Publications by authors named "Jorge Maciel"

27 Publications

  • Page 1 of 1

Composition and natural history of a snake community from the southern Cerrado, southeastern Brazil.

Zookeys 2021 19;1056:95-147. Epub 2021 Aug 19.

Departamento de Ecologia, Instituto de Biociências, Universidade de São Paulo, 05508-090, São Paulo, SP, Brazil Universidade de São Paulo São Paulo Brazil.

The natural history of a cerrado snake community in a protected area in southeastern Brazil (Santa Bárbara Ecological Station; SBES) is described. A visual guide and an identification key are also provided to assist researchers and local people in identifying snakes in that region. Sampling was performed through pitfall traps, time-constrained search, accidental encounters, and observations by local people for two years, which corresponded to 240 days of sampling. Among the 388 individuals found in the field, 33 snake species belonging to 21 genera of seven families were recorded. Most species were restricted or found at least once in non-forest vegetation types (campo sujo, campo cerrado, and cerrado sensu stricto) and a few were restricted to forest habitats (cerradão). Our results show that most species (1) occupy open areas; (2) present both diurnal and nocturnal activity; (3) are primarily terrestrial; (4) include lizards, mammals and/or anurans in the diet; (5) present seasonal reproductive activity; and (6) use mainly visually oriented defensive tactics. Despite its small size (3,154 ha), the SBES harbours preserved habitats and a rich and typical Cerrado snake fauna, including threatened species. Furthermore, most of the SBES snakes occur in non-forest environments (54%) and some species are sensitive to habitat disturbance.
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http://dx.doi.org/10.3897/zookeys.1056.63733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390458PMC
August 2021

Genetic Determinants for Prediction of Outcome of Patients with Papillary Thyroid Carcinoma.

Cancers (Basel) 2021 Apr 23;13(9). Epub 2021 Apr 23.

IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal.

Papillary thyroid carcinoma (PTC) usually presents an excellent prognosis, but some patients present with aggressive metastatic disease. BRAF, RAS, and TERT promoter (TERTp) genes are altered in PTC, and their impact on patient outcomes remains controversial. We aimed to determine the role of genetic alterations in PTC patient outcomes (recurrent/persistent disease, structural disease, and disease-specific mortality (DSM)). The series included 241 PTC patients submitted to surgery, between 2002-2015, in a single hospital. DNA was extracted from tissue samples of 287 lesions (primary tumors and metastases). Molecular alterations were detected by Sanger sequencing. Primary tumors presented 143 BRAF, 16 TERTp, and 13 RAS mutations. Isolated TERTp showed increased risk of structural disease (HR = 7.0, < 0.001) and DSM (HR = 10.1, = 0.001). Combined genotypes, BRAF/TERTp (HR = 6.8, = 0.003), BRAF/TERTp (HR = 3.2, = 0.056) and BRAF/TERTp (HR = 2.2, = 0.023) showed increased risk of recurrent/persistent disease. Patients with tumors BRAF/TERTp (HR = 24.2, < 0.001) and BRAF/TERTp (HR = 11.5, = 0.002) showed increased risk of structural disease. DSM was significantly increased in patients with TERTp regardless of BRAF status (BRAF/TERTp, log-rank < 0.001; BRAF/TERTp, log-rank < 0.001). Our results indicate that molecular markers may have a role in predicting PTC patients' outcome. BRAF/TERTp tumors were prone to associate with local aggressiveness (recurrent/persistent disease), whereas TERTp tumors were predisposed to recurrent structural disease and DSM.
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http://dx.doi.org/10.3390/cancers13092048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122921PMC
April 2021

Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma.

Cancers (Basel) 2020 Oct 29;12(11). Epub 2020 Oct 29.

IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal.

Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients' outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients' files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, = 0.015), venous invasion (OR = 16.7, = 0.022), and lateral compartment LNM (OR = 26.7, = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, = 0.008), lymph vessel invasion (OR = 6.9, < 0.001), and gross ETE (OR = 16.1, = 0.001) were predictors of structural disease status; male gender (OR = 2.9, = 0.011), lymph vessel invasion (OR = 2.8, = 0.006), and incomplete resection margins (OR = 4.6, < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient's surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.
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http://dx.doi.org/10.3390/cancers12113186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693726PMC
October 2020

Superior Vena Cava Syndrome - Blood Changes Its Route.

Rev Port Cir Cardiotorac Vasc 2020 Jan-Mar;27(1):53

General Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal; Universidade Fernando Pessoa, Porto, Portugal.

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October 2020

Idiopathic left omental infarction.

Autops Case Rep 2020 Jan-Mar;10(1):e2019123. Epub 2019 Dec 13.

Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia, Portugal.

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http://dx.doi.org/10.4322/acr.2019.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945327PMC
December 2019

Impact on sexual function of surgical treatment in rectal cancer.

Int Braz J Urol 2018 Jan-Feb;44(1):141-149

Departmento de Urologia, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal.

Introduction: The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients' sexual and urinary function has been recently observed.

Aim: Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa.

Materials And Methods: An observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery.

Discussion: All patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn't resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor's location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery.

Conclusions: This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2017.0318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815544PMC
June 2018

Hemosuccus pancreaticus: a rare complication of chronic pancreatitis.

BMJ Case Rep 2015 Jun 25;2015. Epub 2015 Jun 25.

Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Hemosuccus pancreaticus is a very rare cause of gastrointestinal bleeding and it should be considered in every patient with history of chronic pancreatitis who presents with acute or intermittent gastrointestinal haemorrhage. A 54-year-old man with a history of chronic alcoholic pancreatitis was admitted to hospital for an acute exacerbation. During hospital stay, he presented with haematemesis and haemodynamic instability. Upper gastrointestinal endoscopy revealed a blood clot on Vater papilla. CT investigation showed a 4 cm cephalopancreatic pseudocyst and angiography identified a large pseudoaneurysm of the right gastroepiploic artery, bleeding into the pseudocyst-hemosuccus pancreaticus. Microcoil transcatheter embolisation was performed with success.
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http://dx.doi.org/10.1136/bcr-2015-209872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488631PMC
June 2015

Conventional clinical and pathological features fail to accurately predict recurrence in patients with gastric cancer staged N0.

Eur J Gastroenterol Hepatol 2015 Apr;27(4):425-9

aGeneral Surgery Department of Centro Hospitalar de Vila Nova de Gaia/Espinho bFaculty of Health Sciences of Universidade Fernando Pessoa, Vila Nova de Gaia cInstitute of Biomedical Sciences Abel Salazar, Universidade do Porto dCIDES/CINTESIS, Department of Portuguese Oncology Institute of Porto, Oporto Faculty of Medicine and Gastroenterology eGastroenterology Department of Portuguese Oncology Institute of Porto, Porto, Portugal.

Introduction: Despite the medical-surgical advances, even after R0 gastric resections, some patients without apparent metastatic disease develop cancer recurrence and eventually die.

Aims: We aimed to define recurrence in patients with node-negative gastric adenocarcinoma and to determine whether any clinicopathological features are predictive for recurrence.

Materials And Methods: This was a retrospective cohort study on patients with gastric adenocarcinoma, consecutively diagnosed at our institution, staged as N0M0 between January 2000 and December 2008.

Results: We recruited 129 patients; 53% were men and 56% were older than 60 years. A total of 22% of the patients developed recurrence, with a mortality rate of 93%. Overall, 71% of the patients, N0, with recurrence presented lymphatic permeation. In univariate analysis, on comparing recurrent patients with those with no recurrence, age, size, T status, lymphatic, and venous permeation were factors that were associated significantly with recurrence, but in multivariate analysis, only age (odds ratio:19.5; 95% confidence interval: 2.3-168; P=0.008) and venous permeation (odds ratio: 6.34; 95% confidence interval: 1.8-22.8; P=0.005) were associated with recurrence. On the basis of only these two factors, the proportion of missed recurrent patients by age and venous permeation was 13 and 39%, respectively.

Conclusion: A total of 22% of patients, N0, developed recurrence of their disease. Age and venous permeation were independent risk factors for recurrence, but on the basis of these factors, up to 40% of patients may be missed for recurrence. New methods to predict recurrence are needed.
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http://dx.doi.org/10.1097/MEG.0000000000000307DOI Listing
April 2015

Endoscopic management of non-iatrogenic gastrointestinal perforations--A case series.

Gastroenterol Hepatol 2016 Mar 18;39(3):219-20. Epub 2015 Feb 18.

Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova Gaia, Portugal.

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http://dx.doi.org/10.1016/j.gastrohep.2015.01.002DOI Listing
March 2016

Ruptured jejunal artery aneurysm.

BMJ Case Rep 2013 Jun 13;2013. Epub 2013 Jun 13.

Department of Surgery, Centro Hospitalar Gaia/Espinho, EPE, Gaia, Portugal.

Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs.
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http://dx.doi.org/10.1136/bcr-2013-008772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702830PMC
June 2013

Breast angiosarcoma secondary to phyllodes tumour.

BMJ Case Rep 2012 Dec 3;2012. Epub 2012 Dec 3.

Department of General Surgery, Centro Hospitalar Gaia/Espinho, EPE, Gaia, Portugal.

Angiosarcomas are rare malignant tumours that arise from endothelial cells lining vascular channels, representing 0.04% of malignant neoplasms of the breast. Breast angiosarcomas (BAs) were first described by Schmidt in 1887, and may be primary or secondary to the pre-existing conditions. Primary BAs are more common in young women and present as a palpable mass. Secondary BAs arise in older patients, frequently 5-6 years after radiotherapy, and present as a rash.The authors describe the case of an 83-year-old woman with no history of thoracic radiotherapy or surgery. She had been observed for a breast nodule where biopsy revealed phyllodes tumour. The patient refused surgery and returned 2 years later because of an impressive increase in tumour volume and skin ulceration. She underwent mastectomy with local skin flaps. Histopathological result revealed high-grade angiosarcoma of 15×12 cm. There was follow-up without evidence of recurrence, after radiotherapy.
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http://dx.doi.org/10.1136/bcr-2012-007545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544176PMC
December 2012

Sporadic exophytic hepatic angiomyolipoma.

BMJ Case Rep 2012 Oct 10;2012. Epub 2012 Oct 10.

Department of Surgery, Centro Hospitalar Gaia/Espinho, EPE, Gaia, Portugal.

Angiomyolipomas are rare mesenchymal tumours consisting of smooth muscle, blood vessels and adipocytes in variable proportions. These tumours are more usually seen in kidneys (incidence 0.3-3%), and the extrarenal location is rare. Since its initial description by Ishak in 1976, only about 200 cases of hepatic angiomyolipomas have been reported. We describe the case of a 59-year-old woman, without tuberous sclerosis, with a 6 cm tumour in hepatic segments II and III, gallbladder with parietal calcification and lithiasis. She was proposed to bisegmentectomy (II and III) and cholecystectomy, which were performed without complications. The pathological examination confirmed the diagnosis of hepatic angiomyolipoma (positive for HMB45 and focally positive for HHF35) and chronic cholecystitis. Although typically benign, the emergence of cases with malignant behaviour--recurrence or distant metastasis--led to a change in attitude towards these lesions, from clinical surveillance to surgical excision, with few exceptions.
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http://dx.doi.org/10.1136/bcr-2012-007224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560107PMC
October 2012

Neuroendocrine breast cancer.

BMJ Case Rep 2012 Aug 13;2012. Epub 2012 Aug 13.

General Surgery Department, Centro Hospitalar Gaia/Espinho, Gaia, Portugal.

Neuroendocrine breast cancer is thought to account for about 1% of all breast cancers. This rare type of breast malignancy is more common in older women and presents as a low-grade, slow-growing cancer. The most definitive markers that indicate neuroendocrine carcinoma are the presence of chromogranin, synaptophysin or neuron-specific enolase, in at least 50% of malignant tumour cells. The authors present a case report of an 83-year-old woman, admitted to their institution with right breast lump. Physical examination, mammography and ultrasonography showed a 2.4 cm nodule, probably a benign lesion (BI-RADS 3). A fine needle aspiration biopsy was performed and revealed proliferative epithelial papillary lesion. She was submitted to excisional biopsy and histology showed endocrine breast cancer well differentiated (G1). Immunohistochemically, tumour cells were positive for synaptophysin. These breast cancers are characterised for their excellent prognosis and conservative treatment is almost always enough to obtain patient cure.
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http://dx.doi.org/10.1136/bcr.12.2011.5343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433522PMC
August 2012

[Abdominal compartment syndrome: survey on the awareness of Portuguese general surgeons].

Acta Med Port 2011 Dec 31;24 Suppl 2:131-6. Epub 2011 Dec 31.

Serviço de Cirurgia, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.

The Abdominal Compartment Syndrome (ACS) is a clinical entity recognized for over a century, but only recently its risk criteria, monitorization and treatment have been defined by the World Society of the Abdominal Compartment Syndrome (WSACS). The general surgeon's involvement is vital since this syndrome is common in surgical patients and because its treatment may culminate in a laparostomy. 250 questionnaires of 17 questions were distributed among general surgeons attending the XXVIII Portuguese Congress of Surgery. The data were analyzed using SPSS® v16. We received 36,4% (91) of the delivered questionnaires, most of which from male surgeons (63,7%), from central hospitals (75,8%), working 42 h per week (70.3%), whose average of age was 38 years. About half of the respondents received training in Intensive Care Units. All surgeons had already heard about measuring the Intra- abdominal Pressure (IAP), which was being performed at 89% of their hospitals. About 40% of surgeons only admitted intra-abdominal hypertension above 20 mmHg (only 22% indicated the correct value of 12 mmHg). 36,3% of surgeons suggested that a decompressive laparostomy must be carried out for primary ACS if IAP greater then 20 mmHg with new organ failure; 36.3% favoured the "Vacuum-pack"-like system, and 56% only re-operate the patients "as needed". 48,4% of surgeons had already performed decompressive laparostomy, 66% of which had residence training in a ICU (p = 0,005). Respondents also pointed an average mortality related to ACS of 81% without laparostomy, and a reduction to 38,5% after performing that procedure. Only 26% of the surgeons were aware of the WSACS consensus definitions and recommendations, of those, 83% had already performed a laparostomy (P<0,001). It can be concluded that, in spite of recognizing the ACS as a clinical entity, portuguese general surgeons are quite unaware of the WSACS definitions and treatment guidelines, urging the need for its divulgation.
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December 2011

Gastric GIST with synchronous neuroendocrine tumour of the pancreas in a patient without neurofibromatosis type 1.

BMJ Case Rep 2012 Jun 5;2012. Epub 2012 Jun 5.

Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

The gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. These are rare tumours with an incidence of 15 new cases per million per year. The occurrence of neuroendocrine tumours of the pancreas is rare, representing 1-5% of pancreatic cancers, and it is estimated that its incidence does not exceed five to one million. GISTs are common in patients with neurofibromatosis type 1 (NF1); there are few reported cases of synchronous neuroendocrine tumours in these patients and most are pheochromocytomas. The case reports a 64-year-old woman referred to the General Surgery Outpatient for incidental finding of gastric and pancreatic tumours. She underwent a radical subtotal pancreatectomy + partial gastrectomy with jejunal transposition. The pathological examination revealed: gastric GISTs and a well-differentiated neuroendocrine carcinoma of the pancreas. This is the second case published so far of a patient with both tumours and without NF1. Posterior studies must be performed to evaluate if some other genetic disorder is involved in these patients without NF1.
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http://dx.doi.org/10.1136/bcr.02.2012.5895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543145PMC
June 2012

Analysis of clinicopathologic characteristics and prognosis of gastric cancer in young and older patients.

Pathol Oncol Res 2013 Jan 10;19(1):111-7. Epub 2012 May 10.

Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Background: The worldwide incidence of gastric cancer is gradually declining, however it remains the fourth highest in cancer incidence and the second leading cause of cancer death. Gastric cancer in young people is a disturbing problem and the routine screening does not include people less than 35 years. The clinicopathological features of gastric carcinoma are said to differ between young and elderly patients and it is thought that the prognosis of this disease is worse for younger patients. It is also suggested that the diagnosis is usually made later or have a more aggressive behaviour. Although, others report that tumor staging and prognosis for young patients is similar to older patients and depends on whether the patients undergo a curative resection. All these data need more investigation and studies. Although Portugal has a high incidence of gastric cancer, no studies have yet been performed comparing the clinicopathologic features and prognosis of young and elderly patients with gastric cancer.

Aims: This study intend to assess whether the clinicopathological features and prognosis of gastric cancer in young patients (YGC) is similar to older ones (OGC).

Methods: Between 2000 and 2005, 406 patients with histological diagnosis of primary gastric cancer, treated in the Departments of Surgery and Oncology at the Centro Hospitalar of Vila Nova de Gaia / Espinho, were regularly followed at least for five years after surgery. These were reviewed retrospectively. Several variables were analyzed in young patients and compared with the elder ones. We used the chi-square and Fisher to evaluate the statistical association between categorical variables and t-test for numeric variables. Survival was estimated by the Kaplan-Meier method and used the log-rank test to assess differences in survival among different subgroups of patients. The criteria for statistical significance was p < 0.05. Data analysis was performed using the SPSS 18.

Results And Conclusions: With regard to resectability, 78 % of the tumors were resected in the group of younger patients, the surgery more frequently achieved was total gastrectomy with anastomosis in Y of Roux. In the elder group, about 62 % of the tumors were resected and BII gastrectomy was the most frequent surgery. The diffuse adenocarcinoma was the most frequent histological type in younger patients, whereas in older patients was intestinal adenocarcinoma. With regard to the stage in the first group there was a predominance of stages: IA and IV (26.1 %) in the second: IV (25.8 %). The survival for stage III e IV was significantly worst in YGC compared with OGC.
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http://dx.doi.org/10.1007/s12253-012-9530-zDOI Listing
January 2013

[Bariatric surgery: epidemic of the XXI century].

Acta Med Port 2011 Jan-Feb;24(1):111-6. Epub 2011 Feb 28.

Serviço de Cirurgia Geral do Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.

Obesity is a chronic and endemic disease in developed countries, there is an inverse relationship between the socio-economic level and the prevalence of this disease. Their costs are responsible from 2 to 7% of the total health costs. The prevalence of obesity in the world is so high that the World Health Organization considered this disease as the global epidemic of the XXI century. In Portugal it's estimated that around 16.5% of the population aged over 18 years, has obesity, and due to the morbidity and mortality associated with this pathology, this constitutes a serious public health issue. There are several ancient references to obesity and its consequences, with descriptions of different therapeutic attitudes. But only in 1965 the term bariatric was introduced and consequently the term bariatric surgery. Mason, the father of bariatric surgery, started its history in 1966. Several surgical techniques were subsequently developed, but currently the most used are the gastric bandoplastia, a restrictive surgery, and the gastric bypass, a combined surgery. Today, the bariatric surgery is not limited to the treatment of obesity, but the treatment of a syndrome associated with obesity, allowing a significant improvement in Quality of life of these patients. Thus, it's licit to think that the surgery that allows addressing the epidemic of the XXI century is the surgery of the century, with curative rates, of obesity and their comorbidities, which were never achieved by any other pharmacological treatment.
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November 2011

Port--site metastases following bariatric surgery.

BMJ Case Rep 2011 Aug 4;2011. Epub 2011 Aug 4.

Centro Hospitalar Gaia/Espinho, EPE, Gaia, Portugal.

Morbid obesity is a huge problem of the twenty-first century, mostly treated by bariatric surgery. The authors report the case of a patient with port site metastases from an unknown rectal adenocarcinoma when bariatric surgery took place. Implants in the site of the subcutaneous access port to the band are problematic, particularly in patients with occult intra-abdominal malignancy. This case underlines the importance of preventive measures to avoid cell implant in port sites in benign such as malignant diseases.
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http://dx.doi.org/10.1136/bcr.05.2011.4288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545094PMC
August 2011

Simultaneous gastric and colic laparoscopic adjustable gastric band migration. Complication of bariatric surgery.

Obes Surg 2010 Jun 22;20(6):796-800. Epub 2009 Dec 22.

General Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.

Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive treatment for morbid obesity, which has proved its safety, efficiency, and reversibility. Postoperative complications are rare and might be related with the reservoir, connecting tube, or with the band itself. The lack or unspecificity of clinical signs and symptoms makes the diagnosis of gastric band erosion difficult. The authors present the case of a 54-year-old female, submitted to laparoscopic adjustable gastric banding in April 2004 (BMI = 40 kg/m(2)). During the first year, she reduced her body mass index to 30 and remained stable thereafter. In August 2008, while investigating a moderate colicky abdominal pain, she was submitted to a colonoscopy that showed part of the band inside the transverse colon. Two exams were performed: the abdominal CT scan, which showed the connecting tube inside the transverse colon lumen and the lap band which was apparently well positioned around the stomach, and an upper digestive endoscopy that revealed band migration to the stomach lumen. The patient underwent laparoscopic band removal and closure of both stomach and colon walls, thus treating the fistula. LAGB erosion and migration is a late complication of this surgery that frequently needs surgical removal. LAGB migration to colon or stomach is described in literature isolated. Simultaneous erosion to stomach and colon lumen, with a gastrocolic fistula formation, has never been described before, making this case a unique one.
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http://dx.doi.org/10.1007/s11695-009-0046-xDOI Listing
June 2010

[Validation of a method to predict the etiology of pneumonia in children].

Arch Argent Pediatr 2008 Apr;106(2):126-31

CIM II, Hospital de Niños Dr. Orlando Alassia, Santa Fe.

Introduction: Identifying etiology in children with pneumonia requires time and technical resources, not always available. Therefore, the initial management of pneumonia is often based on clinical, laboratory, and/or radiographic data. Clinical prediction rules based on a combination of factors could increase diagnostic accuracy.

Objective: To validate the diagnostic accuracy of a clinical prediction rule (Bacterial Pneumonia Score, BPS) to distinguish bacterial from viral pneumonia in children. Population and methods. This observational, diag- nostic test evaluation study was performed among January 2004 and December 2006. Children aged 1 month to 15 years old, hospitalized for pneumonia in whom a bacterial or viral etiology was identified were included. Children with chronic pulmonary disease, congenital heart disease, admission to the intensive care unit, underlying immunologic disease, mixed viral and bacterial infection, or inability to identify viral or bacterial pathogens were excluded. Admission data were recorded (age, temperature, WBC count and chest radiograph evaluation). BPS was then calculated (range -3 to 15 points), taking into account that a BPS > or =4 suggests bacterial pneumonia.

Results: We included 82 patients aged 1 to 96 months with pneumonia (79% viral and 21% bacterial). A BPS > or = 4 predicted bacterial pneumonia with sensibility: 94%, specificity: 34%, positive predictive value: 27%, and negative predictive value: 95%.

Conclusion: The BPS was accurate on identifying most children with bacterial pneumonia, who required antibiotic therapy.
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http://dx.doi.org/10.1590/S0325-00752008000200006DOI Listing
April 2008

Critical role of a K+ channel in Plasmodium berghei transmission revealed by targeted gene disruption.

Proc Natl Acad Sci U S A 2008 Apr 23;105(17):6398-402. Epub 2008 Apr 23.

Department of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark.

Regulated K(+) transport across the plasma membrane is of vital importance for the survival of most cells. Two K(+) channels have been identified in the Plasmodium falciparum genome; however, their functional significance during parasite life cycle in the vertebrate host and during transmission through the mosquito vector remains unknown. We hypothesize that these two K(+) channels mediate the transport of K(+) in the parasites, and thus are important for parasite survival. To test this hypothesis, we identified the orthologue of one of the P. falciparum K(+) channels, PfKch1, in the rodent malaria parasite P. berghei (PbKch1) and examined the biological role by performing a targeted disruption of the gene encoding PbKch1. The deduced amino acid sequence of the six transmembrane domains of PfKch1 and PbKch1 share 82% identity, and in particular the pore regions are completely identical. The PbKch1-null parasites were viable despite a marked reduction in the uptake of the K(+) congener (86)Rb(+), and mice infected with PbKch1-null parasites survived slightly longer than mice infected with WT parasites. However, the most striking feature of the phenotype was the virtually complete inhibition of the development of PbKch1-null parasites in Anopheles stephensi mosquitoes. In conclusion, these studies demonstrate that PbKch1 contributes to the transport of K(+) in P. berghei parasites and supports the growth of the parasites, in particular the development of oocysts in the mosquito midgut. K(+) channels therefore may constitute a potential antimalarial drug target.
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http://dx.doi.org/10.1073/pnas.0802384105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359770PMC
April 2008

Murine model for assessment of Plasmodium falciparum transmission-blocking vaccine using transgenic Plasmodium berghei parasites expressing the target antigen Pfs25.

Infect Immun 2008 May 3;76(5):2018-24. Epub 2008 Mar 3.

Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, 615 N. Wolfe Street, Baltimore, MD 21205, USA.

Currently, there is no animal model for Plasmodium falciparum challenge to evaluate malaria transmission-blocking vaccines based on the well-established Pfs25 target antigen. The biological activity of transmission-blocking antibodies is typically assessed using an assay known as the membrane feeding assay (MFA). It is an in vitro method that involves mixing antibodies with cultured P. falciparum gametocytes and feeding them to mosquitoes through an artificial membrane followed by assessment of infection in the mosquitoes. We genetically modified Plasmodium berghei to express Pfs25 and demonstrated that the transgenic parasites (TrPfs25Pb) are susceptible to anti-Pfs25 antibodies during mosquito-stage development. The asexual growth kinetics and mosquito infectivity of TrPfs25Pb were comparable to those of wild-type parasites, and TrPfs25Pb displayed Pfs25 on the surface of ookinetes. Immune sera from nonhuman primates immunized with a Pfs25-based vaccine when passively transferred to mice blocked transmission of TrPfs25Pb to Anopheles stephensi. Furthermore, mice immunized with Pfs25 DNA vaccine and challenged with TrPfs25Pb displayed reduced malaria transmission compared to mice immunized with wild-type plasmid. These studies describe development of an animal malaria model alternative to the in vitro MFA and show that the model can facilitate P. falciparum transmission-blocking vaccine evaluation based on the target antigen Pfs25. We believe that an animal model to test transmission-blocking vaccines would be superior to the MFA, since there may be additional immune factors that synergize the transmission-blocking activity of antibodies in vivo.
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http://dx.doi.org/10.1128/IAI.01409-07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2346707PMC
May 2008

[Congenital absence of inferior vena cava associated to polispleenism. Case report].

Rev Port Cir Cardiotorac Vasc 2006 Oct-Dec;13(4):227-9

Serviço de Cirurgia Geral do Centro Hospitalar de Vila Nova de Gaia.

Interruption of the inferior vena cava with azygos continuation is an uncommon vascular anomaly that results from aberrant development during embryogenesis. We report a case of this anomaly in a young boy of 19 years old sent for our observation for presenting an hipotransparency in the chest x-ray, which study revealed a prominence of the azygos cross. Further evaluation by CT-scans disclosed the diagnosis of congenital absence of the inferior vena cava, associated to multiple spleens (polispleenism).
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November 2009

Aquaglyceroporin PbAQP during intraerythrocytic development of the malaria parasite Plasmodium berghei.

Proc Natl Acad Sci U S A 2007 Feb 6;104(7):2211-6. Epub 2007 Feb 6.

Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2185, USA.

The malaria parasite can use host plasma glycerol for lipid biosynthesis and membrane biogenesis during the asexual intraerythrocytic development. The molecular basis for glycerol uptake into the parasite is undefined. We hypothesize that the Plasmodium aquaglyceroporin provides the pathway for glycerol uptake into the malaria parasite. To test this hypothesis, we identified the orthologue of Plasmodium falciparum aquaglyceroporin (PfAQP) in the rodent malaria parasite, Plasmodium berghei (PbAQP), and examined the biological role of PbAQP by performing a targeted deletion of the PbAQP gene. PbAQP and PfAQP are 62% identical in sequence. In contrast to the canonical NPA (Asn-Pro-Ala) motifs in most aquaporins, the PbAQP has NLA (Asn-Leu-Ala) and NPS (Asn-Leu-Ser) in those positions. PbAQP expressed in Xenopus oocytes was permeable to water and glycerol, suggesting that PbAQP is an aquaglyceroporin. In P. berghei, PbAQP was localized to the parasite plasma membrane. The PbAQP-null parasites were viable; however, they were highly deficient in glycerol transport. In addition, they proliferated more slowly compared with the WT parasites, and mice infected with PbAQP-null parasites survived longer. Taken together, these findings suggest that PbAQP provides the pathway for the entry of glycerol into P. berghei and contributes to the growth of the parasite during the asexual intraerythrocytic stages of infection. In conclusion, we demonstrate here that PbAQP plays an important role in the blood-stage development of the rodent malaria parasite during infection in mice and could be added to the list of targets for the design of antimalarial drugs.
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http://dx.doi.org/10.1073/pnas.0610843104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892982PMC
February 2007

Infection with Plasmodium berghei boosts antibody responses primed by a DNA vaccine encoding gametocyte antigen Pbs48/45.

Infect Immun 2006 Apr;74(4):2043-51

Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, The Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.

An important consideration in the development of a malaria vaccine for individuals living in areas of endemicity is whether vaccine-elicited immune responses can be boosted by natural infection. To investigate this question, we used Plasmodium berghei ANKA blood-stage parasites for the infection of mice that were previously immunized with a DNA vaccine encoding the P. berghei sexual-stage antigen Pbs48/45. Intramuscular immunization in mice with one or two doses of DNA-Pbs48/45 or of empty DNA vaccine as control did not elicit detectable anti-Pbs48/45 antibodies as determined by enzyme-linked immunosorbent assay. An infection with P. berghei ANKA 6 weeks after DNA vaccination elicited comparable anti-Pbs48/45 antibody levels in mice which had been primed with DNA-Pbs48/45 or with empty DNA vaccine. However, a repeat infection with P. berghei ANKA resulted in significantly higher anti-Pbs48/45 antibody levels in mice which had been primed with the DNA-Pbs48/45 vaccine than the levels in the mock DNA-vaccinated mice. In parallel and as an additional control to distinguish the boosting of Pbs48/45 antibodies exclusively by gametocytes during infection, a separate group of mice primed with DNA-Pbs48/45 received an infection with P. berghei ANKA clone 2.33, which was previously described as a "nongametocyte producer." To our surprise, this parasite clone too elicited antibody levels comparable to those induced by the P. berghei gametocyte producer clone. We further demonstrate that the nongametocyte producer P. berghei clone is in fact a defective gametocyte producer that expresses Pbs48/45, much like the gametocyte producer clone, and is therefore capable of boosting antibody levels to Pbs48/45. Taken together, these results indicate that vaccine-primed antibodies can be boosted during repeat infections and warrant further investigation with additional malaria antigens.
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http://dx.doi.org/10.1128/IAI.74.4.2043-2051.2006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1418885PMC
April 2006

Molecular complexity of sexual development and gene regulation in Plasmodium falciparum.

Int J Parasitol 2004 Dec;34(13-14):1451-8

Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins Malaria Research Institute, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.

The malaria parasite, Plasmodium falciparum, has a complex life cycle which alternates between the vertebrate host and the invertebrate vector. Various morphological changes as well as stage-specific transcripts and gene expression profiles that accompany parasite's asexual and sexual life cycle suggest that gene regulation is crucial for the parasite's continual adaptations to survive the changing environments as well as for pathogenesis. Development of sexual stages is crucial for malaria transmission and relatively little is known about the role of specific gene products during asexual to sexual differentiation and further development. Therefore, in order to have a full understanding of the biology of the malaria parasite, gene regulation on a genome-wide global level must be understood, an area remaining to be elucidated in P. falciparum. Parasite features, such as A-T bias, difficulties in cloning, labor-intensive culture and purification of specific stages of the parasite, all contribute to the difficulties to investigate many aspects of parasite biology. However, despite these challenges, limited studies have revealed a number of parallelisms with eukaryotic transcription. For example, the parasite's genes are organised in a similar fashion, contain promoter elements and upstream activation sequences, as shown by structural searches and functional assays, and some of the basal machinery and general transcription factors have been found in Plasmodium. The completion of the full genome sequence of P. falciparum and other species of Plasmodium has resulted in the search for specific transcription factors through genome mining. Although genome mining may identify some of the factors, search for these factors solely by primary sequence homology would result in a non-comprehensive list for transcription factors present in the genome. Here, we present further discussion on putative transcription factors like activities detected in the asexual and sexual stages of P. falciparum.
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http://dx.doi.org/10.1016/j.ijpara.2004.10.013DOI Listing
December 2004

Plasmodium falciparum MAEBL is a unique member of the ebl family.

Mol Biochem Parasitol 2002 Jun;122(1):35-44

Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556-0369, USA.

Malaria is one of the deadliest human diseases and efforts to control it have been difficult due to the protozoan parasites' complex biology. Malaria merozoite invasion of erythrocytes is an essential part of blood-stage infections. The invasion process is mediated by numerous parasite molecules, such as EBA-175, a member of the ebl family of erythrocyte binding proteins. We have identified maebl, an ebl paralogue, in Plasmodium falciparum and found it highly conserved with its orthologues in P. yoelii and P. berghei, but distinct from other Plasmodium ebl. Importantly, the putative MAEBL ligand domains are highly conserved and are similar to AMA-1, but not the consensus DBL ligand domains present in all other ebl. In mature merozoites, MAEBL localized with rhoptry proteins (RhopH2, RAP-1), including surface localization with RhopH2, but not microneme proteins (EBA-175, BAEBL). MAEBL appears as proteolytically processed fragments in P. falciparum parasites. The amino cysteine-rich ligand domains were present primarily in culture supernatants, while the carboxyl cysteine-rich domain adjacent to the transmembrane domain was preferentially isolated from Triton X-100 extracted fractions. These data indicate that the primary structure of maebl is highly conserved among Plasmodium species, while its characteristics demonstrate a function unique among the ebl proteins.
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http://dx.doi.org/10.1016/s0166-6851(02)00067-1DOI Listing
June 2002
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