Browsing by Author "Silva, JM"
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- Apolipoprotein E epsilon-4 polymorphism is associated with younger age at referral to a lipidology clinic and a poorer response to lipid-lowering therapyPublication . Baptista, R; Rebelo, M; Decq-Mota, J; Dias, P; Monteiro, P; Providência, LA; Silva, JMThe risk of coronary heart disease (CHD) is related to environmental factors and genetic variants. Apolipoprotein E (apoE) polymorphisms are heritable determinants of total and low-density lipoprotein cholesterol, with some authors suggesting an association between the ε4 allele and CHD. We investigated the relationship between apoE genotype and age at referral to a specialized lipid clinic by the primary care physician and whether the benefits of treatment with statin differed between genotypes. METHODS: We assessed individual apoE genotypes and lipid blood profile in a total of 463 patients followed at a specialized lipid clinic due to dyslipidemia, with a 3-year median follow-up time. The primary care physician at the time of the referral had no access to the apoE genotyping results. Carriers of apoE ε4/ε2 genotype were excluded. RESULTS: The frequencies of ε2, ε3 and ε4 alleles were 7.8, 78.9 and 13.3%, respectively. There were no significant differences between genders. Although with similar lipid profiles and antidyslipidemic drug usage at baseline, ε4-carriers were referred to the clinic at a younger age (44.2 ± 14.7 years) compared with non-ε4 carriers (50.6 ± 13.8 years) (p < 0.001), with a substantially younger age of referral for homozygous E4/4 and for all genotypes with at least one copy of the ε4 allele (p < 0.001 for trend). Although both ε4 and non-ε4 carriers achieved significant reductions in total cholesterol during follow-up (p < 0.001 vs. baseline), the mean relative decrease in total cholesterol levels was higher in non-ε4 carriers (-19.9 ± 2.3%) compared with ε4 carriers (-11.8 ± 2.3%), p = 0.003. CONCLUSION: Our findings support the concept that there is a reduced response to anti-dyslipidemic treatment in ε4 carriers; this can be a contributing factor for the earlier referral of these patients to our specialized lipid clinic and reinforces the usefulness of apoE genotyping in predicting patients response to lipid lowering therapies.
- Estatinas e microalbuminúriaPublication . Dias, P; Silva, JM; Silva, N; Alexandrino, MB; Alves-Moura, JJ
- Esteato-hepatite não alcoólica: a propósito de um caso clínicoPublication . Devesa, N; Carrola, P; Silva, JM; Alexandrino, MB; Alves-Moura, JJ
- Evolução do peso numa consulta de dislipidemiasPublication . Dias, P; Reis, R; Parente, F; Silva, JM; Moura, JA
- Incontinência urinária secundária ao carvedilolPublication . Porto, J; Silva, JM; Alexandrino, MB; Alves-Moura, JJ
- Intoxicação Por Agonista Beta AdrenérgicoPublication . Carrola, P; Devesa, N; Silva, JM; Ramos, F; Alexandrino, MB; Moura, JJOs autores descrevem dois casos clínicos (pai e filha), que recorreram ao Serviço de Urgência com tremor das extremidades, ansiedade, palpitações, náuseas, cefaleias e tonturas, duas horas após ingestão de fígado de vaca. Analiticamente apresentavam leucocitose com neutrofilia, hipocaliémia e hiperglicémia. Após tratamento com potássio e.v. e propranolol, houve desaparecimento da sintomatologia no SU. Os sintomas reapareceram em casa, pois os doentes não tomaram a medicação prescrita, e persistiram durante cinco dias. A análise posterior do soro de ambos os doentes revelou presença de clembuterol (65,5 hg/ml no pai e 58 hg/ml na filha). O fígado do animal apresentava uma concentração de 1,42 mg/ kg. O clembuterol é um agonista β-adrenérgico pouco específico, com algumas indicações veterinárias. No entanto, este fármaco é usado ilegalmente como promotor do crescimento. Os autores pretendem deste modo alertar os médicos para este problema, nomeadamente aqueles que realizam Urgência Hospitalar.
- The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing PoliciesPublication . Sá-Sousa, A; Fonseca, JA; Pereira, AM; Ferreira, A; Arrobas, A; Mendes, A; Drummond, M; Videira, W; Costa, T; Farinha, P; Soares, J; Rocha, P; Todo-Bom, A; Sokolova, A; Costa, A; Fernandes, B; Chaves Loureiro, C; Longo, C; Pardal, C; Costa, C; Cruz, C; Loureiro, CC; Lopes, C; Mesquita, D; Faria, E; Magalhães, E; Menezes, F; Todo-Bom, F; Carvalho, F; Regateiro, FS; Falcão, H; Fernandes, I; Gaspar-Marques, J; Viana, J; Ferreira, J; Silva, JM; Simão, L; Almeida, L; Fernandes, L; Ferreira, L; van Zeller, M; Quaresma, M; Castanho, M; André, N; Cortesão, N; Leiria-Pinto, P; Pinto, P; Rosa, P; Carreiro-Martins, P; Gerardo, R; Silva, R; Lucas, S; Almeida, T; Calvo, TThe Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.
- The triglyceride lowering effect of fish oils is affected by fish consumptionPublication . Silva, JM; Souza, I; Silva, R; Tavares, P; Teixeira, F; Serra e Silva, PWe investigated the efficacy of fish oils in Portuguese patients with hypertriglyceridaemia and mixed hyperlipidaemia, and the influence of fish consumption on the triglyceride lowering capacity of fish oils. Forty patients participated in this double-blind study, consisting of a 4-week dietary or wash-out baseline period after which patients were randomly assigned to receive either 12 fish oil capsules (3.6 g/day of omega 3) or similar 12 soya oil capsules per day for a period of 2 months. There were no statistically significant changes of total, HDL or LDL-cholesterol, and triglycerides. Nevertheless, triglycerides increased 19.9% with soya oil and decreased 27.8% with fish oils. Also, there was an inverse relationship (rho = -0.352) between fish consumption and fish oils effect on triglycerides, and the triglyceride lowering with fish oils increased (from 27.8% to 44.4%), reaching borderline significance, if we excluded patients consuming one or more meals with fish per day. Glucose increased 11% (P = 0.0047) with fish oils. These findings suggest that the triglyceride lowering effect of fish oils is affected by fish consumption, and confirm that fish oils increase blood glucose levels in diabetics and non-diabetics.
- Think Tank: Relatório Estratégico sobre Publicação Científica Biomédica em PortugalPublication . Tato Marinho, R; Donato, H; Fernandez-Llimos, F; Massano, J; Silva, JM; Almeida, M; Carvalho, JC; Villanueva, T; Fonseca, JE