Browsing by Author "Pereira, ML"
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- Diabetes Gestacional: Avaliação dos Desfechos Maternos, Fetais e NeonataisPublication . Miranda, A; Fernandes, V; Marques, M; Castro, L; Fernandes, O; Pereira, MLIntrodução: Apesar dos progressos na vigilância e tratamento da diabetes gestacional (DG), os resultados obstétricos e neonatais ainda não igualaram os da gravidez sem esta complicação. Este estudo pretendeu caracterizar uma população de grávidas com DG comparando-a com uma população obstétrica com rastreio de DG negativo. Material e Métodos: Realizámos um estudo observacional e retrospetivo, através da consulta de processos clínicos de 201 grávidas com DG e 201 grávidas com rastreio de DG negativo, com seguimento e parto no nosso hospital. Resultados: As grávidas com DG apresentaram idade mais avançada (33 vs 31 anos, p = 0,001) e maior prevalência de hipertensão gestacional (6% vs 2%, p = 0,041). O grupo da DG registou uma taxa de cesariana mais elevada (40,3% vs 24,4%, p = 0,001), sendo a incompatibilidade céfalo-pélvica o principal motivo de cesariana (32,9%). Não se verificaram diferenças entre os grupos relativamente ao peso fetal ao nascimento. Recém-nascidos de mães com DG tiveram mais distócia de ombros (3% vs 0%, p = 0,014) e foram mais frequentemente admitidos da Unidade de Cuidados Intensivos Neonatais (14,9% vs 8,5%, p = 0,044), principalmente por hipoglicemia. Não foram encontrados fatores de risco para este desfecho. Discussão: Grávidas com DG eram mais velhas, apresentaram maior incidência de hipertensão gestacional, parto por cesariana e morbilidade neonatal relativamente ao grupo controlo. Conclusão: No presente estudo, a ocorrência de DG condicionou um aumento da morbilidade obstétrica e, sobretudo, neonatal.
- Diabetes gestacional: determinação de fatores de risco para diabetes mellitusPublication . Carvalho, AM; Nogueira-Silva, C; Melo-Rocha, G; Pereira, ML; Rocha, AObjetivos Identificar fatores preditivos do desenvolvimento de diabetes mellitus (DM) em mulheres com antecedentes de diabetes gestacional (DG). Tipo de estudo Estudo observacional, analítico, retrospetivo e de coorte. Local Hospital de Braga. População Amostra aleatória de 300 mulheres, nascidas antes de 1995, com diagnóstico de DG entre 1 de janeiro de 2001 e 31 de dezembro de 2010 e seguimento da gravidez no Hospital de Braga. Métodos Os dados foram obtidos através da consulta de processos clínicos. A lista de doentes com DM, referente ao ano de 2011, foi utilizada para verificação do desenvolvimento da doença no grupo selecionado. Foram analisados o perfil sociodemográfico, os antecedentes pessoais, familiares e obstétricos e outros fatores anteparto. Foi realizada uma análise descritiva univariada e bivariada. Seguidamente foi criado um modelo de regressão logística binária para identificar potenciais preditores de desenvolvimento de DM tipo 2. Resultados Trinta e dois vírgula sete por cento das mulheres desenvolveu DM. A probabilidade de desenvolvimento de DM após DG aumentou 8,2 vezes quando idade gestacional menor que 24 semanas no momento do diagnóstico (OR = 8,19; p < 0,001), 3,4 vezes se necessidade de insulinoterapia (OR = 3,36; p < 0,001) e 3,1 vezes se índice de massa corporal (IMC) prévio = 26,4 kg/m2 (OR = 3,07; p = 0,003). História familiar de DM tipo 2, 4 valores elevados na prova de tolerância oral à glicose, valor de glicemia em jejum, idade materna no momento do diagnóstico e IMC pós-parto, apesar de apresentarem associação com desenvolvimento de DM não se revelaram seus preditores. Não se verificou associação entre gravidez prévia ou diagnóstico prévio de DG com desenvolvimento de DM. Conclusões Em mulheres com DG, a idade gestacional menor que 24 semanas no momento do diagnóstico, a necessidade de insulinoterapia e o IMC prévio = 26,4 kg/m2 apresentaram-se como fatores de risco para desenvolvimento de DM. Aims: To identify predictive factors to diabetes mellitus (DM) development in women with history of gestational diabetes (GD). Study design: An observational, analytic, cohort retrospective study. Local: Hospital of Braga. Population: A random sample of 300 women, born before 1995, with GD diagnosed since January 1, 2001 to December 31, 2010 and pregnancy surveillance in a public Hospital of Braga. Methods: Data was collected by consultation of medical records. The DM patients’ list of 2011 was used to verification of the disease development in the selected group. Sociodemographic profile, personal, family and obstetric history, and other antepartum factors were analyzed. A univariate descriptive analysis and a bivariate analysis were performed. A binary logistic regression model was created to identify potential predictors of type 2 DM development. Results: 32.7% of women developed DM. The probability of DM development after GD was increased 8.2 times when gestational age at diagnosis was less than 24 weeks (OR = 8.19; p < 0.001), 3.4 times with the need of insulin therapy (OR = 3.36; p < 0.001) and 3.1 times with previous pregnancy body mass index (BMI) ≥ 26.4 kg/m2 (OR = 3.07; p = 0.003). Although family history of type 2 DM, maternal age at diagnosis, postpartum BMI, 4 abnormal values in the diagnostic oral glucose tolerance test and fasting glucose level had presented association with DM development, did not present as its predictors. It was not verified association between previous pregnancy or previous GD diagnosis and DM development. Conclusions: In women with GD, gestational age at diagnosis less than 24 weeks, need of insulin therapy and previous pregnancy BMI ≥ 26.4 kg/m2 were presented as risk factors to DM development.
- Hiperaldosteronismo primário: resultados do primeiro estudo multicêntrico português realizado pelo Grupo de Estudos de Tumores da Supra-RenalPublication . Fernandes, V; Silva, T; Martins, D; Gonçalves, D; Almeida, R; Monteiro, AM; Neves, C; Simões, H; Marques, P; Serra, F; Pereira, ML; Grupo de Estudos de Tumores da Supra-RenalIntroduction: Primary Aldosteronism (PA) is the most prevalent cause of secondary hypertension. Nevertheless, there is no portuguese multicenter study characterizing PA patients. Aims: To characterize the clinical presentation, diagnostic workup, treatment and follow-up of patients with confirmed PA. Methods: Retrospective multicenter study of PA patients followed in 9 portuguese hospitals. Results: Sixty-three cases were selected with a mean age of diagnosis of 52.1 ± 13.1 years, 9.9 years after the diagnosis of hypertension. At presentation, 37 cases (60.7%) had hypertension, 11 (22.9%) had resistant hypertension and 20 (32.8%) of patients had hipokalemia (mean 3.2 mmol/L). Baseline laboratory showed a mean serum aldosterone of 33.4ng/dL, plasmatic renin activity (PRA) of 0.2ng/mL/h with an aldosterone/PRA ratio of 97.1. Confirmatory testing was performed with saline infusion in 55 patients (positive in 84.4%) and captopril test in 14 (positive in 85.7%). Imaging showed adenomas in 55 cases, hyperplasia in 2 and bilateral cases in 8. Arterial venous sampling (AVS) was performed in 9 patients (14,5%) and was conclusive in 1. Iodocholesterol scintigraphy was done in 14 cases (22%) with unilateral fixation in 9 and no fixation in 4. Patients were treated with laparoscopic adrenalectomy in 28 cases (58.3%) and mineralocorticoid receptor antagonists in 20 cases (41.7%). The surgical treated group had less duration of hypertension (8 versus 14 years, p = 0.002), higher prevalence of anti-hypertensive drugs at presentation (100 versus 75% p = 0.009) and bigger tumour size (1.8 versus 1.5 cm, p = 0.022). During follow-up there was a trend towards a greater proportion of patients with no hypertension improvement in the medical treatment group (29.4% versus 7.4%, p = 0.089). Conclusion: This is the first Portuguese PA multicenter study. It suggests that PA remains an under- -diagnosed condition with a significant delay in diagnosis. Surgical treated patients had a more aggressive disease and showed a trend towards better hypertension control.
- Iron Deficiency and Obesity - Are we Diagnosing with Appropriate Indicators?Publication . Monteiro, AM; Fernandes, V; Matta-Coelho, C; Paredes, Sílvia; Pereira, ML; Marques, O; Alves, MINTRODUCTION: We aim to define the iron deficiency prevalence and eventual differences between obese patients with and without metabolic syndrome. MATERIAL AND METHODS: Analysis of patients evaluated at multidisciplinary consultation of obesity in our institution between 2013 and 2015 (n = 260). Iron deficiency: ferritin levels < 15 ng/mL. EXCLUSION CRITERIA: prior bariatric surgery; lack of ferritin or hemoglobin determinations. RESULTS: We analyzed data from 215 patients (84.2% female) with a mean age of 42.0 ± 10.3 years. The median body mass index was 42.5 (40.0 - 46.8) kg/m2 and 52.1% had metabolic syndrome. Iron deficiency was present in 7.0%, with no differences between genders or between patients with or without metabolic syndrome. Hypertension was associated with lower prevalence of iron deficiency. Type 2 diabetes and hypertension patients had higher levels of ferritin. The multivariate analysis showed that metabolic syndrome and increasing body mass index were predictive of higher risk of iron deficiency while hypertension predicted lower odds of iron deficiency. DISCUSSION: The prevalence of iron deficiency was similar in other published studies. Iron deficiency may be underdiagnosed if based only on ferritin concentrations. In our study, diabetes and hypertension appear to contribute to the increase in ferritin levels described in obesity. CONCLUSION: Ferritin may not be a reliable index for evaluating iron stores in obese patients, particularly when associated with comorbidities such as type 2 diabetes and hypertension. Further studies are needed to guide the diagnosis and iron supplementation in these patients.
- A marcoprolactinemia: da determinação laboratorial ao seu significado clínicoPublication . Matos, C; Pereira, ML; Guimarães, JTSince prolactin (PRL) (a hormone produced by the anterior pituitary) was first identificated, the existence of hyperprolactinemic syndrome has been recognized. Main symptoms are galactorrhea, oligomenorrhea, amenorrhea and infertility in women and decreased libido and impotence in men. Macroprolactinemia reflects the predominance of circulating forms with reduced bioactivity not associated with typical clinical manifestations of hyperprolactinemia. It is identified by immunoassays commonly used in clinical practice, resulting in hyperprolactinemia. Polyetilenoglycol (PEG) is the most used method that removes PRL from serum. It is likely that the phenomenon of macroprolactinemia is consistently underestimated and unrecognized. Manufacturers of immunoassays for PRL have been slow to incorporate in the literature, validated protocols, and data related to the interference of PEG. From a clinical and biochemical point of view and, the main concern should be to avoid unnecessary investigation and treatment.
- Universal vs. risk-factor-based screening for gestational diabetes-an analysis from a 5-Year Portuguese CohortPublication . Matta-Coelho, C; Monteiro, AM; Fernandes, V; Pereira, ML; Souto, SBPURPOSE: The criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus. METHODS: Retrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. RISK FACTORS: body mass index > 30kg/m2, history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. EXCLUSION CRITERIA: lack of data concerning risk factors (n = 1563). RESULTS: At least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001). CONCLUSION: Almost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therap