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Article ; Online: 25 ANOS DA REVISTA DO HCPA E DA FAMED

Mauro A. Czepielewski

Clinical and Biomedical Research, Vol 26, Iss

2020 Volume 3

Keywords	Medicine ; R
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Hospital de Clinicas de Porto Alegre
Document type	Article ; Online
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Article ; Online: Letter: Toward Optimized and Cost-Efficient Protocols for Inferior Petrosal Sinus Sampling in the Diagnosis of Cushing Disease.

Skrebsky de Almeida, Tobias / Martins Antunes, Ápio Cláudio / Czepielewski, Mauro Antônio

Neurosurgery

2023 Volume 94, Issue 3, Page(s) e44

MeSH term(s)	Humans ; Petrosal Sinus Sampling/methods ; Pituitary ACTH Hypersecretion/diagnosis ; Diagnosis, Differential
Language	English
Publishing date	2023-11-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002783
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Article ; Online: DIAGNÓSTICO E MANEJO DOS INCIDENTALOMAS ADRENAIS

Eleci Vaz / Mauro Antonio Czepielewski

Clinical and Biomedical Research, Vol 23, Iss 1 -

2022 Volume 2

Abstract: Neste artigo são discutidas as principais causas dos incidentalomas adrenais (IA), chamando a atenção para sua prevalência, principais etiologias e características clínicas, radiológicas e hormonais que orientam sua investigação e manejo. São ... ...

Abstract	Neste artigo são discutidas as principais causas dos incidentalomas adrenais (IA), chamando a atenção para sua prevalência, principais etiologias e características clínicas, radiológicas e hormonais que orientam sua investigação e manejo. São apresentadas também as características das lesões mais prevalentes e as metodologias que permitem melhor acurácia para um diagnóstico preciso. Embasado em ampla revisão e na experiência dos autores, sugere-se um fluxograma de diagnóstico e manejo dos IA, na expectativa de qualificar a abordagem desta alteração em nosso meio, evitando tanto investigações dispendiosas quanto tratamentos cirúrgicos desnecessários ou até mesmo catastróficos.
Keywords	Incidentalomas adrenais ; tumores adrenais ; feocromocitoma ; hiperaldosteronismo ; síndrome de Cushing ; metástases adrenais ; Medicine ; R
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Hospital de Clinicas de Porto Alegre
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cohort cholecystectomies in the Brazilian public system: is access to laparoscopy universal after three decades?

Olijnyk, José Gustavo / Valandro, Isabelle Garibaldi / Rodrigues, Marcela / Czepielewski, Mauro Antônio / Cavazzola, Leandro Totti

Revista do Colegio Brasileiro de Cirurgioes

2022 Volume 49, Page(s) e20223180

Abstract: Objective: videosurgery in Brazil started in 1990 with the performance of laparoscopic cholecystectomy, being included by the public health system in 2008. We evaluated the current situation of the use of this technology in the Unified Health System ( ... ...

Abstract	Objective: videosurgery in Brazil started in 1990 with the performance of laparoscopic cholecystectomy, being included by the public health system in 2008. We evaluated the current situation of the use of this technology in the Unified Health System (SUS - Sistema Único de Saúde). Methods: from 2013 to 2019, 1,406,654 patients registered at the SUS Informatics Department (DATASUS) were analyzed to calculate the rate of laparoscopic cholecystectomies (LC) in relation to open cholecystectomies (OC). Patient characteristics, disease presentation and postoperative mortality were evaluated. Results: the LC rate reached 41.5% (growth of 68%) with no decrease in the absolute number of OC. In University Hospitals (UH), the LC rate reached 91.96%. The open technique in emergencies was more associated with male patients, aged 60 years or older, with prolonged hospitalization and in the ICU. Those undergoing LC were less predisposed to postoperative death, both electively (OR 0.49; 95% CI 0.42 - 0.56; NNT=20) and urgently (OR 0.23; 95% CI 0.20 - 0.25; NNT ≅1), providing a protective effect. Conclusion: despite the increase in the indication of LC, the open technique during the years studied remained stable and the most used in the public health system in Brazil. The effectiveness of public health policies to shorten the complete implementation of videosurgery in SUS needs to be investigated in future epidemiological studies, as well as its impact on postoperative morbidity and mortality.
MeSH term(s)	Brazil ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cohort Studies ; Humans ; Laparoscopy ; Male
Language	Portuguese
Publishing date	2022-07-15
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2223714-8
ISSN	1809-4546 ; 1809-4546
ISSN (online)	1809-4546
ISSN	1809-4546
DOI	10.1590/0100-6991e-20223180-en
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Article: Ketoconazole as second-line treatment for Cushing's disease after transsphenoidal surgery: systematic review and meta-analysis.

Viecceli, Camila / Mattos, Ana Carolina Viana / Hirakata, Vânia Naomi / Garcia, Sheila Piccoli / Rodrigues, Ticiana da Costa / Czepielewski, Mauro Antônio

Frontiers in endocrinology

2023 Volume 14, Page(s) 1145775

Abstract: Introduction: The first-line treatment for Cushing's disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of ... ...

Abstract	Introduction: The first-line treatment for Cushing's disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of this meta-analysis was to analyze hypercortisolism control in patients who used ketoconazole as a second-line treatment after transsphenoidal surgery, in addition to other clinical and laboratory criteria that could be related to therapeutic response. Methods: We searched for articles that evaluated ketoconazole use in Cushing's disease after transsphenoidal surgery. The search strategies were applied to MEDLINE, EMBASE, and SciELO. Independent reviewers assessed study eligibility and quality and extracted data on hypercortisolism control and related variables such as therapeutic dose, time, and urinary cortisol levels. Results: After applying the exclusion criteria, 10 articles (one prospective and nine retrospective studies, totaling 270 patients) were included for complete data analysis. We found no publication bias regarding reported biochemical control or no biochemical control (p = 0.06 and p = 0.42 respectively). Of 270 patients, biochemical control of hypercortisolism occurred in 151 (63%, 95% CI 50-74%) and no biochemical control occurred in 61 (20%, 95% CI 10-35%). According to the meta-regression, neither the final dose, treatment duration, nor initial serum cortisol levels were associated with biochemical control of hypercortisolism. Conclusion: Ketoconazole can be considered a safe and efficacious option for Cushing's disease treatment after pituitary surgery. Systematic review registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, (CRD42022308041).
MeSH term(s)	Humans ; Ketoconazole/therapeutic use ; Pituitary ACTH Hypersecretion/drug therapy ; Pituitary ACTH Hypersecretion/surgery ; Cushing Syndrome ; Hydrocortisone ; Prospective Studies ; Retrospective Studies
Chemical Substances	Ketoconazole (R9400W927I) ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2023-05-08
Publishing country	Switzerland
Document type	Meta-Analysis ; Systematic Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1145775
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Article: Enhancing Cushing's disease diagnosis: exploring the impact of desmopressin on ACTH gradient during BIPSS.

de Almeida, Tobias Skrebsky / Rodrigues, Ticiana da Costa / Costenaro, Fabíola / Scaffaro, Leandro Armani / Farenzena, Maurício / Gastaldo, Fernando / Czepielewski, Mauro Antônio

Frontiers in endocrinology

2023 Volume 14, Page(s) 1224001

Abstract: Introduction: The differential diagnosis between Cushing's disease (CD) and ectopic ACTH syndrome (EAS) is complex, and bilateral inferior petrosal sinus sampling (BIPSS) is considered the gold-standard test. However, BIPSS with corticotropin-releasing ... ...

Abstract	Introduction: The differential diagnosis between Cushing's disease (CD) and ectopic ACTH syndrome (EAS) is complex, and bilateral inferior petrosal sinus sampling (BIPSS) is considered the gold-standard test. However, BIPSS with corticotropin-releasing hormone (CRH) stimulation is rarely available. Objective: This retrospective cohort study aimed to assess the accuracy of the inferior petrosal sinus to peripheral ACTH gradient (IPS:P) before and after desmopressin stimulation for the differential diagnosis of ACTH-dependent Cushing's syndrome (CS), applying different cutoff values. Methods: A total of 50 patients (48 with CD and 2 with EAS) who underwent BIPSS were included in this study. The sensitivity and specificity of IPS:P in BIPSS before and after desmopressin stimulation were evaluated. Various cutoff values for IPS:P were examined to determine their diagnostic accuracy. Results: Using the traditional IPS:P cutoff, the sensitivity was 85.1% before stimulation, 89.6% after stimulation, and a combined sensitivity of 91.7%. Applying cutoff values of IPS:P >1.4 before and >2.8 after stimulation, the sensitivity was 87.2% and 89.6%, respectively, with a combined sensitivity of 91.7%. Receiver operating characteristic (ROC) curve analysis determined optimal cutoff values of 1.2 before stimulation and 1.57 after stimulation, resulting in a sensitivity of 93.6% and 93.8%, respectively, with a combined sensitivity of 97.9%. Specificity remained at 100% throughout all analyses. Among the 43 patients who responded positively to stimulation, 42 (97.7%) did so within the first three minutes, and all 43 (100%) did so within the first five minutes. None of the assessed clinical variables predicted the ACTH response to stimulation in BIPSS with statistical significance. Discussion: ACTH stimulation with desmopressin during BIPSS improves the accuracy of IPS:P, making it a valuable tool for investigating ACTH-dependent Cushing's syndrome. Considering the low risk of complications, we recommend the use of desmopressin stimulation during BIPSS for the differential diagnosis of ACTH-dependent CS.
MeSH term(s)	Humans ; ACTH Syndrome, Ectopic/diagnosis ; Adrenocorticotropic Hormone/metabolism ; Cushing Syndrome/diagnosis ; Deamino Arginine Vasopressin/pharmacology ; Petrosal Sinus Sampling ; Pituitary ACTH Hypersecretion/diagnosis ; Retrospective Studies
Chemical Substances	Adrenocorticotropic Hormone (9002-60-2) ; Deamino Arginine Vasopressin (ENR1LLB0FP)
Language	English
Publishing date	2023-08-03
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1224001
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Article ; Online: Role of ambulatory blood pressure monitoring in patients with acromegaly.

Costenaro, Fabiola / Martin, Adriana / Horn, Roberta F / Czepielewski, Mauro A / Rodrigues, Ticiana C

Journal of hypertension

2016 Volume 34, Issue 7, Page(s) 1357–1363

Abstract: Background: Hypertension is associated with increased cardiovascular deaths in patients with acromegaly.: Objective: To evaluate the accuracy of blood pressure (BP) by 24-h ambulatory blood pressure monitoring (ABPM) and office BP measurements to ... ...

Abstract	Background: Hypertension is associated with increased cardiovascular deaths in patients with acromegaly. Objective: To evaluate the accuracy of blood pressure (BP) by 24-h ambulatory blood pressure monitoring (ABPM) and office BP measurements to represent the real BP status in acromegalic patients and its relationship with acromegalic activity and echocardiogram parameters. Patients and methods: Cohort of 37 patients with acromegaly in a tertiary endocrine outpatient service. Results: Twenty-three percent of the patients were considered hypertensive by ABPM versus 32% by office BP measurements (P = 0.006). BP obtained from the ABPM was associated with growth hormone, insulin-like growth factor type 1 levels and echocardiogram parameters of acromegalic myocardiopathy. Nondipper behavior presented a significant association with the hormonal profile. Conclusion: BP levels assessed by ABPM were associated with acromegalic activity and echocardiogram parameters. ABPM can correctly identify BP levels and their repercussion on acromegalic patients.
MeSH term(s)	Acromegaly/complications ; Acromegaly/physiopathology ; Adult ; Aged ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Cardiomyopathies/etiology ; Cardiomyopathies/physiopathology ; Echocardiography ; Female ; Human Growth Hormone/analogs & derivatives ; Human Growth Hormone/secretion ; Humans ; Hypertension/etiology ; Hypertension/physiopathology ; Insulin-Like Growth Factor I/metabolism ; Male ; Middle Aged
Chemical Substances	IGF1 protein, human ; Human Growth Hormone (12629-01-5) ; Insulin-Like Growth Factor I (67763-96-6) ; pegvisomant (N824AOU5XV)
Language	English
Publishing date	2016-07
Publishing country	England
Document type	Journal Article
ZDB-ID	605532-1
ISSN	1473-5598 ; 0263-6352 ; 0952-1178
ISSN (online)	1473-5598
ISSN	0263-6352 ; 0952-1178
DOI	10.1097/HJH.0000000000000962
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Article ; Online: The importance for growth of dietary intake of calcium and vitamin D.

Bueno, Aline L / Czepielewski, Mauro A

Jornal de pediatria

2008 Volume 84, Issue 5, Page(s) 386–394

Abstract: Objective: To investigate the role of dietary calcium and vitamin D in the process of growth and development of children and adolescents, focusing in particular on the prevention and treatment of delayed growth caused by nutritional deficiency.: ... ...

Abstract	Objective: To investigate the role of dietary calcium and vitamin D in the process of growth and development of children and adolescents, focusing in particular on the prevention and treatment of delayed growth caused by nutritional deficiency. Sources: Information was gathered from articles published in the last 2 decades, from searches on the databases SciELO, PubMed and Medline, technical books and publications of international organizations. Summary of the findings: Growth is influenced by intrinsic (genetic and metabolic) and extrinsic factors (environmental factors such as diet, health, hygiene, housing and access to health services). Among the nutritional factors are vitamin and oligoelement deficiencies which may be associated with malnutrition or caused by insufficient absorption. Since calcium is one of the main mineral components of bone tissue, it is essential for adequate bone formation and, considering that vitamin D plays an important role in calcium metabolism, a diet with insufficient quantities of these nutrients can impact on the formation of the skeleton and on the process of growth and development. Conclusions: In children and adolescents, low intake or low absorption of calcium and vitamin D may limit their statural growth, and it is necessary to supply sufficient quantities of both during the critical growth phases.
MeSH term(s)	Adolescent ; Aged ; Calcium, Dietary/administration & dosage ; Child ; Child, Preschool ; Growth Disorders/prevention & control ; Humans ; Infant ; Infant, Newborn ; Nutrition Policy ; Nutritional Requirements ; Reference Values ; Vitamin D/administration & dosage ; Young Adult
Chemical Substances	Calcium, Dietary ; Vitamin D (1406-16-2)
Language	Portuguese
Publishing date	2008-09-02
Publishing country	Brazil
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	731324-x
ISSN	1678-4782 ; 0021-7557
ISSN (online)	1678-4782
ISSN	0021-7557
DOI	10.2223/JPED.1816
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Article: Evaluation of ketoconazole as a treatment for Cushing's disease in a retrospective cohort.

Viecceli, Camila / Mattos, Ana Carolina Viana / Costa, Maria Carolina Bittencourt / de Melo, Rafael Borba / Rodrigues, Ticiana da Costa / Czepielewski, Mauro Antonio

Frontiers in endocrinology

2022 Volume 13, Page(s) 1017331

Abstract: Objective: The first-line treatment for Cushing's disease is transsphenoidal surgery, after which the rates of remission are 60 to 80%, with long-term recurrence of 20 to 30%, even in those with real initial remission. Drug therapies are indicated for ... ...

Abstract	Objective: The first-line treatment for Cushing's disease is transsphenoidal surgery, after which the rates of remission are 60 to 80%, with long-term recurrence of 20 to 30%, even in those with real initial remission. Drug therapies are indicated for patients without initial remission or with surgical contraindications or recurrence, and ketoconazole is one of the main available therapies. The objective of this study was to evaluate the safety profile of and the treatment response to ketoconazole in Cushing's disease patients followed up at the endocrinology outpatient clinic of a Brazilian university hospital. Patients and methods: This was a retrospective cohort of Cushing's disease patients with active hypercortisolism who used ketoconazole at any stage of follow-up. Patients who were followed up for less than 7 days, who did not adhere to treatment, or who were lost to follow-up were excluded. Results: Of the 172 Cushing's disease patients who were followed up between 2004 and 2020, 38 received ketoconazole. However, complete data was only available for 33 of these patients. Of these, 26 (78%) underwent transsphenoidal surgery prior to using ketoconazole, five of whom (15%) had also undergone radiotherapy; seven used ketoconazole as a primary treatment. Ketoconazole use ranged from 14 days to 14.5 years. A total of 22 patients had a complete response (66%), three patients had a partial response (9%), and eight patients had no response to treatment (24%), including those who underwent radiotherapy while using ketoconazole. Patients whose hypercortisolism was controlled or partially controlled with ketoconazole had lower baseline 24-h urinary free cortisol levels than the uncontrolled group [times above the upper limit of normal: 0.62 (SD, 0.41) Conclusion: Ketoconazole effectively controlled hypercortisolism in 66% of Cushing's disease patients, being a relatively safe drug for those without remission after transsphenoidal surgery or whose symptoms must be controlled until a new definitive therapy is carried out. Hypokalemia is a frequent metabolic effect not yet described in other series, which should be monitored during treatment.
MeSH term(s)	Humans ; Pituitary ACTH Hypersecretion/complications ; Pituitary ACTH Hypersecretion/drug therapy ; Pituitary ACTH Hypersecretion/surgery ; Ketoconazole/therapeutic use ; Retrospective Studies ; Hydrocortisone ; Cabergoline ; Hypokalemia/drug therapy ; Cushing Syndrome/drug therapy
Chemical Substances	Ketoconazole (R9400W927I) ; Hydrocortisone (WI4X0X7BPJ) ; Cabergoline (LL60K9J05T)
Language	English
Publishing date	2022-10-07
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2022.1017331
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Article: Oncologia endócrina: da pesquisa à clínica um novo/antigo cenário de atuação do endocrinologista.

Czepielewski, Mauro A / Gross, Jorge L

Arquivos brasileiros de endocrinologia e metabologia

2006 Volume 49, Issue 5, Page(s) 611–612

Title translation	Endocrine oncology: from research to the clinic a new/old stage for the performance of the endocrinologist.
MeSH term(s)	Biomedical Research ; Brazil ; Endocrine Gland Neoplasms ; Endocrinology/trends ; Humans
Language	Portuguese
Publishing date	2006-01-23
Publishing country	Brazil
Document type	Editorial
ZDB-ID	603919-4
ISSN	1677-9487 ; 0004-2730
ISSN (online)	1677-9487
ISSN	0004-2730
DOI	10.1590/s0004-27302005000500001
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