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Browsing by Author "Alves, JD"

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  • Antibodies against HDL Components in Ischaemic Stroke and Coronary Artery Disease
    Publication . Batuca, J; Amaral, M; Favas, C; Justino, G; Papoila, A; Ames, P; Alves, JD
    Quantitative and qualitative defects of high-density lipoprotein (HDL) are important in atherogenesis. In this study, we investigated whether antibodies against HDL components had additional value to conventional cardiovascular risk factors for the diagnosis of ischaemic stroke (IS) and coronary artery disease (CAD). Cross-sectional study was conducted on 53 patients with IS, 51 with CAD and 55 healthy controls, and in vitro studies to validate findings of the clinical study. We determined serum immunoglobulin G (IgG) antibodies against HDL (aHDL), apolipoproteins (aApoA-I, aApoA-II and aApoC-I) and paraoxonase-1 (aPON1) as well as PON1 activity (PON1a), total antioxidant capacity and biomarkers of endothelial activation (serum nitric oxide metabolites, 3-nitrotyrosine, VCAM-1 and ICAM-1); in vitro assays tested the capacity of IgG aHDL purified from high titer patients to inhibit PON1a and to reverse protective effect of HDL on endothelial cells. IgG aHDL, aApoA-I and aPON1 were higher in IS and CAD than controls (p < 0.001), predicted negatively PON1a and positively VCAM-1 and ICAM-1. By adding IgG aHDL and aApoA-I to a traditional cardiovascular risk factors model for IS and by adding IgG aHDL in a similar model for CAD, we obtained better discrimination of IS and CAD from healthy controls. IgG aHDL purified from IS and CAD inhibited PON1a by 38% (p < 0.01) and abrogated the protective effect of HDL on VCAM-1 expression by 126% compared with non-specific human IgG (p < 0.001). IgG against HDL components interfere with the antioxidant and anti-inflammatory properties of HDL and may represent novel biomarkers for vascular disease that need to be investigated in prospective studies.
    2018Journal article Open access Show more
  • Antibodies towards high-density lipoprotein components in patients with psoriasis
    Publication . Paiva-Lopes, MJ; Batuca, J; Gouveia, S; Alves, M; Papoila, AL; Alves, JD
    Psoriasis is a chronic inflammatory immune disorder associated with an increased risk of atherosclerosis. This increased risk is not fully understood. High-density lipoproteins (HDL) play an important role in the prevention of atherosclerosis and any factors that may hamper HDL function such as anti-HDL antibodies (aHDL) might be associated with an increased cardiovascular risk. We aimed to determine whether anti-HDL antibodies (aHDL) are present in patients with psoriasis. Sixty-seven patients with psoriasis were compared with a healthy control group. Epidemiologic and clinical data were recorded. IgG and IgM aHDL, IgG anti-apolipoprotein A-I (aApoA-I), anti-apolipoprotein E (aApoE), and anti-paraoxonase 1 (aPON1) antibodies, as well as VCAM-1, IL-6, and TNF-α were assessed by ELISA. Apolipoprotein A-I (ApoA-I) and Apolipoprotein E (ApoE) were measured by immunoturbidimetric immunoassay. Patients with psoriasis had higher titers of IgG aHDL (p < 0.001), IgG aApoA-I (p = 0.001) and aApoE antibodies (p < 0.001). IgG aHDL and aApoE titers were higher in patients with severe psoriasis (p = 0.010 and p = 0.018, respectively). Multiple regression analysis, considering all clinical and biological variables, showed that aApoE, IL-6, and aPON1 are the biological variables that best explain aHDL variability. This is the first report showing the presence of aHDL, aApoA-I, and aApoE antibodies in patients with psoriasis. These antibodies were associated with increased disease severity and may contribute to the pathogenesis of atherosclerosis in psoriasis. They may fulfill the clinical need for biomarkers of cardiovascular risk associated with psoriasis that would help to stratify patients for prevention and therapeutic approaches.
    2019Journal article Restricted access Show more
  • Changes in Iron Metabolism Induced by Anti-Interleukin-6 Receptor Monoclonal Antibody are Associated with an Increased Risk of Infection
    Publication . Ribeiro, R; Batista, F; Paula, F; Alves, JD
    (1) Background: Treatment of patients with rheumatoid arthritis (RA) with an anti-IL-6 receptor (anti-IL-6R) monoclonal antibody (tocilizumab) has been found to influence iron metabolism. The objective of the present study was to ascertain whether changes in iron metabolism induced by anti-IL-6R biologic therapy were independently associated with an increased infection risk. (2) Methods: A prospective longitudinal study of patients with RA treated with tocilizumab was conducted. RA patients treated with an antitumor necrosis factor α monoclonal antibody were also included as a control group. The primary outcome was occurrence of infection during the first 24 months of biologic therapy. (3) Results: A total of 15 patients were included, with a mean age of 51.0 ± 4,1 and 73.3% (n = 11) female. A multivariate survival regression model, adjusted for confounding factors, was fitted for each of the iron metabolism variables. Hazard ratios for being above the median of each parameter was considered. Transferrin saturation above the median value (>32.1%) was associated with a higher infection risk (HR 4.3; 95%CI 1.0-19.69; p = 0.05). Similarly, although non-significantly, higher serum iron was strongly associated with infection occurrence. (4) Conclusions: This study identified a probable association between infection risk and higher serum iron and transferrin saturation in patients with RA on anti-IL-6R biologic therapy. We suggest that both these parameters should be considered relevant contributing factors for infection occurrence in patients on anti-IL-6R therapy.
    2019Journal article Open access Show more
  • 2014Journal article Open access Show more
  • Connective tissue disease-associated interstitial lung disease
    Publication . Oliveira, RP; Ribeiro, R; Melo, L; Grima, B; Oliveira, S; Alves, JD
    BACKGROUND: Connective tissue diseases (CTD) are frequently associated with interstitial lung disease (ILD), significantly impacting their morbidity and mortality. AIM: Analyze the experience of an autoimmune specialized unit on treating CTD-ILD and characterize the population based on most frequent diseases, imaging patterns, lung function tests results, serology and treatment. Assess mortality and mortality predictors in these patients. METHODS: Retrospective, descriptive and statistical analysis of the CTD-ILD patients followed up at an autoimmune diseases unit during a 6-year period. RESULTS: Over the study period, 75 patients with CTD-ILD were treated with a mean follow-up of 49 ± 31 months. The most frequent CTD were systemic sclerosis and rheumatoid arthritis. ILD was diagnosed prior to CTD in 8% of patients and concomitantly in 35%. Nonspecific interstitial pneumonia was the CT pattern in 60% and 35% had an isolated diminished DLCO on lung function tests. Pulmonary hypertension was present in 12% and it was the single most important mortality predictor (OR 14.41, p = 0.006). Corticosteroids are the mainstay of treatment but biologics were prescribed in 39% of the patients (mostly tocilizumab and rituximab). Two scleroderma patients were recently treated with nintedanib. CONCLUSIONS: ILD is a potential complication of every CTD and can impose a dramatic burden on these patients. The clinical relevance of ILD together with their early expression in the course of the disease underlines the importance of the presence of chest physicians in these units.
    2020Journal article Open access Show more
  • Crise de retenção esplénica major num adulto com drepanocitose
    Publication . Paula, F; Amaral, M; Oliveira, Alves; Alves, JD
    A crise de retenção esplénica é uma complicação, frequentemente, fatal da drepanocitose. É rara em adultos, pela elevada incidência de autoesplenectomia durante a infância. Heterozigóticos com traços de drepanocitose e de beta-talassémia têm fenótipos menos graves, podendo manter um baço funcional até à idade adulta. Descrevemos um caso de crise de retenção esplénica num homem de 19 anos, com concentração mínima de hemoglobina de 2,9g/dL, que resolveu após esplenectomia emergente. Os poucos casos descritos na literatura acarretam uma mortalidade elevada. Um diagnóstico rápido e actuação imediata são necessários para garantir a sobrevivência. É apresentada uma revisão da fisiopatologia e da abordagem terapêutica desta entidade.
    2015Journal article Open access Show more
  • Drug-Induced Aseptic Meningitis Following Spinal Anesthesia.
    Publication . Oliveira, R; Teixeira, M; Cochito, S; Furtado, A; Grima, B; Alves, JD
    Meningitis is a very uncommon complication of spinal anesthesia, and drug-induced aseptic meningitis (DIAM) is even rarer. We present two cases of DIAM following spinal anesthesia with bupivacaine and ropivacaine, respectively. The patients presented shortly after the procedure with typical meningitis symptoms. Since CSF (cerebrospinal fluid) analysis could not initially exclude bacterial meningitis, they were started on empirical antibiotics. CSF was subsequently found to be negative for viruses and bacteria in both cases, and antibiotics were promptly stopped. Both patients improved rapidly and without neurological sequelae. While it remains a diagnosis of exclusion, it is important to be aware of DIAM as recognition of the condition can lead to shorter admission times and avoid unnecessary use of antibiotics. LEARNING POINTS: A diagnosis of DIAM should be considered when a patient who recently underwent spinal anesthesia is admitted with symptoms and CSF compatible with meningitis.Clinical and laboratory findings (including CSF analysis) cannot distinguish between bacterial meningitis and DIAM.A negative CSF culture and rapid recovery confirm the diagnosis and stopping antibiotics at this point is effective.
    2019Journal article Open access Show more
  • O erro em medicina
    Publication . Monteiro, A; Ferreira, I; Neves, M; Alves, JD
    2011Conference object Open access Show more
  • 2013Conference object Open access Show more
  • Etiology, Treatment and Prognosis of Acute Pericarditis
    Publication . Serodio, J; Trindade, M; Achega, M; Faria, D; Maurício, J; Batista, F; Favas, C; Alves, JD
    Introduction: Acute pericarditis is a common inflammatory condition of the pericardium usually assumed to be viral or idiopathic. Despite recent treatment improvements, information is scarce regarding etiology and prognosis. Our aim was to determine the incidence of pericarditis with a known etiology and assess clinical prognostic predictors. Material and Methods: A clinical retrospective analysis of hospitalized patients with acute pericarditis was conducted from 2012 to 2016. Population was characterized according to etiology, clinical presentation, treatment and prognosis. Outcomes of interest, evaluated at one year after hospital discharge, were pericarditis recurrence, hospitalization, constriction and overall mortality. Results: A total of 94 patients were enrolled, median age 46 years (inter-quartile range 32-61), 65% were male. Idiopathic etiology was responsible for 68% of cases. A specific etiology was found in the remaining 32% of patients, being the most frequent autoimmune disease (12%) and malignancy (5%). Idiopathic pericarditis was associated with myopericarditis (p = 0.049) and a known etiology with pericardial effusion (p = 0.001) and cardiac tamponade (p = 0.027). Recurrence of pericarditis was found in 13% of patients. Corticosteroid treatment in patients with an identified etiology was not associated with an increase in recurrence (p = 0.220). Overall 1-year mortality was 9%. A defined etiology was the only independent predictor of mortality at multivariate analysis (OR 40.3; 95% CI 1.9 – 137.2; p = 0.016). Conclusion: Up to one third of hospitalized patients with acute pericarditis have an identified cause of pericarditis and these patients are at increased risk of mortality.
    2020Journal article Open access Show more