Síndrome de cushing subclínica em incidentalomas adrenais: do desafio do diagnóstico à terapêutica

Trabalho final de mestrado integrado em Medicina (Endocrinologia), apresentado à Faculdade de Medicina da Universidade de Coimbra.Nos últimos anos, o crescente desenvolvimento e utilização de sofisticados métodos imagiológicos de diagnóstico, conduziu a um aumento do diagnóstico ocasional de massas adrenais, definidas como Incidentalomas Adrenais (IA). Consequentemente, a Síndrome de Cushing Subclínica (SCS) tem ganho um importante destaque na atualidade, por ser incontestavelmente, a alteração hormonal mais frequentemente associada aos Incidentalomas Adrenais, com uma prevalência compreendida entre os 5% e 20%, dependendo do protocolo de estudo e dos critérios de diagnóstico aplicados. O objetivo principal deste artigo é a realização de uma revisão bibliográfica, com base na literatura publicada acerca da SCS, abordando a sua definição, história natural, diagnóstico, comorbilidades, terapêutica e seguimento. A SCS corresponde a uma hipersecreção autónoma de cortisol, embora em pequeno grau, sendo portanto insuficiente para se expressar sob a forma de estigmas típicos de Síndrome de Cushing (SC), possuindo, porém, consequências nefastas para a saúde. Apesar de nesta patologia se verificarem algumas alterações nos testes de avaliação da função do eixo hipotálamo-hipófise-suprarrenal (HHS), os critérios de diagnóstico para a SCS são alvo de grande controvérsia e discussão, não existindo, até à data, um protocolo de diagnóstico considerado como padrão de ouro. De entre todos os testes de avaliação hormonal disponíveis, existe consonância quanto ao lugar do Teste de Supressão com Dexametasona (TSD) como teste inicial de rastreio. A discussão acerca deste teste incide nos valores de corte (1,8μg/dL; 3μg/dL; 5μg/dL), acima dos quais se considera a existência de autonomia funcional, bem como nos diferentes protocolos usados (1mg, 2mg, 8mg). Porém, o teste de supressão com Dexametasona tem a vantagem de permitir quantificar o grau de hipersecreção autónoma de cortisol. Têm sido descritas consequências clínicas decorrentes da secreção inapropriada de cortisol, nos doentes com SCS, nomeadamente a presença de hipertensão arterial (HTA), obesidade central, diminuição da tolerância à glicose, dislipidemia ou de osteoporose. Pensa-se que estes doentes possuam um maior risco cardiovascular e que o processo de aterosclerose seja acelerado pelo hipercortisolismo, apesar de silencioso e em pequeno grau. Quanto à orientação terapêutica desta patologia, tanto a adrenalectomia como um seguimento cuidado e regular associado ao tratamento da Síndrome Metabólica, têm sido sugeridos como opções terapêuticas válidas e a considerar caso a caso.In the last years, the increasing development and use of sophisticated medical imaging methods has enabled an increase in diagnosis of occasional adrenal masses, defined as Adrenal Incidentaloma. Consequently and as of today, Subclinical Cushing's Syndrome (SCS) is of utmost importance and stands out as the most frequent hormonal change associated to Adrenal Incidentaloma, with a prevalence ranging from 5% to 20%, depending on the study protocol and the diagnosis’ criteria applied. The main goal of this article is to review the literature on SCS by addressing its definition, natural history, diagnosis, comorbidities, treatment and follow-up. SCS is defined as an autonomous hypersecretion of cortisol at low levels and therefore insufficient to express the typical stigmata of Cushing's syndrome, resulting, however, in adverse consequences to patients health. In spite of the changes found in the tests for assessment of the hypothalamic-pituitaryadrenal axis function, the diagnostic’s criterias for SCS are still very controversial and debatable, and therefore a gold standard diagnostic protocol is still missing. Within all hormonal evaluation tests, different studies seem to agree on the Dexamethasone Suppression Test as the initial screening test. The discussion about this test rather focus on the cut-off values (1.8μg /dL; 3μg/dL; 5 μg/dL) above which the existence of functional autonomy is considered as well as on the various protocols used (1mg, 2mg, 8mg). Nevertheless, the dexamethasone suppression test has the advantage of quantifying the level of autonomous cortisol hypersecretion. Clinical consequences of inappropriate cortisol’s secretion, such as blood hypertension, central obesity, impaired glucose tolerance, dyslipidaemia or osteoporosis, have been described in patients with SCS. Evidences suggests that these patients have increased cardiovascular risk and that atherosclerosis process is accelerated by hypercortisolism, although at a clinically silent and modest level. Regarding the therapeutic management of this disease, adrenalectomy and a careful and regular monitoring associated to treatment of the metabolic syndrome, have both been suggested as valid therapeutic options to be considered case by case

XML schemas for parallel corpora

Parallel corpora are resources used in Natural Language Processing and Computational Linguistics. They are defined as a set of texts, in different languages, that are translations of each other. Note that these translations do not need to cover the full document, as we might have sentences translated just on some of the languages. When dealing with the process of sharing resources, recent years have bet on the use of XML formats. This is no different when talking about parallel corpora sharing. When visiting different projects in the web that release parallel corpora for download, we can find at least three different formats. In fact, this abundance of formats has led some projects to adopt all the three formats. This article discusses these three main formats: XML Corpus Encoding Standard, Translation Memory Exchange format and the Text Encoding Initiative. We will compare their formal definition and their XML schema

Ativação funcional da Default Mode Network na sintomatologia depressiva e ansiosa

Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia Clínica e da Saúde)Resumo: As redes cerebrais no estado de repouso têm sido amplamente investigadas, nomeadamente a Default Mode Network (DMN) cujas funções sustentam a cognição espontânea, bem como, os estados emocionais internos e os processos autorreferentes. Neste estudo colocou-se a hipótese de que as áreas corticais mediais da DMN poderiam apresentar maior ativação durante os estados de ansiedade e humor depressivo. A amostra foi constituída por 24 adultos saudáveis. Os participantes foram avaliados com as escalas HDRS e HARS e realizaram um exame de ressonância magnética funcional no estado de repouso com a duração de 5 minutos. Foi realizada uma análise de regressão múltipla que revelou a relação entre a ativação das áreas da DMN e a variação dos scores de ansiedade e depressão. Verificou-se uma correlação positiva entre a ativação de porções anteriores da DMN, tipicamente envolvidas em pensamento autorreferente e processamento emocional e os scores de ansiedade e depressão. Ao contrário, as áreas posteriores da DMN apresentaram uma correlação negativa com os scores de ansiedade e depressão. Este estudo demonstra que na ansiedade e depressão, os indivíduos apresentam um elevado foco introspetivo e uma regulação emocional disfuncional.Abstract: Brain networks in the resting state have been widely investigated, namely the Default Mode Network (DMN), whose functions sustain spontaneous cognition, as well as, internal emotional states and self-referential processes. In this study it was hypothesized that the cortical areas of the medial DMN might present greater activation during anxiety states and depressed mood. The sample of healthy adults consisted of 24 healthy subjects. Participants were assessed using HARS and HDRS scales and completed a 5 minutes restingstate functional magnetic resonance imaging scan. Multiple regression was performed and revealed which areas of the DMN were being recruited depending on the variation of anxiety and depression scores. It was found a positive correlation between the activation of the anterior portions of DMN involved in self-referential thought and emotional processes and the anxiety and depression scores. However posterior areas were negatively correlated with anxiety and depression scores. The present study demonstrates that anxious and depressed individuals are strongly engaged in introspection and might present dysfunctional emotion regulation

O controlo de qualidade das plantas medicinais e a segurança dos doentes na fitoterapia

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências FarmacêuticasNos últimos anos, tem-se verificado um aumento significativo do interesse pelas plantas medicinais, habitualmente associadas ao seu efeito terapêutico, muitas das vezes visto como um recurso natural e seguro. Contudo, têm sido reportados efeitos adversos e interacções associados a esta toma. Estudos demonstram uma variedade de razões para tais problemas, sendo que uma das principais causas dos efeitos adversos relatados está directamente relacionada com a má qualidade dos produtos, nomeadamente das matérias-primas usadas. No que concerne às interacções associadas à administração concomitante de preparações à base de plantas com medicamentos, são cada vez mais frequentes, podendo desencadear complicações graves. Estas poderiam, por vezes, ser prevenidas pela sua descrição nas rotulagens ou pela partilha desta informação com os profissionais de saúde e consumidores. In recent years there has been a significant increase on the interest for herbal products, which are generally associated with a safe and harmless therapeutic. However, some adverse effects and drug interactions have been reported. Some studies demonstrate a variety of reasons for such problems, but the major cause of the reported adverse effects is directly related to the poor quality of products, including raw materials used. Regarding to the interactions when herbal medicines and drugs are administrated concomitantly, the studies show that these interactions are common and can trigger serious complications, which could sometimes be prevented by its description on labels or by sharing this information with health professionals and consumers

Colite isquémica: fatores de risco, diagnóstico e prognóstico, em doentes submetidos a cirurgia

Berthelot Marcellin. Arrêté fixant la date de l'ouverture de la session d'examen pour les bourses des lycées et collèges de garçons. In: Bulletin administratif de l'instruction publique. Tome 41 n°738, 1887. p. 253

Electronic governance in Portugal: a silent pioneer

This paper sums up the Portuguese experience on launching and implementing a number of successful EGOV policies at different levels. Such a success was based on a holistic understanding of EGOV, in the confluence of technology, administrative reform and innovation processes, and enforced through a number of well- defined, consistent policies carried out over time. The role of national agencies, independent from local political instances and private interests, in the implementation of an effective EGOV strategy is also stressed.(undefined

Iron Metabolism: From Health to Disease

Background Iron is vital for almost all living organisms by participating in a wide range of metabolic processes. However, iron concentration in body tissues must be tightly regulated since excessive iron may lead to microbial infections or cause tissue damage. Disorders of iron metabolism are among the most common human diseases and cover several conditions with varied clinical manifestations. Methods An extensive literature review on the basic aspects of iron metabolism was performed, and the most recent findings on this field were highlighted as well. Results New insights on iron metabolism have shed light into its real complexity, and its role in both healthy and pathological states has been recognized. Important discoveries about the iron regulatory machine and imbalances in its regulation have been made, which may lead in a near future to the development of new therapeutic strategies against iron disorders. Besides, the toxicity of free iron and its association with several pathologies has been addressed, although it requires further investigations. Conclusion This review will provide students in the fields of biochemistry and health sciences a brief and clear overview of iron physiology and toxicity, as well as imbalances in the iron homeostasis and associated pathological conditions

Fungal silver nanoparticles

Este resumo faz parte de: Book of abstracts of the Meeting of the Institute for Biotechnology and Bioengineering, 2, Braga, Portugal, 2010. A versão completa do livro de atas está disponível em: http://hdl.handle.net/1822/1096

Exploiting the FLOSS paradigm in collaborative e-learning : application to e-government

Modern societies face high demands for skilled professionals, able to successfully design, deploy and utilize complex Information Technology (IT) –enabled socio-technical systems at ever- increasing levels of reliability and security. Contrary to traditional education practices, the high-level training required to fulfill this demand should rely on the principle that the learners are themselves responsible for their learning process, that they have control over this process, and that the process aims at developing cross-disciplinary and problem-driven competences, not only at acquiring content knowledge. However, such training requires the presence of a highly interactive, problem-oriented environment for technology-supported learning (or e-learning). This poster presents a doctoral research project, which aims at designing, validating and monitoring a collaborative e-learning environment based on the principles of Free/Libre Open Source Software (FLOSS). In order to validate its outcomes, the project will rely on two real-life professional training programs: in Software Engineering for software managers and in e-Government for public managers. The poster presents the objectives, research methodology and expected results from this project.(undefined