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Freitas C, Lima B, Melo N, Mota P, Novais-Bastos H, Alves H, Sokhatska O, Delgado L, Morais A. Distinct TNF-alpha and HLA polymorphisms associate with fibrotic and non-fibrotic subtypes of hypersensitivity pneumonitis. Pulmonology 2023; 29 Suppl 4:S63-S69. [PMID: 34629327 DOI: 10.1016/j.pulmoe.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Since Hypersensitivity Pneumonitis (HP) categorization in fibrotic and nonfibrotic/inflammatory types seems to be more consistent with the distinctive clinical course and outcomes, recent international guidelines recommended the use of this classification. Moreover, fibrotic subtype may share immunogenetic and pathophysiological mechanisms with other fibrotic lung diseases. AIM To investigate HLA -A, -B, -DRB1 and TNF-α -308 gene polymorphisms among fibrotic and nonfibrotic HP patients due to avian exposure, also in comparison with asymptomatic exposed controls. METHODS We prospectively enrolled 40 HP patients, classified as fibrotic or nonfibrotic/inflammatory, and 70 exposed controls. HLA and TNF-α polymorphisms were determined by polymerase chain reaction-sequence specific primer amplification. RESULTS While HLA alleles were not associated to HP susceptibility, fibrotic HP patients showed increased frequencies of HLA A*02 (46.7% vs 25.7%; OR=2.53, p = 0.02) and HLA DRB1*14 (10.0% vs 0.7%; OR=15.44, p=0.02) alleles when compared with exposed controls, although not statistically significant after correction for multiple comparisons. TNF-α G/G genotype (associated with low TNF-α production) frequencies were significantly increased among the non-fibrotic/inflammatory HP patients comparatively to fibrotic presentations (88% vs 60%; RR=0.44; p=0.04) and controls (88% vs 63%, OR 4.33, p=0.037). Also, these patients had a significantly increased frequency of the G allele (94.0% vs 73.3%, RR=0.44, p=0.01), while fibrotic HP patients predominantly presented the A allele (26.7% vs 6.0%, RR=2.28, p=0.01). CONCLUSIONS Our results support the hypothesis that fibrotic and non-fibrotic HP subtypes exhibit a distinct profile of TNF-α and HLA polymorphisms, which may be relevant to predict disease course and better define treatment strategies.
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Affiliation(s)
- C Freitas
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
| | - B Lima
- Oficina de Bioestatística, Ermesinde, Portugal
| | - N Melo
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - P Mota
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - H Novais-Bastos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Institute for Research and Innovation in Health (I3S), University of Porto, Portugal
| | - H Alves
- National Health Institute Doutor Ricardo Jorge, Porto, Portugal
| | - O Sokhatska
- Basic and Clinical Immunology, Department of Pathology, and Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology, Department of Pathology, and Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
| | - A Morais
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
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Homme P, Truong R, Gong J, Ziegler C, Freitas C, Yeung A, Tan DH, Burchell AN. Sexual health promotion for sexual and gender minorities in primary care: a scoping review protocol. BMJ Open 2023; 13:e066704. [PMID: 36868597 PMCID: PMC9990650 DOI: 10.1136/bmjopen-2022-066704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Sexual and gender minorities (SGMs) face health disparities related to systemic discrimination and barriers to sexual health. Sexual health promotion encompasses strategies that enable individuals, groups and communities to make informed decisions regarding their sexual well-being. Our objective is to describe the existing sexual health promotion interventions tailored for SGMs within the primary care context. METHODS AND ANALYSIS We will conduct a scoping review and search for articles in 12 medical and social science academic databases on interventions that are targeted towards SGMs in the primary care context in industrialised countries. Searches were conducted on 7 July 2020 and 31 May 2022. We defined sexual health interventions in the inclusion framework as: (1) promote positive sexual health, or sex and relationship education; (2) reduce the incidence of sexually transmitted infections; (3) reduce unintended pregnancies; or (4) change prejudice, stigma and discrimination around sexual health, or increase awareness surrounding positive sex. Two independent reviewers will select articles meeting inclusion criteria and extract data. Participant and study characteristics will be summarised using frequencies and proportions. Our primary analysis will include a descriptive summary of key interventional themes from content and thematic analysis. Gender-based Analysis Plus will be used to stratify themes based on gender, race, sexuality and other identities. The secondary analysis will include the use of the Sexual and Gender Minority Disparities Research Framework to analyse the interventions from a socioecological perspective. ETHICS AND DISSEMINATION No ethical approval is required for a scoping review. The protocol was registered on the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/X5R47). The intended audiences are primary care providers, public health, researchers and community-based organisations. Results will be communicated through peer-reviewed publication, conferences, rounds and other opportunities to reach primary care providers. Community-based engagement will occur through presentations, guest speakers, community forums and research summary handouts.
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Affiliation(s)
- Paige Homme
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robinson Truong
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Gong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cassandra Freitas
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Yeung
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Monteiro SS, Santos TS, Pereira CA, Duarte DB, Neto H, Gomes A, Loureiro L, Martins J, Silva F, Martins LS, Ferreira L, Amaral C, Freitas C, Carvalho AC, Carvalho R, Dores J. The influence of simultaneous pancreas-kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease. J Endocrinol Invest 2023:10.1007/s40618-023-02009-3. [PMID: 36645638 DOI: 10.1007/s40618-023-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Simultaneous pancreas-kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft. METHODS We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation. RESULTS Two hundred and eleven patients were included, 50.2% (n = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% (n = 191), 83.4% (n = 176), and 74.9% (n = 158), respectively. Before transplant, 2.8% (n = 6) had PAD and 5.3% (n = 11) had history of foot lesions. In post-transplant period, 17.1% (n = 36) patients presented PAD and 25.6% (n = 54) developed diabetic foot ulcers, 47.6% (n = 35) of which in the ipsilateral and 53.3% (n = 40) in the contralateral lower limb of the kidney graft (p = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft (p = 0.29). CONCLUSIONS Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the 'steal syndrome' role in these patients.
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Affiliation(s)
- S S Monteiro
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
| | - T S Santos
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C A Pereira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - D B Duarte
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - H Neto
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - A Gomes
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L Loureiro
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - J Martins
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - F Silva
- Division of Nephrology and Transplant, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L S Martins
- Division of Nephrology and Transplant, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L Ferreira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C Amaral
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C Freitas
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - A C Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - R Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - J Dores
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
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Tsutsui H, Lam CSP, Zhang J, Godoy-Palomino A, Tziakas D, Cohen-Solal A, Freitas C, Patel MJ, Ezekowitz JA, Hernandez AF, Pieske B, O'Connor CM, Westerhout CM, Alemayehu W, Armstrong PW. Geographic variation in heart failure with reduced ejection fraction: insights from the VICTORIA trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Geographic differences and background therapy have not been explored in the global VICTORIA trial, which enrolled high-risk patients with recent worsening heart failure with reduced ejection fraction (HFrEF).
Methods and results
Among 5050 patients enrolled in 5 pre-specified geographic regions, 34% were from Eastern Europe, 18% Western Europe, 23% Asia Pacific, 14% Latin and South America, and 11% North America (Table 1). Patients from Western Europe were older, had more atrial fibrillation, and lower glomerular filtration rates. Patients from Eastern Europe had more coronary artery disease and exhibited more advanced symptoms (∼50% New York Heart Association [NYHA] class III), whereas those from Latin and South America were less symptomatic (∼70% NYHA class II). North American patients had the largest body mass index as well as more diabetes and hypertension. Levels of NT-proBNP at randomization and MAGGIC risk scores were highest in Western European patients. Evidence-based triple medication therapy was used most frequently in Latin and South America and less frequently in North America; conversely, cardiac resynchronization therapy and implantable cardioverter defibrillators were most frequently used in North America and least frequently in Latin and South America. The overall primary composite event rate (cardiovascular death or HF hospitalization) in the placebo arm was 36.6/100 person-years over a median of 10.8 months and after adjusting for the MAGGIC score. When examined by region, these event rates were nominally highest in North America and lowest in Western Europe.
Conclusion
Substantial regional differences exist in characteristics and treatments among patients in this global trial of patients with HFrEF and a recent worsening event. These findings demonstrate the continuing unmet needs and opportunities for enhancing care in HFrEF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VICTORIA was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
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Affiliation(s)
- H Tsutsui
- Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - C S P Lam
- National Heart Centre Singapore, Duke-NUS , Singapore , Singapore
| | - J Zhang
- Fuwai Hospital Chinese Academy of Medical Sciences , Beijing , China
| | | | - D Tziakas
- Democritus University of Thrace , Alexandroupolis , Greece
| | | | | | - M J Patel
- Merck & Co., Inc. , Kenilworth , United States of America
| | - J A Ezekowitz
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine , Durham , United States of America
| | - B Pieske
- Charité - University Medicine Berlin , Berlin , Germany
| | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
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Trovisco R, Freitas C, Serino M, Ferreira P, Martins B, Coelho D, Melo N, Fernandes G, Magalhães A, Bastos HN. Predictors of lung entrapment in malignant pleural effusion. Pulmonology 2022:S2531-0437(22)00199-4. [PMID: 36180353 DOI: 10.1016/j.pulmoe.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a common complication in advanced stages of malignancy and is associated with poor prognosis. Non-expandable lung (NEL) often occurs and its presence influences the MPE approach. Our main objective was to assess risk factors for malignant NEL. METHODS Patients diagnosed with pathologically confirmed MPE between January 2012 and December 2018 in our institution were retrospectively analyzed. Demographic and clinical data of patients were reviewed and compared according to the presence or absence of NEL. A univariate and multivariate binary logistic regression analysis were used to determine predictors of the development of NEL. RESULTS Of 365 patients included, 68 (18.6%) had NEL. After multivariate analysis, we found that loculated MPE (OR 8.63, 95%CI 4.30-17.33, p<0.001), complete hemithorax opacification (OR 2.81, 95%CI 1.17-6.76, p<0.021), lung cancer (OR 2.09, 95%CI 1.01-4.31, p=0.047) and higher effusion-serum LDH ratio (OR 1.09, 95%CI 1.00-1.17, p=0.039) were independent predictors of malignant NEL. There were no significant differences compared with expandable lung group regarding time from primary malignancy diagnosis to MPE diagnosis (3.0, IQR 0.0-75.8 vs 2.0, IQR 0.0-75.5 weeks, p=0.942) or MPE symptoms onset to MPE diagnosis (4.0, IQR 1.0-9.0 vs 3.0, IQR 1.0-9.0 weeks, p=0.497). Patients with NEL had a higher number of therapeutic pleural drainages (3.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0; p<0.001) and longer hospital stay (32.5, IQR 15.5-46.3 vs 21.0, IQR 11.0-36.0, p=0.007), measured in hospitalization days until the end of life, than patients with expandable lung. The rate of recurrence of pleural effusion was not significantly different between groups (p=0.291). Overall survival (OS) was 3.0 (95%CI, 2.3-3.7) months, regardless of lung expandability (p=0.923). CONCLUSION Loculated MPE, complete hemithorax opacification, lung cancer and a higher effusion-serum LDH ratio were found to be independent predictors for NEL. These patients underwent thoracocenteses more frequently and had longer hospitalization days, although without significant impact in the OS.
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Affiliation(s)
- R Trovisco
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - C Freitas
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - M Serino
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - P Ferreira
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - B Martins
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - D Coelho
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - N Melo
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - G Fernandes
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - A Magalhães
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - H N Bastos
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal.
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Freitas C, Felizardo M. Rationality and suicide, cultural context and mental illness – tenuous limits: about a clinical case. Eur Psychiatry 2022. [PMCID: PMC9567848 DOI: 10.1192/j.eurpsy.2022.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Suicide results from a complex interaction between biological, genetic, psychological, sociological, cultural and environmental factors. The frequency of suicide among psychiatric pathologies is quite variable, with depression accounting for 45% to 70% of suicides. The association of suicide with the existence of mental illness is not consensual, with reports of rational suicides in 2% to 9% of suicide cases. It is unquestionable that the awareness of the lived experience limits the person’s condition to what it is. Objectives To describe a clinical case on the subject and discuss the influence of cultural context in suicide. Methods The authors describe a case of a patient hospitalized in Psychiatry, after a suicide attempt and a consummated suicide by his wife. Results The patient and his wife lived their entire lives as hermits. Although no acute psychopathology was found in the patient to justify the act, such as psychotic or depressive symptoms, dysfunctional personality traits were found, which translated into an attitude of superiority, requirement of subservience, hostility when contradicted and breaches of basic rules. Conclusions Taking into account what has been described, the authors discuss the influence of personality on the patient’s life choices and on the decision that led to the suicide attempt, as well as the suicide of his wife. A reflection is made on whether suicide can be completely independent of mental illness or whether, even in cases where rationality seems to be the causal factor, personality dysfunctionality and a profound influence of the cultural context, are present or not. Disclosure No significant relationships.
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Felizardo M, Freitas C. Valproic acid-induced hyperammonemic encephalopathy: a clinical case. Eur Psychiatry 2022. [PMCID: PMC9568048 DOI: 10.1192/j.eurpsy.2022.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Valproic acid is a psychotropic drug used for several years, due to its properties as a mood stabilizer, being considered as first-line treatment for bipolar disorder. In addition to its teratogenic potential, which prevents its recommendation for the treatment of bipolar disorder in women of childbearing age, valproic acid is associated with some side effects, such as gastrointestinal symptoms, alopecia, weight gain, tremor or hepatotoxicity. Hyperammonemia is a side effect that is little described, but relatively frequent, and may progress to variable encephalopathy.
Objectives
The authors describe a clinical case of a 48-year-old female patient, hospitalized due to a manic episode, who was prescribed valproic acid, in association with lorazepam and olanzapine.
Methods
After three days on a dose of 1000mg of valproic acid, the patient began an acute condition of confusion, psychomotor retardation, temporal-spatial disorientation and ataxia. Infection, electrolyte disturbance and acute cerebral event were excluded. Noteworthy only hyperammonemia. Valproic acid was withdrawn and replaced by lithium, with the patient recovering from the confusional state two days later.
Results
Hyperamonemic encephalopathy secondary to valproic acid was concluded. The mechanisms of valproic acid-linked hyperammonemia are not clear, although it appears to be independent of hepatotoxicity. The most studied hypotheses are related to glutamine reabsorption and serum levels carnitine in patients medicated with valproic acid.
Conclusions
It is essential that there is a high level of suspicion in clinicians for this secondary effect of valproic acid, in order to adequately treat the patient who presents with acute confusional conditions, not explained by other complications.
Disclosure
No significant relationships.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- M Serino
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - C Freitas
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Martins
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - P Ferreira
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Cardoso
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - F Veiga
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - V Santos
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - H Novais-Bastos
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Magalhães
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - H Queiroga
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - G Fernandes
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
| | - V Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário São João; Faculty of Medicine, University of Porto, Porto, Portugal
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Guedes P, Oliveira C, Dias H, Freitas C, Camargo A, Saraiva N, Camargo L. Ultrasound characteristics and pregnancy loss in bovine IVF-derived pregnancies. Livest Sci 2022. [DOI: 10.1016/j.livsci.2022.104847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Serino M, Freitas C, Saleiro S, Cabrita B, Conde M, Fernandes MGO, Magalhães A. Airway stents in malignant central airway obstruction. Pulmonology 2021; 27:466-469. [PMID: 33744216 DOI: 10.1016/j.pulmoe.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Serino
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - C Freitas
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - S Saleiro
- Pulmonology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - B Cabrita
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - M Conde
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - M G O Fernandes
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - A Magalhães
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal
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11
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Freitas C, Veiga F, Costa J, Araújo D, Novais-Bastos H, Santos V, Magalhães A, Hespanhol V, Queiroga H, Fernandes G. P01.15 Immune-Related Adverse Effects of Immunotherapy in Patients With Advanced Non-Small Cell Lung Carcinoma. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Shin S, Austin PC, Ross HJ, Abdel-Qadir H, Freitas C, Tomlinson G, Chicco D, Mahendiran M, Lawler PR, Billia F, Gramolini A, Epelman S, Wang B, Lee DS. Machine learning vs. conventional statistical models for predicting heart failure readmission and mortality. ESC Heart Fail 2020; 8:106-115. [PMID: 33205591 PMCID: PMC7835549 DOI: 10.1002/ehf2.13073] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/06/2020] [Accepted: 10/05/2020] [Indexed: 01/09/2023] Open
Abstract
Aims This study aimed to review the performance of machine learning (ML) methods compared with conventional statistical models (CSMs) for predicting readmission and mortality in patients with heart failure (HF) and to present an approach to formally evaluate the quality of studies using ML algorithms for prediction modelling. Methods and results Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, we performed a systematic literature search using MEDLINE, EPUB, Cochrane CENTRAL, EMBASE, INSPEC, ACM Library, and Web of Science. Eligible studies included primary research articles published between January 2000 and July 2020 comparing ML and CSMs in mortality and readmission prognosis of initially hospitalized HF patients. Data were extracted and analysed by two independent reviewers. A modified CHARMS checklist was developed in consultation with ML and biostatistics experts for quality assessment and was utilized to evaluate studies for risk of bias. Of 4322 articles identified and screened by two independent reviewers, 172 were deemed eligible for a full‐text review. The final set comprised 20 articles and 686 842 patients. ML methods included random forests (n = 11), decision trees (n = 5), regression trees (n = 3), support vector machines (n = 9), neural networks (n = 12), and Bayesian techniques (n = 3). CSMs included logistic regression (n = 16), Cox regression (n = 3), or Poisson regression (n = 3). In 15 studies, readmission was examined at multiple time points ranging from 30 to 180 day readmission, with the majority of studies (n = 12) presenting prediction models for 30 day readmission outcomes. Of a total of 21 time‐point comparisons, ML‐derived c‐indices were higher than CSM‐derived c‐indices in 16 of the 21 comparisons. In seven studies, mortality was examined at 9 time points ranging from in‐hospital mortality to 1 year survival; of these nine, seven reported higher c‐indices using ML. Two of these seven studies reported survival analyses utilizing random survival forests in their ML prediction models. Both reported higher c‐indices when using ML compared with CSMs. A limitation of studies using ML techniques was that the majority were not externally validated, and calibration was rarely assessed. In the only study that was externally validated in a separate dataset, ML was superior to CSMs (c‐indices 0.913 vs. 0.835). Conclusions ML algorithms had better discrimination than CSMs in most studies aiming to predict risk of readmission and mortality in HF patients. Based on our review, there is a need for external validation of ML‐based studies of prediction modelling. We suggest that ML‐based studies should also be evaluated using clinical quality standards for prognosis research. Registration: PROSPERO CRD42020134867
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Affiliation(s)
- Sheojung Shin
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Peter C Austin
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Heather J Ross
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Husam Abdel-Qadir
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Cassandra Freitas
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - George Tomlinson
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Davide Chicco
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Meera Mahendiran
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Patrick R Lawler
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Filio Billia
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Anthony Gramolini
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Slava Epelman
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Bo Wang
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
| | - Douglas S Lee
- University of Toronto, ICES, Rm G-106, 2075 Bayview Ave., Toronto, ON, M4G2E1, Canada
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Freitas C, Pereira T, Pinheiro G, Dias C, Hespanhol V, Costa J, Cunha A, Oliveira H. THE ROLE OF RADIOGENOMICS IN EGFR AND KRAS MUTATION STATUS PREDICTION AMONG NON-SMALL CELL LUNG CANCER PATIENTS. Chest 2020. [DOI: 10.1016/j.chest.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Freitas C, Amorim P, Queiroga H, Drummond M. WHAT CAN REAL WORLD DATA TELL US ABOUT OBSTRUCTIVE SLEEP APNEA AND LUNG CANCER? Chest 2020. [DOI: 10.1016/j.chest.2020.05.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Freitas C, Sousa C, Novais-Bastos H, Fernandes G, Morais A, Magalhães A. 16 YEARS INSIDE THE TRACHEA. Chest 2020. [DOI: 10.1016/j.chest.2020.05.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Hoang-Kim A, Parpia C, Freitas C, Austin PC, Ross HJ, Wijeysundera HC, Tu K, Mak S, Farkouh ME, Sun LY, Schull MJ, Mason R, Lee DS, Rochon PA. Readmission rates following heart failure: a scoping review of sex and gender based considerations. BMC Cardiovasc Disord 2020; 20:223. [PMID: 32408892 PMCID: PMC7222562 DOI: 10.1186/s12872-020-01422-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/09/2020] [Indexed: 12/23/2022] Open
Abstract
Background Although hospital readmission for heart failure (HF) is an issue for both men and women, little is known about differences in readmission rates by sex. Consequently, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Our study aims were: (1) to identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender. Methods We conducted a scoping review using the Arksey and O’Malley framework to include full text articles published between 2002 and 2017 drawn from multiple databases (MEDLINE, EMBASE), grey literature (i.e. National Technical information, Duck Duck Go), and expert consultation. Eligible articles included an index heart failure episode, readmission rates, and sex/gender-based analysis. Results The search generated 5887 articles, of which 746 underwent full abstract text consideration for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies stratified data for sex. Good inter-rater agreement was reached: 83% title/abstract; 88% full text; kappa: 0.69 (95%CI: 0.53–0.85). Twelve of 34 studies reported higher heart failure readmission rates for men and six studies reported higher heart failure readmission rates for women. Using non composite endpoints, five studies reported higher HF readmission rates for men compared to three studies reporting higher HF readmission rates for women. Overall, there was heterogeneity between studies when examined by sex, but one observation emerged that was related to the timing of readmissions. Readmission rates for men were higher when follow-up duration was longer than 1 year. Women were more likely to experience higher readmission rates than men when time to event was less than 1 year. Conclusions Future studies should consider different time horizons in their designs and avoid the use of composite measures, such as readmission rates combined with mortality, which are highly skewed by sex. Co-interventions and targeted post-discharge approaches with attention to sex would be of benefit to the HF patient population.
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Affiliation(s)
| | | | - Cassandra Freitas
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Heather J Ross
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Ted Rogers Centre for Heart Research, Toronto, Canada
| | - Harindra C Wijeysundera
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Karen Tu
- Faculty of Medicine, University of Toronto, Toronto, Canada.,North York General Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Susanna Mak
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Sinai Health System, Toronto, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Louise Y Sun
- ICES, Toronto, Canada.,Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Michael J Schull
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robin Mason
- Women's College Research Institute, Toronto, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre of University Health Network, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Faculty of Medicine, University of Toronto, Toronto, Canada. .,Ted Rogers Centre for Heart Research, Toronto, Canada.
| | - Paula A Rochon
- Women's College Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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18
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Abstract
IntroductionOver the last years, literature has dedicated increased interest to post-traumatic stress disorder (PTSD), a mental disorder that was initially included in Diagnostic and Statistical Manual of mental disorders in 1980. Trauma is any event that overwhelms the individual coping strategies. Patients with PTSD experience symptoms of hyper-vigilance, intrusive thoughts, flashbacks, re-experiencing the trauma event, avoidance of stimuli related with trauma or exaggerated startle response. Mindfulness is the process of being aware, paying attention in the present moment, in a non-judgmental way. Research has been showing that mindfulness has positive effects on mental health.Objectives and aimsAssessment of eventual benefits of mindfulness in patients with PTSD.MethodsLiterature research.ResultsMany studies have reported on correlations between self-reported mindfulness and mental health. Literature suggests that mindfulness training can enhance life skills and its effectiveness is being studied in several mental disorders. Its positive effects on enhancing emotion regulation and decreasing anxiety, hyperarousal and depressive symptoms, led to investigation in the context of PTSD's treatment. Some studies show decreased perceived stress and post-traumatic avoidance symptoms and increased positive states of mind. Most studies reviewed were related with war veterans with PTSD and showed that mindfulness-based treatments could enhance their quality of life. Other results imply that mindful awareness alone may not be sufficient to help reduce symptoms.ConclusionsMindfulness based therapies could be useful on improving PTSD symptoms but, to assess its efficacy, further research is needed, in different samples of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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19
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Freitas C, Wang X, Ge Y, Ross HJ, Austin PC, Pang PS, Ko DT, Farkouh ME, Stukel TA, McMurray JJV, Lee DS. Comparison of Troponin Elevation, Prior Myocardial Infarction, and Chest Pain in Acute Ischemic Heart Failure. CJC Open 2020; 2:135-144. [PMID: 32462127 PMCID: PMC7242506 DOI: 10.1016/j.cjco.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background Patients with heart failure (HF) with concomitant ischemic heart disease (IHD) have not been well characterized. We examined survival of patients with ischemic HF syndrome (IHFS), defined as presentation with acute HF and concomitant features suggestive of IHD. Methods Patients were included if they presented with acute HF to hospitals in Ontario, Canada. IHD was defined by any of the following criteria: angina/chest pain, prior myocardial infarction (MI), or troponin elevation that was above the upper limit of normal (mild) or suggestive of cardiac injury. Deaths were determined after hospital presentation. Results Of 5353 patients presenting with acute HF, 4088 (76.4%) exhibited features of IHFS. Patients with IHFS demonstrated a higher rate of 30-day (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.33-2.68) and 1-year death (HR, 1.16, 95% CI, 1.00-1.35) compared with those with nonischemic HF. Troponin elevation demonstrated the strongest association with mortality. Mildly elevated troponin was associated with increased hazard over 30-day (HR, 1.77; 95% CI, 1.12-2.81) and 1-year (HR, 1.63; 95% CI, 1.38-1.93) mortality. Troponins indicative of cardiac injury were associated with increased hazard of death over 30 days (HR, 2.33; 95% CI, 1.63-3.33) and 1 year (HR, 1.40; 95% CI, 1.21-1.61). The association between elevated troponin and higher mortality at 30 days was similar in left ventricular ejection fraction subcategories of HF with reduced ejection fraction, HF with mildly reduced ejection fraction, or HF with preserved ejection fraction (P interaction = 0.588). After multivariable adjustment, prior MI and angina were not associated with higher mortality risk. Conclusions In acute HF, elevated troponin, but not prior MI or angina, was associated with a higher risk of 30-day and 1-year mortality irrespective of left ventricular ejection fraction.
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Affiliation(s)
- Cassandra Freitas
- University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Yin Ge
- University of Toronto, Toronto, Ontario, Canada
| | - Heather J Ross
- University Health Network, Toronto, Ontario, Canada.,Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Peter C Austin
- University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dennis T Ko
- University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael E Farkouh
- University Health Network, Toronto, Ontario, Canada.,Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Heart & Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Ontario, Canada
| | - Therese A Stukel
- University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Douglas S Lee
- University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
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20
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Figueiredo A, Almeida M, Almodovar M, Alves P, Araújo A, Araújo D, Barata F, Barradas L, Barroso A, Brito U, Camacho E, Canário D, Cardoso T, Chaves A, Costa L, Cunha J, Duarte J, Estevinho F, Felizardo M, Fernandes J, Ferreira L, Ferreira L, Fidalgo P, Freitas C, Garrido P, Gil N, Hasmucrai D, Jesus E, Lopes J, de Macedo J, Meleiro A, Neveda R, Nogueira F, Pantorotto M, Parente B, Pego A, Rocha M, Roque J, Santos C, Saraiva J, Silva E, Silva S, Simões S, Soares M, Teixeira E, Timóteo T, Hespanhol V. Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC). Pulmonology 2020; 26:10-17. [DOI: 10.1016/j.pulmoe.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
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21
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Freitas C, Martins N, Novais-Bastos H, Morais A, Fernandes G, Magalhães A. The role of interventional bronchoscopy in the management of post-intubation tracheal stenosis: A 20-year experience. Pulmonology 2019; 27:296-304. [PMID: 31901372 DOI: 10.1016/j.pulmoe.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Benign tracheal stenosis management is still controversial, and there is no international consensus on the best treatment option. Thus, we aimed to look into the history of PITS and the different strategies used in its treatment. The importance of bronchoscopic treatment was also defined, and its effectiveness and safety were assessed. METHODS Retrospective study of patients diagnosed with PITS, who were referred to the Bronchology Department between January 1996 and December 2016. RESULTS Of 115 patients enrolled (mean age 48.5±17.6 years, 53% males), 66.1% had complex stenosis. The most common causes of intubation were respiratory (29.9%), neurological (26.8%) and surgical (19.6%). Complex stenosis was caused by longer intubation, and was more frequent among previously tracheostomized patients. The most common location was the upper third of trachea (60.9%). Most cases were initially treated by interventional bronchoscopy, and although serial dilations were effective in some complex PITS, a higher proportion of simple stenosis was successfully managed with this treatment option. Long-term recurrence after serial dilation was observed in 25.0% of cases. Stent placement was required (19.1%) only for complex PITS. Stent-related complications were frequent (61.9%) and linked to the stenting time (p<0.001). Overall, there were no procedure-related complications. Surgical intervention was also performed (30.0%), always with complex PITS. Post-surgical recurrences were observed in 24.2% of cases. CONCLUSIONS Interventional bronchoscopy is an efficient and safe modality in PITS management. Further studies are needed for better classification and improved knowledge of PITS pathogenesis, and to achieve international consensus of definition to guide clinicians in their practice.
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Affiliation(s)
- C Freitas
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
| | - N Martins
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal
| | - H Novais-Bastos
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal
| | - A Morais
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - G Fernandes
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - A Magalhães
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
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22
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Donio PJ, Freitas C, Austin PC, Ross HJ, Abdel-Qadir HM, Wijeysundera HC, Tu K, Cram P, Liu P, Abrams H, Udell JA, Mak S, Farkouh ME, Tu JV, Wang X, Tobe SW, Lee DS. Comparison of Readmission and Death Among Patients With Cardiac Disease in Northern vs Southern Ontario. Can J Cardiol 2019; 35:341-351. [PMID: 30825954 DOI: 10.1016/j.cjca.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Geographic factors may influence cardiovascular disease outcomes in Canada. Circulatory diseases are a major reason for higher population mortality rates in Northern Ontario, but it is unknown if hospitalized patients with cardiovascular disease experience differential outcomes compared with those in the South. METHODS We examined 30-day and 1-year mortality and readmissions for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), or stroke in Northern compared with Southern Ontario, using the Canadian Institute for Health Information Discharge Abstract Database (2005-2016). Northern patients were defined as those residing and hospitalized in the Northwest or Northeast Local Health Integration Network regions. We used multiple Cox proportional hazards regression analysis for time-to-first event and Prentice-Williams-Peterson method to evaluate repeat and multiply admitted patients. RESULTS A total of 47,745 Northern and 465,353 Southern patients hospitalized with AMI (n = 182,158), HF (n = 130,770), AF (n = 72,326), or stroke (n = 127,844) were studied. Rates of first readmission were higher among Northern patients for AMI (adjusted hazard ratio [HR], 1.32), HF (HR, 1.16), AF (HR, 1.21), and stroke (HR, 1.27) compared with Southern patients (all P < 0.001). Repeat readmission rates among Northern patients for AMI (HR, 1.23), HF (HR, 1.13), AF (HR, 1.18), and stroke (HR, 1.22) were also increased (all P < 0.001 vs Southern). Thirty-day mortality did not differ significantly between Northern and Southern patients. CONCLUSIONS Readmissions were increased in those residing and hospitalized in the North. To reduce readmissions in the North, the quality of postacute transitional care should be examined further.
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Affiliation(s)
- Patrick J Donio
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Cassandra Freitas
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Husam M Abdel-Qadir
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Peter Cram
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Howard Abrams
- University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jacob A Udell
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jack V Tu
- ICES, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | | | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Douglas S Lee
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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23
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Abstract
Abstract
Background
Breastfeeding provides benefits for children, mothers, society and the environment. The promotion of optimal breastfeeding, from an early stage in life is, therefore, a public health priority. Infant feeding can be influenced by maternal country of birth. However, studies carried out in European settings point to inconsistent findings. This study aims to compare first day in-hospital exclusive breastfeeding among migrant and native women in Portugal.
Methods
This study is based on a national project on perinatal health among migrants and natives in Portugal (baMBINO). Out of 39 public maternity units in mainland Portugal, 32 were enrolled. Women aged 18 years old or older with a live birth were recruited. The final sample included 5109 participants (2431 natives and 2678 migrants). Logistic regression was used to assess the association between maternal country of birth and in-hospital exclusive breastfeeding.
Results
Migrant participants included women from Portuguese-speaking African countries (PSAC) (49,7%), Brazil (18%), Eastern Europe (10.2%), other European countries (9.6%), Asia (5.5%) and other countries (7.0%). No differences were found between migrants and natives, with the exception of women from PSAC who were more likely to exclusively breastfeed during the first day of hospital stay (aOR 1.34 CI95% 1.05-1.72), irrespective of maternal age, education, parity, type of pregnancy, reproductive assistance, tobacco use, gestational age, newborn birth weight, mode of delivery and antenatal care.
Conclusions
In Portugal, women from PSAC are more likely to exclusively breastfeed their babies during the first day of hospital stay when compared to native women. Strategies to maintain healthy breastfeeding practices in this population are fundamental.
Key messages
Women from PSAC are more likely to breastfeed exclusively in the first day after delivery than Portuguese natives. They should be supported in the maintenance of optimal breastfeeding practices.
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Affiliation(s)
- C Lisi
- EPIUnit, Institute of Public Health of the University of Porto, Porto, Portugal
- Global Public Health Doctoral Programme, Faculty of Medicine of University of Porto, Porto, Portugal
| | - C Freitas
- EPIUnit, Institute of Public Health of the University of Porto, Porto, Portugal
- Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine of University of Porto, Porto, Portugal
| | - H Barros
- EPIUnit, Institute of Public Health of the University of Porto, Porto, Portugal
- Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine of University of Porto, Porto, Portugal
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24
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Hoang-Kim A, Parpia C, Freitas C, Austin PC, Ross HJ, Wijeysundera HC, Tu K, Mak S, Farkouh ME, Schull M, Rochon P, Mason R, Lee DS. P3518Men with heart failure have higher readmission rates: a closer review of sex and gender based analyses. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There has been increased attention on reducing hospital readmission rates. However, little is known about any difference in readmission rates in heart failure by sex, although evidence exists demonstrating differences in the etiology of heart failure. As a result, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear.
Purpose
(1) To identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender.
Methods
A scoping protocol was developed using the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. Our search strategy was reviewed according to the peer-review of electronic search strategy (PRESS) checklist. Full text articles published between 2002 and 2017 and drawn from multiple databases (i.e. MEDLINE, EMBASE), grey literature (i.e. National Technical Information, Duck Duck Go), and experts were consulted for additional articles. Screening criteria were established a priori. Once an acceptable inter-rater agreement was established at 80% by two independent reviewers, articles were screened for potential eligibility. A descriptive analytical method was employed to chart primary research articles. Articles were considered relevant if the cohort consisted of adult heart failure patients who were readmitted after an index hospitalization and a sex/gender-based analysis was performed.
Results
The literature search yielded 5887 articles, of which 746 underwent full text assessment for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies included disaggregated data for sex but no subsequent interaction was reported. Good inter-rater agreement was reached: 83% for title and abstract screening; 88% for full text review; kappa: 0.69 (95% CI: 0.526–0.851). Twelve of 34 studies included for the primary outcome reported higher readmission rates for men compared to five studies reporting higher readmission rates for women. However, there were differential readmission rates that were dependent on duration of follow-up. Women were more likely to experience higher readmission rates than men when time to event was less than one year. Readmission rates for men were higher when follow-up was longer than one year.
Conclusion
Sex differences in readmission rates were dependent on follow up time. Most studies used composite outcomes and had short times to event, which may mask underlying effects of sex on readmission.
Acknowledgement/Funding
Ontario SPOR Support Unit
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Affiliation(s)
| | - C Parpia
- Women's College Hospital, Toronto, Canada
| | - C Freitas
- University Health Network, Toronto, Canada
| | | | - H J Ross
- University Health Network, Toronto, Canada
| | | | - K Tu
- University Health Network, Toronto, Canada
| | - S Mak
- Mount Sinai Hospital of the University Health Network, Toronto, Canada
| | | | | | - P Rochon
- Women's College Hospital, Toronto, Canada
| | - R Mason
- Women's College Hospital, Toronto, Canada
| | - D S Lee
- University Health Network, Toronto, Canada
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25
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26
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Freitas C, Tavares N, Jacob M, Mendonça D, Oliveira P, Araújo D, Novais-Bastos H, Fernandes G, Magalhães A, Queiroga H, Hespanhol V. P1.04-59 Modified Glasgow Prognostic Score Predict Survival Among Non-Small Cell Lung Cancer Patients Treated with Immune Checkpoint Inhibitors. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Carneiro-Leão L, Gomes I, Freitas C, Costa E Silva M, Viseu R, Cernadas J. Multiple Drug Hypersensitivity Syndrome to Antituberculosis Drugs: A Case Report. J Investig Allergol Clin Immunol 2019; 30:70-71. [PMID: 31530510 DOI: 10.18176/jiaci.0446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L Carneiro-Leão
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - I Gomes
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - C Freitas
- Faculty of Medicine, University of Porto, Porto, Portugal.,Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - M Costa E Silva
- Dermatology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - R Viseu
- Immunology and Molecular Biology Lab, Allergy and Clinical Immunology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - J Cernadas
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Allergy and Clinical Immunology Unit, Hospital dos Lusíadas, Porto, Portugal
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28
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Jácome C, Marques F, Paixão C, Rebelo P, Oliveira A, Cruz J, Freitas C, Rua M, Loureiro H, Peguinho C, Simões A, Santos M, Valente C, Simão P, Marques A. Embracing digital technology in chronic respiratory care: Surveying patients access and confidence. Pulmonology 2019; 26:56-59. [PMID: 31160235 DOI: 10.1016/j.pulmoe.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- C Jácome
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.
| | - F Marques
- ESTGA - Águeda School of Technology and Management, Águeda, Portugal; IEETA - Institute of Electronics and Informatics Engineering of Aveiro, Aveiro, Portugal
| | - C Paixão
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - P Rebelo
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - A Oliveira
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - J Cruz
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; School of Health Sciences (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal
| | - C Freitas
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Rua
- Research Centre on Didactics and Technology in the Education of Trainers - CIDTFF, Aveiro, Portugal
| | - H Loureiro
- Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - C Peguinho
- Institute of Accounting and Administration, University of Aveiro (ISCA-UA), Aveiro, Portugal
| | - A Simões
- Câmara Municipal de Aveiro, Aveiro, Portugal
| | - M Santos
- Câmara Municipal de Mira, Mira, Portugal
| | - C Valente
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - P Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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29
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Cardoso L, Ribeiro K, Valadares S, Cecon P, Freitas C, Raimundi T, Pena Y, Pereira O. PSVIII-33 In vitro DM and NDF degradability of signal grass and forage peanut. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Cardoso
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - K Ribeiro
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - S Valadares
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - P Cecon
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - C Freitas
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - T Raimundi
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - Y Pena
- Universidade Federal de Vicosa, Viçosa, Brazil
| | - O Pereira
- Universidade Federal de Vicosa, Viçosa, Brazil
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30
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Freitas C, Ribeiro K, Valote P, Jaguaribe T, Abreu M, Sousa M, Morenz M, Gomide C. PSXI-3 Tussock dynamics in pastures of BRS Zuri and BRS Quênia under rotational stocking. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Freitas
- Universidade Federal de Viçosa, Viçosa, Brazil
| | - K Ribeiro
- Universidade Federal de Viçosa, Viçosa, Brazil
| | - P Valote
- Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - T Jaguaribe
- Federal University of Juiz de For a, Juiz de For a, Brazil
| | - M Abreu
- IFET Rio Pomba,Rio Pomba, Brazil
| | - M Sousa
- Federal University of Bahia,Salvador, Brazil
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31
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Donio P, Freitas C, Austin P, Ross H, Abdel-Qadir H, Wijeysundera H, Tu K, Cram P, Liu P, Abrams H, Udell J, Mak S, Farkouh M, Tu J, Wang X, Tobe S, Lee D. COMPARISON OF READMISSION AND DEATH AMONG CARDIAC PATIENTS IN NORTHERN VS. SOUTHERN ONTARIO. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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32
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Pereira A, Palma Dos Reis R, Monteiro J, Sousa JA, Rodrigues R, Neto M, Sousa AC, Freitas S, Rodrigues M, Freitas AI, Freitas C, Ornelas I, Drumond A, Mendonca MI. P934Gene-gene interaction in ischemic cardiopathy by MDR: beyond logistic regression. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Pereira
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal
| | - J Monteiro
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - R Rodrigues
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M Neto
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - C Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Funchal Hospital, Research Unit, Cardiology Department, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
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33
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Ponte Monteiro J, Mendonca MI, Pereira A, Sousa AC, Rodrigues R, Henriques E, Freitas S, Freitas AI, Freitas C, Ornelas I, Drumond A, Reis RP. P6188Predicting type 2 diabetes mellitus: combining a genetic risk score with traditional risk factors. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - M I Mendonca
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - A Pereira
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - A C Sousa
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - R Rodrigues
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - E Henriques
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - S Freitas
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - A I Freitas
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - C Freitas
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - I Ornelas
- Hospital Dr. Nélio Mendonça, Unidade de Investigação, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nélio Mendonça, Cardiology, Funchal, Portugal
| | - R P Reis
- University of Lisbon, Faculdade de Medicina Da Universidade de Lisboa, Lisbon, Portugal
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34
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Habal MV, Nanthakumar K, Austin PC, Freitas C, Labos C, Lee DS. Heart rate in patients with reduced ejection fraction: relationship between single time point measurement and mean heart rate on prolonged implantable cardioverter defibrillator monitoring. BMC Cardiovasc Disord 2018; 18:17. [PMID: 29385998 PMCID: PMC5793357 DOI: 10.1186/s12872-018-0751-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/18/2018] [Indexed: 11/25/2022] Open
Abstract
Background Heart rate (HR) is a prognostic marker that is increasingly used as a therapeutic target in patients with cardiovascular disease. The association between resting and mean HR remains unclear. We therefore set out to determine the relationship between resting HR on the electrocardiogram (ECG) obtained at a single time point, and mean HR on implantable cardioverter defibrillator (ICD) interrogation amongst patients with a reduced left ventricular ejection fraction (LVEF). Methods Prospective ICD data were obtained from 54 patients with LVEF < 40%. Mean HR determined using the ICD HR histograms was compared with resting HR measured on the ECG performed in the clinic. Results Average resting and ICD mean HRs were 67.9 ± 10.1 and 67.8 ± 9.6 bpm respectively. There was good correlation in the overall cohort (r = 0.79), in those with resting ECG HRs ≤ 70 bpm (r = 0.62), and amongst the 27 patients on intermediate-to-high dose beta-blockers (r = 0.91). However, Bland-Altman analysis demonstrated wide limits of agreement in the overall cohort (− 12.5, 12.7 bpm), at resting HRs ≤ 70 bpm (− 12.7, 9.8 bpm), and on intermediate-to-high dose beta-blockers (− 8.9, 7.4 bpm). Moreover, resting HR did not predict the 10-bpm interval where the most time was spent. Conclusions While resting HR correlated with mean HR in patients with reduced LVEF, and in important subgroups, the limits of agreement were unacceptably wide raising concern over the use of single time point resting HR as a therapeutic target. Electronic supplementary material The online version of this article (10.1186/s12872-018-0751-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Kumaraswamy Nanthakumar
- University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Peter C Austin
- University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Cassandra Freitas
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, Toronto, ON, Canada
| | | | - Douglas S Lee
- University of Toronto, Toronto, ON, Canada. .,Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Ted Rogers Centre for Heart Research, Toronto, ON, Canada. .,University Health Network, Toronto General Hospital, 200 Elizabeth Street, 4NU-482, Toronto, ON, M5G 2C4, Canada.
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35
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Irwin G, Freitas C, McIntosh S, Savage K. BRCA ‘variants of unknown significance’ need regular review to facilitate optimal patient management. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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36
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Pereira A, Palma dos Reis R, Rodrigues R, Sousa AC, Gomes S, Borges S, Ornelas I, Freitas AI, Guerra G, Henriques E, Rodrigues M, Freitas S, Freitas C, Brehm A, Pereira D, Mendonça MI. Association of ADAMTS7 gene polymorphism with cardiovascular survival in coronary artery disease. Physiol Genomics 2016; 48:810-815. [DOI: 10.1152/physiolgenomics.00059.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/08/2016] [Indexed: 12/13/2022] Open
Abstract
Recent genetic studies have revealed an association between polymorphisms at the ADAMTS7 gene locus and coronary artery disease (CAD) risk. Functional studies have shown that a CAD-associated polymorphism (rs3825807) affects ADAMTS7 maturation and vascular smooth muscular cell (VSMC) migration. Here, we tested whether ADAMTS7 (A/G) SNP is associated with cardiovascular (CV) survival in patients with established CAD. A cohort of 1,128 patients with angiographic proven CAD, who were followed up prospectively for a mean follow-up period of 63 (range 6–182) mo, were genotyped for rs3825807 A/G. Survival statistics (Cox regression) compared heterozygous (AG) and wild-type (AA) with the reference homozygous GG. Kaplan-Meier (K-M) survival curves were performed according to ADAMTS7 genotypes for CV mortality. Results showed that 47.3% of patients were heterozygous (AG), 36.5% were homozygous for the wild-type allele (AA) and only 16.2% were homozygous for the GG genotype. During the follow-up period, 109 (9.7%) patients died, 77 (6.8%) of CV causes. Survival analysis showed that AA genotype was an independent risk factor for CV mortality compared with reference genotype GG (HR = 2.7, P = 0.025). At the end of follow-up, the estimated survival probability (K-M) was 89.8% for GG genotype, 82.2% for AG and 72.3% for AA genotype ( P = 0.039). Carriage of the mutant G allele of the ADAMTS7 gene was associated with improved CV survival in patients with documented CAD. The native overfunctional ADAMTS7 allele (A) may accelerate VSMC migration and lead to neointimal thickening, atherosclerosis progression and acute plaque events. ADAMTS7 gene should be further explored in CAD for risk prediction, mechanistic and therapeutic goals.
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Affiliation(s)
- A. Pereira
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - R. Palma dos Reis
- Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal; and
| | - R. Rodrigues
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - A. C. Sousa
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - S. Gomes
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - S. Borges
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - I. Ornelas
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - A. I. Freitas
- Laboratory of Human Genetics, Madeira University, Campus da Penteada, Funchal, Madeira, Portugal
| | - G. Guerra
- Laboratory of Human Genetics, Madeira University, Campus da Penteada, Funchal, Madeira, Portugal
| | - E. Henriques
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - M. Rodrigues
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - S. Freitas
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - C. Freitas
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - A. Brehm
- Laboratory of Human Genetics, Madeira University, Campus da Penteada, Funchal, Madeira, Portugal
| | - D. Pereira
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
| | - M. I. Mendonça
- Funchal Hospital Center, Research Unit and Cardiology Department, Funchal, Madeira, Portugal
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37
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Freitas C, Deschênes S, Au B, Smith K, Schmitz N. Risk of Diabetes in Older Adults with Co-Occurring Depressive Symptoms and Cardiometabolic Abnormalities: Prospective Analysis from the English Longitudinal Study of Ageing. PLoS One 2016; 11:e0155741. [PMID: 27227974 PMCID: PMC4882076 DOI: 10.1371/journal.pone.0155741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 05/03/2016] [Indexed: 11/18/2022] Open
Abstract
High depressive symptoms and cardiometabolic abnormalities are independently associated with an increased risk of diabetes. The purpose of this study was to assess the association of co-occurring depressive symptoms and cardiometabolic abnormalities on risk of diabetes in a representative sample of the English population aged 50 years and older. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item binary Centre for Epidemiologic Studies–Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Multiple imputation by chained equations was performed to account for missing data. Covariates included age, sex, education, income, smoking status, physical activity, alcohol consumption, and cardiovascular comorbidity. The follow-up period consisted of 106 months, during which 193 participants reported a diagnosis of diabetes. Diabetes incidence rates were compared across the following four groups: 1) no or low depressive symptoms and no cardiometabolic abnormalities (reference group, n = 2717); 2) high depressive symptoms only (n = 338); 3) cardiometabolic abnormalities only (n = 1180); and 4) high depressive symptoms and cardiometabolic abnormalities (n = 219). Compared to the reference group, the hazard ratio for diabetes was 1.29 (95% CI 0.63, 2.64) for those with high depressive symptoms only, 3.88 (95% CI 2.77, 5.44) for those with cardiometabolic abnormalities only, and 5.56 (95% CI 3.45, 8.94) for those with both high depressive symptoms and cardiometabolic abnormalities, after adjusting for socio-demographic, lifestyle and clinical variables. These findings suggest that those with high depressive symptoms and cardiometabolic abnormalities are at a particularly increased risk of type 2 diabetes.
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Affiliation(s)
- Cassandra Freitas
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
- * E-mail:
| | - Sonya Deschênes
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Bonnie Au
- Primary Care Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kimberley Smith
- Department of Life Sciences, Brunel University London, Uxbridge, Middlesex, England
| | - Norbert Schmitz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Abstract
IntroductionClassical homocystinuria (cystathionine beta synthase deficiency) is a rare autosomal recessive disease of methionine metabolism that causes accumulation of homocysteine in the blood and cysteine deficiency. It is characterized by intellectual disability, ectopia lentis, skeleton abnormalities resembling Marfan syndrome and thromboembolic episodes. The majority of patients have psychiatric disturbances as depression, behavioral disorders, personality disorders, obsessive-compulsive disorder and, less commonly, bipolar disorder and psychosis.Objectives and aimsTo briefly review psychiatric disturbances in patients with homocystinuria and present a case report.MethodsLiterature research and analysis of patient's clinical data.ResultsA 22-year-old male was diagnosed with classical homocystinuria at age 4 due to intellectual disability and renal alterations. With aging, other problems emerged: epilepsy; postural tremor; dysesthesia; ectopia lentis; orofacial myofunctional disorder; asthma; and patellar instability. He went to a special education program. At age sixteen, he initiated Child Psychiatry consultations due to anxiety and behavioral changes, as difficulty in controlling impulses, establishing relationships and in the perception of the self. Nowadays, the patient is followed in psychiatric consultations, where he has demonstrated high difficulty to empathize. He is being treated with vitamin supplements; betaine; levetiracetam; clobazam; and propranolol, combined with a special diet.ConclusionsIt is not practical to screen every psychiatric patient for Homocystinuria, but this disease should be considered when there is a family history, early and/or acute onset, intellectual disability, atypical symptoms, unusual response to treatment, progressive cognitive change and other organic disturbances present in this disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Abstract
Obsessive-compulsive disorder (OCD) is a severe mental illness that causes significant stress in children and adolescents. It is possible to infer three distinct etiologies – neurobiology, environment and dysfunctional interpretative patterns. Certain characteristics are attributable to OCD with onset in childhood or adolescence as higher prevalence in males, increased frequency of isolated compulsions (more cleaning, repeating and checking), higher rate of aggressive obsessions and more common accumulation behaviors. There are several psychiatric comorbidities associated with OCD like anxiety disorder and major depression. The first-line treatment in OCD is the association of a selective serotonin reuptake inhibitor (SSRI) and individual psychotherapy.The authors reviewed the clinical records of patients diagnosed with OCD observed in a child and adolescence psychiatry liaison consultation between April and September 2015, inclusive, aiming to characterize the sample, to describe the typical clinical picture and to evaluate the existence of physical and/or psychiatric comorbidities, comparing the results with those expected in literature.The typical patient profile found was a 12-year-old male, living with relatives, with no neonatal complications, with stable home environment, without family psychiatric history, with associated medical comorbidities, with age of onset symptoms at 10.5 years-old, with only an obsession (contamination), with only a compulsion (cleaning or checking), with psychiatric comorbidities, treated with SSRI and without psychologyaccompaniment.There are some limitations that must be taken into account because the sample was taken from a liaison psychiatry consultation, but in general terms, the results were similar to those described in the literature.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Freitas C, Mendes A, Queirós S. The role of modified states of consciousness in drug use. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Modified state of consciousness (MSC) is defined as a mental state that can be subjectively recognized by an individual or by an objective observer of the individual, as representing a difference in the psychological functioning of the “normal” state, alert and awake of the individual. Drugs are products with definitions and conceptual boundaries, historically defined. The use of psychoactive drugs is related to the increased plasticity of human subjectivity which is reflected in various technical means to change the perception, cognition, affect and mood. The authors propose to conduct a literature review on the types of MSC, the way to achieve them and their implications in drug consumption pattern.A MSC consists of dimensions such as self-oceanic limitlessness, agonizing self-dissolution and visionary restructuring.Normal MSC includes dreams, hypnagogic state and sleep. Others may be induced by hypnosis, meditation or psychoactive substances. Those achieved by drugs allow the subject to access feelings and sensations which go beyond the everyday reality or, on the other hand, leakage of reality.Anthropological studies show that in almost all civilizations, man sought ways to induce MSC.What characterizes the problematic or abusive use of certain substances is not necessarily the amount and frequency of drug use, but the disharmony in the socio-cultural, family and psychosocial contexts of the individual.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Freitas C, Figueiredo A, Abreu T, Queirós S. Paraphrenia: Evolution of the Concept. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Paraphrenia was identified as a psychopathological entity characterized by chronic delirium, described next to schizophrenia, but with rich and fanciful elaborations, without social and cognitive impairment associated. Despite having been extensively described, paraphrenia fell into disuse. With this work, the authors intend to carry out a literature review on the concept of paraphrenia, since its first report to the extinction from the current practice of psychiatry. The term paraphrenia (para “near” phrenia “pathological mental state”) was first noted by Kahlbaum in 1863, who identified dementia and subdivided it into three types: “neofrenia”, “paraphrenia hebetica” and “senilis paraphrenia”). Magnan and Manager suggested the concept of “chronic hallucinatory psychosis” in 1963, while Kraepelin started jobs with similar characteristics, defining the concept of paraphrenia. Kraepelin distinguished dementia praecox from the later onset dementia, despite considering them closer to one another than any of them to paranoia. Paraphrenia would be characterized by less formal disturbances of thought and greater preservation of affection. In 1911, with “schizophrenia” expression, Bleuler broke with Kraepelin concept, as Mayer, who reviewed Kraepelin patients, concluding that more than half had progressed to a diagnosis of schizophrenia. At this time, paraphrenia was virtually abolished from the practice of psychiatry. Despite the observations made over the years, the concept of paraphrenia have revealed that the description proposal does not correspond to an isolated and distinct psychiatric condition, several times, in clinical practice we have encountered with patients presenting diagnostic criteria for schizophrenia but with the evolution of the disease showing no significant deterioration in several areas.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Freitas C, Deschênes S, Au B, Smith K, Schmitz N. Evaluating lifestyle and health-related characteristics of older adults with co-occurring depressive symptoms and cardiometabolic abnormalities. Int J Geriatr Psychiatry 2016; 31:66-75. [PMID: 25827712 DOI: 10.1002/gps.4290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Comorbid depression and cardiometabolic abnormalities might represent an important subgroup of depression. The aim of the present study was to evaluate lifestyle and health-related characteristics of individuals with both depressive symptoms and cardiometabolic abnormalities. METHODS Data were from the English Longitudinal Study of Ageing. The sample was comprised of 5365 adults aged 50-80 years. High depressive symptoms were based on the eight-item Center for Epidemiologic Studies - Depression scale. Cardiometabolic abnormalities were defined as having ≥3 cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, hypertriglyceridemia, and central obesity). Four groups were created based on Center for Epidemiologic Studies - Depression scores and cardiometabolic abnormalities: those with (i) comorbid depressive symptoms and cardiometabolic abnormalities (DCM); (ii) depressive symptoms only (DnoCM); (iii) cardiometabolic abnormalities only; and (iv) neither depressive symptoms nor cardiometabolic abnormalities. Lifestyle and health-related characteristics of the four groups were compared using chi-square tests. A modified Poisson regression analysis was performed to compare the DCM and the DnoCM groups with respect to lifestyle and health-related characteristics. RESULTS Those in the DCM group were significantly less physically active (p = 0.003), had poorer self-rated health (p < 0.001), had lower income (p = 0.001), and were more likely to be retired (p < 0.001) than those in the DnoCM group. The pattern of results remained after controlling for other lifestyle and health-related factors. CONCLUSION These results provide support for a cardiometabolic subgroup of depression that is associated with physical inactivity, poorer self-rated health, lower income, and retirement. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Cassandra Freitas
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Sonya Deschênes
- Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Bonnie Au
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Kimberley Smith
- Department of Life Sciences, Brunel University London, Uxbridge, Middlesex, England
| | - Norbert Schmitz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Abreu T, Freitas C, Oliveira G. Not What It Seems – Delusional Misidentification Syndromes. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Freitas C, Macedo S, Queirós S. Manic Episode Induced by Endogenous Hypercortisolism. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Freitas C, Abreu T, Queirós S. From Perfectionism to Mental Illness. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sales JNS, Iguma LT, Batista RITP, Quintão CCR, Gama MAS, Freitas C, Pereira MM, Camargo LSA, Viana JHM, Souza JC, Baruselli PS. Effects of a high-energy diet on oocyte quality and in vitro embryo production in Bos indicus and Bos taurus cows. J Dairy Sci 2015; 98:3086-99. [PMID: 25726114 DOI: 10.3168/jds.2014-8858] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022]
Abstract
The effects of different dietary energy levels [100 and 170% for maintenance (M) and high energy (1.7M), respectively] on metabolic, endocrine, and reproductive parameters were evaluated in nonlactating Bos indicus (Gir; n=14) and Bos taurus (Holstein; n=14) cows submitted to ultrasound-guided ovum pick-up followed by in vitro embryo production. The oocyte donor cows were housed in a tiestall system and fed twice daily (0800 and 1600 h). Twenty-one days before the beginning of the experiment, the animals were fed with a maintenance diet for adaptation followed by the experimental diets (M and 1.7M), and each cow underwent 9 ovum pick-up procedures 14 d apart. The recovered oocytes were cultured in vitro for 7 d. We measured glucose and insulin concentrations and performed glucose tolerance tests and the relative quantification of transcripts (PRDX1, HSP70.1, GLUT1, GLUT5, IGF1R, and IGF2R) from the oocytes recovered at the end of the experimental period. No interactions were observed between the effects of genetic groups and dietary energy level on the qualitative (viable oocytes, quality grade, and oocyte quality index) and quantitative (oocytes recovered) oocyte variables. There were no effects of dietary energy level on the qualitative and quantitative oocyte variables. However, Bos indicus cows had greater numbers of recovered structures, viable oocytes, and A and B oocyte grades as well as better oocyte quality index scores and lower DNA fragmentation rates compared with Bos taurus donors. In vitro embryo production (cleavage and blastocyst rates and number of embryos) was similar between diets, but the 1.7M diet reduced in vitro embryo production in Bos indicus cows after 60 d of treatment. Moreover, Bos indicus cows on the 1.7M diet showed lower transcript abundance for the HSP70.1, GLUT1, IGF1R, and IGF2R genes. All cows fed 1.7M diets had greater glucose and insulin concentrations and greater insulin resistance according to the glucose tolerance test. In conclusion, increasing dietary energy did not interfere with oocyte numbers and quality, but the 1.7M diet reduced in vitro embryo production in Bos indicus cows after 60 d of treatment. Finally, Bos indicus cows had greater oocyte quality, greater numbers of viable oocytes and greater in vitro embryo yield than Bos taurus.
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Affiliation(s)
- J N S Sales
- Department of Animal Reproduction, Faculdade de Medicina Veterinaria e Zootecnia, Universidade de São Paulo (FMVZ-USP), Rua Prof. Orlando Marques de Paiva, 87, 05508-000 São Paulo, SP, Brazil; Department of Veterinary Medicine, Departamento de Medicina Veterinaria (DMV), Universidade Federal de Lavras, 37200-000, Lavras, MG, Brazil.
| | - L T Iguma
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | | | - C C R Quintão
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | - M A S Gama
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | - C Freitas
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | - M M Pereira
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | - L S A Camargo
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | - J H M Viana
- EMBRAPA Gado de Leite, 36038-330 Juiz de Fora, MG, Brazil
| | - J C Souza
- Department of Veterinary Medicine, Departamento de Medicina Veterinaria (DMV), Universidade Federal de Lavras, 37200-000, Lavras, MG, Brazil
| | - P S Baruselli
- Department of Animal Reproduction, Faculdade de Medicina Veterinaria e Zootecnia, Universidade de São Paulo (FMVZ-USP), Rua Prof. Orlando Marques de Paiva, 87, 05508-000 São Paulo, SP, Brazil.
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Monteiro E, Lopes V, Dantas M, Freitas C, Pinto-de-Sousa J. Frontal totalmente expuesto: ¿y ahora? Cir plást iberolatinoam 2014. [DOI: 10.4321/s0376-78922014000400012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fonseca F, Freitas C, Dutra L, Guimarães R, Carvalho O. Spatial modeling of the schistosomiasis mansoni in Minas Gerais State, Brazil using spatial regression. Acta Trop 2014; 133:56-63. [PMID: 24521991 DOI: 10.1016/j.actatropica.2014.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/19/2013] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
Schistosomiasis is a transmissible parasitic disease caused by the etiologic agent Schistosoma mansoni, whose intermediate hosts are snails of the genus Biomphalaria. The main goal of this paper is to estimate the prevalence of schistosomiasis in Minas Gerais State in Brazil using spatial disease information derived from the state transportation network of roads and rivers. The spatial information was incorporated in two ways: by introducing new variables that carry spatial neighborhood information and by using spatial regression models. Climate, socioeconomic and environmental variables were also used as co-variables to build models and use them to estimate a risk map for the whole state of Minas Gerais. The results show that the models constructed from the spatial regression produced a better fit, providing smaller root mean square error (RMSE) values. When no spatial information was used, the RMSE for the whole state of Minas Gerais reached 9.5%; with spatial regression, the RMSE reaches 8.8% (when the new variables are added to the model) and 8.5% (with the use of spatial regression). Variables representing vegetation, temperature, precipitation, topography, sanitation and human development indexes were important in explaining the spread of disease and identified certain conditions that are favorable for disease development. The use of spatial regression for the network of roads and rivers produced meaningful results for health management procedures and directing activities, enabling better detection of disease risk areas.
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Brem AK, Schilberg L, Freitas C, Atkinson N, Seligson E, Pascual-Leone A. Synergistic effects of rTMS and cognitive training in Alzheimer's Disease. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schilberg L, Atkinson N, Seligson E, Gold E, Freitas C, Vidrin I, Brem AK, Pascual-Leone A. P 170. Characterization of brain plasticity in Diabetes Type II and Alzheimer’s disease supports link between both diseases. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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