Browsing by Author "Sabino, T"
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- Absolute Hyperglycemia versus Stress Hyperglycemia Ratio for the Prognosis of Hospitalized Patients with COVID-19 in the First Months of the Pandemic: A Retrospective StudyPublication . Matias, AA; Manique, I; Sabino, T; Rego, T; Mihon, C; Panarra, A; Rizzo, M; Silva-Nunes, JDiabetes is a risk factor for greater severity of coronavirus disease 2019 (COVID-19). The stress hyperglycemia ratio (SHR) is an independent predictor of critical illness, and it is reported to have a stronger association than absolute hyperglycemia. The aim of this study was to assess the relationship of absolute hyperglycemia and SHR with the severity of COVID-19, since there are no studies investigating SHR in patients with COVID-19. We conducted a retrospective observational study on hospitalized patients with COVID-19 in the first months of the pandemic, regarding absolute hyperglycemia, SHR, and severity outcomes. Of the 374 patients, 28.1% had a previous diagnosis of type 2 diabetes. Absolute hyperglycemia (64.8% versus 22.7%; p < 0.01) and SHR [1.1 (IQR 0.9-1.3) versus 1.0 (IQR 0.9-1.2); p < 0.001] showed a statistically significant association with previous diabetes. Absolute hyperglycemia showed a significant association with clinical severity of COVID-19 (79.0% versus 62.7%; p < 0.001), need for oxygen therapy (74.8% versus 54.4%; p < 0.001), invasive mechanical ventilation (28.6% versus 11.6%; p < 0.001), and intensive care unit (30.3% versus 14.9%; p = 0.002), but not with mortality; by contrast, there was no statistically significant association between SHR and all these parameters. Our results are in agreement with the literature regarding the impact of absolute hyperglycemia on COVID-19 severity outcomes, while SHR was not a significant marker. We therefore suggest that SHR should not be evaluated in all patients admitted in the hospital for COVID-19, and we encourage the standard measures at admission of blood glucose and HbA1c levels.
- Aspergilose Pulmonar InvasivaPublication . Peixinho, P; Sabino, T; Duarte, C; Cruz, T; Bragança, NA Aspergilose é a mais frequente das micoses pulmonares, representando um grupo díspar de doenças de patogénese variável que têm em comum o agente causal - o Aspergillus. Este é saprófita das vias respiratórias, tornando-se patogénico em doentes imunocomprometidos. Existem diferentes formas anatomo-clínicas de Aspergilose, algumas fatais, exigindo um diagnóstico e tratamento atempados. Os autores descrevem um caso de Aspergilose Pulmonar Invasiva num doente submetido a corticoterapia de longa duração. Iniciou terapêutica com Anfotericina B lipossómica, descontinuada por nefrotoxicidade e substituída por Itraconazol, com evolução clínica, laboratorial e radiológica favorável.
- Oftalmopatia Tiroideia Severa e Tiroidite de Hashimoto, em Doente EutiroideuPublication . Espírito Santo, R; Sabino, T; Agapito, A
- POEMS Syndrome: a Rare Cause of Adrenal Insufficiency in a Young MalePublication . Prokop, J; Estorninho, J; Marote, S; Sabino, T; Botelho de Sousa, A; Silva, E; Agapito, ASummary: POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes) is a rare multisystemic disease. Clinical presentation is variable, the only mandatory criteria being polyneuropathy and monoclonal gammapathy in association with one major and one minor criterion. Primary adrenal insufficiency is rarely reported. We describe a case of a 33-year-old patient, in whom the presenting symptoms were mandibular mass, chronic sensory-motor peripheral polyneuropathy and adrenal insufficiency. The laboratory evaluation revealed thrombocytosis, severe hyperkalemia with normal renal function, normal protein electrophoresis and negative serum immunofixation for monoclonal protein. Endocrinologic laboratory work-up confirmed Addison's disease and revealed subclinical primary hypothyroidism. Thoracic abdominal CT showed hepatosplenomegaly, multiple sclerotic lesions in thoracic vertebra and ribs. The histopathologic examination of the mandibular mass was nondiagnostic. Bone marrow biopsy revealed plasma cell dyscrasia and confirmed POEMS syndrome. Axillary lymphadenopathy biopsy: Castleman's disease. Gluco-mineralocorticoid substitution and levothyroxine therapy were started with clinical improvement. Autologous hematopoietic cell transplantation (HCT) was planned, cyclophosphamide induction was started. Meanwhile the patient suffered two ischemic strokes which resulted in aphasia and hemiparesis. Cerebral angiography revealed vascular lesions compatible with vasculitis and stenosis of two cerebral arteries. The patient deceased 14 months after the diagnosis. The young age at presentation, multiplicity of manifestations and difficulties in investigation along with the absence of serum monoclonal protein made the diagnosis challenging. We report this case to highlight the need to consider POEMS syndrome in differential diagnosis of peripheral neuropathy in association with endocrine abnormalities even in young patients. Learning points: POEMS syndrome is considered a 'low tumor burden disease' and the monoclonal protein in 15% of cases is not found by immunofixation. Neuropathy is the dominant characteristic of POEMS syndrome and it is peripheral, ascending, symmetric and affecting both sensation and motor function. Endocrinopathies are a frequent feature of POEMS syndrome, but the cause is unknown. The most common endocrinopathies are hypogonadism, primary hypothyroidism and abnormalities in glucose metabolism. There is no standard therapy; however, patients with disseminated bone marrow involvement are treated with chemotherapy with or without HCT.
- Síndrome de Klinefelter. Experiência de uma Consulta de InfertilidadePublication . Sabino, T; Gardete Correia, L; Nunes Corrêa, J; Rocha, T; Carvalho, MJ; Sá e Melo, PO Síndrome de Klinefelter é uma das causas mais frequentes de hipogonadismo masculino. As manifestações clínicas do Síndrome de Klinefelter variam consideravelmente de indivíduo para indivíduo. Assim, alguns doentes têm alterações no desenvolvimento dos caracteres sexuais secundários, enquanto que outros não se distinguem de indivíduos saudáveis. Os autores avaliaram a variabilidade de apresentação clínica em 25 doentes com S. de Klinefelter, diagnosticados numa consulta de infertilidade.