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Nocardia infections among immunomodulated inflammatory bowel disease patients:A review

World Journal of Gastroenterology 2015年第21期21卷 6491-6498页

作者： Candida Abreu nuno rocha-pereira António Sarmento Fernando Magro Department of Infectious Diseases Faculty of MedicineCentro Hospitalar S.Joao4200 PortoPortugal Nephrology Research and Development Unit University of Porto Department of Gastroenterology Faculty of MedicineCentro Hospitalar S.Joao4200 PortoPortugal Department of Pharmacology and Therapeutics Faculty of MedicineUniversity of Porto MedInUP Center for Drug Discovery and Innovative MedicinesUniversity of Porto

Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune *** can occur as an acute life-threatening disease,with lung,brain and skin being commonly *** infection was classically diagnosed in HIV infected persons,organ transplanted recipients and long term corticosteroid treated *** the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this *** purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory *** reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed *** cases of nocardiosis associated with anti-tumor necrosis factor(TNF) prescription(9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease(IBD),4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients,lung disease in 4 patients,hepatic in one and disseminated disease in 3 *** the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and *** conclusion,nocardiosis requires high levels of clinical suspicion and experience of laboratory staff,in order to establish a timely diagnosis and by doing so avoid worst *** for long periods tailored by the susceptibility of the isolated species whenever possible is *** safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.

关键词： Nocardiosis Immunomodulation Nocardiaspp. Inflammatory diseases

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Rhino-Orbito-Cerebral Mucormycosis in a Diabetic Patient with Idiopathic CD4+Lymphocytopenia

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Advances in Infectious Diseases 2013年第4期3卷 248-252页

作者： nuno rocha pereira Paulo Andrade Laura Sa Candida Abreu Rita Figueiredo Roberto Silva Antonio Sarmento Infectious Diseases Department Centro Hospitalar Sao Joao and Faculty of Medicine of Porto UniversityPortoPortugal Neuroradiology Department Centro Hospitalar Sao JoaoPortoPortugal Pathology Department Centro Hospitalar Sao Joao and Faculty of Medicine of Porto UniversityPortoPortugal

A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left peripheral facial palsy and hypoesthesia. More than a month after admission, a palate ulcer appeared and Infectious Diseases consultation was required. Mucormycosis was suspected and the diagnosis was confirmed by histologic examination. Despite early surgery and combination antifungal therapy, the patient did not survive. This case report illustrates the difficulty in diagnosing a rare condition with non-specific clinical manifestations and underlines the importance of a timely multidisciplinary approach in order to recognise this highly fatal disease earlier. It also describes a previously non-reported situation of mucormycosis in a patient with idiopathic CD4 + lymphocytopenia.

关键词： Mucormycosis Idiopathic CD4+Lymphocytopenia Diabetes Amphotericin B

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Trophic niche changes associated with the eradication of invasive mammals in an insular lizard: an assessment using isotopes

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Current Zoology 2022年第2期68卷 211-219页

作者： Sara F.NUNES Mario MOTA-FERREIRA Marta SAMPAIO Joana ANDRADE nuno OLIVEIRA Rui REBELO Ricardo rocha Faculty of Sciences Centre for EcologyEvolution and Environmental ChangesUniversity of LisbonLisbon1749-016Portugal CIBI0-lnBI0 Research Center in Biodiversity and Genetic ResourcesUniversity of PortoVairao4485-661Portugal CIBI0-lnBI0 Research Center in Biodiversity and Genetic ResourcesInstitute of AgronomyUniversity of LisbonLisbon1349-017Portugal Sociedade Portuguesa Para o Estudo das Aves Av.Columbano Bordalo Pinheiro873°AndarLisboa1070-062Portugal

Invasive species are a major threat to island biodiversity,and their eradications have substantially contributed to the conservation of island ***,the consequences of eradications on the trophic ecology of native taxa are largely ***,we used the eradication of invasive black rats Rattus rattus and European rabbits Oryctolagus cuniculus from the Berlenga Island,in the western coast of Portugal,as a whole-ecosystem experiment to investigate the effects of the eradication of invasive mammals on the trophic niche and body dimensions of the island-restricted Berlenga wall lizard Podarcis carbonelli berlengensis over a 2-year *** results suggest an expansion of the isotopic niche and an intensification of the sexual dimorphism of the lizard following mammal ***,we found considerable variability in isotopic niche across the island and detected evidence of sex-specific and season-modulated nutritional requirements of this threatened *** findings support that the eradication of 2 of the planets most problematic invasive vertebrates led to changes in the lizard trophic niche and sexual dimorphism in just 2 *** suggests that the ecological pressuresfor example,prey availability and habitat structureto which lizards are exposed have substantially changed *** study emphasizes the scientific value of island eradications as experiments to address a wide range of ecological questions and adds to the increasing body of evidence supporting substantial conservation gains associated with these restoration interventions.

关键词： food-webs invasive species eradication Oryctolagus cuniculus Podarcis carbonelli berlengensis Rattus rattus

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Development of a warning score for early detection of colorectal anastomotic leakage:Hype or hope?

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World Journal of Gastrointestinal Surgery 2022年第11期14卷 1297-1309页

作者： nuno J G Rama Óscar Lourenço Patrícia C Motta Lima Maria Pedro S Guarino Diana Parente Ricardo Castro Ana Bento Anabela rocha Fernando Castro-Poças João Pimentel Division of Colorectal Surgical Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Division of Clinical Pathology Leiria Hospital CentreLeiria 2410-541Portugal Division of Surgical Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterOporto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of OPortoOporto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Division of Surgical Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL),a severe postoperative complication,is associated with high morbidity,hospital readmission,and overall healthcare *** detection of CAL remains a challenge in clinical ***,some decision models have been developed to increase the diagnostic accuracy of this *** To develop a score based on easily accessible variables to detect CAL *** Based on the least absolute shrinkage and selection operator method,a predictive classification system was developed[Early ColoRectAL Leakage(E-CRALL)score]from a prospective observational,single center cohort,carried out in a colorectal division from a non-academic *** score performance and CAL threshold from postoperative day(POD)3 to POD5 were *** on a precise analytical decision model,the standard clinical practice was compared with the E-CRALL adoption on POD3,POD4,or POD5.A cost-minimization analysis was conducted,on the assumption that all alternatives delivered similar health-related *** In this study,396 patients who underwent colorectal resection surgery with anastomosis,and 6.3%(n=25)developed *** of the patients who developed CAL(n=23;92%)were diagnosed during the first hospital admission,with a median time of diagnosis of 9.0±6.8 *** POD3 to POD5,the area under the receiver operating characteristic curve of the E-CRALL score was 0.82,0.84,and 0.95,*** POD5,if a threshold of 8.29 was chosen,87.4%of anastomotic failures were identified with E-CRALL ***,score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d,if used on POD3 and POD5,*** of score adoption,episode comprehensive costs were markedly greater(up to four times)in patients who developed CAL in comparison with patients who did not develop ***,the use of the E-CRALL warning score was associated with cost savings of€421442.20,with most(92.9%)of the savings from patients

关键词： Anastomotic leakage Colorectal Surgery Biomarkers Score Costs

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Abdominal Muscular Metastases of a Pulmonar Adenocarcinoma

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Advances in Lung Cancer 2015年第2期4卷 25-27页

作者： Joana de Castro rocha Pedro nuno Brandao Ana Rita Cruz Vítor Valente Internal Medicine Department Centro Hospitalar do PortoPortoPortugal General Surgery Department Centro Hospitalar do PortoPortoPortugal

Metastases are synonymous of malignant neoplasm in advanced stage and so associated with a poor prognosis. As the first manifestation of cancer disease, the muscle metastasis is very rare. The definitive diagnosis of its presence is made based on histology. The authors presented the case of a patient with a lung adenocarcinoma, being with first manifestation of it, a muscle metastasis only about a month later there were clinical manifestations with imaging appearance that led to the diagnosis of a primary neoplasm. The rare manifestation of the disease motivated the study and surveillance of the patient and lead to the diagnosis.

关键词： Muscular Metastasis Adenocarcinoma Lung

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Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage:A prospective observational study

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World Journal of Gastroenterology 2022年第24期28卷 2758-2774页

作者： nuno J G Rama Marlene C C Lages Maria Pedro S Guarino Óscar Lourenço Patrícia C Motta Lima Diana Parente Cândida S G Silva Ricardo Castro Ana Bento Anabela rocha Fernando Castro-Pocas João Pimente Colorectal Surgical Division Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute(ICBAS) University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Clinical Pathology Division Leiria Hospital CentreLeiria 2410-541Portugal Surgical Division Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterPorto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of PortoPorto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Surgical Division Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL)is one of the most dreaded complications after colorectal surgery,with an incidence that can be as high as 27%.This event is associated with increased morbidity and mortality;therefore,its early diagnosis is crucial to reduce clinical consequences and *** biomarkers have been suggested as laboratory tools for the diagnosis of *** To assess the usefulness of plasma C-reactive protein(CRP)and calprotectin(CLP)as early predictors of *** A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis,from March 2017 to August *** were divided into three groups:G1–no complications;G2–complications not related to CAL;and G3–*** biomarkers were measured and analyzed in the first 5 postoperative days(PODs),namely white blood cell(WBC)count,eosinophil cell count(ECC),CRP,CLP,and procalcitonin(PCT).Clinical criteria,such as abdominal pain and clinical condition,were also *** correlation between biomarkers and CAL was *** operating characteristic(ROC)curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL,and the area under the ROC curve(AUROC),specificity,sensitivity,positive predictive value,and negative predictive value(NPV)during this period were *** In total,25 of 396 patients developed CAL(6.3%),and the mean time for this diagnosis was 9.0±6.8 *** operative characteristics,such as surgical approach,blood loss,intraoperative complications,and duration of the procedure,were notably related to the development of *** length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications(median of 21 d vs 13 d and 7 d respectively;P<0.001).For abdominal pain,the best predictive performance was on POD4 and POD5,with the largest AUROC of 0.84 on ***

关键词： Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin

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Psychotropic drugs and liver disease:A critical review of pharmacokinetics and liver toxicity

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第1期8卷 26-38页

作者： Diogo Telles-Correia António Barbosa Helena Cortez-Pinto Carlos Campos nuno B F rocha Sérgio Machado Faculty of Medicine University of Lisbon Institute of Psychiatry Federal University of Rio de Janeiro School of Health Technologies Polytechnic Institute of Porto Postgraduate Program of Physical Activity Sciences Salgado de Oliveira University

The liver is the organ by which the majority of sub-stances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first--pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.

关键词： Liver Toxicity Psychotropic drugs Pharmacokinetics Hepatic disease

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