Browsing by Author "Oliveira, D."
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- Climate changes in south western Iberia and Mediterranean Outflow variations during two contrasting cycles of the last 1 Myrs: MIS 31-MIS 30 and MIS 12-MIS 11Publication . Goni, Maria F. Sanchez; Llave, E.; Oliveira, D.; Naughton, F.; Desprat, S.; Ducassou, E.; Hodell, D. A.; Hernandez-Molina, Francisco J.Grain size analysis and physical properties of Sites U1388, U1389 and TJ1390 collected in the Contourite Depositional System of the Gulf of Cadiz during the Integrated Ocean Drilling Program (IODP) Expedition 339 "Mediterranean Outflow" reveal relative changes in bottom current strength, a tracer of the dynamics of the Mediterranean Outflow Water (MOW), before and after the Middle Pleistocene Transition (MPT). The comparison of MOW behavior with climate changes identified by the pollen analysis and 8180 benthic foraminifera measurements of Site U1385, the Shackleton Site, collected in the south western Iberian margin shows that the interval MIS 31-MIS 30,similar to 1.1-1.05 million years ago (Ma), before the MPT, was marked by wetter climate and weaker bottom current than the interval MIS 12-MIS 11 (0.47-0.39 Ma), after the MPT. Similarly, the increase in fine particles from these glacials to interglacials and in coarse fraction from interglacials to glacials was coeval with forest and semi-desert expansions, respectively, indicating the lowering/enhancement of MOW strength during periods of regional increase/decrease of moisture. While these findings may not necessarily apply to all glacial/interglacial cycles, they nonetheless serve as excellent supporting examples of the hypothesis that aridification can serve as a good tracer for MOW intensity. The strongest regional aridity during MIS 12 coincides with a remarkable increase of coarse grain size deposition and distribution that we interpret as a maximum in MOW strength. This MOW intensification may have pre-conditioned the North Atlantic by increasing salinity, thereby triggering the strong resumption of the Meridional Overturning Circulation that could contribute to the great warmth that characterizes the MIS 11c super-interglacial. (C) 2015 Elsevier B.V. All rights reserved.
- Portuguese recommendations for the management of Raynaud’s phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseasesPublication . Santiago, T.; Duarte, A. C.; Sepriano, A.; Castro, A.; Rosa, B.; Resende, C.; Oliveira, D.; Dourado, D.; Costa, E.; Santos, F. Cunha; Terroso, G.; Boleto, G.; Silva, I.; Barbosa, L.; Silva, J.; Neves, J. Sousa; Salvador, M. J.; Gonçalves, M. J.; Guerra, M. Gomes; Ferreira, R. M.; Fernandes, R. Duarte; Barreira, S.; Teixeira, C. Silvestre; Tomás, A. L.; Romão, V. C.; Cordeiro, A.Objective: To develop evidence-based recommendations for the non-pharmacological and pharmacological management of Raynaud's phenomenon (RP) and digital ulcers (DUs) in patients with systemic sclerosis and other immune-mediated connective tissue diseases (CTDs). Methods: A task force comprising 21 rheumatologists, 2 surgeons (vascular and plastic), 2 nurses, and 1 patient representative was established. Following a systematic literature review performed to inform the recommendations, statements were formulated and discussed during two meetings (one online and one in-person). Levels of evidence, grades of recommendation (GoR), and level of agreement (LoA) were determined. Results: Five overarching principles and 13 recommendations were developed. GoR ranged from A to D. The mean +/- standard difference (SD) LoA with the overarching principles and recommendations ranged from 7.8 +/- 2.1 to 9.8 +/- 0.4. Briefly, the management of RP and DUs in patients with CTDs should be coordinated by a multidisciplinary team and based on shared decisions with patients. Nifedipine should be used as first-line therapy for RP and/ or DUs. Sildenafil, tadalafil, and/or iloprost IV are second-line options for severe and/or refractory patients with RP and/or DUs. Sildenafil, tadalafil and/or Iloprost IV, should be prescribed for healing and prevention (also including bosentan) of DUs. In patients with RP and/or DUs, non-pharmacological interventions might be considered as add-ons, but there is limited quality and quantity of scientific evidence supporting their use. Conclusions: These recommendations will inform rheumatologists, specialist nurses, other healthcare professionals, and patients about a comprehensive and personalized management of RP and DUs. A research agenda was developed to address unmet needs, particularly for non-pharmacologic interventions.
- Predictors of myositis in mixed connective tissue disease: a multicentre retrospective studyPublication . Melo, A. T.; António, M. Silvério; Martinho, J. Martins; Guimarães, F.; Dourado, E.; Oliveira, D.; Lopes, J.; Saraiva, A.; Gago, A.; Correia, M.; Fernandes, A. L.; Dinis, S.; Teixeira, R.; Silva, S. P.; Costa, C.; Beirão, T.; Furtado, C.; Abreu, P.; Khmelinskii, N.Objectives: We aimed to identify clinical and serological predictors of myositis in mixed connective tissue disease (MCTD). Methods: We performed a nationwide, retrospective, multicentre study including adult-onset MCTD patients fulfilling at least one of the following diagnostic criteria: Sharp’s, Kasukawa, Alarcón-Segovia, or Kahn’s. Univariable analysis was performed using Chi-square, Fisher exact, Student’s t or Mann-Whitney U tests, as appropriate. Multivariable analysis was performed using binary logistic regression. Results: Ninety-eight patients were included. Myositis was observed in 43.9% of patients, of whom 60.5% had myositis at disease onset. Proximal muscle weakness was described in 30 patients with muscle involvement (70%). Gastrointestinal involvement was identified in 28% and respiratory involvement in 29% of myositis patients. In the same subgroup of patients, 41.7% had a myopathic pattern on electromyography, and 47.1% had histological myositis features in the muscle biopsy. Fever (OR=6.96, p=0.022) was an independent predictor of myositis, regardless of sex, age at diagnosis, ancestry, and respiratory involvement. African ancestry (OR=8.39, p=0.019), leukopenia at the disease onset (OR 6.24, p=0.021), and younger age at diagnosis (OR=1.07/year, p=0.035) were identified as independent predictors of myositis at disease onset, regardless of sex and scleroderma pattern in capillaroscopy. Conclusions: Myositis is a common manifestation of MCTD, even at the disease onset. African ancestry, leukopenia at the disease onset, younger age at diagnosis, and fever should prompt a thorough evaluation for myositis.
- Wunderlich syndrome as a rare complication of polyarteritis nodosa: a case reportPublication . Oliveira, D.; Martins, A.; Martins, F.; Rato, M.; Pinheiro, F.; Fonseca, D.; Vaz, C.; Mariz, E.; Costa, L.Spontaneous subcapsular and perirenal hemorrhage, known as Wunderlich syndrome (WS), is a rare clinical manifestation of polyarteritis nodosa (PAN). We report a case of a 48-year-old male with a history of recurrent episodes of leg muscle tenderness and dysesthesia, bilateral flank pain, painful nodular skin lesions in the lower limbs, weight loss, and difficult-to-control arterial hypertension. The abdominopelvic computed tomography angiography showed a large left perirenal hematoma, leading to the patient's admission to the intensive care unit. After the exclusion of infectious or neoplastic foci, the patient was diagnosed with PAN and started intravenous methylprednisolone pulses with a good response. Since WS is a rare initial clinical manifestation of PAN, an early diagnosis and aggressive treatment will significantly improve clinical outcomes.