IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.
A significant number of patients did not obtain an imaging response. Biochemical and imaging responses were asynchronous and occurred mainly in the first 4 years of treatment. This may allow an earlier identification of partially resistant and resistant macroprolactinomas, with consequent change in the therapeutic approach.
Objective: Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. Subjects and methods: Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. Results: In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA 1 c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m 2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA 1 c < 7% (16.1% vs 22.5%) and fewer patients with HbA 1 c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA 1 c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA 1 c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m 2 and 24.0 [P25 22.0; P75 26.2] kg/m 2 , respectively) (p < 0.05). Overweight (HR 4.319,) and obesity (HR 8.112, predicted greater weight gain. Conclusion: FGM use was associated with significant improvement in HbA 1 c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m 2 , so weight control strategies should be emphasized.
pT3 papillary thyroid carcinoma (PTC) can be divided into three subgroups according to the largest diameter >4 cm or evidence of minimal extrathyroidal extension (ETE): A >4 cm, no ETE; B ≤4 cm, with ETE; and C >4 cm, with ETE. The aim of this study was to analyze whether these subgroups are clinically different. A retrospective analysis of clinicopathological data of patients with pT3 PTC, with a minimum follow-up of 2 years, at a referral center was conducted. Outcome was evaluated after primary treatment and after 2 and 5 years of follow-up. Patients were classified as no evidence of disease (NED), biochemical evidence of disease (BED), and structural evidence of disease (SED) either locoregional (SED-L) or at distance (SED-D). The study patients were classified into three groups as follows: Group A (n = 91), Group B (n = 101), and Group C (n = 23). Most patients were female (80.0 %); mean age at diagnosis was 49.9 ± 16.5 years. 214 patients underwent total thyroidectomy; 208 patients were treated with (131)I. Median follow-up was 6.0 years. After primary treatment, the condition of NED was significantly different between the groups (A-87.9 %, B-68.3 %, C-43.5 %; p < 0.001). Recurrence rate, either biochemical or structural, was 8.8, 7.2, and 30.0 % in groups A, B, and C, respectively. Clinical status after 2 years anticipated clinical status after 5 years, except for Group B. ETE and tumor size were found to be predictors of disease status after primary treatment and after 2 years. ETE appeared as the strongest predictor of persistence of disease after primary treatment as well as of evidence of disease, either biochemical or structural, after 2 years of follow-up.
SUMMARY Giant prolactinomas are rare pituitary tumours of which management can be a challenge. A 28-year-old man presented with headaches, visual impairment and behavioural changes. Clinically, the patient was found to have hypogonadism and bitemporal hemianopsia. A MRI demonstrated a pituitary tumour 76 mm in diameter and blood tests revealed a serum prolactin of 158 700 mU/mL (reference range 58-254). Initially, a craniotomy was performed. Immunohistochemistry of the tumour identified a prolactinoma with a high proliferative index and the patient was started on treatment with a dopamine agonist. A year later, neurological symptoms worsened due to regrowth of the lesion's cystic component, and so further surgery was performed. After 10 years of treatment with dopamine agonists, the prolactin levels decreased by 96.8%, there was an effective reduction in tumour size, and the neurological signs and symptoms resolved. BACKGROUND
informação sobre o artigo Historial do artigo: Recebido a 13 de janeiro de 2015 Aceite a 23 de março de 2015 On-line a 6 de junho de 2015 Palavras-chave: Pneumonia adquirida na comunidade Diabetes mellitus Hiperglicemia Complicaç ões r e s u m o Introduç ão: A pneumonia adquirida na comunidade (PAC) é uma patologia frequente e com uma importante morbimortalidade associada. A diabetes mellitus (DM) aumenta o risco e complicaç ões de doenç as infeciosas. Todavia, continua por esclarecer qual o papel da DM e glicemia na admissão enquanto fatores de prognóstico em doentes com PAC. Objetivos: Em doentes com PAC, avaliar a relaç ão entre DM/glicemia na admissão e desenvolvimento de complicaç ões, duraç ão do internamento e mortalidade; e em doentes com diabetes a relaç ão entre controlo glicémico e existência de complicaç ões. Métodos: Estudo observacional, analítico e retrospetivo dos adultos admitidos no nosso hospital entre outubro/2011 e març o/2012, com PAC. Consultaram-se os processos clínicos eletrónicos e para avaliaç ão da mortalidade aos 30 e 90 dias efetuaram-se chamadas telefónicas. Utilizaram-se os testes Qui-quadrado, Mann-Whitney, Kruskal-Wallis e regressão logística.Resultados: Dos 440 doentes incluídos, 51,1% eram mulheres, 83,1% idosos e 29,3% tinham diabetes. Destes, 48,8% tinham HbA1c doseada no internamento (mediana 6,8%, AIQ: 6,3-7,8%). A mediana da glicose na admissão foi 134 mg/dL (AIQ: 111-176 mg/dL). Os doentes com diabetes eram mais velhos (p = 0,002), tiveram pneumonias mais graves (p = 0,025), mais complicaç ões (p = 0,001) e internamentos mais prolongados (p = 0,001). A DM revelou-se um preditor de complicaç ões (p = 0,008). Não se demonstrou relaç ão entre DM e mortalidade, nem entre os níveis de HbA1c e complicaç ões, tempo de internamento e mortalidade. Níveis mais elevados de glicemia na admissão associaram-se a tempo de internamento mais prolongado (p = 0,016) e verificou-se uma tendência para mais complicaç ões nos doentes hiperglicémicos. Não se encontrou associaç ão entre mortalidade e glicemia à admissão. Conclusão: A DM e a hiperglicemia na admissão são fatores de mau prognóstico em doentes admitidos com PAC, associando-se a prolongamento do tempo de internamento. Ademais, a DM revelou-se um fator preditor independente de complicaç ões nestes doentes. a b s t r a c tBackground: Community acquired pneumonia (CAP) is a common condition and a major cause of morbidity. Diabetes mellitus (DM) increases the risk and complications of infectious diseases. However, the role of DM and glycemia at the time of presentation as prognostic factors in patients with CAP remains to be clarified. Aims: To evaluate the relationship between DM/glycemia at the time of presentation and complications, length of stay and mortality in patients with CAP, and the relationship between glycemic control and complications in patients with diabetes.
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