Percorrer por autor "Lacerda, Pedro Castro"
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- A paramiloidose em Portugal: reflexão sobre o paradigma da transplantação hepática motivada por um caso clínicoPublication . Lacerda, Pedro Castro; Moreira, Luciana; Vitorino, Rui; Costa, Paulo PinhoA Polineuropatia Amiloidótica Familiar de tipo português (PAF) ou ATTR V30M é uma doença hereditária cuja prevalência em Portugal é elevada, sendo diagnosticados cerca de 60 novos casos todos os anos. Uma doente com PAF submeteu-se a um segundo transplante hepático de um dador cadavérico depois de se ter constatado que o primeiro dador era portador de TTR V30M. Com este artigo breve pretende-se realizar uma reflexão sobre o interesse, a prática e o enquadramento legal que condicionam a realização de testes genéticos preditivos em dadores de fígado na transplantação de doentes com paramiloidose. A determinação da presença (ou não) de proteína mutada no soro do segundo dador foi realizada por espectrometria de massa precedida de imunoprecipitação da proteína transtirretina. A realização de testes genéticos que permitam determinar a condição de portador de TTR V30M em dadores de fígado, deveria ser considerada no quadro das políticas de transplante em Portugal.
- Systemic lupus erythematosus and the gut microbiome: To look forward is to look within – A systematic review and narrative synthesisPublication . Oliveira, Daniel Guimarães; Machado, Alexandra; Lacerda, Pedro Castro; Karakikla-Mitsakou, Zoe; Vasconcelos, CarlosBackground: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease shaped by complex interactions involving genetic and environmental factors. Among these, the gut microbiome is emerging as potentially modulating immune responses and influencing disease susceptibility, progression, and activity. Objectives: To synthesize current evidence on gut microbiome changes in adult SLE patients, framed along the clinical pathway – from diagnosis to treatment – to help bridge bench and bedside for microbiome-informed SLE care and research. Methods: A systematic search identified primary research studies examining gut microbiota in adult SLE patients. Studies were reviewed in a stepwise manner by independent investigators. Findings were synthesized narratively, emphasizing human data. Results: SLE patients exhibit gut microbiome dysbiosis, with reduced microbial richness and altered bacterial taxa. A lower Firmicutes/Bacteroidetes ratio is frequently observed. Enrichment of specific taxa, such as Enterococcus, Lactobacillus, and Ruminococcus gnavus, is reported. Dysbiosis correlates with increased gut permeability, immune activation, and autoreactivity. Clinical associations include disease activity, flares, nephritis, and other manifestations. SLE treatments, such as hydroxychloroquine and corticosteroids, influence the microbiome. Emerging interventions such as dietary modulation and fecal microbiota transplantation show promise in early studies. However, considerable heterogeneity exists across studies in terms of patient characteristics, methodology, and taxa-level findings. Conclusions: The gut microbiome has multifaceted associations with SLE pathogenesis, disease activity, and therapeutic response. Translation will require standardized methods, functional validation, longitudinal followup, and clinical integration. While uncertainties remain, the gut microbiome is increasingly relevant, and clinicians caring for patients with SLE should be aware of its emerging implications.