Programa de Pós-Graduação em Oncologia e Ciências Médicas - PPGOCM/NPO

URI Permanente desta comunidadehttps://repositorio.ufpa.br/handle/2011/4631

O Programa de Pós-Graduação em Oncologia e Ciências Médicas (PPGOCM) integra o Núcleo de Pesquisas em Oncologia (NPO) da Universidade Federal do Pará (UFPA). Trata-se do único centro de referência em pesquisa e formação de recursos humanos stricto sensu na área de oncologia na região Norte do Brasil. Os outros centros se concentram nas cidades do Rio de Janeiro e São Paulo.

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Acesso aberto (Open Access)
Avaliação da qualidade de vida de pacientes com Diabetes Mellitus tipo 1: dados do primeiro estudo multicêntrico no Brasil
(Universidade Federal do Pará, 2013) SOUZA, Ana Carolina Contente Braga de; FELÍCIO, João Soares; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/8482132737976863; http://lattes.cnpq.br/7240314827308306
The type 1 diabetes mellitus type 1 (T1DM) is the most common endocrine disease of childhood and adolescence and it negatively impacts the quality of life (QOL). The EuroQol is an instrument that assess the health state. It has been used in most global multicenter studies in diabetes and it has been shown to be an extremely useful and reliable tool. The aim of this study is to evaluate the QOL of patients with T1DM in Brazil, a country of continental proportions, by analyzing the EuroQol. For this purpose, we performed a retrospective and cross-sectional study, which analyzed questionnaires from patients with T1DM, answered in the period of December 2008 to December 2010 in 28 research centers in 20 cities of the four regions (Southeast, North-Northeast, South and Midwest). We also collected data about chronic micro and macrovascular complications and lipid profile. The assessment of quality of life by EuroQol shows that the average score assigned to general health is markedly lower than those found in two other T1DM population studies conducted in Europe (EQ – VAS from Germany, Netherlands and Brazil were 82.1 ± 14, 81 ± 15 and 72 ± 22, respectively). The EuroQol shows that the North-Northeast region has the best index in the assessment of the overall health status compared to the Southeast and lower frequency of self-reported anxiety -depression, compared to other regions of the country (North-Northeast = 1.53 ± 0.6, Southeast = 1.65 ± 0.7, South = 1.72 ± 0.7 and Midwest = 1.67 ± 0.7, p <0.05). Additionally, several known variables (age, duration of diabetes, physical activity, HbA1c, fasting glucose, and presence of chronic complications correlated with QOL (r = -0.1, p <0.05, r = -0.1, p <0.05, r = -0.1, p <0.05, r = -0.2, p <0.05, r = -0.1, p <0.05 and r = -0.1, p <0.05, respectively). This is the first population study to evaluate the quality of life of patients with type 1 diabetes in the south hemisphere. Our data indicates poorer quality of life of patients with T1DM in Brazil when compared to data from European countries. Although we found an inferior diabetes duration and lower presence of microvascular complications in the North -Northeast region compared to other regions, our data suggests the existence of additional factors responsible for better QOL and lower presence of anxiety-depression found in this region. More studies are necessary to identify these possible factors.
Acesso aberto (Open Access)
Avaliação dos picos de hormônio do crescimento nos testes de estímulo com insulina e clonidina em pacientes com diagnóstico de baixa estatura
(Universidade Federal do Pará, 2016-12-28) PINTO, Carlliane Lima e Lins; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Short stature (SS) is an important referral cause for evaluation in pediatric endocrinology. Growth hormone deficiency (GHD) needs to be considered when other causes of BE are excluded, but there are limitations in establishing its definitive diagnosis, being the subject of several debates and controversies. Although highly questioned, GH stimulation tests are still considered the standard for the diagnostic confirmation of GHD. The present study aimed to evaluate the sensitivity, specificity and accuracy of the different GH peak cut-off points for diagnosis of GHD, in response to stimulus by insulin tolerance test (ITT) and clonidine test, in addition to identifying the best GH peak level to confirm diagnosis using a Receiver Operating Characteristics (ROC) curve analysis. For this purpose, a retrospective and observational study was carried out. Clinical and laboratory data from 62 patients at the endocrinology department of the Hospital Universitário João de Barros Barreto (HUJBB) were collected. The gold standard considered for performance analysis of cut-off points in both GH stimulation tests was the therapeutic response. Thus, 26 patients who achieved a height increase of at least 0,3 standard-deviation at the end of one year of treatment with recombinant human GH (rhGH) were classified as GHD. The remaining patients who did not obtain this gain formed the group called non-GHD. Both groups had similar mean height (p = 0,8155) and gained height at the end of follow-up, but this gain was higher in the GHD group compared to the non-GHG group (20,5 ± 14,8 cm vs. 9,2 ± 6,7 cm, respectively, p = 0,0064). GHD group had a significantly lower meddle GH peak than the non-GHG group in both tests (p <0,0001). Sensitivity, specificity and accuracy of cut-off points 3, 5, 7 and 10 ng/mL were defined in the TTI and in the clonidine test, and there was no superiority of one test over the other. In addition, the cut-off points found were 7,92 ng/mL and 6,78 ng/mL in the TTI and clonidine test, respectively, based on the construction of the ROC curve, representing the most sensitive and specific GH peak levels for the diagnosis of GHD. We conclude that the cut-off points found in this study may represent an emerging tool in the selection of patients who would probably benefit from treatment with rhGH, both in cases of GHD for a known cause and in cases of IGHD.
Acesso aberto (Open Access)
Efeito da suplementação de altas doses de colecalciferol sobre o comportamento da pressão arterial em pacientes normotensos com diabetes mellitus tipo 1
(Universidade Federal do Pará, 2018-12-26) QUEIROZ, Natércia Neves Marques de; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Type 1 diabetes mellitus is an endocrine disease highly associated to cardiovascular (CV) risk. Vitamin D (VD) deficiency has been associated to a burden of chronic diseases due to the presence of vitamin D receptors (VDR) through diverse human tissues such as smooth vascular muscle, endothelium, cardiomiocytes and juxtaglomerular cells. Some studies have suggested an inverse relationship between vitamin D levels and blood pressure. High mean blood pressure levels have been found in vitamin D deficient patients. Additionally, previous studies have suggested that the VD-VDR complex might act as a negative regulator factor over renin angiotensin system, which could be responsible for positive effects on blood pressure. The main objective of this study was to evaluate high doses vitamin D supplementation effects on blood pressure of normotensive T1DM patients. Our study was a prospective interventionist study in 35 T1DM patients. The patients with vitamin D lower them 30ng/ml received 10.000UI/daily e if was 30-60 ng/ml was gave 4.000UI/daily. They made 24-hour ambulatory blood pressure monitoring, gycated hemoglobin, creatin, lipids profile, PCRus, before and after 12 weeks. We found an expressing reduce of systolic and diastolic morning blood pressures (117 ± 14 vs 112±14, p<0,05; 74±9 vs 70±10 mmHg, p<0,05, respectively) with no changes in order pressoric markers. Besides, we notice correlation between levels of VD after supplementation and diastolic morning blood pressure (r= -0,4; p<0.05). In conclusion, our study suggest that was an association with supplementation of high doses of vitamin D and reduce of morning blood pressure in normotensives type 1 diabetes mellitus patients.
Acesso aberto (Open Access)
Efeito da suplementação de altas doses de vitamina D sobre a neuropatia autonômica cardiovascular em pacientes com diabetes mellitus tipo 1
(Universidade Federal do Pará, 2018-12-10) SILVA, Lilian de Souza d’Albuquerque; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306
Cardiovascular autonomic neuropathy (CAN), associated with diabetes mellitus (DM), despite being a subclinical condition, is an important morbidity and mortality factor in these patients. In type 1 diabetes mellitus (DM1) CAN is so alarming that it must be screened after the first 5 years of illness. Few therapeutic measures are recommended in international guidelines on the subject. Some authors have been studying drugs that can modified natural history of disease and then improve outcomes. Vitamin D seems promising resource and low cost. The aim of our study was to evaluate the effects of high-dose vitamin D (DV) supplementation on CAN in patients with DM1. We performed a prospective, interventional study in which 17 patients diagnosed with DM1 and CAN were included. Patients with VD levels below 30 ng / mL received 10,000 IU / day, and when 30-60 ng / mL, they used 4,000 IU / day. Serum VD dosage and CAN tests were performed before and after 12 weeks of treatment. There was an improvement in the parameters related to resting heart rate (HR) variability, which were: LF (1.9 ± 0.4 vs 2.2 ± 0.7 sec, p = 0.05), TP (2.5 ± 0.3 vs 2.7 ± 0.5 sec, p <0.05) , RRmax (0.8 ± 0.09 vs 0.9 ± 0.23 sec, p <0.05), RRNN (0.72 ± 0.09 vs 0.76 ± 0.09 sec, p <0.05) and SDNN (0.015 ± 0.005 vs 0.026 ± 0.018 sec; p <0.05). In addition, it was demonstrated that the variation of the RV level correlated with both the final HF (after treatment) and the LF / HF ratio (r = 0.57, p <0.05). Our pilot study is the first to suggest a strong association between high-dose vitamin D supplementation and improved cardiovascular autonomic neuropathy in DM1 patients. This occurred without any variation in HbA1C, blood pressure levels, lipids and insulin doses used
Acesso aberto (Open Access)
Influência da suplementação de altas doses de vitamina D no controle glicêmico em pacientes com diabetes mellitus tipo 1
(Universidade Federal do Pará, 2018-12-10) MELO, Franciane Trindade Cunha de; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306
Although the intensive glycemic control of Diabetes Mellitus (DM) with insulin has reduced the incidence of microvascular and macrovascular complications, most patients still develop these injuries with high morbidity and mortality. It has been suggested that low levels of vitamin D (VD) may be associated with the development of Type 1 diabetes mellitus (DM1) and poor glycemic control. As a therapeutic potential, the use of VD in patients with DM1 has presented controversial results regarding the reduction of glucose levels. The objective of this study is to analyze the effects of high-dose vitamin D supplementation on glycemic control of patients with DM1, assessed through glycated hemoglobin levels (HbA1c). A prospective, 12week clinical trial including 52 patients with DM1, which were supplemented with high doses of cholecalciferol, was performed. The dose used for this vitamin was according to the participant's VD value. Patients with VD levels below 30 ng / mL received 10,000 IU / day, and when 30-60 ng / mL, they used 4,000 IU / day. The levels of VD and HbA1c were evaluated before and after 3 months of vitamin supplementation. When we analyzed the total number of patients (N = 52), there was no improvement in the glycemic control evaluated by HbA1c ((9.3 ± 2.3 vs 9.5 ± 2.4, p=NS). To better study the effects of VD on HbA1c, patients were divided into 3 groups according to HbA1c variation: those whose HbA1c reduced ≥ 0.5% (group 1, N = 14); those with no variation in HbA1c (group 2, N = 19) and those with ≥ 0.5% increase in HbA1c (group 3, N = 24). There was a decrease in HbA1c in only one specific group (N = 14). In addition, there was no reduction in prandial basal insulin needs or full dose after three months of VD supplementation. Thus, our data suggest that there is no additional benefit of VD supplementation in the optimization of glycemic control evaluated by HbA1C in patients with DM1.
Acesso aberto (Open Access)
Influência da suplementação de vitamina D na variabilidade glicêmica em pacientes com diabetes Mellitus tipo 1
(Universidade Federal do Pará, 2016-01-27) FELÍCIO, Karem Mileo; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Recent studies suggest that glycemic variability (GV) could influence the risk of complications in diabetes, independently from glycemic control (GC). GV is the evaluation of the daily fluctuations of glycemia through specific calculations. The few studies that have assessed the effects of supplementation with vitamin D (VD) in patients with diabetes type 1(DM1) on GC are controversial and there is no data about a possible action of VD on GV in these patients. Our study aims to evaluate the effects of VD supplementation on GV in patients with DM1. We executed a prospective, controlled study with 22 patients with DM1. Doses of either 4.000 or 10.000 IU/day of cholecalciferol were administered for 12 weeks according to the patient’s previous vitamin D serum levels. All patients were submitted to continuous glucose monitoring system (CGMS) with the analysis of 41.000 glycemias, dosage of vitamin D and HbA1c before and after the treatment. When the pre and post treatment variables were compared, no differences were observed, except for the expected improvement of the levels and status of VD (26,1 ± 9,0 vs 44,4 ± 24,7 ng/mL ; p<0,01 e 1,00 ± 0,76 vs 0,36 ± 0,66 ; p<0,01), respectively. Correlations were found between the percentage variation (Δ) of the glycemia standard deviation (ΔGSD), calculated using the CGMS, with Δ of the basal (r= 0,6; p<0,01) and total insulin (r= 0,6; p<0,01). Our study also found a correlation between the VD status after supplementation and Δ of the prandial (r= 0,5; p<0,05) and total insulin (r= 0,4; p<0,05), indicating that the better the vitamin D status, lower the doses of insulin needed by the patients. To efficiently study the GV, patients were divided in two groups: Patients in which the ΔGSD improved (group 1; N= 12 (55%)) and those in which the ΔGSD worsened (group 2; N= 10 (45%)). Group 1 when compared to group 2 showed lower needs of insulin (Δbasal insulin = -8,0 vs 6,3%; (p<0,05)) and lower frequency of hypoglycemia (12/44 (27%) vs 21/33 (64%), hypoglycemias / days evaluated ; p<0,01). Our data suggests that supplementation of VD on patients with DM1 could improve the GV associated to a lower need of insulin in more than 50% of these patients. The improvement of GV was strongly associated with reduction in frequency of hypoglycaemia. However, it was not possible to demonstrate benefits of vitamin D on glycaemic control measured by the HbA1c.
Acesso aberto (Open Access)
Injeção percutânea de etanol no tratamento de nódulos tireoidianos sólidos e mistos: um protocolo baseado em novas metas
(Universidade Federal do Pará, 2016-11-24) SANTOS, Flávia Marques; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Percutaneous ethanol injection (PEI) guided by ultrasound (US) has been suggested for thyroid nodules (NT) benign treatment. However, there is no consensus on the standard amount of ethanol injection, number of applications and the re-evaluation time, in order to reach the maximum volume reduction with lower potential side effects. The aim of this study was to evaluate the effectiveness of an IPE protocol to treat solid and mixed NT based on a new goal. A prospective study was conducted to evaluate the results of the IPE in 52 patients with solid and mixed benign NT. In each session the ethanol dose was fixed at 30% of nodular volume. The patients returned a month after each session for NT reassessment by the US. Therapeutic success was established as a reduction ≥ 30% of the volume associated with the disappearance of clinical symptoms and a complete aesthetic satisfaction reported by the subject. It performed an average of 2.8 ± 1.9 PEI sessions with a total average volume of ethanol injected by 9.1 ± 10.3 mL and follow-up of 10.0 ± 8.7 months. A reduction of at least 50% of nodular initial volume in 33 patients (63.5%). In 11 patients (21.2%) reduction did not reach 50% (mean reduction of 31 ± 11%), but these, six individuals reported satisfactory clinical and cosmetic results and treatment was stopped. So, our therapeutic success rate, whereas patients with clinical and aesthetic resolution was 75%. There were no severe complications. Our study suggests that the protocol is effective and safe for the treatment of solid and mixed benign NT based on our established outcome.
Acesso aberto (Open Access)
Micobacteriose não tuberculosa pulmonar em hospital de referência no Estado do Pará: espécies mais frequentes, apresentação radiológica e evolução clínica
(Universidade Federal do Pará, 2013-12-27) BARRETTO, Adriana Rodrigues; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
The nontuberculous mycobacteria are present in environment and has been isolated from natural waters, soil, animals and water distribution systems. It’s characterized by the presence of mycolic acid in the cell wall. In general, the disease is acquired through inhalation of droplets containing mycobacteria. This disease can manifest itself in many ways as lymphadenitis, pulmonary, cutaneous and disseminated. They are opportunistic pathogens of variable pathogenicity. Immunity defects, local or systemic, are required to cause disease in humans. We evaluated epidemiological, clinical and radiological features of 44 cases with pulmonary nontuberculous mycobacteriosis at Hospital Universitário João de Barros Barreto. In addition, we treated and followed 21/44 (47,7%) patients during a period of six to seventeen months in a prospective cohort study. There was an increase more than 100% in the number of cases in 2010 when compared to previous years. The most frequently isolated mycobacterias were M. intracellulare (22.7%) and M. massiliense (20.5%). The conditions associated included previous treatment for tuberculosis (93.2%), bronchiectasis (59%), HIV (11.4%), asthma (9.1%) and chronic obstructive pulmonary disease (9.1%). In general, there were no differences between NTM groups in radiological aspects, but when we analyzed chest radiographs, we found atelectasis more frequently in M. massiliense group vs. M. abscessus group. When we considered mycobacterial cultures, there was a good treatment outcome. Negative, persistent positive and positive after an initial negative culture occurred in 58,8%, 11,7% and 11,7% of patients, respectively. During the follow-up period, the death rate was 17,7%. Our data suggest that of pulmonary nontuberculous mycobacteriosis has become a disease with increasing importance in our region. Additionally, the response to treatment performed in major hospital has been quite satisfactory when compared to literature. However, it is necessary to follow these patients for a longer period to determine the actual success rate of our therapeutic approach.
Acesso aberto (Open Access)
Vitamina D e nefropatia em pacientes com diabetes Mellitus tipo 1
(Universidade Federal do Pará, 2015-10-06) LUZ, Rafael Mendonça; YAMADA, Elizabeth Sumi; http://lattes.cnpq.br/7240314827308306; FELÍCIO, João Soares; http://lattes.cnpq.br/8482132737976863
Diabetes Mellitus type 1 (DM1) results from destruction of the pancreatic beta cells by an immunological process, which may progress to kidney complications. Both genetic and environmental factors are involved in the pathogenesis of type 1 diabetes, and vitamin D deficiency appears as a candidate among the risk factors for developing both diabetes and diabetic nephropathy. The objective of this study was to evaluate the existence of an association between low levels of vitamin D with the presence and degree of diabetic nephropathy in patients with type 1 diabetes. Additionally, our study aimed to establish the prevalence of vitamin D deficiency in normal individuals of our region and determine if it differs from DM1 patients. A cross-sectional study, between November 2013 and December 2014, in which levels of 25 (OH) D and albuminuria were analyzed in 37 patients with DM1, normal creatinine levels and 36 control subjects. The patients with DM1 and hypovitaminosis D had higher levels of albuminuria compared with those with normal vitamin D levels (albuminuria = log10 1.92 vs. 1.44; p <0.05). When the group of patients was separeted according to the stage of diabetic nephropathy in those with normoalbuminuria, microalbuminuria, and macroalbuminuria, we found lower levels of 25(OH)D in the latter when compared to the first two groups (26.7 ± 6.2, 24.8 and 15.9 ± 7 ± 7.6 ng / mL; p <0.05, respectively). In DM1 group, we found correlations between vitamin D levels with the levels of albuminuria and diabetic nephropathy stages (r= -0.5, p<0.01 r= -0.4; p <0.05, respectively). Additionally, the prevalence of vitamin D deficiency among control subjects was quite high (78%), and there was no difference compared to patients with DM1, whose prevalence was 73%. Patients with type 1 diabetes when compared to control group also showed no difference regarding the average levels of 25(OH)D (24.2 ± 7.4 versus 25.8 ± 11.2 ng / mL, NS). Our data suggest an association between reduced levels of vitamin D and the presence and severity of diabetic nephropathy. In addition, patients with type 1 diabetes mellitus, when compared to normal control subjects in our region did not differ in average and status of 25(OH)D levels.

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