Browsing by Author "Ruas, L"
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- Crescimento fetal e controlo glicémico em grávidas diabéticas tipo 1Publication . Campos, MV; Ruas, L; Paiva, S; Leitão, P; Lobo, C; Marta, E; Sobral, E; Cravo, AINTRODUCTION: Conflicting results have been reported with respect to the relationship between direct or indirect measures of glycemic control in mothers with type 1 diabetes and macrosomia. OBJECTIVE: To evaluate the frequency of LGA babies in type 1 diabetic pregnancies and analyse the influence of some maternal characteristics and glucose control in oversized babies. MATERIAL AND METHODS: A retrospective study of 18 pregnant women with type 1 diabetes mellitus was performed. It was divided in two groups: group 1 (G1- n=9)--pregnant women with LGA babies and group 2 (G2- n=9)--pregnant women with AGA (Appropriate weight for gestational age) babies. We evaluate the follow parameters: HbA1c in the third trimester of pregnancy, fasting and 1 h postprandial capillary glucose levels, pregestational BMI, maternal age, duration of Diabetes mellitus, weight gain during pregnancy, microvascular diabetes complications (retinopathy and nefropathy), and type of delivery. We defined LGA birth weight over the 90 centile. RESULTS: LGA babies occurred in 50% of gestations. We did not find any statistical differences in maternal age, diabetes mellitus duration, pregestational BMI, weight gain during pregnancy, microvascular diabetes complications, HbA1c levels (medium value in the two groups 6,5%). The glucose fasting values were higher in G1: 95,7 +/- 31.7 mg/ dl, vs G2: 83.3 +/- 17.1 mg/dl without, however, reaching statistically significant differences. There was statically differences in postprandial glucose values G1: 160.3 +/- 60.2 mg/dl vs G2: 111.9 +/- 27.1 mg/dl -- p= 0.043. CONCLUSIONS: The frequency of LGA babies was elevated 50% in type 1 diabetic pregnancies, although normal HbA1c values. Thus we conclude that the 1 h postprandial glucose levels should be considered a strong predictor of fetal growth.
- Diabetes Mellitus após transplante renalPublication . Ruas, L; Bastos, M; Alves, R; Rodrigues, D; Barros, L; Mota, A; Carvalheiro, M; Ruas, A; Furtado, AL
- Hiperplasia Congénita da Suprarrenal de Expressão Tardia por Deficiência de 21-HidroxilasePublication . Vieira, A; Paiva, S; Baptista, C; Ruas, L; Silva, J; Gonçalves, J; Carrilho, F; Carvalheiro, MThe deficiency of the enzyme 21-hydroxylase (21-HO) is responsible for about 90% to 95% of all cases of congenital adrenal hyperplasia (HCSR). This disorder is one of the most frequent hereditary illnesses of autosomal recessive trait. The illness can be presented in two clinical forms: 1 - classic, subdivided in saltwasting form and simple virilizing form; 2 - nonclassic or late-onset. The severity of the illness is correlated with the degree of enzymatic activity of 21-HO, which depends on the type of mutation that occurs in gene CYP21A2. The late onset congenital adrenal hyperplasia is that one where the enzymatic blockade is less intense. The clinical is variable: precocious pubarche, polycystic ovaries, hirsutism, oligoamenorrhea, acne and infertility. Gold standard for the diagnosis of late onset congenital adrenal hyperplasia consists on the test of the tetracosactide, considering itself diagnostic positive when 17-hidroxiprogesterona (17-OHP) is higher of 10-15 ng per mL. Many patients don't need treatment; however, if necessary, such a treatment essentially consists on the Administration of glucocorticoids and antiandrogens. Considering that affected individuals and the carriers may have a severe mutation in CYP21A2, they can have descendents with the classic form (if their partner is also a carrier of a severe mutation), it is mandatory the genetic study of the couple. The authors illustrate the importance of this genetic study through five clinical cases, whose common link is the desire to have children, as well as the presence on the feminine element of late onset congenital adrenal hyperplasia. The genetic study of the couple allows adequate pre-conception counseling and also prevents the use of corticoids throughout the pregnancy (if there's no risk of descendents being affected with the classic form). This aspect must be had in account in programming the pregnancy, in order to prevent therapeutics and unnecessary distrusts.
- Hipertiroidismo e antitiroideus de síntese na gravidezPublication . Oliveira, V; Correia, P; Marques, JP; Marta, E; Paiva, S; Ruas, L
- Tiroidites agudasPublication . Paiva, S; Bastos, M; Gomes, L; Durão, A; Moreira, A; Barros, L; Rodrigues, D; Ruas, L; Ribeiro, C; Rodrigues, F; Paiva, I; Fagulha, A; Carrilho, F; Geraldes, E; Carvalheiro, M; Ruas, AWe review the pathophysiology, clinical features and therapy of acute thyroiditis. Four cases are reported stressing the role of fine needle aspiration for the diagnosis of this clinical entity.
- Transplantação renal em doentes com diabetes mellitus tipo I e tipo IIPublication . Baptista, C; Bastos, M; Gomes, L; Macário, F; Ruas, L; Rodrigues, D; Alves, R; Gomes, H; Ferreira, C; Roseiro, A; Paiva, S; Barros, L; Carvalheiro, M; Mota, A; Furtado, AL; Ruas, AA total of 618 patients with end-stage renal disease received kidney transplants between 1980 and September 1996. Twenty eight of them were diabetics. Better results were achieved for type 1 diabetic patients than for type 2 (mortality: 5.9% vs 27.3%; functioning graft: 88.2% vs 72.7%). The morbility was also higher in those patients (infections: 81.8% vs 29.4%; vascular complications: 45.5% vs 17.6%). Actuarial patient and graft survival were lower for type 2 than for non diabetic patients. For type 1 diabetics the results are similar to those for non diabetics. Better results can probably be achieved by restricting the selection criteria. The decision to transplant or maintain on dialysis should be made on a case by case basis.