8 resultados para clinical diagnosis

em Instituto Nacional de Saúde de Portugal


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Aim: Familial Hypercholesterolemia (FH) is a common autosomal dominant disorder, caused by mutations in genes involved in cholesterol’s clearance (LDLR, APOB, PCSK 9). Clinical diagnosis is usually based on high total cholesterol or LDL-C levels and family history of premature coronary heart disease. Using an extended lipid profile of paediatric dyslipidemic patients, we aim to identify biomarkers for a better diagnosis of FH in clinical settings.

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Aim: Vascular disease such as cardiovascular and cerebrovascular diseases, or retinopathy, nephropathy and neuropathy are common in diabetes. Maturity - onset diabetes of the young (MODY) describes a clinically heterogeneous group of familial diabetes characterized by monogenic, autosomal dominant inheritance that generally results from beta cell dysfunction. This study aims to assess the presence of vascular complications on Portuguese patients with a clinical diagnosis of MODY.

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Introduction: Familial hypercholesterolaemia (FH) is a common genetic cause of premature coronary heart disease (CHD) due to lifelong elevated plasma low-density lipoprotein (LDL) levels. Worldwide only 40 % of patients (FH+) with a clinical diagnosis of FH carry a mutation in any of the three genes (namely: LDLR, APOB, PCSK 9) that are currently known to be associated to the disease. We guess that the remaining 60 % of the patients (FH-) probably includes a high percentage of individuals with a polygenic form of dyslipidemia or an environmental form of hypercholesterolemia and a small percentage of individuals with mutations in some novel genes, never associated before with dyslipidemias. Here we present the preliminary results of an integrative approach intended to identify new candidate genes and to dissect pathways that can be dysregulated in the disease.

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Aims: Familial hypercholesterolemia (FH) is a genetic disorder of lipid metabolism, clinically characterised by high levels of low-density lipoprotein cholesterol (LDL-C) that leads to cholesterol accumulation in tendons and arteries, premature atherosclerosis and increased risk of premature coronary heart disease. In 1999, the Portuguese FH Study was established at the National Institute of Health to identify the genetic cause of hypercholesterolemia in individuals with a clinical diagnosis of FH and to perform an epidemiologic study to determine the prevalence and distribution of FH in Portugal. In the last 16 years, a genetic defect was identified in 749 patients, representing 3. 7 % of the cases estimated to exist in Portugal. Index patients were included in this study using the Simon Broome (SB) criteria. However, there are different FH clinical criteria to diagnose index cases. Since there are no clinical criteria to identify relatives with FH, the aim of this work was to investigate if a diagnostic tool based on population specific 95 th percentile improves the clinical identification of Portuguese FH patients comparing with SB criteria.

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Dissertação de mestrado em Biologi apresentada à Faculdade de Ciências da Universidade do Porto, 2008

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O Histoplasma capsulatum é o agente etiológico da histoplasmose, apresenta duas variedades com caraterísticas epidemiológicas diferentes var. capsulatum e var. duboisii endémicas no continente americano e no continente africano, respetivamente. Nas últimas décadas têm sido descritos casos de histoplasmose na Europa e em países asiáticos como a China, onde esta infeção não é considerada endémica. A facilidade de movimentação das populações tem contribuído para alterar o padrão epidemiológico desta infeção. Este trabalho tem como objetivo analisar o número de casos registados em Portugal e chamar a atenção para a importância de melhor se conhecer a epidemiologia desta infeção no nosso país. A histoplasmose não é uma doença de declaração obrigatória, os casos de histoplasmose existentes resultam de diagnósticos clínicos observados no âmbito dos internamentos hospitalares. O número médio de episódios de internamento hospitalar referenciados nos Base de dados de Grupos de Diagnóstico Homogéneo durante o período de 2009 a 2014 foi de 23 episódios/ano. No mesmo período foram descritos na literatura dez casos de Histoplasmose em Portugal, tratando-se sobretudo de apresentações clínicas de interesse científico em que algumas se referem a casos com período de latência de 40 anos após exposição. Apesar de ser considerada uma doença rara na Europa, clínicos e microbiologistas devem estar em alerta e aumentar o seu conhecimento sobre a patogenicidade, os métodos de diagnóstico diferencial, o tratamento e a evolução do padrão epidemiológico desta e de outras infeções fúngicas.

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Still a big gap exists between clinical and genetic diagnosis of dyslipidemic disorders. Almost the 60% of the patients with a clinical diagnosis of Familial hypercholesterolemia (FH) still lack of a genetic diagnosis. Here we present the preliminary results of an integrative approach intended to identify new candidate genes and to dissect pathways that can be dysregulated in the disease. Interesting hits will be subsequently knocked down in vitro in order to evaluate their functional role in the uptake of fluorescently-labeled LDL and free cell cholesterol using automated microscopy.

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Aims of the study: 1) Cardiovascular risk assessment of a cohort of children with a clinical diagnosis of FH; 2) Identification of biomarkers to distinguish between monogenic and polygenic/environmental dyslipidemia in clinical settings; 3) Clinical criteria improvement to identify FH children.