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- A case of trigeminal malignant melanotic nerve sheath tumor in the wide spectrum of melanotic and nerve sheath tumorsPublication . Rachão, Augusto; Ferro, Margarida; Roque, Rafael; Rainha Campos, Alexandre; Pimentel, JoséWe report the case of a 42-year-old male, without any other personal or familiar relevant background, who was referred to a neurosurgery outpatient clinic due to a yearlong altered right facial sensitivity with paresthesia. Facial hypoesthesia in V1 and V2 divisions of the right trigeminal nerve was noticed. No other deficits were evidenced, and the remaining objective examination was unremarkable, namely for cutaneous lesions. Brain magnetic resonance imaging (MRI) displayed a space-occupying lesion in the right cavernous sinus, suggestive of a melanin-rich lesion. Three months later, the patient reported right facial hypoesthesia extending to V3, along with chewing difficulties lateralized to the right. A new MRI showed lesion growth toward Meckel’s cavum and the path of the right trigeminal nerve, and the patient was referred to neurosurgery. Using a subtemporal, extradural approach, a lesion with black coloration that was confined to Meckel’s cavum between trigeminal fascicles was nearly completely removed. The posterior fossa extent was also removed after all of the Meckel’s cavum portion was decompressed.
- The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disabilityPublication . Charneca, Sofia; Ferro, Margarida; Vasques, João; Carolino, Elisabete; Martins-Martinho, Joana; Duarte-Monteiro, Ana Margarida; Dourado, Eduardo; Fonseca, João Eurico; Guerreiro, Catarina SousaPurpose: To assess the relationship between adherence to the Mediterranean Diet (MD) /individual Dietary Inflammatory Index (DII) and disease activity, disease impact, and functional status in Rheumatoid Arthritis (RA) patients. Methods: RA patients followed at a hospital in Lisbon, Portugal, were recruited. DII was calculated using dietary intake data collected with a food frequency questionnaire (FFQ). Adherence to the MD was obtained using the 14-item Mediterranean Diet assessment tool. Disease Activity Score of 28 Joints (DAS28) and the DAS28 calculated with C-Reactive Protein (DAS28-CRP) were used to assess disease activity. Impact of disease and functional status were evaluated using the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Health Assessment Questionnaire (HAQ), respectively. Results: 120 patients (73.3% female, 61.8 ± 10.1 years of age) were included. Patients with higher adherence to the MD had significantly lower DAS28-CRP (median 3.27(2.37) vs 2.77(1.49), p = 0.030), RAID (median 5.65(2.38) vs 3.51(4.51), p = 0.032) and HAQ (median 1.00(0.56) vs 0.56(1.03), p = 0.013) scores. Higher adherence to the MD reduced the odds of having a higher DAS28 by 70% (OR = 0.303, 95%CI = (0.261, 0.347), p = 0.003). Lower adherence to MD was associated with higher DAS28-CRP (β = - 0.164, p = 0.001), higher RAID (β = - 0.311, p < 0.0001), and higher HAQ scores (β = - 0.089, p = 0.001), irrespective of age, gender, BMI and pharmacological therapy. Mean DII of our cohort was not significantly different from the Portuguese population (0.00 ± 0.17 vs - 0.10 ± 1.46, p = 0.578). No associations between macronutrient intake or DII and RA outcomes were found. Conclusions: Higher adherence to the MD was associated with lower disease activity, lower impact of disease, and lower functional disability in RA patients.
- Probiotic supplementation for Rheumatoid Arthritis: a promising adjuvant therapy in the gut microbiome eraPublication . Ferro, Margarida; Charneca, Sofia; Dourado, Eduardo; Guerreiro, Catarina Sousa; Fonseca, João EuricoRheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease that ultimately leads to joint destruction and functional disability. Although the exact etiology of RA is not fully understood, it is well established that gut microbiota (GM) plays a vital role in the pathogenesis of RA, with accumulating evidence suggesting that gut dysbiosis induces a chronic inflammatory response that may be linked to disease development. Of interest, patients with RA have significant changes in the intestinal microbiota compared to healthy controls, and several studies have suggested the use of probiotics as a possible adjuvant therapy for RA. Benefits of probiotic supplementation were reported in animal models of arthritis and human studies, but the current evidence regarding the effect of probiotic supplementation in the management of RA remains insufficient to make definite recommendations. Several different strains of Lactobacillus and Bifidobacteria, as single species or in mixed culture, have been investigated, and some have demonstrated beneficial effects on disease activity in RA human subjects. As of now, L.casei probiotic bacteria seems to be the strongest candidate for application as adjuvant therapy for RA patients. In this review, we highlight the role of GM in the development and progression of RA and summarize the current knowledge on the use of probiotics as a potential adjuvant therapy for RA. We also review the proposed mechanisms whereby probiotics regulate inflammation. Finally, the role of fermented foods is discussed as a possible alternative to probiotic supplements since they have also been reported to have health benefits.
- Diet as a modulator of intestinal microbiota in rheumatoid arthritisPublication . Dourado, Eduardo; Ferro, Margarida; Guerreiro, Catarina Sousa; Fonseca, João EuricoRheumatoid arthritis (RA) is a chronic immune-driven inflammatory disease characterised by synovial inflammation, leading to progressive cartilage and bone destruction, impacting patients’ functional capacity and quality of life. Patients with RA have significant differences in gut microbiota composition when compared to controls. Intestinal dysbiosis influences the intestinal barrier strength, integrity and function, and diet is considered the main environmental factor impacting gut microbiota. Over the last few years, researchers have focused on the influence of single components of the diet in the modulation of intestinal microbiota in RA rather than whole dietary patterns. In this review, we focus on how the Mediterranean diet (MD), a whole dietary pattern, could possibly act as an adjuvant therapeutic approach, modulating intestinal microbiota and intestinal barrier function in order to improve RA-related outcomes. We also review the potential effects of particular components of the MD, such as n-3 polyunsaturated fatty acids (PUFAs), polyphenols and fibre.