1
|
Martins M, Serino M, Viana-Machado F, Novais-Bastos H. Management and prognosis of malignant pleural effusions managed with indwelling pleural catheters. J Bras Pneumol 2023; 49:e20230225. [PMID: 38055389 PMCID: PMC10760441 DOI: 10.36416/1806-3756/e20230225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
|
2
|
Barbosa H, Brás A, Martins M, Coroa M, Marcos A. Anesthesia management in a patient with Churg-Strauss syndrome in the ambulatory setting: A case report. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:593-595. [PMID: 37666453 DOI: 10.1016/j.redare.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/07/2022] [Indexed: 09/06/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare type of vasculitis with multisystemic involvement. Very few authors have described the anaesthesia technique in these patients. We present the first report on ambulatory surgery in a patient with EGPA. This case dispels concerns about the safety of day surgery and reports successful regional anaesthesia management in a patient with EGPA.
Collapse
|
3
|
Martins M, Keir HR, Chalmers JD. Endotypes in bronchiectasis: moving towards precision medicine. A narrative review. Pulmonology 2023; 29:505-517. [PMID: 37030997 DOI: 10.1016/j.pulmoe.2023.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023] Open
Abstract
Bronchiectasis is a highly complex entity that can be very challenging to investigate and manage. Patients are diverse in their aetiology, symptoms, risk of complications and outcomes. "Endotypes"- subtypes of disease with distinct biological mechanisms, has been proposed as a means of better managing bronchiectasis. This review discusses the emerging field of endotyping in bronchiectasis. We searched PubMed and Google Scholar for randomized controlled trials (RCT), observational studies, systematic reviews and meta-analysis published from inception until October 2022, using the terms: "bronchiectasis", "endotypes", "biomarkers", "microbiome" and "inflammation". Exclusion criteria included commentaries and non-English language articles as well as case reports. Duplicate articles between databases were initially identified and appropriately excluded. Studies identified suggest that it is possible to classify bronchiectasis patients into multiple endotypes deriving from their co-morbidities or underlying causes to complex infective or inflammatory endotypes. Specific biomarkers closely related to a particular endotype might be used to determine response to treatment and prognosis. The most clearly defined examples of endotypes in bronchiectasis are the underlying causes such as immunodeficiency or allergic bronchopulmonary aspergillosis where the underlying causes are clearly related to a specific treatment. The heterogeneity of bronchiectasis extends, however, far beyond aetiology and it is now possible to identify subtypes of disease based on inflammatory mechanisms such airway neutrophil extracellular traps and eosinophilia. In future biomarkers of host response and infection, including the microbiome may be useful to guide treatments and to increase the success of randomized trials. Advances in the understanding the inflammatory pathways, microbiome, and genetics in bronchiectasis are key to move towards a personalized medicine in bronchiectasis.
Collapse
|
4
|
Guillemin R, Inhester L, Ilchen M, Mazza T, Boll R, Weber T, Eckart S, Grychtol P, Rennhack N, Marchenko T, Velasquez N, Travnikova O, Ismail I, Niskanen J, Kukk E, Trinter F, Gisselbrecht M, Feifel R, Sansone G, Rolles D, Martins M, Meyer M, Simon M, Santra R, Pfeifer T, Jahnke T, Piancastelli MN. Isotope effects in dynamics of water isotopologues induced by core ionization at an x-ray free-electron laser. STRUCTURAL DYNAMICS (MELVILLE, N.Y.) 2023; 10:054302. [PMID: 37799711 PMCID: PMC10550338 DOI: 10.1063/4.0000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
Dynamical response of water exposed to x-rays is of utmost importance in a wealth of science areas. We exposed isolated water isotopologues to short x-ray pulses from a free-electron laser and detected momenta of all produced ions in coincidence. By combining experimental results and theoretical modeling, we identify significant structural dynamics with characteristic isotope effects in H2O2+, D2O2+, and HDO2+, such as asymmetric bond elongation and bond-angle opening, leading to two-body or three-body fragmentation on a timescale of a few femtoseconds. A method to disentangle the sequences of events taking place upon the consecutive absorption of two x-ray photons is described. The obtained deep look into structural properties and dynamics of dissociating water isotopologues provides essential insights into the underlying mechanisms.
Collapse
|
5
|
Soares A, Ferreira L, Calderipe C, Bologna-Molina R, Damian M, Martins M, Silveira F, Vasconcelos AC. Stafne's bone defect: a systematic review. Med Oral Patol Oral Cir Bucal 2023; 28:e264-e271. [PMID: 36565221 PMCID: PMC10181032 DOI: 10.4317/medoral.25676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND This systematic review integrated the available data published in the literature on Stafne's bone defect (SBD), considering the clinical, imaging and histopathological results. MATERIAL AND METHODS An electronic search was undertaken in six databases. Eligibility criteria were: articles in English, Spanish, and Portuguese describing case reports or case series of SBD, reported up to September/2021. Risk of bias was assessed using the Joanna Briggs Institute tool. RESULTS A total of 98 articles were retrieved, involving 465 individuals with SBD and were included for quantitative analysis. Mean age was 52.78 years (range: 11-89 years), with male predilection (n=374/80.85%). Radiographs were the most frequent imagiological exams (n=298/64.09%), followed by computed tomography (n=98/21.08%). SBD was more prevalent in the posterior mandible (n=361/93.77%) as a hypodense radiolucent lesion (n=250/77.40%). Mean size was 1.58 cm (range: 0.3-.8.0 cm). Two-hundred-and-two lesions (97.37%) were unilocular and 126 (91.97%) were classified as well-defined. Clinical symptoms were reported in 73 cases, while 68 cases (93.15%) were asymptomatic. Only 34 cases (12.32%) were submitted to histopathological examination. Mean follow-up time was 26.42 ±25.39 months. CONCLUSIONS SBD is more frequent in male patients in the fifth and sixth decade of life. Classic SBD is radiographically characterized as a single, unilocular and well-defined lesion in the posterior region of the jaw with a radiolucent/hypodense appearance.
Collapse
|
6
|
Schippers S, Hillenbrand PM, Perry-Sassmannshausen A, Buhr T, Fuchs S, Reinwardt S, Trinter F, Müller A, Martins M. Vibrationally Resolved Inner-Shell Photoexcitation of the Molecular Anion C 2. Chemphyschem 2023:e202300061. [PMID: 36815408 DOI: 10.1002/cphc.202300061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 02/24/2023]
Abstract
Carbon 1s core-hole excitation of the molecular anion C2 - has been experimentally studied at high resolution by employing the photon-ion merged-beams technique at a synchrotron light source. The experimental cross section for photo-double-detachment shows a pronounced vibrational structure associated with 1 σ u → 3 σ g ${1\sigma _u \to 3\sigma _g }$ and 1 σ g → 1 π u ${1\sigma _g \to 1\pi _u }$ core excitations of the C2 - ground level and first excited level, respectively. A detailed Franck-Condon analysis reveals a strong contraction of the C2 - molecular anion by 0.2 Å upon this core photoexcitation. The associated change of the molecule's moment of inertia leads to a noticeable rotational broadening of the observed vibrational spectral features. This broadening is accounted for in the present analysis which provides the spectroscopic parameters of the C2 - 1 σ u - 1 3 σ g 2 2 Σ u + ${1\sigma _u^{ - 1} \,3\sigma _g^2 \;^2 \Sigma _u^ + }$ and 1 σ g - 1 3 σ g 2 2 Σ g + ${1\sigma _g^{ - 1} \,3\sigma _g^2 \;^2 \Sigma _g^ + }$ core-excited levels.
Collapse
|
7
|
Reinwardt S, Baev I, Linß F, Cieslik P, Raberg O, Buhr T, Perry-Sassmannshausen A, Schippers S, Müller A, Trinter F, Guda A, Laasch R, Martins M. An integrated ion trap for the photon-ion spectrometer at PETRA III. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:023201. [PMID: 36859035 DOI: 10.1063/5.0111097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
We have added a multipole ion trap to the existing photon-ion spectrometer at PETRA III (PIPE). Its hybrid structure combines a ring-electrode trap with a segmented 16-pole trap. The interaction of gases and ions with extreme ultraviolet radiation from the beamline P04 is planned to be investigated with the newly installed multipole trap. The research focus lies on radiation-induced chemical reactions that take place in the interstellar medium or in the atmospheres of planets, including natural as well as man-made processes that are important in the Earth's atmosphere. In order to determine the mass-to-charge ratio of the stored ions as efficiently as possible, we are using an ion time-of-flight spectrometer. With this technique, all stored ions can be detected simultaneously. To demonstrate the possibilities of the trap setup, two experiments have been carried out: The photoionization of xenon and the ion-impact ionization of norbornadiene. This type of ion-impact ionization can, in principle, also take place in planetary atmospheres. In addition to ionization by photon or ion impact, chemical reactions of the trapped ions with neutral atoms or molecules in the gas phase have been observed. The operation of the trap enables us to simulate conditions similar to those in the ionosphere.
Collapse
|
8
|
Kirkman-Brown J, Calhaz-Jorge C, Dancet E, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. O-104 Providing accurate information – impact of ancestry testing. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Providing information to patients and, or donors at the ART clinic is essential but challenging, especially in the case of reproductive donation.
Recent developments in direct-to-consumer genetic testing combined with social media have increased the degree of difficulty. Concepts such as donor anonymity, secrecy and disclosure have to be revisited and totally re-thought as the anonymity of donors, their relatives and also of the children born through donation is no longer guaranteed.
This potentially has significant effects on everyone involved: to donors who donated under the assumption that their donation was completely anonymous, to recipients who were under the impression that they could keep donor conception a secret and to donor offspring who were unaware of their donor-assisted conception. It is also effectively retrospective affecting everyone who has, is or might participate.
Providing the correct information to donors, ART couples and donor-conceived offspring is the key, and advise for such information provision will be presented in line with the recently published ESHRE good practice recommendations for information provision for those involved in reproductive donation.
Trial registration number
Collapse
|
9
|
Dâmaso S, Paiva R, Pinho I, Martins M, Brás R, Alvim C, Costa A, Costa L. P-265 High peripheral monocyte count is associated with increased risk of venous thromboembolism in patients with advanced pancreatic cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
10
|
Leal B, Vila-Chã D, Garcia S, Pinto I, Mateiro R, Avelino M, Martins M, Salgado J. Nitrous Oxide in Treatment Resistant Major Depression: Should We Laugh About It? Eur Psychiatry 2022. [PMCID: PMC9567984 DOI: 10.1192/j.eurpsy.2022.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Nitrous oxide (NO), also known as “laughing gas” is a colorless gas used as an anesthetic, a propellant in some foods, an engine performance enhancer and a recreational drug. When inhaled, it is known to provoke a rapid feeling of euphoria or excitement for a short period of time, dissociative phenomena and sometimes laughter. As its fellow anesthetic agent and NMDA-receptor antagonist, ketamine, NO is being studied for its possible therapeutic profile in treatment resistant major depression (TRMD). Objectives TRMD is a serious illness, that urges for effective alternative treatments. In that regard, we explored the recent studies conducted in these patients, using NO in different dosages when compared to placebo. Methods The authors revised the published literature about this topic, selecting relevant articles with the topic words: “Depression”, “Treatment Resistant Major Depression” and “Nitrous Oxide” in scientific data base. Results Since 2018, at least two randomized clinical trials have demonstrated that NO has considerable antidepressant effects in TRMD, when compared to placebo. Investigators noted that these positive effects where maintained at least for two weeks after a single 1-hour inhalation. In a more recent study, scientists compared different NO concentrations (25% vs. 50%) concluding that the 25% concentration had similar efficacy with a lower risk of adverse effects. Conclusions There appears to be encouraging results when treating patients with TRMD with NO in a 25% concentration. Nonetheless, there is need for further investigation, namely through studies that compare NO with other valid TRMD treatments and not only versus placebo. Disclosure No significant relationships.
Collapse
|
11
|
Leal B, Vila-Chã D, Garcia S, Pinto I, Mateiro R, Avelino M, Martins M, Salgado J. Treating Patients with Aripiprazol: A Safe Gamble? Eur Psychiatry 2022. [PMCID: PMC9567850 DOI: 10.1192/j.eurpsy.2022.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Aripiprazole (ARI) is an atypical antipsychotic drug with D2 partial agonist properties, usually prescribed to treat mood disorders (major depression or bipolar disorder) and schizophrenic disorder (schizophrenia or schizoaffective disorder). Dopamine receptor agonists, as is ARI, have been implicated in some cases of impulse-control problems, such as gambling disorder (GD), increased spending, hypersexuality and compulsive eating. Objectives Currently, it is hypothesized that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We intend to do a non-systematic review of the scientific information regarding this subject. Methods The authors revised the published literature about this topic, selecting relevant articles, systematic reviews and case reports, with the topic words: “aripiprazol”, “gambling disorder” and “dopamine receptor” in scientific data base. Results Overall, a few cases of ARI-induced pathological gambling as well as ARI-induced hypersexuality have been reported. In one study it was verified that comorbid psychiatric and substance use disorders were common among those who have experienced GD or worsened GD after beginning ARI treatment. In another study, it was verified that the group of patients who reported this alleged side-effect were mostly young (mean age, 33.6 years), mostly men (88.2%) and most lived alone. Conclusions Attributing to dopamine agonists the only factor that can explain the onset of GD is simplistic and dangerous. Many other potential risk factors, including individual vulnerability factors (temperament, genetics) as well as environmental factors, must be considered. Disclosure No significant relationships.
Collapse
|
12
|
Couto Pereira S, Valente Silva B, Silverio Antonio P, Brito J, Alves Da Silva P, Simoes De Oliveira C, Beatriz Garcia A, Martins M, Nobre Menezes M, Garcia L, Jorge C, Cortez-Dias N, Pinto FJ. Electrocardiography: an usefull tool for prediction of the diagnosis and severity of pulmonary embolism. Europace 2022. [DOI: 10.1093/europace/euac053.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pulmonary embolism (PE) is associated with morbidity and mortality. Immediate recognition of this condition is critical to commencement of early and appropriate therapy which could be lifesaving. Particularly in patients with suspected PE in which computed tomography pulmonary angiography (CTPA) is not promptly available or is contra-indicated, an electrocardiographic (ECG) score could serve as a ubiquitously available test to raise suspicion of PE. This study aimed to evaluate the diagnostic value of an ECG score for PE diagnosis.
Methods
Retrospective study of consecutive patients who performed CTPA in Emergency Department due to PE suspicion. All ECG were scored according to the previous published Daniel’s ECG score, by an investigator blinded for the CTPA result.
Results
The most common ECG findings in patients with PE were incomplete right-brand bock (48%), T wave inversion in DIII (48%), sinus tachycardia (41%) and Q wave in DII (31%). The S1Q3T3 sign was documented in 20% of patients.
The ECG score was significantly higher in patients with PE compared to those without PE (5.06 vs 3.70, p=0.005). ECG score showed moderate accuracy to detect PE (AUC: 0.60; 95%CI: 0.53-0.67; p=0.004), but it is of a particular value because of very high specificity: an ECG score > 12 identified PE with a specificity of 96% (95% CI 91.93 – 98.38).
The ECG score significantly increased the diagnostic accuracy of the diagnostic algorithm based on pretest clinical probability evaluated by Wells score combined with D-Dimer measurement (Wells & DD). In comparison to patients in which clinical pretest probability combined with D-dimer measurement considers PE excluded (Wells & ECG -), PE was 6.3 times more frequent in patients with Wells & DD +/ECG- (95% 2.7- 14.5) and 14.6 times more prevalent in the ones with Wells & DD +/ECG+ (95%CI: 4.1-51.3; p<0.001) – Figure 1.
Conclusion
In patients with clininal suspition of PE, na ECG score (Daniel’s score) >12 predicts PE with 96% specificity and could be used to increase the suspicion and define therapeutic strategy in patients in whom CTPA could not be immediately performed or is contra-indicated.
Collapse
|
13
|
Serino M, Freitas C, Martins M, Ferreira P, Cardoso C, Veiga F, Santos V, Araújo D, Novais-Bastos H, Magalhães A, Queiroga H, Fernandes G, Hespanhol V. Predictors of immune-related adverse events and outcomes in patients with NSCLC treated with immune-checkpoint inhibitors. Pulmonology 2022:S2531-0437(22)00076-9. [PMID: 35414494 DOI: 10.1016/j.pulmoe.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify predictors of immune-related adverse events (IRAEs) in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). Assess associations between outcomes and the development of IRAEs. METHODS Retrospective analysis of patients with NSCLC treated with ICIs between 2016 and 2020 in the Pulmonology Department of our hospital. Patients with and without IRAEs were compared. A logistic regression analysis was performed to determine predictors of IRAEs. Progression-free survival (PFS) and overall survival (OS) curves were calculated using the Kaplan-Meier method, and the long-rank test was used to assess survival differences between groups. Univariate and multivariate Cox proportional-hazards regression models were used to identify factors associated with PFS and OS. The value considered statistically significant was p≤0.05. RESULTS A total of 184 patients (77.7% men, mean age 66.9±9.5 years) treated with ICIs were analyzed. During follow-up, 49 (26.6%) patients developed IRAEs and 149 (81.0%) died. According to the multivariate logistic regression analysis, treatment with statins (OR:3.15; p = 0.007), previous systemic corticosteroid therapy (OR:3.99; p = 0.001), disease controlled as response to ICI (OR:5.93; p < 0.001) and higher hemoglobin values (OR:1.28; p = 0.040) were independent predictors for the development of IRAEs. Patients who developed IRAEs had significantly longer medians of PFS (41.0 vs 9.0 weeks, p < 0.001) and OS (89.0 vs 28.0 weeks; p < 0.001). CONCLUSIONS Patients treated with statins, pre-ICI systemic corticosteroids, higher baseline hemoglobin value and controlled disease as initial response to ICI had a higher risk of developing IRAEs. The development of IRAEs was associated with better outcomes.
Collapse
|
14
|
Froes F, Morais A, Hespanhol V, Nogueira R, Carlos J, Jacinto N, Martins M, Gomes C, Cordeiro C. The Vacinómetro® initiative: an eleven-year monitorization of influenza vaccination coverage rates among risk groups in Portugal. Pulmonology 2022; 28:427-430. [DOI: 10.1016/j.pulmoe.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
|
15
|
Martins M, Carvalho L, Carvalho T, Gomes I. Impact of the COVID-19 pandemic on in-hospital diagnosis of tuberculosis in non-HIV patients. Pulmonology 2022; 28:481-483. [PMID: 35697607 PMCID: PMC9091262 DOI: 10.1016/j.pulmoe.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/07/2023] Open
|
16
|
Silverio Antonio P, Rodrigues T, Cunha N, Couto Pereira S, Brito J, Valente Silva B, Alves Da Silva P, Beatriz Garcia B, Martins M, Oliveira C, David C, Caldeira D, J Pinto F, G Almeida A. Aortic atherosclerotic plaques: the role of anticoagulation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Aortic atherosclerotic plaques (AAPs) are one of the major causes of spontaneous and iatrogenic stroke and peripheral emboli, carrying an high morbidity and mortality. Transoesophageal echocardiography (TOE) plays a key rule on detecting AAP. The therapeutic approach of this patients (pts) is not well stablished.
Purpose
To evaluate the impact of anticoagulation (ACO) therapy on major events in asymptomatic pts with AAP detected in TOE.
Methods
Single-center retrospective study of consecutive patients submitted to TOE between 2010 and 2019 with documentation of AAP. Plaques were described as complex (1) >4mm, (2) ulcerated and (3) mobile thrombi. The plaque location was also documented. We consulted pts data charts for clinical characterization and events recording during the follow up. Major events were defined as stroke, bleeding, hospital admissions (either cardiovascular (CV) and non-CV) and death. Statistical analysis was performed using Cox regression and Chi-square tests.
Results
We enrolled 177 pts with a mean age of 70±10.5 years, 63.8% males, 31.1% diabetic, 73.4% hypertensive, 54.2% with dyslipidaemia, 62.7% obese, 25.4% with peripheral arterial disease, 25.9% with previous stroke and 55.4% with supraventricular arrhythmia. Most of pts had plaques >4mm (80.8%), mobile thrombi in 11.9% and ulcerated plaques in 7.3%; most of the plaques were located in proximal descending aorta (50.3%) and aortic cross (38.4%). Regarding baseline therapy, 52% were under ACO and 50.3% under statin. The main indication of ACO was atrial fibrillation (45.8%).
During follow up (mean time: 1613±1255 days), 61.5% pts died (10.7% from CV causes, 13% with unknown cause), 17.5% had a stroke, 5.7% had other embolic event (lower limbs emboli, unilateral amaurosis and ischemic colitis). Bleeding occurred in 18.3% pts; 47% pts were hospitalized (28.3% from CV cause).
Adjusting for age and comorbidities, there were no significant differences between the group with and without ACO. ACO therapy prevented death from any cause, being also an independent predictor (p=0.08, OR 0.489, IC 95% 0.288–0.831) when adjusted for comorbidities and age. ACO was associated with bleeding events (p=0.003), but not with stroke or hospitalization from any cause (p=NS).
Conclusion
In this subset of pts, ACO therapy prevented death from any cause in pts with AAP. This may have therapeutic implications when approaching this pts, although larger studies to confirm these results are needed.
Funding Acknowledgement
Type of funding sources: None. Non-CV death and anticoagulation
Collapse
|
17
|
Martins M, Maia M, Gil-Martins E, Gales L, Remião F, Pinto M, Silva R, Sousa E. Towards the development of potential dual GSK-β/BACE-1 inhibitors: a strategy to fight Alzheimer's disease. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Antunes J, Branco V, Sobral P, Martins M. Polystyrene nanoparticles interference in human colon adenocarcinoma cell line HT29. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Martins M, Fernandes J, Pedro J, Barros A, Xavier P. P–473 Should couples be educated on how to try to conceive (TTC) before an infertility diagnosis? A comparative study of fertile, subfertile and infertile couples. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What sexual strategies do individuals TTC with different fertility status use?; What are the predictors of sexual dysfunction(SD) and frequency of intercourse(IF) when TTC? Summary answer: TTC strategies with no evidence of effectiveness are the most used. Poor marital quality predicted SD, and female SD was a significant predictor of IF.
What is known already
It is well known that couples TTC have low fecundity knowledge. Previous evidence showed that after 12 months the frequency of intercourse decreases. After seeing a fertility specialist couples report a feeling of waiting time by attempting natural conception, which can be associated to evidence of an overestimation and excessive confidence in the success of fertility treatments. Existing guidelines recommend intercourse every other day, but no comparative studies exist up to date on what sexual strategies are used in different fertility status and what are the predictors of sexual frequency and sexual dysfunction when trying to conceive.
Study design, size, duration
This study is part of a randomized controlled trial on the effects of timed intercourse in psychosocial outcomes. Data was collected between July 2016 and November 2019 via an advertising strategy and obstetrics/gynecology centers. Inclusion criteria were: i) adult in a marital/cohabitation heterosexual relationship >1 year; ii) not knowing of any condition that can prevent pregnancy; iii) being actively TTC; iv) female age >22<42 years old; v) no previous children. Measurements were carried out online.
Participants/materials, setting, methods
Our final sample had 399 subjects (252 women). Participants rated the use of the following strategies: intercourse every other day (EOD), fertile week (FW), basal temperature, cervical mucus monitoring (CMM), ovulation predictor kits (OPK), and keeping legs elevated afterwards (EL). We also accessed psychological adjustment, relationship quality, SD and IF. Comparisons between groups were made by analysis of variance (ANOVA) and Chi-square tests, and logistic regression was used to determine predictors of SD and IF.
Main results and the role of chance
Participants were highly educated (72,8%), in the relationship for 9 years (±5.2), cohabitating for 5 (±3.6), and TTC for 2,5 years (range 0–16). Women were 33 years old (±4.4) and men 36 (±5.5). Regarding fertility status, 22.6% of participants were TTC <12 months, 22.8% >12 months but not diagnosed, 23.6% had a diagnosis but no treatment, and 31.1% had ART. The most reported female strategy in all groups was EL, and the most never used was OPK. Differences were found in EOD, with significantly more women TTC <12 months that never used it, and more women with previous ART using it. Women who had ART are the ones who more frequently use FW and CMM comparing to other women (P>.05). In all groups, the majority reported IF once or twice/week. SD was found in 17.5% of women and 10,9% of men. Age (OR 0.91, 95%CI 0.85–0.97) and SD (OR 2.47, 95%CI 1.02–6.02) were the only predictors of low IF for women, with no significant findings for men. Poor relationship quality increased the risk of SD for both men (OR 0.11, 95%CI 0.03–0.40) and women (OR 0.46, 95%CI 0.03–0.40), and depression increased the risk of female SD (OR 1.24, 95%CI 1.06–0.46).
Limitations, reasons for caution
The cross-sectional nature of this study does not allow causal relationships to be determined. Further cohort studies allowing to assess differences as couples cross different fertility status are warranted. There are important predictors of SD that were not considered, specifically the comorbidity of diseases and pain.
Wider implications of the findings: Findings indicate that individuals TTC are misinformed, and that those using evidence-based sexual strategies are fertility patients. SD should be screened in patients TTC given that it might be an important predictor of IF. Couples might benefit from counselling to improve marital quality and consequently sexual functioning.
Trial registration number
NCT028140069
Collapse
|
20
|
Martins M, Fernandes J, Pedro J, Barros A, Xavier P. P-473 Should couples be educated on how to try to conceive (TTC) before an infertility diagnosis? A comparative study of fertile, subfertile and infertile couples. Hum Reprod 2021. [DOI: 10.1093/humrep/deab127.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What sexual strategies do individuals TTC with different fertility status use?; What are the predictors of sexual dysfunction(SD) and frequency of intercourse(IF) when TTC?
Summary answer
TTC strategies with no evidence of effectiveness are the most used. Poor marital quality predicted SD, and female SD was a significant predictor of IF.
What is known already
It is well known that couples TTC have low fecundity knowledge. Previous evidence showed that after 12 months the frequency of intercourse decreases. After seeing a fertility specialist couples report a feeling of waiting time by attempting natural conception, which can be associated to evidence of an overestimation and excessive confidence in the success of fertility treatments. Existing guidelines recommend intercourse every other day, but no comparative studies exist up to date on what sexual strategies are used in different fertility status and what are the predictors of sexual frequency and sexual dysfunction when trying to conceive.
Study design, size, duration
This study is part of a randomized controlled trial on the effects of timed intercourse in psychosocial outcomes. Data was collected between July 2016 and November 2019 via an advertising strategy and obstetrics/gynecology centers. Inclusion criteria were: i) adult in a marital/cohabitation heterosexual relationship >1 year; ii) not knowing of any condition that can prevent pregnancy; iii) being actively TTC; iv) female age >22<42 years old; v) no previous children. Measurements were carried out online.
Participants/materials, setting, methods
Our final sample had 399 subjects (252 women). Participants rated the use of the following strategies: intercourse every other day (EOD), fertile week (FW), basal temperature, cervical mucus monitoring (CMM), ovulation predictor kits (OPK), and keeping legs elevated afterwards (EL). We also accessed psychological adjustment, relationship quality, SD and IF. Comparisons between groups were made by analysis of variance (ANOVA) and Chi-square tests, and logistic regression was used to determine predictors of SD and IF.
Main results and the role of chance
Participants were highly educated (72,8%), in the relationship for 9 years (±5.2), cohabitating for 5 (±3.6), and TTC for 2,5 years (range 0-16). Women were 33 years old (±4.4) and men 36 (±5.5). Regarding fertility status, 22.6% of participants were TTC <12 months, 22.8% >12 months but not diagnosed, 23.6% had a diagnosis but no treatment, and 31.1% had ART.
The most reported female strategy in all groups was EL, and the most never used was OPK. Differences were found in EOD, with significantly more women TTC <12 months that never used it, and more women with previous ART using it. Women who had ART are the ones who more frequently use FW and CMM comparing to other women (P>.05). In all groups, the majority reported IF once or twice/week. SD was found in 17.5% of women and 10,9% of men. Age (OR 0.91, 95%CI 0.85-0.97) and SD (OR 2.47, 95%CI 1.02-6.02) were the only predictors of low IF for women, with no significant findings for men. Poor relationship quality increased the risk of SD for both men (OR 0.11, 95%CI 0.03-0.40) and women (OR 0.46, 95%CI 0.03-0.40), and depression increased the risk of female SD (OR 1.24, 95%CI 1.06-0.46).
Limitations, reasons for caution
The cross-sectional nature of this study does not allow causal relationships to be determined. Further cohort studies allowing to assess differences as couples cross different fertility status are warranted. There are important predictors of SD that were not considered, specifically the comorbidity of diseases and pain.
Wider implications of the findings
Findings indicate that individuals TTC are misinformed, and that those using evidence-based sexual strategies are fertility patients. SD should be screened in patients TTC given that it might be an important predictor of IF. Couples might benefit from counselling to improve marital quality and consequently sexual functioning.
Trial registration number
NCT028140069
Collapse
|
21
|
Crouzet S, Gelet A, Hostiou T, Rouviere O, Badet L, Regusci S, Martins M. Focal HIFU treatment of Apical lesion: Safety and oncological results. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Cezario K, Bennemann P, Maciel J, Herdt G, Martins M, Tonin A, Prestes A, Machado S. A molecular survey reveals high occurrence of co-infections in intensive pork production farms with increased rates of mummified swine fetuses in Southern Brazil. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
23
|
Cajão R, Martins M, Estrada J, Lima G. Mind the gap! transition from child & adolescent to adult mental health services: A narrative review and results of 18 months consultation. Eur Psychiatry 2021. [PMCID: PMC9475609 DOI: 10.1192/j.eurpsy.2021.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Discontinuity in child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) constitutes an important challenge in mental health care. In the last decade, efforts have been made to better define the transitioning population and build consensual models for CAMHS-AMHS’ transition. Objectives We aim to present our protocol and transition consultation results on the scope of published literature. Methods Description of protocol and casuistic of 18 months’ transition consultation at Centro Hospitalar Barreiro-Montijo. The literature found on PubMed was published from 2008 to 2020 and was reviewed using the keywords: transition, CAMHS, AMHS, adolescent, mental health service, young people. Articles with full text available written in English and French were selected. The included clinical studies focused on populations with neurodevelopmental disorders, psychotic disorders, non-suicidal self-harm and suicidal attempts. Results Forty-four articles were included, published from 2008 to 2020. 4 articles were excluded on basis of language and diagnosis criteria (eating disorders). Twelve were reviews, 24 were clinical studies and 4 were opinion articles. There are cultural and referral issues that explain the loss of patients in this transition gap. Individuals with history of severe mental illness were more frequently referred than those with neurodevelopmental disorders. Optimal transition is defined as adequate transition planning with a flexible age cut-off and continuity of care following transition. Conclusions For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, executed and experienced. Improving transition models is essential to the patients autonomy’ promotion and a stronger adult mental health.
Collapse
|
24
|
Azevedo J, Martins M, Castilho P, Barreto C, Pereira A, Macedo A. Pertinence and development of cibd – clinical interview for bipolar disorder. Eur Psychiatry 2021. [PMCID: PMC9480172 DOI: 10.1192/j.eurpsy.2021.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionBipolar disorder (BD) is frequently underdiagnosed and due to poor screening, the average time between onset of symptoms and diagnosis is more than 7-years (Mantere et al., 2004). Improper diagnosis has serious consequences in intervention (Ghaemi et al., 2001), and previous assessment instruments are now considered insufficient to detect intervention changes, and to provide a more functional and integrated view of BD.ObjectivesOur study aims to develop a new DSM-5 based Clinical Interview for Bipolar Disorder (CIBD), providing criteria to diagnose BD, but also the individual’s perceptions dealing with BD symptoms. This interview follows the same structure of CIPD (Martins et al., 2015), which has shown acceptability by the participants and experts.MethodsCIBD was developed by a multidisciplinary team considering the DSM-5 criteria for Bipolar Disorders. There was a thorough research regarding assessment and evaluation of BD, and several suggestions from an international task force of specialist working with BD patients were considered, when writing the questions for the interview. A detailed description of CIBD development is presented. The authors of the interview have extended experience in the management and assessment of BD patients, and CIBD is now being assessed by a wider non-related panel, regarding pertinence and clarity.ResultsPreliminary assessment and qualitative feedback from participants that were interviewed is shown, with an overall positive feedback.ConclusionsCIBD assesses both the diagnosis/presence of mood episodes (hypo/mania, and depressive) and symptoms’ psychosocial correlates. CIBD detects subtle changes caused by intervention adding a much needed recovery focused perspective.DisclosureNo significant relationships.
Collapse
|
25
|
Fernandes L, Ribeiro C, Martins M, Carreno J, Guerra I, Oliveira C, Vieira C, Luís A, Maia T. Psychiatric disorders during acute hospital treatment of COVID-19 - a case series. Eur Psychiatry 2021. [PMCID: PMC9480149 DOI: 10.1192/j.eurpsy.2021.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Coronavirus disease (COVID-19) has been associated with the development mental and behavioural symptoms and psychiatric disorders. This association is stronger in severe cases of the disease and in those needing inpatient treatment, particularly in intensive care units (ICU). Objectives To determine the incidence of psychiatric disorders in a Portuguese hospital-based sample of patients with COVID-19. To describe relevant demographic and clinical data. Methods We reviewed all COVID-19 inpatients assessed by liaison psychiatry at our hospital between April and September 2020. Patients admitted due to a psychiatric disorder were excluded from the analysis. We reviewed medical records and retrieved relevant clinical data. ICD-10 was used to classify diagnoses. Results We identified 36 cases with a mean age of 62.64 years-old (SD 19.23). The most common disorder was delirium, which occurred in 41.7% of our sample (15 patients), followed by adjustment disorder (22.2%, n=8), and depressive episode (16.7%, n=8). Most patients had no personal (61.1%, n=22) nor family (75%, n=27) history of a psychiatric disorder. Mean length of admission was 36.89 days (SD 28.91). Seventeen cases (47.22%) had at least one risk factor for severe COVID-19 disease and 14 (38.89%) were admitted at some point to the ICU. Conclusions In our sample, delirium was the main cause for mental or behavioural symptoms in COVID-19 patients. However, we observed a wide array of presentations in our center. A larger sample would allow to better characterize this often-overlooked symptoms and identify risk factors to psychiatric syndromes. Disclosure No significant relationships.
Collapse
|