Browsing by Author "Ferreira, L"
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- Chronic granulomatous disease associated with common variable immunodeficiency - 2 clinical casesPublication . Pacheco, C; Morais, A; Rolo, R; Ferreira, L; Nabiço, R; Cunha, JINTRODUCTION: Chronic granulomatous disease associated with common variable immunodeficiency (GD-CVID), although well documented, is rare. Granulomatous lesions can affect several organs and are histologically indistinguishable from sarcoidosis. CLINICAL CASES: Case 1: A 39-year-old male patient with CVID, asymptomatic although with thrombocytopenia and mediastinal-hilar adenopathies. GD-CVID was diagnosed by bone marrow biopsy. Progressive clinical and radiological improvement was obtained with corticotherapy. Case 2: A 38-year-old male patient with CVID, suffered from asthenia, anorexia, myalgia, lower limbs edemas, and dry cough. He had mediastinal and bilateral hilar adenopathies within which biopsy revealed non-necrotizing granulomatous infiltrate. A spontaneous resolution was detected after 9 months of evolution. CONCLUSION: GD-CVID is rare and can mimetize other pathologies, namely, sarcoidosis; it should therefore be publicized and discussed so that it becomes a general clinical knowledge.
- Melanoma maligno associado a nevo melanocíticoPublication . Gomes, J; Parente, J; Ferreira, L; Viana, I; Vale, EObjectives: To determine clinical and histopathological differences between melanoma associated with nevus (MAN) and de novo melanoma (MN). Methods: Retrospective study of all cases of cutaneous melanoma diagnosed between 2001 and 2009 in Centro de Dermatologia Médico-Cirúrgica de Lisboa. Results: Of the 397 melanomas included, 52.6% were of feminine sex and 47.4% of the masculine. Of these melanomas only 9.3% were histologically associated with nevus, with discrete predominance of cases in the feminine sex (54%, p=0,033). In the group of the MAN the average of ages was slightly inferior (56,5 vs 59,3 years, p=0,577). The trunk was the preferential localization of all the melanomas (42.1%, p=0,005). Histologically the superficial spreading subtype was more frequently associated with MAN. The MAN were thinner than the MN (1,42 versus 2,13 mm, p=0,030), specially in the feminine sex (0,99mm, p=0,031). The Breslow tumor thickness and the presence of ulceration had a significant statistical correlation with the metastatic spread and the mortality by melanoma. Conclusions: The majority of the melanomas seem to arise de novo. In our study, factors that were significantly associated with MAN include feminine sex, trunk location, younger age, inferior Breslow thickness and superficial spreading subtype.
- Mixoma endobrônquico: Caso clínicoPublication . Rolo, R; Pereira, R; Eisele, L; Ferreira, L; Nogueira, R; Cunha, JINTRODUCTION: Pulmonary myxoma is an extremely rare benign neoplasm. It is mostly parenchymal but may occasionally occur within the tracheobronchial tree. There are very few reports of endobronchial myxoma. CASE REPORT: We describe a case of endobronchial myxoma in a 40-year-old female patient with a history of asthma and repeated right-sided pneumonia. Thoracic computed tomography (CT) showed medium lobe atelectasis. Fiber optic bronchoscopy revealed a polypoid, well-circumscribed tumor, causing total obstruction of the medium lobe bronchus. Biopsy of the mass was non-diagnostic. Further study included a positron emission tomography (PET) which demonstrated low metabolic activity of the tumor and no evidence of neoplasia in other location. The patient was submitted to a medium lobectomy and microscopic examination of the tumor revealed myxoid stroma with lobulated pattern, elongated and stellate cells, compatible with myxoma. CONCLUSION: Pulmonary myxoma is extraordinary rare and endobronchial location is very few reported in medical literature.
- Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC)Publication . Figueiredo, A; Almeida, M A; Almodovar, M T; Alves, P; Araújo, A; Araújo, D; Barata, F; Barradas, L; Barroso, A; Brito, U; Camacho, E; Canário, D; Cardoso, T; Chaves, A; Costa, L; Cunha, J; Duarte, J; Estevinho, F; Felizardo, M; Fernandes, J P; Ferreira, L; Ferreira, L; Fidalgo, P; Freitas, C; Garrido, P; Gil, N; Hasmucrai, D; Jesus, E; Lopes, J A; de Macedo, J E; Meleiro, A; Neveda, R; Nogueira, F; Pantorotto, M; Parente, B; Pego, A; Rocha, M; Roque, J; Santos, C; Saraiva, J; Silva, E; Silva, S; Simões, S; Soares, M; Teixeira, E; Timóteo, T; Hespanhol, VOBJECTIVE: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. METHODS: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). RESULTS: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. CONCLUSIONS: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.
- Relapsing COVID-19 in a Patient With Non-Hodgkin Lymphoma on ChemotherapyPublication . Carujo, A; Ferreira, L; Bergantim, R; Santos Silva, A; Vasconcelos, ALHematologic malignancies and chemotherapy are risk factors for COVID-19 progression and mortality. Immunocompromised hosts, particularly those with severe B-cell depletion, can shed viable viruses for extended periods, which can lead to persistent infection. We present the case of a 73-year-old male with diffuse large B-cell lymphoma (stage IV-B) under curative immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). After the first episode of mild COVID-19, he developed two severe relapses following the third and fourth cycles of R-CHOP. Lung CT scans performed in both episodes showed new-onset ground-glass infiltrates and fibrosis of previously affected pulmonary segments. In light of similar semiquantitative SARS-CoV-2 viral loads between episodes, without further risk exposure or microbiological findings, persistent COVID-19 with severe clinical relapses was assumed and successfully treated with polyclonal immunoglobulin and remdesivir. Whole-genome sequencing was performed in all samples, confirming the same specimen, which belonged to the B.1.177 lineage. This case stands out for the unusually long viral persistence and the various relapses of severe COVID-19 related to the worsening immune status with each immunochemotherapy cycle.
- Unmasking the hidden threat: COPD awareness and knowledge in Portugal study of COPD and awareness in the Portuguese populationPublication . Oliveira, AS; Cortesão, N; Gomes, J; Pinto, P; Shiang, T; Alfaro, T; Rodrigues, C; Ferreira, L; Barros, A; Morais, A