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Ferreira PP, Martins R, Tavares DP, Valente J. COVID-19 Dashboard for the Lisbon Region - an advisory tool for policy. Eur J Public Health 2021. [PMCID: PMC8575066 DOI: 10.1093/eurpub/ckab165.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue/problem
At the time of arrival of the COVID-19 pandemic to Portugal, the Public Health Department of Lisbon and Tagus Valley Regional Health Administration was confronted with its obsolete information system, which could not provide the information that Public Health Authorities needed to bring the pandemic under control. In order to tackle this issue, our goal was to aggregate all the relevant epidemiological data for the region in an accessible and user-friendly dashboard.
Methods
Starting from March 2020 we created a dashboard, which compiled and analyzed COVID-19 data, such as: confirmed and active cases, deaths, hospitalizations (including ICU beds), high/low risk contacts, mandatory confinements, tests, and clusters. This dashboard had anonymized data and was updated daily as well as constantly upgraded by taking into consideration new incoming data and feedback provided by users, serving its purpose as an advisory tool for policy.
Results
The dashboard was available to Local, Regional, and National Public Health Authorities and made possible to monitor trends and predict epidemiological changes that, prior to its existence, were dispersed in several datasets. Most importantly, it allowed for a better allocation of human resources for contact tracing and case management activities, to easily identify basic social needs for the most vulnerable citizens. It also provided for policy measures adjusted to the smallest administrative division in Portugal, the parish, that ultimately allowed for a better epidemiological control in Lisbon Metropolitan Area in 2020.
Lessons
The regional dashboard is far from perfect, but it highlights the constant need for robust information and epidemiological surveillance systems, serving both National, Regional and Local Public Health Authorities. It appeared out of necessity during a pandemic and it proved once more the importance of data analytics for guiding public health action based on evidence.
Key messages
Data analytics can serve both as an advisory tool for policy as well as to guide public health interventions. The COVID-19 Dashboard for the Lisbon Region aggregates relevant epidemiological data that helped Public Health authorities better understand and control the Pandemic in the region.
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Mendes-Oliveira F, Martins R, Souza VR, Gomes F, Bolina E, Ozahata M, Franco L, Carneiro-Proietti AB, Sabino E, Belisário AR. ANÁLISE DO MICROBIOMA EM ÚLCERA DE PERNA DE PACIENTES COM ANEMIA FALCIFORME. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.025] [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] Open
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Abstract
IntroductionSleep problems are a common presenting symptom of elderly patients to Primary care physicians and Psychiatrists. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation.ObjectivesThe aim of this article is to sumarize and explore the facts envolving sleep disorders, discusses approaches to treatment and highlights new research in the area of geriatric sleep disorders.MethodsAn online bibliographic search was carried out on PubMed and Medline using the keywords “Elderly”, “sleep” and “Psychiatry”.ResultsManagement of sleep disorders is complicated by the risk of side effects of pharmacologic treatment approaches, and thus nonpharmacologic strategies are preferred when possible. Additionally, many of the pharmacologic strategies used in treating younger adults have not been studied adequately in the geriatric population, and more specifically in patients with underlying cognitive disorders, making treatment choices difficult.ConclusionsThis review has provided insights into the biopsychosocial impact of sleep disorders in the elderly, as this group pose unique challenges for diagnosis and treatment. Sleep changes in the elderly may have a far broader impact on geriatric health than originally thought, with implications for AD and delirium, and further research is needed in these areas as well.
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Martins R, Brito LF, Machado PC, Pinto LFB, Silva MR, Schenkel FS, Pedrosa VB. Genome-wide association study and pathway analysis for carcass fatness in Nellore cattle measured by ultrasound. Anim Genet 2021; 52:730-733. [PMID: 34370325 DOI: 10.1111/age.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/16/2022]
Abstract
Identifying genes or genomic regions influencing carcass-quality traits such as fatness (FTN) is essential to optimize the genetic selection processes in beef cattle. The aim of this study was to identify genomic regions associated with FTN in Nellore cattle as well as to elucidate the metabolic pathways related to the phenotypic expression. Ultrasound-based measurements of FTN were collected in 11 750 animals, with 39 903 animals in the pedigree file. Additionally, 1440 animals were genotyped using the GGP-indicus 35K SNP panel, which contained 33 623 SNPs after quality control. Twenty genes related to FTN were found on 11 chromosomes, explaining 12.96% of the total additive genetic variance. Gene ontology revealed seven genes: NR1L2, PKD2, GSK3β, EXT1, RAD51B, SORCS1 and DPH6, associated with important processes related to FTN. In addition, novel candidate genes (MAATS1, LYPD1, CDK5RAP2, RAD51B, c13H2Oorf96 and TRAPPC11) were detected and could provide further knowledge to uncover genetic regions associated to carcass fatness in beef cattle.
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Bellec J, Rigal L, Jaksic N, Caille P, Lederlin M, Lafond C, Martins R, De Crevoisier R, Simon A. PD-0891 Cardio-respiratory ITV for cardiac radioablation in case of ventricular tachycardia. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bessiere F, Gardey K, Duthoit G, Koutbi L, Labombarda F, Marquie C, Gourraud JB, Mondoly P, Bordachar P, Martins R, Pasquie JL, Combes N, Di Filippo S, Marijon E, Waldmann V. Impact of pulmonary valve replacement on ventricular arrhythmias in patients with tetralogy of Fallot. Europace 2021. [DOI: 10.1093/europace/euab116.495] [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
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSERM - French Society of Cardiology
OnBehalf
DAIT4F Investigators
Background
Sudden cardiac death is a major cause of death in tetralogy of Fallot (TOF) and right ventricular overload is commonly considered as a potential trigger for ventricular arrhythmias.
Purpose
We aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden using a population of TOF patients with continuous cardiac monitoring by implantable cardioverter defibrillator (ICD).
Methods
Nationwide French registry including all TOF patients with an ICD. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period.
Results
A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% males) were included from 40 centers. Over a median (IQR) follow-up period of 6.8 (2.5-11.4) years, 26 (15.8%) patients underwent PVR. Among those patients, 18 (69.2%) experienced at least one appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of ICD appropriate therapies was significantly lower after PVR (HR 0.21, 95%CI 0.08-0.56, p = 0.002). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR 0.29, 95%CI 0.10-0.89, p = 0.031).
Conclusions
In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall making-decision process. Abstract Figure.
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Silva D, Martins R, Polido F, Cruz M. A closer look to apathy. Eur Psychiatry 2021. [PMCID: PMC9475982 DOI: 10.1192/j.eurpsy.2021.1266] [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
IntroductionApathy is a neuropsychiatry syndrome, conceptualised as a loss of motivation free of altered consciousness, cognitive impairment or emotional distress, associated with a wide range of brain disorders such as Dementia, Major depression and schizophrenia. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures.ObjectivesThe aim of this article is to review the concept of Apathy and clarify its nosology, pathopshysiology and treatment.MethodsAn online bibliographic search was carried out on PubMed and Medline using “Apathy” as a term.ResultsThe literature reviewed shows that apathy is a multi-dimensional clinical construct with a current definition and validated diagnostic criteria. Analysis reveals that apathy is strongly associated with disruption particularly of anterior cingulate cortex (ACC), ventral striatum (VS) and nucleus accumbens (N acc). Remarkably, these changes are consistent across clinical disorders and imaging modalities, playing a crucial role in normal motivated behaviour.ConclusionsThe neuromodulator dopamine is heavily implicated in ACC and VS. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder Further research is needed to help understand the functional neuroanatomy, neuromodulators involved and possible treatment options of this clinical construct.
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Ferreira J, Goncalves V, Marques P, Martins R, Monteiro S, Teixeira R, Goncalves L. Left atrial functional assessment and mortality in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.083] [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
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe. Both symptoms and systolic dysfunction can appear late in the course of the disease, being often synonym of irreversible damage to the myocardium when found. Thus, there is a necessity to find other sensitive markers present at an earlier stage of the disease.
Purpose
Our primary aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up.
Methods
We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated all 3 left atrial (LA) functional phases (reservoir, conduit and pump) by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and own patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up.
Results
After exclusion criteria, a total of 451 patients were included in the analysis (aged 74 ±11years, 54% male) and were followed during a median period of 73 months (interquartile range 44.5). A total of 55.8% of patients underwent AVR and 45,5% of patients registered the primary outcome. Left atrial emptying fraction (LAEF) was the best LA functional parameter in discriminating primary outcome (AUC 0.840, p < 0.001), even when compared to left ventricular ejection fraction, aortic valve area, aortic mean pressure gradient and aortic Vmax. Patients in the lower tercile of LAEF were older, had greater comorbidities, had greater AS severity, with greater degree of diastolic disfunction. After adjustment for clinical and demographic variables, cumulative survival of patients with LAEF <37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (adjusted HR 19.04, 95% CI 8.30-43.67, P < 0.001 and adjusted HR 4.09, 95% CI 1.85-9.06, P = 0.001). Survival was also higher in patients with LAEF 37 to 53% when compared to patients with LAEF <37% (adjusted HR 0.22, 95% CI 0.13-0.37, P < 0.001). All associations remained true after adjustment for AVR (LAEF <37% versus LAEF 37 to 53% and LAEF ≥54%, respectively, adjusted HR 3.97, 95% CI 1.80-8.78, P = 0.001 and adjusted HR 13.95, 95% CI 5.98-32.54, P < 0.001, respectively)
Conclusion(s) In patients with a first diagnosis of severe AS in hospital setting, LA function assessed by volumetric parameters is an independent predictor of all-cause mortality. Compared to classical severity parameters, different LA functional parameters were found to be more potent predictors of death. These data can be useful in clinical practice for risk stratification and therefore for decision of timing for AVR.
Abstract Figure. Survival of patients stratified by group
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Bourenane H, Auffret V, Martins R. Incidence, timing, predictors, and impact of sustained ventricular arrythmias complicating ST-segment elevation myocardial infarction. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2020.10.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bellec J, Simon A, Benali K, Jaksic N, Caille P, Lederlin M, Lafond C, de Crevoisier R, Martins R. Cardiac stereotactic body radiation therapy for refractory ventricular tachycardia: Impact of cardiac and respiratory movement on the target volume definition. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2020.10.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kosaner Kließ M, Martins R, Connolly M. Major Cost Drivers in Assessing the Economic Burden of Alzheimer’s Disease: A Structured, Rapid Review. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2021; 8:362-370. [DOI: 10.14283/jpad.2021.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Alzheimer’s Disease is the most common cause of dementia, affecting memory, thinking and behavior. Symptoms eventually grow severe enough to interfere with daily tasks. AD is predicted to increase healthcare spending and costs associated with formal and informal caregiving. The aim of this study was to identify and quantify the contribution of the different cost components associated with AD. Methods: A structured literature review was conducted to identify studies reporting the economic burden of Alzheimer`s Disease beyond the healthcare setting. The search was conducted in Medline, Embase and EconLit and limited to studies published in the last 10 years. For each identified cost component, frequency weighted mean costs were calculated across countries to estimate the percentage contribution of each component by care setting and disease severity. Results obtained by each costing approach were also compared. Results: For community-dwelling adults, the percentage of healthcare, social care and indirect costs to total costs were 13.9%, 17.4% and 68.7%, respectively. The percentage of costs varied by disease severity with 26.0% and 10.4% of costs spent on healthcare for mild and severe disease, respectively. The proportion of total spending on indirect costs changed from 60.7% to 72.5% as disease progressed. For those in residential care, the contribution of each cost component was similar between moderate and severe disease. Social care accounted on average for 85.9% of total costs. Conclusion: The contribution of healthcare costs to the overall burden was not negligible; but was generally exceeded by social and informal care costs.
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Valente AM, Acevedo P, Figueiredo AM, Martins R, Fonseca C, Torres RT, Delibes-Mateos M. Dear deer? Maybe for now. People's perception on red deer (Cervus elaphus) populations in Portugal. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 748:141400. [PMID: 32823227 DOI: 10.1016/j.scitotenv.2020.141400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
The human dimension of wildlife is a subject of increasing interest, especially considering the potential impact of people's perceptions on decision-making concerning wildlife management and thus on species' distribution and abundance. This is particularly important for species that inhabit human-dominated landscapes, where conflicts are likely to arise. These conflicts typically emerge between different human collectives when their interests collide and thus an assessment of their perceptions is valuable. Throughout Europe, ungulates have expanded, and Portugal is no exception. The expansion of red deer (Cervus elaphus) comes with benefits (e.g. hunting opportunities), but also with costs (e.g. vehicle collision or damage to crops), that can shape people's perceptions of these populations. To assess perceptions of red deer populations in continental Portugal, we developed a questionnaire survey with three interest groups: general public, farmers and hunters (total n = 1532). Our results show that perceptions about red deer were generally positive with a high acknowledgement of deer benefits, which we link to a broad level of sympathy towards this species. In addition, farmers showed a higher concern with crop damage caused by deer than non-farmers. Nonetheless, a general lack of knowledge regarding wildlife was present, particularly among younger people, who are potentially more apart and disconnected from nature. Now is the time to implement preventive and mitigation measures - e.g. fencing, reduction of population density - which can be a small contribution to address this problem. The focus should be put on people's acceptance of the required strategies to manage deer populations (which can also include unpopular practices, such as hunting). For that, an evaluation of people's attitudes towards deer populations and awareness of associated problems is essential. People's opinions, as well as the success of monitoring and management strategies, should be evaluated through multi-disciplinary teams, that include natural and social scientists, to ensure their success.
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Loureiro H, Pocinho M, Faria A, Marques M, Silva M, Martins R, Veríssimo M. Effects of endurance and strength exercises associated with whey protein supplementation on functional status community-dwelling seniors. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ferreira J, Martins R, Goncalves V, Freitas A, Almeida J, Monteiro S, Goncalves L. Epicardial fat tissue: a new tool for identification of coronary artery disease patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1709] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Epicardial fat (EF), the true visceral fat depot of the heart, has been strongly correlated with both coronary artery disease (CAD) incidence and severity. However, the methods for its measurement were not always affordable. Its measurement by echocardiography is fast, accessible and easily reproducible, turning it into a promising clinical tool for assessing cardiovascular risk to predict the incidence of CAD.
Purpose
To determine the correlation between EF tissue dimensions measured by transthoracic echocardiography and the presence of CAD.
Methods
We prospectively analysed data from 196 consecutive patients admitted for acute coronary syndrome in our coronary care unit. All patients underwent diagnostic coronary angiography and echocardiogram during stay. EF dimensions were obtained with transthoracic echocardiography by measuring maximum EF diameter (mm) at the basal right ventricular free wall (PLAXB) level and mid-right ventricular free wall (PLAXM) level [in paraesternal long-axis view (PLAX)] and maximum right-ventricle free wall EF diameter at basal (PSAXB) level and papillary-muscle (PSAXM) level [in paraesternal short-axis view (PSAX)]. All measures were taken at end-systole. Patients were divided in 2 groups according to the presence of significant CAD (sCAD) or not (nCAD), defined as having at least 1 diseased epicardial vessel with a stenosis >50%.
Results
One-hundred and sixty-three (83.2%) had significant CAD. 22 patients (11.2%) were admitted for unstable angina, 60 patients (30.6%) for non-ST elevation myocardial infarction and 93 patients (47,4%) for ST-elevation myocardial infarction. Mean EF diameters were as follows: PLAXB (19,3±5.1 mm), PLAXM (11.3±2.6), PSAXB (10,6±2.8), PSAXM (10.5±2.8). We found a direct correlation between number of diseased epicardial coronary vessels and epicardial fat thickness in PLAXB (r=0.506, p<0.001), PLAXM (r=0.372, p<0.001), PSAXB (r=0.445, p<0.001) and PSAXM (r=0.372, p<0.001). EF was significantly different between groups: PLAXB (20,6±4.4 vs. 13.8±3,8, p<0.001), PLAXM (11.8±2.5 vs. 9.0±1.9, p<0.001), PSAXB (11.1±2.7 vs. 8.3±2.3, p<0.001) and PSAXM (11.0±2.6 vs. 8.2±4, p<0.001). Receiver operating characteristic curve analysis showed that the predictive value of mean right ventricular EF [(PLAXB+PSAXB)/2] for significant CAD was 0.895 (AUC=0.895, CI 95% 0.818–0,972, p<0.001). For a [(PLAXB+PLAXM)/2] value of 12.57 mm, sensitivity was 86.3% and specificity was 79.3%.
Conclusions
In a population of high suspicion of acute coronary syndromes, echocardiographic EF is a sensitive and specific marker of the presence of significant coronary disease and could become an important tool for coronary risk prediction.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Ferreira Fonseca M, Baptista R, Samouco G, Soeiro P, Martins R, Castro G, Goncalves L. Right atrial mechanics by strain echocardiography in chronic thromboembolic pulmonary hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2244] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Chronic thromboembolic pulmonary hypertension (CPTEH) is the result of thromboemboli leading not only to mechanical obstruction but also pulmonary vascular remodelling and progressive increase in right heart afterload. Prognostic assessment in CPTEH is complex and multifactorial.
Purpose
We used two-dimensional strain echocardiography (2D-STE) to quantify right atrial (RA) mechanics and its correlation with invasive hemodynamics, load-dependent biomarkers and well-known prognostic markers in patients with CTEPH.
Methods
A total of 44 patients (24 females, mean age 61±15.6 years) with CTEPH were recruited. 2D-STE was used to measure right atrial reservoir strain (RASr) (Figure 1) which was then compared to conventional ultrasound measurements, right heart catheterisation (RHC) measurements, the percentage of obstruction in ventilation-perfusion pulmonary single-photon emission computed tomography (V/Q SPECT), B-type natriuretic peptide (BNP) values and 6-minute walk test (6MWT) performance. All patients underwent transthoracic echocardiographic evaluation with a maximal time distance of three months to RHC.
Results
There was a significant positive correlation of RASr with RV longitudinal function determined by tricuspid annular plane systolic excursion (TAPSE) (r=0.488, p=0.003), tricuspid annular peak systolic velocity (S') (r=0.490, p=0.002), right ventricular outflow tract velocity time integral (RVOT VTI) (r=0.457, p=0.005), as well as with 6MWT (r=0.491, p=0.004). There was a significant negative correlation of RASr with mean pulmonary artery pressure (r=−0.513, p=0.002), pulmonary vascular resistance (r=−0.439, p=0.011) and right atrial pressure (RAP) (r=−0.513, p=0.002). RASr was also correlated with Log-transformed BNP values (r=−0.552, p<0,001), and in a multivariate linear regression model, RASr was an independent predictor of Log-transformed BNP values (β=−0.448, 95% CI: −0.046 to −0.009; p=0.005). There was no correlation between RASr and the percentage of obstruction in V/Q SPECT (r=0.164, p=0.388).
Conclusion
2D-STE-derived RA mechanics demonstrated to be a useful, non-invasive, surrogate measurement of RHC parameters. It also predicted important clinical/laboratory prognostic measurements, such as BNP and 6MWT performance. The absence of correlation between 2D-STE values and the percentage of vessel obstruction determined by SPECT may suggest that RV maladaptive response to the obstruction, rather than the degree of obstruction, dictates right heart failure in CTEPH.
Right atrial strain components
Funding Acknowledgement
Type of funding source: None
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Auffret V, Bourenane H, Sharobeem S, Martins R, Leurent G, Bedossa M, Boulmier D, Le Breton H. Incidence, timing, predictors, and impact of sustained ventricular arrhythmia complicating st-segment elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1767] [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
Aims
To describe the incidence, predictors, and in-hospital impact of early SVA (eSVA, occurring < day 2 post-STEMI) and late SVA (lSVA, occurring ≥ day 2 post-STEMI) in STEMI patients. To derive and internally validate a risk score to identify patients at high-risk of lSVA.
Methods
Data of 13523 patients enrolled in the ORBI registry were analysed. Logistic regression was performed to identify predictors of eSVA, lSVA, and in-hospital all-cause mortality. Predictors of lSVA were used to build a risk score.
Results
eSVA occurred in 678 patients (5%) whereas 120 patients (0.9%) experienced lSVA at a median timing of 3 days post-STEMI. eSVA associated with a significantly higher risk of all-cause mortality (adjusted OR:1.90, 95% CI: 1.39–2.61, p<0.001) whereas only a trend was observed with lSVA (adjusted OR: 1.69, 95% CI:0.91–3.13, p=0.09). Multivariable predictors of eSVA are listed in Table 1. Multivariable predictors of lSVA are listed in the Figure. The score derived from these variables allowed the classification of patients into four risk categories: low (0–21), low-to- intermediate (22–34), intermediate-to-high (35–44), and high (≥45). Observed lSVA rates were 0.2%, 0.4%, 0.8%, and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow p=0.40).
Conclusion
eSVA are 5-fold more common than lSVA in the setting of STEMI, mainly associate with other early complications, and portends a 2-fold higher risk of in-hospital mortality. Moreover, we developed a risk score identifying patients at high risk of lSVA for whom early ICU discharge may not be suitable.
Funding Acknowledgement
Type of funding source: None
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Goncalves V, Ferreira J, Almeida J, Freitas A, Martins R, Vieira H, Goncalves L. Left atrial emptying fraction: a powerful predictor of events in severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1888] [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
Background
Increasing evidence suggests that left atrial (LA) structural and functional changes have an important role in risk stratification and prediction of clinical outcomes. We know from multiple data that left atrial maximum volume (LAVI), measured at end-systole, is a powerful prognostic marker in multiple patient groups. However, recent studies have suggested that this marker may not be the best representative of diastolic function as it does not image the full spectrum of atrial mechanics. Another measure of LA function is the left atrial emptying fraction (LAEF), which has proved to be a significant prognostic marker in many patient groups. Less known is its role in event prediction in severe aortic stenosis patients, a disease with a very important burden in modern societies.
Purpose
The authors hypothesised that LAEF is a powerful predictor of clinical outcomes at 1 year in patients with severe aortic stenosis.
Methods
We retrospectively evaluated 151 patients referred to our echocardiography laboratory with the diagnosis of severe aortic stenosis. All patients underwent transthoracic echocardiography. LA maximum volume was indexed to body surface area. LAEF was calculated as LAVI-LA minimum volume divided by LAVI. Patients were followed for 1 year regarding clinical outcomes. Clinical outcome was defined as a composite of hospital admission for a cardiovascular (CV) cause, emergency department recurrence for a CV cause or CV death. Logistic binary regression was used to evaluate associations of LAEF with the outcome.
Results
A total of 51.7% of patients (n=78) were males. Mean patient age was 76.6±8.0 years. A total of 38.4% of patients were diabetics (n=56), 96% had dyslipidaemia (n=145) and 25% (n=37) had atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 60.6±7.3, and mean LAVI was 41.4±12.1. In a multivariable regression model including clinical and echocardiographic markers, higher LAVI and pulmonary artery systolic pressure (PASP) were associated with lower LAEF. Receiver operating characteristic curve analysis showed that the predictive value of LAEF for outcomes at 1 year was 0.693 (AUC=0.693, CI 95% 0.578–0.809, p=0.002), performing better than other echocardiographic markers such as LAVI (AUC=0.567, CI 95% 0.440–0.694, p=0.286), PASP (AUC=0.582, CI 95% 0.451–0.714, p=0.191) and LVEF (AUC=0.590, CI 95% 0.464–0.716, p=0.153). After adjustment of baseline characteristics, a LAEF less than 41.3% remained a good predictor of clinical outcomes at 1 year (OR 2.615, CI 95% 1.085–6.305, p=0.32).
Conclusions
In this cohort of severe aortic stenosis patients, a reduced LAEF was associated with greater incidence of cardiovascular events, being a stronger predictor than LAVI, PASP or LVEF. This study suggests that LA dysfunction over LA volumes correlates better with clinical outcomes.
Funding Acknowledgement
Type of funding source: None
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Martins R, Urien J, Barbarot N, Sellal J, Clementy N, Guenancia C, Gandjbakhch E, Duchateau J, Hamon D, Champ-Rigot L, Marijon E, Garcia R, De Chillou C, Sacher F, Galand V. Efficacy of deep sedation for patients with intractable electrical storm refractory to anti-arrhythmic drugs. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0752] [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
Background
Sympathetic overactivity is implicated in the initiation and maintenance of electrical storm (ES). Deep sedation has empirically been considered as an efficient therapeutic option to blunt sympathetic tone and control ES.
Purpose
The aim of this multicenter study was to determine the efficacy of deep sedation in patients presenting intractable ES refractory to anti-arrhythmic drugs.
Methods
Patients requiring deep sedation for refractory ES from January 1st 2007 to July 31st 2018 were retrospectively included in 13 centers. The primary endpoint was the rate of acute response to sedation, defined as ES termination within 15 minutes after deep sedation.
Results
Among the 116 patients, 55 (47.4%) had ES termination within 15 minutes and were considered “acute responders” to deep sedation. Clinical signs of congestive heart failure before deep sedation (OR=3.31, 95% CI:1.001–10.97, p=0.049) was the only independent predictor of non-acute response. Twenty-one non-acute responders (34.4%) had an extracorporeal membrane oxygenation (ECMO) implanted. Non-acute responders had a significantly lower in-hospital survival (Log-rank, p=0.010). ECMO implantation did not influence survival in non-acute responders to sedation. Acute response to deep sedation was an independent protector of in-hospital mortality, decreasing by 73% the risk of death (OR 0.27; 95% CI:0.10–0.70, p=0.008).
Conclusion
To the best of our knowledge, this multicenter study is the first analysis of the efficacy of deep sedation in patients with intractable ES refractory to anti-arrhythmic drugs, and demonstrating the positive impact of “acute response” on in-hospital survival.
Funding Acknowledgement
Type of funding source: None
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Bellec J, Simon A, Jaksic N, Caille P, Léderlin M, Lafond C, Martins R, de Crevoisier R. Radiothérapie ablative des tachycardies ventriculaires : impact des mouvements cardiaques et respiratoires sur la définition du volume cible. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaczerewska O, Martins R, Figueiredo J, Loureiro S, Tedim J. Environmental behaviour and ecotoxicity of cationic surfactants towards marine organisms. JOURNAL OF HAZARDOUS MATERIALS 2020; 392:122299. [PMID: 32092649 DOI: 10.1016/j.jhazmat.2020.122299] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 06/10/2023]
Abstract
Cationic surfactants are surface-active compounds that can be found in many products, including household and cleaning agents. As a consequence, they tend to be discarded into water streams, ultimately ending up in the aquatic environment. In spite of this environmental issue, studies describing their effects towards marine species are lacking. The aim of this study was therefore to evaluate the short-term exposure effects of two commercial cationic surfactants and three novel gemini surfactants on four marine species, the green microalgae Nannochloropsis gaditana and Tetraselmis chuii, the diatom Phaeodactylum tricornutum, and the crustacean Artemia salina. Furthermore, biodegradation and size distribution of the cationic surfactants in artificial seawater were also studied by UV-vis spectrophotometry and dynamic light scattering, respectively. Ecotoxicity tests revealed that the commercial cationic surfactant N-cetyl-N,N,N-trimethylammonium bromide is toxic to all tested marine species while N-dodecyl-N,N,N-trimethylammonium chloride and 1,4-bis-[N-(1-dodecyl)-N,N-dimethylammoniummethyl]benzene dibromide showed the lowest toxicity among the tested cationic surfactants. Besides the novel insights regarding the effects caused by these five cationic surfactants, this work opens prospects for the replacement of commercially available surfactants by more environmentally friendly alternatives.
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Loureiro H, Pocinho M, Faria A, Azenha J, Silva M, Martins R, Veríssimo M. Effects of endurance and strength exercises associated with whey protein supplementation on quality of life (SF36) in community-dwelling seniors. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040] [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
Introduction Ageing is a natural, physiological and markedly heterogeneous process; however, it is possible to modify the functional decline and to promote healthy ageing. The practise of physical exercise and nutrition have shown benefits in the promotion of a better quality of life (QoL).
Objectives To verify whether protein supplementation associated with physical exercise contributes to the QoL of seniors living in the community.
Methodology A clinical prospective, blind, randomized, placebo-controlled study with a control group was conducted. The sample was probabilistic and randomly assigned. They were distributed through the 4 arms of the study with 19 participants each:1-physical exercise (strength and endurance) + whey protein supplement (20g); 2-physical exercise (strength and endurance) + placebo; 3-only whey protein supplement (20g); 4-control (without intervention). Each group was assessed at baseline and past 12 weeks. QoL was evaluated through SF36, before and after the intervention. Descriptive and inferential statistics were used.
Results The sample consisted of 79 individuals, 55 women and 25 men, with a mean age of 68.54±5.72, mean height 1.57±0.09m, mean weight 72.7±14.3kg, being homogeneous with respect to age by sex and the anthropometric characteristics (body mass index, arm and leg circumferences). The comparison between the pre and post-intervention results showed that groups 1 and 2 significantly improved their QoL (p < 0.05); patients in groups 1 and 3 improved substantially more than in groups 2 and 4 (p < 0.05). Subjects in group 4 worsened their outcomes in all domains of QoL assessed.
Conclusion Protein supplementation showed a positive influence on the quality of life, primarily when associated with physical exercise. In fact, seniors who were not submitted to supplementation or a prescribed exercise showed a worsening of their quality of life throughout the study.
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Aguiar VAP, Medina NH, Added N, Macchione ELA, Alberton SG, Leite AR, Aguirre FR, Ribas RV, Perego CC, Fagundes LM, Terassi JC, Brage JAP, Simões RF, Morais OB, Almeida EA, Joaquim PM, Souza MS, Cecotte AFM, Martins R, Duarte JG, Scarduelli VB, Allegro PRP, Escudeiro R, Leistenschneider E, Oliveira RAN, Servelo WA, Silva MT, Sarmento VE, Carreira CA, Abreu JC, Silva SC, Santos HC, Rodrigues CL, Assis RF, Silva TF, Tabacniks MH, Joaquim AS, Minas JHP, Kashinsky D, Guazzelli MA, Seixas LE, Finco S, Benevenutti F. SAFIIRA: A heavy-ion multi-purpose irradiation facility in Brazil. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2020; 91:053301. [PMID: 32486736 DOI: 10.1063/1.5138644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
This work describes the new facility for applied nuclear physics at the University of Sao Paulo, mainly for irradiation of electronic devices. It is a setup composed of a quadrupole doublet for beam focusing/defocusing plus multiple scattering through gold foils to produce low intensity, large-area, and high-uniformity heavy-ion beams from 1H to 107Ag. Beam intensities can be easily adjusted from 102 particles cm2/s to hundreds of nA for an area as large as 2.0 cm2 and uniformity better than 90%. Its irradiation chamber has a high-precision motorized stage, and the system is controlled by a LabViewTM environment, allowing measurement automation. Design considerations and examples of use are presented.
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Martín-Sierra C, Martins R, Coucelo M, Abrantes AM, Oliveira RC, Tralhão JG, Botelho MF, Furtado E, Domingues MR, Paiva A, Laranjeira P. Elevated soluble TNFα levels and upregulated TNFα mRNA expression in purified peripheral blood monocyte subsets associated with high-grade hepatocellular carcinoma. J Inflamm (Lond) 2020; 17:14. [PMID: 32256215 PMCID: PMC7106708 DOI: 10.1186/s12950-020-00243-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic inflammation is involved in the initiation and progression of various cancers, including liver cancer. The current study focuses on the characterization of the peripheral immune response in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) patients, before and after surgical procedure, in order to assess the effect of tumor resection in the immune system homeostasis and to determine possible prognostic factors associated with high-grade tumors. We developed a whole-blood assay to monitor immune alterations and functional competence of peripheral monocytes in a group of 10 healthy individuals (HG), in 20 HCC patients and 8 CCA patients, by multi-color flow cytometry, qRT-PCR, and ELISA techniques. RESULTS The qRT-PCR analysis showed an upregulation of TNFα expression by classical and intermediate monocytes purified from HCC patients presenting tumors in grade G3-G4 as compared to G1-G2 HCC patients. Moreover, ELISA assay confirmed elevated serum levels of TNFα in G3-G4 compared to G1-G2 HCC patients. A significant decrease of circulating non-classical monocytes was detected in both CCA and HCC patients before and after surgical procedure. In addition, a functional defect in circulating classical and intermediate monocytes was observed in both groups of cancer patients when compared to the HG, with partial recovery after the surgical intervention. CONCLUSIONS This integrated analysis permitted the identification of altered functional competence of monocyte subsets in CCA and HCC patients. In addition, our results point to a potential role of TNFα as a prognostic peripheral biomarker in HCC patients, indicating the presence of high-grade tumors that should be further validated.
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Cotrim C, Joao I, Guardado J, Cordeiro P, Sampaio MANA, Marques A, Cafe H, Martins R, Cotrim H, Baquero L. P794 Treadmill exercise stress echocardiography in children; our experience. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.450] [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: 11/13/2022] Open
Abstract
Abstract
Background
Exercise stress echocardiography (ESE) is routinely used in adults but its role in children (C) is less established
Purpose
To assess the feasibility and clinical value of ESE in outpatient children
Methods
We enrolled 309 consecutive C (mean age = 14,1 ± 2,6 years, range 6-17 yrs) who underwent treadmill ESE between 2002 and 2019: One group (Group I) of 258 C including: 237 with exercise related symptoms (chest pain and/or dyspnea and/ or lypotimia-syncope), 15 with resting ECG alterations, 6 with positive ECG stress test and other group of C (Group II) including: 10 asymptomatic for screening requested by parents, 11 with symptoms unrelated to exercise, 12 with antecedents of sudden death in the family, and 17 with known pathology - 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, 1 each with Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, aortic switch operation. Regional wall motion abnormalities (RWMA) by 2-D and continuous wave Doppler (transvalvular or transaortic or intraventricular (IVG) gradients were assessed in all.
Results
The success rate was 309/309 (100%). Only one complication (allowing asthma diagnosis by serendipity) occurred: a severe asthmatic crisis in one girl studied because of chest pain with exercise (with ESE negativity), Stress-induced RWMA occurred in 2 pts (one with HCM, the other with normal coronary arteries). A significant orthostatic exercise induced IVG (> 30 mmHg) was present in 101 of the 258 C (39%) studied due to symptoms, ECG alterations or positive stress ECG.
In group II the C with induced IVG attained
greater heart rate (HR) 184 ± 12 vs 174 ± 16 (p < 0,001); greater blood pressure (BP) 150 ± 19 mmHg vs 136 ± 23 mmHg (p < 0,001). The OR to the reproduced symptoms that motivated the exam during the SE comparing the 101 C with IVG with the 158 without IVG was 8,22 (4,83-13,99) p < 0,001 (95% CI).
Conclusions
Treadmill ESE is feasible and safe in young people. RWMA are of limited usefulness in our outpatient C group. Doppler often documents significant exercise induced IVG, occult at rest that associate with symptoms.
Abstract P794 Figure. ESE Induced IVG in a C with chest pain
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Waldmann V, Bouzeman A, Duthoit G, Koutbi R, Bessiere F, Hermida A, Elbaz N, Messali A, Garcia R, Pujadas P, Halimi F, Bun S, Lagrange P, De Guillebon M, Mansourati J, Da Costa A, Martins R, Gourraud J, Combes N, Marijon E. Electrocardiographic predictors of appropriate implantable cardioverter defibrillator therapies in patients with tetralogy of Fallot. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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