=0.03), pain/discomfort (p=0.001), and anxiety/depression (p<0.001). Conclusions: Although some comorbidities are more common in male obese patients, they are a minority in the bariatric surgery setting. A difference is present between male and female patients in eating patterns and motivation for surgery, inducing a psychological profile characterized by higher anxiety prevalence. This greater prevalence impacts in QoL, contributing to a higher burden of obesity among obese women.
- Artifactual hypoglycemia: a condition that should not be forgotten [case report]Publication . Amaral, Sara; Palha, Ana; Bernardino, Vera; Silva-Nunes, JoséBackground: Hypoglycemia is uncommon in people who are not being treated for diabetes mellitus and, when present, the differential diagnosis is broad. Artifactual hypoglycemia describes the discrepancy between low capillary and normal plasma glucose levels regardless of symptoms and should be considered in patients with Raynaud's phenomenon. Case presentation: A 46-year-old female patient with a history of a sleeve gastrectomy started complaining about episodes of lipothymias preceded by sweating, nausea, and dizziness. During one of these episodes, capillary blood glucose was obtained with a 24 mg/dl value. She had multiple emergency admissions with low-capillary glycemia. An exhaustive investigation for possible causes of hypoglycemia was made for 18 months. The 72h fasting test was negative for hypoglycemia. A Raynaud phenomenon was identified during one appointment. Conclusion: Artifactual hypoglycemia has been described in various conditions including Raynaud's phenomenon, peripheral arterial disease, Eisenmenger syndrome, acrocyanosis, or hypothermia. With this case report, we want to reinforce the importance of being aware of this diagnosis to prevent anxiety, unnecessary treatment, and diagnostic tests.
- Novel pharmaceutical and nutraceutical-based approaches for cardiovascular diseases prevention targeting atherogenic small dense LDLPublication . Vekic, Jelena; Zeljkovic, Aleksandra; Stefanovic, Aleksandra; Bogavac-Stanojevic, Natasa; Ilias, Ioannis; Silva-Nunes, José; Stoian, Anca Pantea; Janez, Andrej; Rizzo, ManfrediCompelling evidence supports the causative link between increased levels of low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (CVD) development. For that reason, the principal aim of primary and secondary cardiovascular prevention is to reach and sustain recommended LDL-C goals. Although there is a considerable body of evidence that shows that lowering LDL-C levels is directly associated with CVD risk reduction, recent data shows that the majority of patients across Europe cannot achieve their LDL-C targets. In attempting to address this matter, a new overarching concept of a lipid-lowering approach, comprising of even more intensive, much earlier, and longer intervention to reduce LDL-C levels, was recently proposed for high-risk patients. Another important concern is the residual risk for recurrent cardiovascular events despite optimal LDL-C reduction, suggesting that novel lipid biomarkers should also be considered as potential therapeutic targets. Among them, small dense LDL particles (sdLDL) seem to have the most significant potential for therapeutic modulation. This paper discusses the potential of traditional and emerging lipid-lowering approaches for cardiovascular prevention by targeting sdLDL particles.
- Quality of life in obese patients from a multidisciplinary bariatric consultation: a cross-sectional study comparing to a non-bariatric population and to the general populationPublication . Figueiredo, Inês Rego de; Vasques, Miguel Carvalho; Cunha, Nelson; Martins, Diana; Silva-Nunes, JoséObesity is a chronic disease defined by a body mass index of ≥30 kg/m2, which can result in a decrease in quality of life (QoL). Our study aim was to assess the QoL of an obese population of bariatric surgery (BS) candidates and to compare it to both that of a non-bariatric obese population (C) and that of the general population. This was a cross-sectional study using: (1) the EQ-5D-3L instrument: comparing BS with the C population and with the Portuguese general population; and (2) the Bariatric Quality of Life (BQL) Index: comparing the two groups of obese patients. We included 228 BS and 68 C obese patients. BS patients had higher BMI (44 ± 6 kg/m2 vs. 41 ± 6.5 kg/m2; p < 0.001), higher waist circumference (130 ± 13 cm vs. 123 ± 17 cm; p = 0.03), and higher total body fat mass (49.9 ± 6.7% vs. 45 ± 6.7%; p < 0.001). QoL as evaluated by EQ-5D-3L was similar, but the BQL index showed lower QoL in BS patients (40.9 ± 8.9 vs. 44.2 ± 11.2; p = 0.01). Compared to the Portuguese general population, BS patients had lower QoL (VAS: 55 ± 19 vs. 74.9; p < 0.001; index: 0.33 ± 0.2 vs. 0.76; p < 0.001). Despite higher adiposity in the BS group, QoL was similar between the groups by EQ-5D-3L. Nevertheless, there was a decrease in the QoL for the BS patients as determined using the BQL, a tool with higher sensitivity to bariatric patients.
- Absolute hyperglycemia versus stress hyperglycemia ratio for the prognosis of hospitalized patients with COVID-19 in the first months of the pandemic: a retrospective studyPublication . Matias, Alexandra A.; Manique, Inês; Sabino, Teresa; Rego, Teresa; Mihon, Claudia; Panarra, António; Rizzo, Manfredi; Silva-Nunes, JoséDiabetes is a risk factor for the greater severity of coronavirus disease 2019 (COVID-19). The stress hyperglycemia ratio (SHR) is an independent predictor of critical illness, and it is reported to have a stronger association than absolute hyperglycemia. The aim of this study was to assess the relationship between absolute hyperglycemia and SHR with the severity of COVID-19 since there are no studies investigating SHR in patients with COVID-19. We conducted a retrospective observational study on hospitalized patients with COVID-19 in the first months of the pandemic, regarding absolute hyperglycemia, SHR, and severity outcomes. Of the 374 patients, 28.1% had a previous diagnosis of type 2 diabetes. Absolute hyperglycemia (64.8% versus 22.7%; p < 0.01) and SHR [1.1 (IQR 0.9-1.3) versus 1.0 (IQR 0.9-1.2); p < 0.001] showed a statistically significant association with previous diabetes. Absolute hyperglycemia showed a significant association with the clinical severity of COVID-19 (79.0% versus 62.7%; p < 0.001), need for oxygen therapy (74.8% versus 54.4%; p < 0.001), invasive mechanical ventilation (28.6% versus 11.6%; p < 0.001), and intensive care unit (30.3% versus 14.9%; p = 0.002), but not with mortality; by contrast, there was no statistically significant association between SHR and all these parameters. Our results are in agreement with the literature regarding the impact of absolute hyperglycemia on COVID-19 severity outcomes, while SHR was not a significant marker. We, therefore, suggest that SHR should not be evaluated in all patients admitted to the hospital for COVID-19, and we encourage the standard measures at the admission of blood glucose and HbA1c levels.