Medicina

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Navegando Medicina por Orientador "Caldato, Milena Coelho Fernandes"

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    Endocrinopatias em pacientes oncológicos tratados com imunobiológicos
    (Centro Universitário do Estado do Pará, 2021) Rodrigues, Márcia Maine Cardoso; Alves, Matheus Sousa; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309
    Introduction: Immunotherapy consolidates immuno-oncology as an important therapeutic component in the fight against several types of cancer. They are drugs that modulate the immune system, enabling an adequate response to the disease and avoiding mechanisms of tumor evasion. Among the drugs most used in this immunotherapy, there are monoclonal antibodies that inhibit CTLA- 4 and PD-1 inhibitors. However, its own mechanisms of action predispose to imbalance in the regulation of immunological pathways, constituting an important adverse effect of this therapy, resulting in immune-mediated toxicity to organs and tissues, which manifests itself in gastrointestinal, hepatic, cutaneous and endocrine alterations, such as hypophysitis, thyroid diseases, primary adrenal insufficiency and type 1 diabetes mellitus. Objectives: To describe endocrine and metabolic abnormalities found during the use of immunotherapy to oncological diseases. Methodology: Medical records of cancer patients with more than eighteen years old in immunotherapy were selected in two oncology services in the city of Belém - Pará. Data were collected from June 2020 to March 2021, using questionnaires developed by the researchers of this study, containing the following variables aimed to identify endocrine abnormalities in this population: age; sex; diagnosis; immunobiological in use; time of treatment; frequently reported symptoms; dosage of LH, FSH, estradiol, testosterone, prolactin, TSH, free T4, ACTH, cortisol, IGF-1, GH, fasting glucose level, sodium and potassium. Results: In the two oncology services participating in this research, twenty- seven patients were using immune checkpoint inhibitors and had their medical records analyzed. However, only five medical records met the necessary inclusion criteria for this study. In this series of cases, the patients were on immunotherapy with pembrolizumab and nivolumab, for periods varying between 8 and 144 weeks. Of these, only two had clinical complaints that could be related to signs of endocrinopathies. In the analysis of laboratory tests, one patient presented changes in thyroid hormones, three patients presented changes in the gonadal axis and three patients presented changes in blood glucose. Conclusion: The clinical pattern suggestive of endocrinopathies did not appear uniformly in all exposed cases, even diverging from the pattern classically reported in previous studies. In this study, among the evaluated patients were found: glycemic alterations, thyroid dysfunction, increased levels of gonadotropins and increased estradiol. Among these, only thyroid dysfunction is commonly reported in the literature. It is essential that the clinical team responsible for the therapeutic follow-up of these patients adequately follow the recommendations for the early identification of immunomediated adverse events related to the endocrine system.
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    Ganglioneuroblastoma em adolescente: incidentaloma adrenal pós-COVID 19 - um relato de caso raro
    (Centro Universitário do Estado do Pará, 2021) Azevedo, Andressa Lima; Ferreira, Jéssika Araújo; Caldato, Milena Coelho Fernandes; http://lattes.cnpq.br/9477878606835309
    Introduction: Ganglioneuroblastoma (GNB) is a rare malignant tumor of the adrenal gland. Symptoms depend on the location of the mass effect or the existence of the metastasis. As for the diagnosis, tumors of the neural crest in adults are rare and there is a difficulty in differentiating them only by imaging exams. Objective: To report a case of rare adrenal pathology with an incidence of less than five cases per 1,000,000 children, discovered after Computed Tomography of the Chest performed as a protocol of the COVID-19 disease, making a comparison with the cases reported in the world literature. Method: This is a rare case report study associated with a review of articles published in the world literature on the topic of ganglioneuroblastoma in adults. Case report: We present the case of a previously healthy 18-year-old man was diagnosed with Covid-19 and performed a chest Computed Tomography (CT) scan that showed an incidentaloma described as an oval formation in the right retroperitoneum, anterior to the adrenal. An endocrinologist evaluated the patient with a complete normal physical examination, as well as a hormonal laboratory that proved to be normal. Specialist indicated diagnostic excision, a procedure performed laparoscopically. The pathological examination consisted of a right adrenal and a nodular mass. With diagnosis of GNB intermixed subtype. Conclusion: The patient in the reported case does not fit the disease presentation pattern. Few data are available on the diagnosis and treatment of adults with GNB, making clear the importance of case report publications on the subject.
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    Prevalência de câncer em pacientes acromegálicos atendidos no Centro de Especialidades Médicas do CESUPA
    (Centro Universitário do Estado do Pará, 2020) Diniz, Beatriz Abdelnor Hanna Piqueira; Abreu, Joyce Cangussu de; Caldato, Milena Coelho Fernandes; Bastos, Fabíola de Arruda; http://lattes.cnpq.br/9386935778704228; http://lattes.cnpq.br/9477878606835309
    Introduction: Acromegaly is a rare, debilitating, slow-progressing and chronic endocrinopathy, resulting from pathological growth hormone (GH) hypersecretion and subsequent levels of insulin-like growth factor-1 (IGF-1). a moderate risk of cancer in acromegalic patients with uncontrolled disease and a greater association of acromegaly with colorectal, thyroid and, to a lesser extent, breast, kidney, prostate, bone cancer. As a result, an important current debate questions whether patients with acromegaly should undergo specific cancer screening and surveillance protocols. Objectives: To identify the prevalence of cancer in acromegalic patients treated at the Cesupa Medical Specialties Center. Methodology: This is an epidemiological, crosssectional and retrospective study, based on exploratory analysis of the medical records of the Endocrinology Service of the Cesupa Medical Specialties Center (CEMEC) - Belém/PA from October 2019 to October 2020.Results: The prevalence of cancer among acromegalic patients treated at CEMEC is 18.18%, 8 cases out of 44 patients.The proportion of men and women affected is the same (50%). It was evidenced that the patients have an average age equal to 68 years, with a variation of ± 13 years (σ = 12.79), with a minimum age of 46 years and a maximum age of 88 years. Patients had 6 different types of Ca, the most prevalent is Colon Cancer seen in 3 patients (38%), followed by 1 case of the other types of cancer: breast, prostate, lymphoma, thyroid and gastric. It was seen that the main comorbidity is high blood pressure (5; 75%), 1 (13%) patient has metastasized, 1 (13%) patient has a family history of Ca and 3 (38%) patients have a smoking history. Moreover, of the 4 patients (50%) who died, 3 were due to cancer. In the first evaluation, patients presented mean GH equal to 6.2, increasing to 8.7 in the final evaluation. Considering the number of patients who presented compensated IGN-1 LSN levels at the beginning and at the end of the segment performed at CEMEC, a 25% increase in the number of patients who started to have controlled serum levels of this hormone was observed. At Cemec, a proprietary screening protocol that includes colonoscopy and ultrasound of the thyroid for all patients diagnosed with Acromegaly.Conclusion: According to the clinical and epidemiological profile of these patients, most were decompensated at the beginning of the follow-up at the service, and after they started multimodal therapies including surgery, medications and radiotherapy when necessary.In the last record, most patients were compensated, showing the conduction of appropriate treatment within the clinic.It is agreed that the screening tests adopted at this service , one of the bare of paramount importance in the group, considering that colon and thyroid cancer are the most prevalent in acromegalic patients today, as well as having a greater scientific basis to justify such screening.This work is of great value for a more global clinical analysis of a complication of high morbidity and mortality among acromegalics, the cancer, inside one of the main reference centers of treatment for acromegaly in the North-Northeast Brazil.
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    Utilização da ferramenta AcroQoL na avaliação da qualidade de vida de pacientes acromegálicos acompanhados no Centro de Especialidades Médicas do Cesupa – CEMEC
    (Centro Universitário do Estado do Pará, 2022-11-07) Santos, Felipe Augusto Casseb dos; Bernardo, Paulo André Vieira de Carvalho; Caldato, Milena Coelho Fernandes; Bastos, Fabíola de Arruda; http://lattes.cnpq.br/9386935778704228; http://lattes.cnpq.br/9477878606835309; Rocha, Vanessa Campos Couto da; http://lattes.cnpq.br/1897095774561517; Carvalho, Ana Emília Vita; http://lattes.cnpq.br/1981562999898097
    Acromegaly is a rare chronic disease often caused by a GH-secreting pituitary tumor, and is associated with enlarged extremities, multiple organ dysfunction, physical limitations, decreased daily productivity, social isolation, and worsening quality of life. To evaluate the health-related quality of life in patients with acromegaly in a specialized outpatient clinic in the Amazon from January 2021 to August 2022. This is an observational and cross-sectional study with quantitative analysis, carried out at the Hypophysis and Adrenal Outpatient Clinic of the Centro de Especialidades Médicas do Centro Universitário do Estado do Pará (CEMEC - CESUPA), using the AcroQoL health-related quality of life questionnaire. Sociodemographic, clinical, and therapeutic data were correlated with the scores obtained, using specific statistical tests executed in Bioestat 5.5 software. Data were organized in Microsoft Excel 2010 software. Graphs and tables were constructed with the tools available in the Microsoft Word, Excel and GraphPad Prism 8.4.2 programs. Results with p ≤ 0.05 (two-sided) were considered statistically significant. Most of the patients in the sample were female with age ranging from 24 to 74 years. Most patients had pituitary macroadenomas and metabolic complications. Higher AcroQoL scores were observed in patients who were regular practitioners of physical activities; furthermore, there was no relationship between biochemical control of the disease and AcroQoL scores. Conclusion: In the present study, it was possible to realize the importance of using tools such as the AcroQoL to analyze health-related factors and their impacts on the quality of life of acromegalic patients. The findings of the study show the importance of stimulating the practice of physical activities and the adoption of healthy life habits. Evidencing the need for a multidisciplinary approach to achieve not only biochemical control but also an improvement in health-related quality of life.