Pheochromocytoma during pregnancy - a rare diagnose with a complex multidisciplinary approach

Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although pheochromocytoma is a rare of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. Early diagnosis and timely, appropriate management reduce possible maternal and fetal complications. We report a case of a 32-week pregnant woman diagnosed with hypertension secondary to pheochromocytoma. An elective caesarian section was performed at 37 weeks of gestational age and underwent a laparoscopic left adrenalectomy with success. A multidisciplinary approach is of utmost importance and essential during the management of this life-threatening condition during pregnancy

Abstracts

Tradução, para a língua Inglesa, dos resumos dos artigos publicados nesta edição

Bronchoalveolar Lavage Proteomics in Patients with Suspected Lung Cancer

All experiments including MS analysis were supported by Fundacao para a Ciencia e Tecnologia project EXPL/DTP-PIC/0616/2013. RM is supported by FCT investigator program 2012 (IF/01002/2012). ASC is supported by grant SFRH/BPD/85569/2012 funded by Fundacao para a Ciencia e Tecnologia.Lung cancer configures as one of the deadliest types of cancer. The future implementation of early screening methods such as exhaled breath condensate analysis and low dose computed tomography (CT) as an alternative to current chest imaging based screening will lead to an increased burden on bronchoscopy units. New approaches for improvement of diagnosis in bronchoscopy units, regarding patient management, are likely to have clinical impact in the future. Diagnostic approaches to address mortality of lung cancer include improved early detection and stratification of the cancers according to its prognosis and further response to drug treatment. In this study, we performed a detailed mass spectrometry based proteome analysis of acellular bronchoalveolar lavage (BAL) fluid samples on an observational prospective cohort consisting of 90 suspected lung cancer cases which were followed during two years. The thirteen new lung cancer cases diagnosed during the follow up time period clustered, based on liquid chromatography-mass spectrometry (LC-MS) data, with lung cancer cases at the time of BAL collection. Hundred and thirty-tree potential biomarkers were identified showing significantly differential expression when comparing lung cancer versus non-lung cancer. The regulated biomarkers showed a large overlap with biomarkers detected in tissue samples.publishersversionpublishe

APLICAÇÃO DE PROTOCOLOS DE AVALIAÇÃO RÁPIDA COMO FERRAMENTA ROBUSTA NA QUALIFICAÇÃO AMBIENTAL EM DOIS CÓRREGOS URBANOS QUE DESAGUAM NO RIO PARAGUAI

Os córregos urbanos são ambientes bastante utilizados para a disposição de efluentes e amplamente conhecidos pela má qualidade. A má utilização destes ambientes é principalmente decorrente da crescente urbanização desordenada e da falta de sensibilização tanto do poder público quanto do individual. Alguns protocolos de avaliação rápida são utilizados para a caracterização destes ambientes como ferramentas rápidas subjetivas a dados sensoriais do observador. Este trabalho tem como objetivo analisar dois protocolos de avaliação rápida em dois diferentes córregos urbanos da cidade de Cáceres, estado de Mato Grosso, Brasil. Os protocolos foram aplicados em quatro trechos de 100 a 200 metros previamente determinados, abrangendo da Nascente a Foz destes. Três observadores foram responsáveis pelas tomadas dos dados sensoriais, enquanto os dados físico-químico e biológicos foram tomados por outro pesquisador. Nossos resultados demonstram que há uma diferença na qualificação ambiental dependendo dos protocolos utilizados. Enquanto um traz o ambiente como alterado, o outro o traz como bom. Trechos dos córregos também apresentaram diferenças entre os protocolos. Houve positiva e significativa relação entre as pontuações dos protocolos aplicados. Os dados físico, químico e biológicos incrementaram a caracterização ambiental dos protocolos, fornecendo dados mais robustos. Assim, esta pesquisa propõe a utilização de novos parâmetros para serem incorporados juntamente com a aplicação dos protocolos para que os ambientes sejam qualificados mais claramente e assim tomadas melhores medidas de manejo ambiental

Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin

Thromboembolic events are associated with high mortality and morbidity indexes. In this context, warfarin is the most widely prescribed oral anticoagulant agent for preventing and treating these events. This medication has a narrow therapeutic range and, consequently, patients usually have difficulty in achieving and maintaining stable target therapeutics. Some studies on the literature about oral anticoagulant management showed that pharmacists could improve the efficiency of anticoagulant therapy. However, the majority of these studies included general patients retrospectively. The aim of this study was to prospectively evaluate a pharmacist’s warfarin management in patients with poor quality of anticoagulation therapy (Time in the Therapeutic Range- TTR < 50%). We included 268 patients with atrial fibrillation (AF) and without stable dose of warfarin (TTR < 50%, based on the last three values of International Normalized Ratio-INR). We followed them up for 12 weeks, INR values were evaluated and, when necessary, the dose adjustments were performed. During the first four visits, patient’s INR was measured every 7 days. Then, if INR was within the target therapeutic range (INR: 2–3), the patient was asked to return in 30 days. However, if INR was out the therapeutic target, the patient was asked to return in 7 days. Adherence evaluation was measured through questionnaires and by counting the pills taken. Comparison between basal TTR (which was calculated based on the three last INR values before prospective phase) and TTR of 4 weeks (calculated by considering the INR tests from visits 0 to 4, in the prospective phase of the study) and basal TTR and TTR of 12 weeks (calculated based on the INR tests from visits 0 to 12, in the prospective phase of the study) revealed significant statistical differences (0.144 ± 0.010 vs. 0.382 ± 0.016; and 0.144 ± 0.010 vs. 0.543 ± 0.014, p < 0.001, respectively). We also observed that the mean TTR of 1 year before (retrospective phase) was lower than TTR value after 12 weeks of pharmacist-driven treatment (prospective phase) (0.320 ± 0.015; 0.540 ± 0.015, p < 0.001). In conclusion, pharmaceutical care was able to improve TTR values in patients with AF and poor quality of anticoagulation with warfarin