Prevalência de Doença Carotídea na Patologia Cérebro-Vascular Isquémica. O Papel do Eco-Doppler

BACKGROUND: Atherosclerotic carotid disease represents approximately 20% of the causes of ischemic stroke. Effective treatment options, such as endovascular or surgical revascularization procedures, are available. Doppler Ultrasound (DUS) is a non-invasive, inexpensive, routine exam used to evaluate the presence of internal carotid artery (ICA) stenosis. We retrospectively analysed the prevalence of severe atherosclerotic carotid disease in a population of patients with acute ischemic stroke/transitory ischemic attacks (TIAs), and the role of DUS in the detection of ICA stenosis and treatment decisions in these patients. METHODS: A total of 318 patients with ischemic stroke or TIAs was admitted to our stroke unit, and 260 patients were studied by DUS. ICA stenosis was evaluated by DUS according to peak systolic velocity. All DUS exams were performed by the same operator. ICA stenosis was further assessed in 43 patients by digital subtraction angiography (DSA) using NASCET criteria. RESULTS: Of the total 318 patients, 260 (82%) had DUS evaluation. Of the total 520 ICAs studied by DUS, degrees of ICA stenosis were: 0-29% n= 438 (84%); 30-49% n= 8 (2%); 50-69% n= 27 (5%); 70-89% n= 15 (3%); 90-99% n= 20 (4%); oclusão n= 14 (2%). Of the total 260 patients studied, 43 (16.5%) underwent DSA. Sensibility and specificity of DUS in the diagnosis of carotid stenosis over 70% were, respectively, 91% e 84%. Of the total 31 patients with significant carotid stenosis (70-99%), 23 (74%) underwent subsequent carotid revascularization procedures. DISCUSSION: DUS is an important screening test in our stroke unit, justifying its use as a routine exam for all patients with ischemic stroke/TIAs. Moreover, our results show the relevance of severe carotid disease in a population with acute ischemic stroke/TIAs (16.5%), with a total of 9% of patients being submitted to carotid revascularization procedures

IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease

Hashimoto's thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment

Mismatch repair SNPs and thyroid cancer susceptibility: a potential role for the MSH6 rs1042821 (Gly39Glu) polymorphism

Abstract of the Poster presented at the 3rd ESPT Conference (European Society of Pharmacogenomics and Personalised Therapy / European Society of Pharmacogenomics and Theranostics), 7-9 October 2015, Budapest

Malignancy risk of thyroid nodules: quality assessment of the thyroid ultrasound report

Background Thyroid nodules are a challenge in clinical practice and thyroid ultrasonography is essential for assessing the risk of malignancy. The use of ultrasound-based malignancy risk classification systems has been recommended by several scientific societies but radiologist’s adherence to these guidelines may vary. The authors aimed to analyze the quality of the information provided by the thyroid ultrasound report, to assess the malignancy risk of thyroid nodules, in Portugal. Methods Multicenter and retrospective study, conducted in three of the five Portuguese NUTS2 corresponding to about 88.3% of the mainland population. We included 344 consecutive unselected participants aged ≥ 18 years who underwent thyroid ultrasonography in 2019. The description of six features of the dominant thyroid nodule was analyzed: maximum size, shape, margins, composition, echogenicity and echogenic foci. A utility score, including these six features, was used as an indicator of the report’s quality. A score of 4 was considered as a minimum value. Results Maximum diameter was reported for all nodules. Shape, margins, composition, echogenicity and echogenic foci were reported in 8.1%, 25.0%, 76.5%, 53.2% and 20.9%, respectively. Only 21.8% of the nodules had a score ≥ 4. At least one of four suspicious features, including marked hypoechogenicity, microcalcifications, irregular margins and non-oval shape, was identified in 8.7% of the nodules. Cervical lymph nodes’ status was reported in 93% of the exams. The risk category was only reported in 7.8% of the participants. Conclusion The adherence of Portuguese radiologists to a standardized reporting model and to an ultrasound-based malignancy risk stratification system is still low and has implications for the correct characterization of the malignancy risk of nodules and the decision to perform fine-needle aspiration biopsy

Influence of Weather on Seizure Frequency - Clinical Experience in the Emergency Room of a Tertiary Hospital

info:eu-repo/semantics/publishedVersio

Análise da estrutura fatorial da versão em português da Escala de Auto-Silenciamento

This study focuses on the adaptation of the Portuguese version of the Escala de Autosilenciamiento [EAS, for its Portuguese acronym] (Neves, 2005) that has been designed to assess the use of cognitive schemas for self silencing in intimate relationships. Participants were 371 women with a mean age of 22.36 years (SD=2.69; Min=18; Max=31), who at that time were involved in affective relationships with an average duration of 39.65 months (SD=33.93; Min=10; Max=192).The exploratory factor analysis suggests a factor solution of three factors, where the first factor includes items from the silencing of the sef and divided self subscales. The second factor includes items from the care-giving subscale such as self-sacrifice. And the third factor includes items from the externalized self-perception subscale. Results of the confirmatory factor analysis show reliable global indices of fitness of the model, confirming the quality of the model in terms of adjustment to empirical data (X2/df=1.964, CFI=.862, GFI=.894, RMSEA=.051) compared to the original model. Implications for a further study of the construct validity of the scale are discussed.Este estudo se centra na adaptação da versão em português da Escala de Auto-silenciamento (EAS; Neves, 2005) que está desenhada para avaliar o uso de esquemas cognitivos de auto-silenciamento nas relações íntimas. Neste estudo participaram 371 mulheres, com uma idade média de 22,36 anos (DP = 2,69, mín. = 18, máx. = 31), que nessa época estavam envolvidas em relações afetivas com uma duração média de 39,65 meses. (DP = 33,93, mín. = 0,10; máx. = 192). Uma análise fatorial exploratória posterior sugere uma solução de três fatores, aonde o primeiro fator inclui os itens da sub-escala de silenciamento do self e do self dividido; o segundo inclui os itens da sub-escala de Provisão de cuidados como o auto sacrifício, e o terceiro inclui os itens da sub-escala de auto percepção externalizada. Os resultados da análise fatorial confirmatória mostram índices gerais de adequação confiáveis, o que confirma a qualidade do ajuste do modelo aos dados empíricos (X2/df = 1964, CFI = .862, GFI = 0,894, RMSEA = 0,051) em comparação com a teste original. Analisam-se as implicações para um estudo más profundo da validez de constructo da escala.Este estudio se centra en la adaptación de la versión en portugués de la Escala de Autosilenciamiento (EAS; Neves, 2005) que está diseñada para evaluar el uso de esquemas cognitivos de autosilenciamiento en las relaciones íntimas. En este estudio participaron 371 mujeres, con una edad media de 22,36 años (DP = 2,69, mín. = 18, máx. = 31), que en esa época estaban involucradas en relaciones afectivas con una duración promedio de 39,65 meses. (DP = 33,93, mín. = 0,10; máx. = 192). Un análisis factorial exploratorio posterior sugiere una solución de tres factores, donde el primer factor incluye los ítems de la subescala de silenciamiento del self y del self dividido; el segundo incluye los ítems de la subescala de Provisión de cuidados como el autosacrificio, y el tercero incluye los ítems de la subescala de autopercepción externalizada. Los resultados del análisis factorial confirmatorio muestran índices generales de adecuación fiables, lo que confirma la calidad del ajuste del modelo a los datos empíricos (X2/df = 1964, CFI = .862, GFI = 0,894, RMSEA = 0,051) en comparación con la prueba original. Se analizan las implicaciones para un estudio más profundo de la validez de constructo de la escala

Thyroid Ultrasound Report: A Position Statement of the Thyroid Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism

A ecografi a tiroideia é o exame de imagem de primeira linha na investigação da patologia estrutural da tiroide. A utilização de sistemas de classifi cação do risco de malignidade dos nódulos da tiroide, em função das suas características ecográfi cas, veio conferir à ecografi a tiroideia um papel determinante na seleção dos nódulos com indicação para citologia aspirativa com agulha fi na da tiroide. Os relatórios da ecografi a tiroideia precisam de ser adaptados a esta realidade. Assim, a adoção de um modelo de relatório estruturado de ecografi a da tiroide, que inclua a utilização de um léxico comum e a informação sufi ciente para a classifi cação do risco dos nódulos da tiroide torna-se premente. Em Portugal, a qualidade dos relatórios de ecografi a da patologia nodular da tiroide, defi nida pela capacidade de classifi car corretamente o risco de malignidade dos nódulos, poderá ser baixa. Com o objetivo de contribuir para uma melhor qualidade dos relatórios de ecografi a da tiroide, o Grupo de Estudo da Tiroide da Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo propôs-se estabelecer recomendações sobre a elaboração de um relatório estruturado da ecografi a tiroideia, tendo por base a classifi cação EU-TIRADS da European Thyroid Association, assim como sobre princípios e termos a utilizar na sua descrição.Thyroid ultrasound is the first-line imaging exam in the investigation of thyroid structural disease. The use of thyroid nodule malignancy risk classification systems according to their ultrasound characteristics has given the thyroid ultrasound a determining role in the selection of which nodules have indication for thyroid fine needle aspiration and cytology. Thyroid ultrasound reports need to be adapted to this reality. Thus, the adoption of a structured thyroid ultrasound report model that includes the use of a common lexicon and sufficient information to classify the risk of thyroid nodules becomes urgent. The quality of thyroid nodule ultrasound reports, defined by the ability to correctly classify the risk of nodule malignancy, may be low in Portugal. In order to contribute to an improvement in the quality of thyroid ultrasound reports, the Thyroid Study Group of the Portuguese Society of Endocrinology. Diabetes and Metabolism intended to establish recommendations on the elaboration of a structured report of thyroid ultrasound, based on the EU-TIRADS classification of the European Thyroid Association, as well as to establish principles and terminologies to be used in their implementation.These recommendations were developed within the Thyroid Study Group and were supported by the Portuguese Society of Endocrinology, Diabetes and Metabolism