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Magalhães V, Severo M, Costa SA, Correia D, Carvalho C, Torres D, Casal S, Cunha S, Lopes C. Bisphenol A and cardiometabolic risk in adolescents: Data from the Generation XXI cohort. Nutr Metab Cardiovasc Dis 2024; 34:1088-1096. [PMID: 38403484 DOI: 10.1016/j.numecd.2024.01.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS Bisphenol A (BPA), an endocrine disruptor widely used in food contact materials, has been linked to a worse health profile. This study intends to estimate the association between BPA exposure and cardiometabolic patterns at adolescence. METHODS AND RESULTS Data from the Portuguese population-based birth cohort Generation XXI at the age of 13 were used (n = 2386 providing 3-day food diaries and fasting blood samples). BPA exposure was measured in 24-h urine from a subsample (n = 206) and then predicted in all participants using a random forest method and considering dietary intake from diaries. Three cardiometabolic patterns were identified (normal, modified lipid profile and higher cardiometabolic risk) using a probabilistic Gaussian mixture model. Multinomial regression models were applied to associate BPA exposure (lower, medium, higher) and cardiometabolic patterns, adjusting for confounders. The median BPA exposure was 1532 ng/d, corresponding to 29.4 ng/kg/d. Adolescents higher exposed to BPA (compared to medium and lower levels) had higher BMI z-score (kg/m2) (0.68 vs. 0.39 and 0.52, respectively; p = 0.008), higher levels of body fat (kg) (16.3 vs. 13.8 and 14.6, respectively; p = 0.002), waist circumference (76.2 vs. 73.7 and 74.9, respectively; p = 0.026), insulinemia (ug/mL) (14.1 vs. 12.7 and 13.1, respectively; p = 0.039) and triglyceridemia (mg/dL) (72.7 vs. 66.1 and 66.5, respectively; p = 0.030). After adjustment, a significant association between higher BPA and a higher cardiometabolic risk pattern was observed (OR: 2.55; 95%CI: 1.41, 4.63). CONCLUSION Higher BPA exposure was associated with a higher cardiometabolic risk pattern in adolescents, evidencing the role of food contaminants in health.
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Affiliation(s)
- Vânia Magalhães
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Sofia Almeida Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Daniela Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Catarina Carvalho
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Duarte Torres
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Susana Casal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; LAQV-REQUIMTE - Laboratório de Bromatologia e Hidrologia, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Sara Cunha
- LAQV-REQUIMTE - Laboratório de Bromatologia e Hidrologia, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
| | - Carla Lopes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Vieira L, Carvalho C, Grilo A, Reis J, Pires AF, Pereira E, Carolino E, Almeida-Silva M. Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis. Radiography (Lond) 2024; 30:589-604. [PMID: 38330892 DOI: 10.1016/j.radi.2024.01.014] [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: 08/25/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI. METHODS A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023. RESULTS Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group. CONCLUSION Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective. IMPLICATIONS FOR PRACTICE MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.
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Affiliation(s)
- L Vieira
- H&TRC, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal.
| | - C Carvalho
- H&TRC, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal.
| | - A Grilo
- H&TRC, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal; Centro de Investigação em Ciência Psicológica, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal.
| | - J Reis
- Escola Superior de Música de Lisboa, Instituto Politécnico de Lisboa, Campus de Benfica do IPL, Lisbon 1500-651, Portugal; Instituto de Etnomusicologia - Centro de Estudos de Música e Dança, Faculdade de Ciências Sociais e Humanas, Universidade Nova de Lisboa, Lisboa, Av. De Berna, 26 C 1069-061, Lisboa, Portugal.
| | - A F Pires
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal.
| | - E Pereira
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal; Nuclearmed - Instituto de Medicina Nuclear, R. Manuel Febrero 85, 2805-192, Almada, Portugal.
| | - E Carolino
- H&TRC, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal.
| | - M Almeida-Silva
- H&TRC, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, Parque das Nações, 1990-096 Lisboa, Portugal; OSEAN-Outermost Regions Sustainable Ecosystem for Entrepreneurship and Innovation, 9000-082 Funchal, Portugal.
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Sousa S, Santos S, Alves CM, Gonçalves G, Carvalho C, Duarte R. Impact of annual TB screening on stone quarry workers in high-incidence Portuguese municipalities. Int J Tuberc Lung Dis 2024; 28:136-141. [PMID: 38454185 DOI: 10.5588/ijtld.23.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
SETTING The Portuguese municipalities of Penafiel and Marco de Canaveses are high TB incidence areas, where stone quarry workers represent a vulnerable population.OBJECTIVE To assess the annual rate of TB infection (ARI) in stone quarry workers and to compare it with the TB notification rate in the general community.DESIGN An annual TB infection screening strategy using interferon-gamma release assay (IGRA) was implemented in 2018 for workers from high-risk stone quarries. A prospective cohort was enrolled and workers screened in periods of 2 years were included. IGRA-positive workers were referred for preventive treatment. ARI was calculated as the proportion of workers with IGRA conversion.RESULTS Of the 232 IGRA-negative workers in 2018, 20 tested positive in 2019 (8.6% ARI). Of 171 IGRA-negative workers in 2019, eight tested positive in 2021 (4.7% in 2 years). Two of the 150 IGRA-negative workers in 2021 tested positive in 2022 (1.3% ARI). ARI decreased by 84.9% between 2019 and 2022. In the two municipalities, the TB notification rate declined 23.9% between 2018 and 2021.CONCLUSION A more pronounced reduction in ARI was observed among stone quarry workers regularly screened for TB infection compared to the notification rate among the general population in high-incidence municipalities. A screening strategy for high-risk populations, together with enforced community measures, could foster risk reduction in the community..
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Affiliation(s)
- S Sousa
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Estudo das Populações, ICBAS, Universidade do Porto, Porto
| | - S Santos
- Northern Regional Health Administration, Porto
| | - C M Alves
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Instituto Superior Ave, Amares
| | - G Gonçalves
- Public Health Unit, Unidade Local de Saúde do Médio Ave, Vila Nova de Famalicão
| | - C Carvalho
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto
| | - R Duarte
- Estudo das Populações, ICBAS, Universidade do Porto, Porto, EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Serviço de Pneumologia, Unidade Local de Saúde de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Smith S, Ravikumar R, Carvalho C, Normahani P, Lane T, Davies AH. Neuromuscular electrical stimulation for the treatment of diabetic sensorimotor polyneuropathy: A prospective, cohort, proof-of-concept study. Neurophysiol Clin 2024; 54:102943. [PMID: 38422719 DOI: 10.1016/j.neucli.2024.102943] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN). METHODS In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one daily 30-minute NMES therapy session (Revitive® IX) for 10 weeks, with 20 patients completing the study. The primary outcome measure was nerve conductivity assessed using a nerve conduction study of the sural, superficial peroneal, common peroneal and tibial nerves at 10 weeks compared to baseline. Secondary outcomes included superficial femoral artery (SFA) haemodynamics during NMES therapy compared to rest and quality-of-life at 10 weeks compared to baseline. RESULTS At 10 weeks, there were significant increases in sural sensory nerve action potential amplitude and conduction velocity (p < 0.001), superficial peroneal sensory nerve action potential amplitude (p = 0.001) and conduction velocity (p = 0.002), common peroneal nerve conduction velocity (p = 0.004) and tibial nerve compound muscle action potential amplitude (p = 0.002) compared to baseline. SFA volume flow and time-averaged mean velocity significantly increased (p ≤ 0.003) during NMES compared to rest. Patient-reported Michigan Neuropathy Screening Instrument scores significantly decreased (p = 0.028) at 10 weeks compared to baseline. Three unrelated adverse events occurred, and 15 participants adhered to treatment. CONCLUSIONS NMES therapy as an adjunct to standard care for 10 weeks significantly increased lower limb nerve conductivity in patients with DSPN and may be beneficial in the treatment of DSPN.
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Affiliation(s)
- Sasha Smith
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Raveena Ravikumar
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Catarina Carvalho
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Pasha Normahani
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom.
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Carvalho C, Correia MR, Barros A, Rocha R, Banquart-Leitão J, Carvalho F, Marinho AS. Pushing Backwards: Evaluating Effectiveness of Conservative Treatment of Intestinal Intussusception. Pediatr Emerg Care 2024; 40:114-118. [PMID: 38295193 DOI: 10.1097/pec.0000000000003117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Intestinal intussusception (II) is a common cause for acute abdomen in children, occurring in 0.33 to 0.71 per 1000 children per year. Early diagnosis and treatment are fundamental for prevention of irreversible intestinal damage. The first line of treatment is conservative, with saline reduction enema or air reduction enema. Our goal is to evaluate results with conservative treatment of II in children. METHODS A retrospective single-center review of all patients with diagnosis of II from January 2014 to December 2019 was performed. Demographics, clinical data, treatment option, and results were assessed. RESULTS Thirty-eight cases were identified. The mean age was 26 months, and 68% were males. Most presented with abdominal pain (95%) and vomiting (66%), after an average of 30 hours. Rectal bleeding was present in 32% of patients. Abdominal ultrasound was performed in all patients for diagnosis. Conservative treatment was first option in 95% of patients, with a global effectiveness of 83% after 1 attempt. Saline reduction enema was more effective than air reduction enema (88% vs 70%), and patients with successful reduction were younger (24 vs 33 months), but neither reached statistical significance. Two patients had a subsequent II episode within 1 week after hospital discharge. Neither age, sex, symptoms and respective duration, rotavirus inoculation, intussuscepted bowel length, nor technique used was predictive of treatment failure or II relapse. CONCLUSIONS Conservative treatment in II is a safe and effective option, preventing invasive surgical procedures. Effectiveness of such treatments may be as high as 88% after 1 attempt, with rapid diet reintroduction. Same-day discharge after oral feeding toleration is safe.
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Affiliation(s)
- Catarina Carvalho
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto
| | - Mário Rui Correia
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto
| | - Ana Barros
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto
| | - Rúben Rocha
- Department of Pediatric Emergency, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Banquart-Leitão
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto
| | - Fátima Carvalho
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto
| | - Ana Sofia Marinho
- From the Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto
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Carvalho C, Morandi A, Samuk I, Gine C, Gorter R, Martinez-Urrutia MJ, Vilanova-Sánchez A. Anatomical variations of the external genitalia in posterior cloaca: clinical consequences of misdiagnosis. A systematic review of the literature and the ARM-net Consortium experience. Eur J Pediatr Surg 2024. [PMID: 38216143 DOI: 10.1055/a-2244-4551] [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: 01/14/2024]
Abstract
PURPOSE All types of cloacal malformations may be associated with anatomic variations of the external genitalia, including hypoplasia of the labia minora and enlarged clitoris; these variations could be even higher in posterior cloacas (PC). If a careful physical examination is not performed, patients may be misdiagnosed with ambiguous genitalia, leading to subsequent unnecessary testing, surgeries or even wrong gender assignment. The aim was to analyze data of patients with PC within the ARM-Net registry, focusing on the description of the genitalia, gender assignment and its consequences. Additionally, we investigated the presence of ambiguous genitalia (AG) diagnosis in utero or at birth in patients with PC in the literature. METHODS The ARM-Net registry was scanned for PC cases and data on diagnosis were collected. A systematic literature search was conducted using the PubMed, EMbase, and Web-of-Science databases. Descriptive statistics was used to report data. RESULTS Nine patients with PC were identified in the ARM-Net registry. Five patients (55%) were diagnosed with AG, two (22%) were assigned as males and only 2 patients were correctly assigned as females and diagnosed with PC with respective variations of external genitalia. All patients diagnosed with AG had extensive blood testing including karyotype and hormonal studies. One of the patients who was diagnosed as a male, had surgery for pelvic cystic mass removal, which ultimately led to unaware salpingo-oophorectomy, hysterectomy, and vaginectomy. In the literature we identified 60 patients, 14 (23%) with AG, 1 with clitorolabial transposition and 1 with undeveloped vulva and vagina; 4 patients had normal anatomy. In forty (67%) patients the anatomy of genitalia was not mentioned. Conclusion Patients with PC are at high risk of being diagnosed with AG or even assigned the wrong gender at birth. In our series two patients were assigned as males, and consequently one of them underwent a highly mutilating surgery. A thorough physical examination together with a high index of suspicion and lab workup are mandatory to identify these variations, avoiding further investigations, unnecessary surgeries, and parental stress.
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Affiliation(s)
- Catarina Carvalho
- Pediatric Surgery, Centro Hospitalar Universitário do Porto EPE Centro Materno-Infantil do Norte Dr Albino Aroso, Porto, Portugal
- Pediatric surgery, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Anna Morandi
- Pediatric Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Inbal Samuk
- Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Carlos Gine
- Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Childrens' Hospital UMC, Amsterdam, Netherlands
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Sousa S, Macedo R, Alves CM, Carvalho C, Gonçalves G, Duarte R. Coffee shops, a hub for TB clusters? Pulmonology 2024; 30:71-74. [PMID: 37236905 DOI: 10.1016/j.pulmoe.2023.04.007] [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] [Received: 04/06/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- S Sousa
- Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, ICBAS-UP, Porto, Portugal.
| | - R Macedo
- National Reference Laboratory for Mycobacteria, Department of Infectious Diseases, National Institute of Health (INSA), Lisbon, Portugal
| | - C M Alves
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Northern Regional Health Administration, Portugal
| | - C Carvalho
- Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, ICBAS-UP, Porto, Portugal
| | - G Gonçalves
- Public Health Unit, ACeS Ave-Famalicão, ARS Norte, Health Ministry, Portugal
| | - R Duarte
- Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, ICBAS-UP, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Fu MX, Carvalho C, Milan-Chhatrisha B, Gadi N. Stereotactic Body Radiotherapy for Management of Pulmonary Oligometastases in Stage IV Colorectal Cancer: A Perspective. Clin Colorectal Cancer 2023; 22:402-410. [PMID: 37748936 DOI: 10.1016/j.clcc.2023.09.001] [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: 03/22/2022] [Revised: 02/05/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
In pulmonary oligometastases from colorectal cancer (POM-CRC), metastasectomy is the primarily recommended treatment. Stereotactic body radiotherapy (SBRT) has been suggested as a viable alternative therapy. SBRT efficacy for POM-CRC is poorly delineated compared to selected non-CRC primaries. This perspective article aims to critically summarize the existing evidence regarding efficacy of SBRT in terms of overall survival (OS) and local control (LC), and factors modulating this, in the treatment of POM-CRC. Overall, reasonable LC and OS rates were observed. The wide range of expansions in planning target volume margins introduced variation in pretreatment protocols. Dose-fractionation schedules varied according to patient and tumor characteristics, though leverage of BED10 in select studies enabled standardization. An association between SBRT dose and improved OS and LC was observed across multiple studies. Prognostic factors that were associated with improved LC included: fewer oligometastases, absence of extra-pulmonary metastases, primary tumor histology, and smaller gross tumor volume. Differences in SBRT modality and techniques over time further confounded results. Many studies included patients receiving additional systemic therapies; preprotocol and adjuvant chemotherapies were identified as prognostic factors for LC. SBRT compared with metastasectomy showed no differences in short-term OS and LC outcomes. In conclusion, SBRT is an efficacious treatment for POM-CRC, in terms of OS and LC. Heterogeneity in study design, particularly pertaining to dose protocols, patient selection, and additional therapies should be controlled for future randomized studies to further validate SBRT efficacy.
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Affiliation(s)
- Michael X Fu
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | - Catarina Carvalho
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Bella Milan-Chhatrisha
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nishita Gadi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Sentís A, Prats-Uribe A, Peixoto VR, Caylà JA, Gomes MD, Sousa S, Duarte R, Carvalho I, Carvalho C. Decline of tuberculosis notification rate in different populations and regions in Portugal, 2010-2017. Pulmonology 2023; 29 Suppl 4:S36-S43. [PMID: 34544672 DOI: 10.1016/j.pulmoe.2021.08.002] [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: 06/14/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. METHODS We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010-2017, disaggregated by region, age group, nationality and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. RESULTS The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). CONCLUSIONS The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.
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Affiliation(s)
- A Sentís
- Epiconcept, Epidemiology Department, Paris, France; Pompeu Fabra University (UPF), Barcelona, Spain
| | - A Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - V R Peixoto
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
| | - J A Caylà
- Foundation of Tuberculosis Research Unit of Barcelona, Spain
| | - M D Gomes
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal
| | - S Sousa
- National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal; Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - R Duarte
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal; Pulmonology Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | - I Carvalho
- National Tuberculosis Programme, Directorate-General of Health, Lisbon, Portugal; Pediatric Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | - C Carvalho
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.
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10
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Costa SA, Severo M, Correia D, Carvalho C, Magalhães V, Vilela S, Cunha S, Casal S, Lopes C, Torres D. Methodological approaches for the assessment of bisphenol A exposure. Food Res Int 2023; 173:113251. [PMID: 37803563 DOI: 10.1016/j.foodres.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/27/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/08/2023]
Abstract
Bisphenol A (BPA) is an endocrine disruptor used in food contact materials, by the application of polycarbonate plastics and epoxy resins. The main objective of this study is to compare the estimate of daily BPA exposure at 13 years of age and in the adult Portuguese population, using different methodological approaches, and assess the associations between this exposure and sociodemographic characteristics. METHODOLOGY Cross-sectional data of 13-years follow-up from a population-based birth cohort Generation XXI (GXXI) (n = 2804) and from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) (n = 3845, ≥18 years old) was used. Dietary information was collected through three food diaries for adolescents and two non-consecutive 24-hour-recalls for adults. To estimate the daily exposure to BPA, three methodological approaches were used. "Food groups attribution" merged the food consumption data with the concentration of BPA in food groups. "Regression tree model" and "random forest" combined food consumption information with urinary BPA, measured in a subsample of 24-hour urine (in adolescents n = 216, and in adults n = 82), both used to predict BPA exposure in the remaining sample. The fit-index of the methodologies was assessed through the root mean square error (RMSE), mean absolute error (MAE) and Spearman correlation coefficient (ρ). Associations between BPA exposure and sociodemographic variables were tested by linear regression models, adjusted for sex, age groups (in adults) and educational level. Tolerable Daily Intake (TDI) of 0.2 ng/kg body weight (bw), recently proposed by the European Food Safety Authority (EFSA), was used for the risk characterization of BPA exposure. RESULTS The "random forest" was found as the best methodology to estimate the daily BPA exposure (adolescents: RMSE = 0.989, MAE = 0.727, ρ = 0.168; adults: RMSE = 0.193, MAE = 0.147, ρ = 0.250). The median dietary BPA exposure, calculated by "food groups attribution", was 79.1 and 46.1 ng/kg bw/day for adolescents and adults, respectively, while "random forest" estimated a BPA exposure of 26.7 and 38.0 ng/kg bw/day. 99.9% of the Portuguese population presented a daily exposure above TDI. Male adolescents, females and higher educated adults, were those more exposed to BPA. CONCLUSIONS The estimated daily BPA exposure strongly depends on the methodological approach. Food groups attribution may overestimate the exposure while the random forest appears to be a better methodological approach to estimate BPA exposure. Nevertheless, for all methods, the Portuguese population presented an unsafe BPA exposure by largely exceeding the safe levels proposed by EFSA.
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Affiliation(s)
- Sofia Almeida Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Daniela Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro Porto, 4200-319 Porto, Portugal
| | - Catarina Carvalho
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Vânia Magalhães
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Sofia Vilela
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Sara Cunha
- LAQV-REQUIMTE, Laboratório de Bromatologia e Hidrologia, Faculdade de Farmácia, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Susana Casal
- LAQV-REQUIMTE, Laboratório de Bromatologia e Hidrologia, Faculdade de Farmácia, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Carla Lopes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro Porto, 4200-319 Porto, Portugal
| | - Duarte Torres
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
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Sousa S, Alves CM, Macedo R, Carvalho C, Gonçalves G, Duarte R. An investigation of TB infection and reinfection among stone quarry workers. Pulmonology 2023; 29:570-572. [PMID: 37263863 DOI: 10.1016/j.pulmoe.2023.05.004] [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: 04/28/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- S Sousa
- Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, ICBAS-UP, Porto, Portugal.
| | - C M Alves
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Northern Regional Health Administration, Portugal
| | - R Macedo
- National Reference Laboratory for Mycobacteria, Department of Infectious Diseases, National Institute of Health (INSA), Lisbon, Portugal
| | - C Carvalho
- Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, ICBAS-UP, Porto, Portugal
| | - G Gonçalves
- Public Health Unit, ACeS Ave-Famalicão, ARS Norte, Health Ministry, Portugal
| | - R Duarte
- Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, ICBAS-UP, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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12
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Biscotti P, Del Bo' C, Carvalho C, Torres D, Reboul E, Pellegrini B, Vinelli V, Polito A, Censi L, Porrini M, Martini D, Riso P. Can the Substitution of Milk with Plant-Based Drinks Affect Health-Related Markers? A Systematic Review of Human Intervention Studies in Adults. Nutrients 2023; 15:nu15112603. [PMID: 37299566 DOI: 10.3390/nu15112603] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The consumption of plant-based drinks (PBDs) in substitution for cow's milk (CM) is increasing due to concerns for human and planet health and animal welfare. The present review aims to analyze the main findings from intervention trials investigating the effect of PBDs in comparison with CM on markers of human health. Suitable articles published up to July 2022 were sourced from PubMed and Scopus databases. A total of 29 papers were collected, with 27 focusing on soy drinks (1 of which also evaluated the effects of an almond drink), while only 2 focused on rice drinks. Among studies focused on soy drinks, the most investigated factors were anthropometric parameters (n = 13), the lipid profile (n = 8), markers of inflammation and/or oxidative stress (n = 7), glucose and insulin responses (n = 6) and blood pressure (n = 4). Despite some evidence of a beneficial effect of PBDs, especially for the lipid profile, it was not possible to draw any overall conclusions due to some conflicting results. As well as the low number of studies, a wide heterogeneity was found in terms of the characteristics of subjects, duration and markers, which reduces the strength of the available results. In conclusion, further studies are needed to better elucidate the effects of substituting CM with PBDs, especially in the long term.
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Affiliation(s)
- Paola Biscotti
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
| | - Cristian Del Bo'
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
| | - Catarina Carvalho
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
| | - Duarte Torres
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal
| | - Emmanuelle Reboul
- Aix-Marseille Université, INRAE, INSERM, C2VN, 13885 Marseille, France
| | - Beatrice Pellegrini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
| | - Valentina Vinelli
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
| | - Angela Polito
- Council for Agricultural Research and Economics-Research Centre for Food and Nutrition, 00178 Rome, Italy
| | - Laura Censi
- Council for Agricultural Research and Economics-Research Centre for Food and Nutrition, 00178 Rome, Italy
| | - Marisa Porrini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
| | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
| | - Patrizia Riso
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy
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13
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Carvalho C, Severo M, Correia D, Lopes C, Torres D. Meat or meatless meals at lunch and dinner – exploring the associated factors and transition between meals. Int J Food Sci Nutr 2023:1-12. [PMID: 36971097 DOI: 10.1080/09637486.2023.2190504] [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] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
This study aimed to explore the factors associated with the consumption of meat vs. meatless meals and to assess the applicability of a multi-state model to describe transitions between lunch and dinner. Fifteen thousand four hundred and eight main meals (lunch and dinner) from a sample of adults (18-84 years, n = 3852) from the Portuguese Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) were categorised as meat, fish, ovolactovegetarian or snack. Adjusted generalised-mixed-effects models were used to explore the associations and a time-homogeneous Markov-multi-state model was applied to study the transitions. Women, older and higher educated individuals presented higher odds of consuming meatless meals and lower hazard of transitioning to meat in the following main meal. Strategies for replacing meat with more sustainable foods should be specific towards different population groups. Studying transitions across main meals, using multi-state models, can support the development of feasible, realistic and group-specific strategies to replace meat and promote dietary variety.
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Carvalho C, Marinho AS, Sequeira JB, Banquart-Leitão J, Carvalho F. Primary focal hyperhidrosis in children: Are we improving their lives? Australas J Dermatol 2023; 64:e84-e86. [PMID: 36349454 DOI: 10.1111/ajd.13950] [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] [Received: 07/24/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Catarina Carvalho
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Sofia Marinho
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Barbosa Sequeira
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Banquart-Leitão
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Fátima Carvalho
- Pediatric Surgery Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
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15
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Carvalho C, Lopes-Rodrigues S, Lopes Dos Santos J, Sousa C, Preto AS. Fatty-Ligament Appendage Torsion: A Harmless Cause of Upper Abdominal Pain in Children. J Pediatr 2023; 252:219-220. [PMID: 36044937 DOI: 10.1016/j.jpeds.2022.08.042] [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] [Received: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Catarina Carvalho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - José Lopes Dos Santos
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Sousa
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Sofia Preto
- Department of Radiology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Policiano C, Mendes JM, Fonseca A, Barros J, Vargas S, Cal M, Martins I, Carvalho C, Martins D, Clode N, Graca LM. Routine Ultrasound at 30th-33rd weeks versus 30th-33rd and 35th-37th weeks in Low-Risk Pregnancies: A Randomized Trial. Fetal Diagn Ther 2022; 49:425-433. [PMID: 36535245 DOI: 10.1159/000527112] [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: 02/23/2022] [Accepted: 09/12/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the accuracy of 35-37 weeks' ultrasound for fetal growth restriction (FGR) detection and the impact of 30th-33rd weeks versus 30th-33rd and 35th-37th weeks' ultrasound on perinatal outcomes. METHODS This was a randomized controlled trial that enrolled 1,061 low-risk pregnant women: 513 in the control group (routine ultrasound performed at 30th-33rd weeks) and 548 in the study group (with an additional ultrasound at 35th-37th weeks). FGR was defined as a fetus with an estimated fetal weight (EFW) below the 10th percentile. p values < 0.05 were considered statistically significant. RESULTS The ultrasound at 35-37 weeks had an overall accuracy of FGR screening of 94%. Spearman's correlation coefficient between EFW and birthweight centile was higher for at 35-37 weeks' ultrasound (ρ = 0.75) compared with 30-33 weeks' ultrasound (ρ = 0.44). The study group had a lower rate of operative vaginal deliveries (24.4% vs. 39.3%, p = 0.005) and cesarean deliveries for nonreassuring fetal status (16.8% vs. 38.8%, p < 0.001). DISCUSSION/CONCLUSION A later ultrasound (35-37 weeks) had a high accuracy for detection of FGR and had a higher correlation between EFW and birthweight centiles. Furthermore, it was also associated with lower adverse perinatal outcomes compared to an earlier ultrasound.
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Affiliation(s)
- Catarina Policiano
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal.,Faculty of Medicine of University of Lisbon, CAM- Academic Center of Medicine of Lisbon, Lisbon, Portugal
| | | | - Andreia Fonseca
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal
| | - Joana Barros
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal.,Faculty of Medicine of University of Lisbon, CAM- Academic Center of Medicine of Lisbon, Lisbon, Portugal
| | - Sara Vargas
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal
| | - Margarida Cal
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal
| | - Inês Martins
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal
| | - Catarina Carvalho
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal.,Faculty of Medicine of University of Lisbon, CAM- Academic Center of Medicine of Lisbon, Lisbon, Portugal
| | - Diana Martins
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal
| | - Nuno Clode
- Department of Obstetrics and Gynecology, CHLN - University Hospital of Santa Maria, Lisbon, Portugal
| | - Luis M Graca
- Faculty of Medicine of University of Lisbon, CAM- Academic Center of Medicine of Lisbon, Lisbon, Portugal
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Carvalho C, Marinho AS, Barbosa-Sequeira J, Correia MR, Banquart-Leitão J, Carvalho F. Quality of life after otoplasty for prominent ears in children. Acta Otorrinolaringologica (English Edition) 2022:S2173-5735(22)00118-1. [DOI: 10.1016/j.otoeng.2022.11.004] [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] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022]
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18
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Rodrigues J, Sá A, Fontes R, Barbosa A, Barbosa-Martins J, Oliveira C, Peixoto M, Santos S, Rocha J, Almeida M, Carvalho C, Queiroz L, Fernandes R, Faustino I, Portela C, Coutinho C, Nabiço R. Anxiety and depression screening during neoadjuvant chemotherapy treatment in early breast cancer patients: a multicenter longitudinal observational study. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01446-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Barbosa-Sequeira J, Correia MR, Carvalho C, Paupério G, Carvalho F. Mediastinal Teratoma In Children - Case Report. Port J Card Thorac Vasc Surg 2022; 29:71-74. [PMID: 36197831 DOI: 10.48729/pjctvs.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/24/2022] [Indexed: 06/16/2023]
Abstract
Mediastinal teratomas presenting in the pediatric age are extremely rare. We report three cases of mediastinal teratomas in children aged 15 months to 9 years. Patients were submitted to complete tumor resection, with an uneventful postoperative course and follow-up. Our report emphasizes the importance of a detailed patient examination and careful interpretation of routinely performed image studies.
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Affiliation(s)
- Joana Barbosa-Sequeira
- Pediatric Surgery Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Mário Rui Correia
- Pediatric Surgery Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Catarina Carvalho
- Pediatric Surgery Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
| | - Gonçalo Paupério
- Thoracic Surgery Department, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal
| | - Fátima Carvalho
- Pediatric Surgery Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Portugal
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Rocha Carvalho P, Monteiro J, Carvalho C, Mateus P, Goncalves F, Fontes P, Moreira JI. Utility of the Age Shock Index in 27312 patients with an acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1483] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The Shock Index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), represents a bedside reflection of the integrated response from the cardiovascular and autonomic systems and has been reported to predict adverse prognosis in patients with acute coronary syndromes (ACS).
Age Shock Index (ASI), the product of SI multiplied with age, could also be useful in this setting, but its prognostic value is yet to be determined in ACS patients.
Methods
Acute myocardial infarction patients included in a national registry between October 2010 and January 2022. Optimal shock index cutoff was determined according to ROC curve analysis. Patients were categorized into two groups based on their initial ASI. Baseline characteristics, management and outcomes were compared between the two groups. The primary outcome was in-hospital cardiovascular death.
Results
A total of 27312 patients were included with a mean age of 66±13 years, 72.3% male, 47.5% with ST-elevation myocardial infarction. Based on ROC analysis, which showed AUC=0.80, the optimal ASI cutoff was 44 (with a sensitivity of 73% and a specificity of 74%); 19997 patients (73.2%) had an ASI <44 and 26.8% had an ASI ≥44. The former group was older (mean age of 75±10.0 vs 63±13.0 years, p<0.001), and had more comorbidities: arterial hypertension (77.3% vs 66.3%, p<0.001), diabetes mellitus (39.8% vs 28.1%, p<0.001), peripheral artery disease (7.1% vs 4.4%, p<0.001) and previous history of heart failure (11.0% vs 4.3%, p<0.001).
Patients with ASI ≥44 had higher Killip class at admission and worse left ventricular ejection fraction on discharge (46.0±13.0 vs 53.0±11.0, p<0.001).
In a multivariate regression analysis, after adjusting for possible confounders, ASI ≥44 was an independent predictor of cardiovascular death (HR 3.09, 95% CI: 2.56–3.71, p<0.001).
ASI was a significantly better predictor of cardiovascular death than Shock Index (AUCASI = 0,80 vs AUCSI = 0.72, p<0,0001), but not in comparison to GRACE score (AUCASI=0.80 vs AUCGRACE=0.85, p<0.001) and TIMI (score AUCASI=0.80 vs AUCGRACE=0.84, p<0.001).
At one year, using a Kaplan Meyer survival analysis, mortality was higher in patients with ASI ≥44 (log rank p<0.001)
Conclusion
ASI can identify almost immediately ACS patients at high risk of cardiovascular death, and combined with its simple use, makes it a practical tool for early risk stratification in these patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Rocha Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J Monteiro
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - C Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - P Mateus
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - F Goncalves
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - P Fontes
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J I Moreira
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
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21
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Carvalho C, Monteiro J, Carvalho P, Baptista A, Moreira J. Beta-blockers in acute coronary syndrome: does rhythm matter? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1392] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Beta-blockers (BB) are recommended in patients with previous acute myocardial infarction (AMI), aiming to reduce morbidity and mortality. Their benefit is greater in patients with associated left ventricular dysfunction. However, in patients with atrial fibrillation (AF) its prognostic benefit is controversial.
Purpose
To assess and compare the in-hospital and 1-year prognostic impact of BB prescription after acute coronary syndrome (ACS), in patients with previous or de novo AF, and in patients with sinus rhythm (SR).
Methods
This was a national multicentre retrospective study of patients hospitalized for ACS between October 2010 and December 2021. A total of 35279 patients was included, and divided in two groups according to the prescription or not of BB. Patients with previous history of ischemic heart disease (myocardial angina, AMI or coronary revascularization) or heart failure, as well as presenting in Killip class IV or submitted to coronary artery bypass graft during admission were excluded. The impact of BB prescription on in-hospital and 1 year mortality rates, in patients with AF versus SR, was compared.
Results
A total of 14906 patients was selected, 82.5% with and 17.5% without BB prescription. Most patients were in SR (90.2%), with 9.8% presenting previous or new-onset AF.
Patients without BB prescription were older (67±14 vs. 63±13 years) and had more comorbidities, namely valvular disease (2.3% vs. 1.2%, p<0.001) and chronic pulmonary obstructive disease (7.1% vs. 3.1%). The mean left ventricular ejection fraction was 53±13% in patients without BB prescription and 52±11 in the group with BB prescription (p<0.001). In-hospital and after discharge BB prescription was less frequent in AF patients (80.2% vs. 82.5% and 74.7% vs. 78.8%, respectively).
The in-hospital mortality rate was 2.2%, 1.3% in the BB group and 6.6% in patients without BB prescription (p<0.001). At 1 year, mortality rate increased to 5.1%.
BB prescription was associated with lower in-hospital mortality rate regardless of the rhythm, with an 81% risk reduction in SR (OR = 0.19, 95% CI 0.14–0.24) and 79% in AF patients (OR = 0.21, 95% CI 0.13–0.35). In a multivariate regression analysis, after adjusting for all the possible confounders, in-hospital BB prescription was associated with 70% of mortality risk (OR = 0.30, 95% CI 0.23–0.35).
Overall, after discharge BB prescription was associated with reduced 1-year mortality risk (HR = 0.57, 95% CI 0.44–0.73), although it didn't reach statistical significance in AF patients (p=0.413). Nevertheless, in a bivariate Cox regression, rhythm showed no impact on BB protective effect (p-interaction = 0.335). As expected, AF had a negative prognostic impact (HR = 3.85, 95% CI 2.66–5.02).
Conclusion
BB prescription was associated with reduced in-hospital and 1 year mortality rates. The prognostic benefit of BB therapy was equivalent in ACS patients in sinus rhythm and with previous or new-onset AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J Monteiro
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - P Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - A Baptista
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J Moreira
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
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22
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Monteiro JJ, Chemba JM, Carvalho P, Carvalho C, Bernardo M, Moreira I, Ribeiro H, Moreira JI. Positive predictive value of the crusade score for bleeding events in patients with acute coronary syndromes on dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1393] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Crusade score (CS) quantifies intrahospital major bleeding (IHMB) risk in patients admitted with acute coronary syndrome (ACS). Hemorrhagic risk after ACS increases with age, although, it's not considered in score estimation.
Purpose
Evaluate CS ability to predict IHBM risk according to different patient ages (higher or lower than 75 years) admitted with ACS diagnosis and submitted to double antiagreggation therapy with acetylsalicylic acid and Clopidogrel.
Methods
A retrospective study based on the Portuguese National Registry of ACS, including patients (pts) hospitalized with ACS and treated with double antiagreggation therapy with acetylsalicylic acid (AAS) and clopidogrel between October 2010 and January 2021 (n=8401). Were excluded patients submitted to coronary artery bypass grafting, with ticagrelor or prasugrel switch to clopidogrel during hospitalization.
Patients were divided into two groups according to their age (above or below 75 years) and then subdivided in 5 groups according to CS category of IHBM risk estimation: very low (CS ≤20, 3,1% risk predicted by the score), low (21 ≤ CS≤30, 5,5%), moderate (31 ≤ CS≤40, 8,6%), high (41 ≤ CS≤50, 11,9%) and very high risk (CS≥51, 19,5%). Then, the incidence of IHMB observed in each group during hospitalization (mean 5 days) was compared to the IHBM risk predicted by the CS.
Results
The IHMB rate was 1.78%, significantly lower than predicted by the Crusade score (7.1%, p<0.001). Bleeding rates in each group of patients (above or below 75 years and according to CS calculation are depicted in Figure 1. CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years (see Figure 2).
Conclusion
As shown in different literature, crusade score overestimate bleeding risk after ACS compared to real-life cohorts. Despite the same trend observed in our cohort of patients, in this retrospective study, CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years in patients submitted to double antiaggregation with AAS and clopidogrel.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J J Monteiro
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J M Chemba
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - P Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - C Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - M Bernardo
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - I Moreira
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - H Ribeiro
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J I Moreira
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
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23
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Rocha Carvalho P, Moreira I, Carvalho C, Bernardo M, Monteiro J, Fontes P, Moreira JI. The diastolic blood pressure U-curve. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2228] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
It is known that low diastolic blood pressure (DBP) at admission is associated with short-term cardiovascular events after acute coronary syndrome (ACS). However, there is a lack of further investigation into the nonlinear relationship between admission diastolic blood pressure (DBP) and adverse outcomes of ACS patients.
Objective
To investigate the relationship between admission diastolic blood pressure and subsequent cardiovascular mortality in patients with acute coronary syndrome.
Methods
Retrospective study of patients with ACS periodically included in our center registry between October/2012 and September/2018. Patients with class killip 4 at admission or that needed ionotropic support during hospitalization were excluded. The association between admission DBP and cardiovascular mortality during the follow-up period among this population was analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 70 mm Hg; Q2, from 71 to 80 mm Hg; Q3, from 81 to 90 mm Hg; Q4, above 90 mmHg.
Results
A total of 548 patients were included in this cohort study. Mean patient age was 65.9±13.1 years and 75.2% were men. A nonlinear relation was observed between DBP at admission and cardiovascular mortality over the follow-up.
During a median follow-up of 42 months (IQR: 27–59), 47 patients (8.6%) died from cardiovascular causes. After adjusting for potential confounders (age and diabetes mellitus), patients in Q3 had the lowest risk for cardiovascular death by Cox proportional hazard model (HR 0.44; 95% CI: 0.16–1.00). Meanwhile, compared with Q1, Q3 patients had significantly lower risk for cardiovascular death (HR 0.35, 95% CI: 0.13–0.92).
Conclusion
Among patients admitted for ACS, there is a U curve relationship between admission DBP and risk for cardiovascular death. These results could be explained by a reduction in diastolic coronary blood flow which influences myocardial oxygen supply relative to the necessary demand in an ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Rocha Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - I Moreira
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - C Carvalho
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - M Bernardo
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J Monteiro
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - P Fontes
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
| | - J I Moreira
- Hospital Center of Tras-os-Montes and Alto Douro , Vila Real , Portugal
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24
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Bramatti I, Carvalho C, Branco V. P16-08 Effect of ethylmercury-containg thimerosal over hypoxia-related factors in glioblastoma cells. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.598] [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: 10/14/2022]
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25
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Soares J, Carvalho C, Silva AD. A systematic review on career interventions for university students: Framework, effectiveness, and outcomes. Australian Journal of Career Development 2022. [DOI: 10.1177/10384162221100460] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study presents a systematic literature review about career interventions for university students exploring (1) which theoretical framework; (2) structure; (3) evaluation system; and (4) outcomes are reported. Fourteen keywords, five databases, and six eligibility criteria were defined. Among the 596 articles collected, 26 remained for meta-synthesis. Results indicated a predominance of (1) three theoretical frameworks, (2) group intervention modality, (3) pre-and post-test evaluation system, and (4) the positive development of skills in decision-making. Recommendations are presented to guide future research and practice in the field. For example, this study indicates the importance of providing updated information about the world of work within career interventions or educational programs.
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26
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Carvalho F, Macedo A, Manão A, Cabacos C, Azevedo J, Marques C, Marques M, Carneiro M, Telles Correia D, Novais F, Carvalho C, Araújo A, Pereira A. Further Validation of the Short Form of the Self-Compassion Scale in a sample of Portuguese Medicine Students. Eur Psychiatry 2022. [PMCID: PMC9565275 DOI: 10.1192/j.eurpsy.2022.472] [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 The Short Form of the Self-Compassion Scale (SCS-SF; Raes et al. 2011) is composed of 12 items that evaluate the same six dimensions (Self-Kindness/SK, Self-Judgement/SJ, Common Humanity/CH, Isolation, Mindfulness/M, Over-Identification/OI) as the long scale (26 items). The Portuguese version of the SCS-SF (Castilho et al. 2015) was validated in a vast sample from clinical and general populations, the latter being composed of students, other than from medicine courses. Objectives To analyze the psychometric properties of the Portuguese version of the SCS-SF in a sample of Medicine/Dentistry students. Methods Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the SCS and other validated questionnaires from the OECD Study on Social and Emotional Skills/SSES: Stress resistance, Emotional control, Optimism and Persistence. Results Confirmatory Factor Analysis showed that the model composed of six factors, two second order factors (positive and negative) and one third order factor (total) presented good fit indexes (χ2/df=3.013; RMSEA=.0066, p<.001; CFI=.970; TLI=.948, GFI=.947). The Cronbach’s alfas were .892, .869 and .877 respectively for the total, self-compassion and self-criticism dimension. Pearson correlations of the SCS-SF total score, self-compassion and self-criticism dimensional scores were moderate to high with the SSES measures, from .272/-.236/.247 with Persistence to .709/-.634/.615 with Optimism. Conclusions Although reduced to less than half than the original SCS, the SCS–SF is a valid and useful alternative to measure general self-compassion and their positive and negative components in an ongoing longitudinal research with medicine/dentistry students. Disclosure No significant relationships.
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27
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Carvalho C, Correia D, Severo M, Magalhães V, Casal S, Ramos E, Lopes C, Torres D. Dietary exposure to artificial sweeteners and associated factors in the Portuguese population. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2022; 39:1206-1221. [PMID: 35604339 DOI: 10.1080/19440049.2022.2075039] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to evaluate the risk of the Portuguese population's exposure to six non-nutritive intense sweeteners (NNIS) and their main associated factors. A tiered approach was used to estimate the usual exposure to the NNIS obtained from two 1-day food diaries among children and two 24-hour recalls among adults in the Portuguese national dietary survey (IAN-AF 2015-2016; age: 3-84 y; n = 5005). The tiers considered were the following: Tier 2.1 represents the most conservative tier, in which all foods reported were matched with the respective maximum permitted levels (MPLs); in Tier 2.2, the MPLs were attributed only to the foods for which the brand's label information identified the presence of an added NNIS; finally, Tier 3 was identical to Tier 2.2, but analytical NNIS occurrence data were used, instead of MPLs. The usual exposure of the Portuguese population to each NNIS was very low in all tiers across all age groups, as was the estimated prevalence of exposure above the acceptable daily intake. Soft drinks were the main source of exposure for most sweeteners, and acesulfame K and aspartame were the most consumed NNIS. The odds of exposure to at least one NNIS were higher in more highly educated adults and elderly, obese elderly, women, and people with lower healthy diet scores. The estimated risk of exceeding the safety levels of NNIS intake was very low in all evaluated population groups, even when considering the most conservative approach.
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Affiliation(s)
- Catarina Carvalho
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Daniela Correia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Vânia Magalhães
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Susana Casal
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Farmácia, LAQV/REQUIMTE, Laboratório de Bromatologia e Hidrologia, Universidade do Porto, Porto, Portugal
| | - Elisabete Ramos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carla Lopes
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Duarte Torres
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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28
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Pinheiro TA, Monteiro J, Pinho R, Carvalho C, Monteiro V. O Papel do Médico na Abordagem de uma Criança com Dificuldades de Aprendizagem. Gaz Med 2022. [DOI: 10.29315/gm.v9i2.588] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A dificuldade de aprendizagem constitui um dos principais motivos de referenciação à consulta de neurodesenvolvimento. Este problema, para além de afetar a criança, envolve também a família, escola e os profissionais de saúde. As crianças com dificuldades de aprendizagem têm maior risco de insucesso escolar. A falta de intervenção adequada numa criança com dificuldades de aprendizagem pode ter consequências tanto no seu desenvolvimento psicomotor, quanto no percurso académico e profissional futuros. A avaliação médica da criança com dificuldades de aprendizagem requer uma abordagem sistematizada das áreas neurocognitivas e comportamentais, assim como das características sociofamiliares, com o objetivo de identificar e orientar disfunções que podem ser responsáveis pelos compromissos observados. As dificuldades de aprendizagem são frequentemente complexas na sua etiologia e orientação terapêutica, necessitando de intervenções multiprofissionais e prolongadas no tempo, com impacto significativo na criança e sua família. A articulação do médico, e de outros profissionais de saúde envolvidos, com a comunidade educativa, através da partilha autorizada de informações relevantes, pode ajudar no planeamento nas medidas educativas a serem instituídas pela escola.
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29
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Costa SA, Correia D, Carvalho C, Vilela S, Severo M, Lopes C, Torres D. Risk characterization of dietary acrylamide exposure and associated factors in the Portuguese population. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2022; 39:888-900. [PMID: 35286252 DOI: 10.1080/19440049.2022.2047540] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acrylamide exposure, mainly resulting from food cooking and processing, has been associated with a higher risk of health problems, due to genotoxic effects. This study aims to estimate acrylamide dietary exposure of the Portuguese population and its associated factors. Dietary data collected through 2 non-consecutive 24 hour recalls or food diaries from a representative sample of the Portuguese population from the National Food, Nutrition and Physical Activity Survey was used (n = 5811; 3-84 years). Occurrence data of acrylamide in food were obtained from EFSA. The margins of exposure (MOE) were calculated for peripheral neuropathy and neoplastic effects. The association between acrylamide and socio-demographic characteristics was estimated through linear regression models. For the total population, the estimated median daily dietary exposure per body weight to acrylamide was 0.38 µg/kg/day, ranging from 0.14 to 0.88 µg/kg/day for the 5th and 95th percentile, respectively. Children aged between 1-2 years had the highest acrylamide exposure (median 0.75 µg/kg/day, 95th percentile 1.41 µg/kg/day). For the peripheral neuropathy and neoplastic effects, the median MOE estimated was 1140 and 451, respectively. Men compared to women had a higher acrylamide dietary exposure, as well as smokers compared to non-smokers. Elderly and less educated individuals were inversely associated with acrylamide exposure. 'Bread and rusks' (24.2%) were the main source of acrylamide, followed by 'coffee' (21.3%). The current dietary exposure to acrylamide in the Portuguese population is of concern mainly regarding neoplastic effects. Our results point to the need to reduce exposure to acrylamide, especially in men, young children, higher educated individuals and smokers.
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Affiliation(s)
- Sofia Almeida Costa
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Daniela Correia
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto Alameda Prof. Hernâni Monteiro Porto, Porto, Portugal
| | - Catarina Carvalho
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Sofia Vilela
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto Alameda Prof. Hernâni Monteiro Porto, Porto, Portugal
| | - Carla Lopes
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto Alameda Prof. Hernâni Monteiro Porto, Porto, Portugal
| | - Duarte Torres
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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30
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Affiliation(s)
- Filipa Lima Coelho
- Radiology, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
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31
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Díaz-Tocados S, Rodríguez-Ortiz ME, Almadén Y, Carvalho C, Frazão JM, Rodríguez M, Muñoz-Castañeda JR. Efecto de una dieta rica en calcio sobre el metabolismo mineral y óseo en ratas. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000100006] [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: 12/05/2022] Open
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Carvalho C, Marinho AS, Barbosa-Sequeira J, Correia MR, Banquart-Leitão J, Carvalho F. Compensatory sweating after thoracoscopic sympathectomy for primary focal hyperhidrosis in children: Are there patient-related risk factors? J Pediatr Surg 2022; 57:203-206. [PMID: 34815104 DOI: 10.1016/j.jpedsurg.2021.10.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Compensatory sweating (CS) is a common complication after thoracoscopic sympathectomy (TS) and is mainly associated with surgical technique. Our aim was to identify potential risk-factors for CS following TS for primary focal hyperhidrosis in children. METHODS A retrospective, single-center review of all bilateral TS was performed between 2017 and 2019. Hyperhidrosis disease severity scale was used for pre-operative severity assessment. Post-operative evaluations were performed after three and six months. RESULTS More than the 36-month period, 41 patients were submitted to T2-T4 TS, and 25 were females (60.9%). Median age at surgery was 15.5 years. CS was identified at the 3rd month in 17 (41%) children with most in the dorsolumbar region (56%). By the 6th month, there was a significant reduction in CS (41 to 32%, p = 0.02). The probability of resolution of CS by 6 months is about 50% in both the dorsolumbar and abdominal regions. Neither age, gender, body mass index, family history, or concomitant illnesses seemed to influence CS (p > 0.05). Axillary hyperhidrosis appears to be associated with the development of dorsolumbar CS (p = 0.037). CONCLUSION Thoracoscopic sympathectomy for PFH is a safe and effective procedure, but compensatory sweating can be a common and debilitating side effect. Age, gender, and body mass index do not appear to influence CS. Axillary hyperhidrosis may be related to the development of dorsolumbar CS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Catarina Carvalho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal.
| | - Ana Sofia Marinho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - Joana Barbosa-Sequeira
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - Mário Rui Correia
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - José Banquart-Leitão
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
| | - Fátima Carvalho
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto, Rua da Maternidade, Porto 4050-371, Portugal
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Magalhães J, Quelhas-Santos J, Pereira L, Neto R, Castro-Ferreira I, Martins S, Frazão JM, Carvalho C. Could Bone Biomarkers Predict Bone Turnover after Kidney Transplantation?—A Proof-of-Concept Study. J Clin Med 2022; 11:jcm11020457. [PMID: 35054152 PMCID: PMC8780588 DOI: 10.3390/jcm11020457] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
Aim: Bone disease after kidney transplant (KT) results from multiple factors, including previous bone and mineral metabolism disturbances and effects of transplant-related medications. New biomolecules have been recently associated with the development and progression of the chronic kidney disease–associated bone and mineral disorder (CKD-MBD). These include sclerostin and the soluble receptor activator of nuclear factor-kB ligand (sRANKL). Methods: To better understand the role of biomarkers in post-transplant bone disease, this study was designed to prospectively evaluate and correlate results from the histomorphometric analysis of bone biopsies after KT with emerging serum biomarkers of the CKD-MBD: sclerostin, Dickkopf-related protein 1 (Dkk-1), sRANKL and osteo-protegerin (OPG). Results: Our data shows a significant increase in plasma levels of bioactive sclerostin after KT accompanied by a significant reduction in plasma levels of Dkk-1, suggesting a promotion of the inhibition of bone formation by osteoblasts through the activation of these inhibitors of the Wnt signaling pathway. In addition, we found a significant increase in plasma levels of free sRANKL after KT accompanied by a significant reduction in plasma levels of its decoy receptor OPG, suggesting an enhanced bone resorption by osteoclasts mediated by this mechanism. Conclusions: Taken together, these results suggest that the loss of bone volume observed after KT could be explain mainly by the inhibition of bone formation mediated by sclerostin accompanied by an enhanced bone resorption mediated by sRANKL.
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Affiliation(s)
- Juliana Magalhães
- Nephrology and Infectious Diseases Research Group, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), University of Porto, 4200-135 Porto, Portugal; (J.M.); (L.P.); (R.N.); (I.C.-F.); (J.M.F.)
- Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal;
| | | | - Luciano Pereira
- Nephrology and Infectious Diseases Research Group, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), University of Porto, 4200-135 Porto, Portugal; (J.M.); (L.P.); (R.N.); (I.C.-F.); (J.M.F.)
- Nephrology Department, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
| | - Ricardo Neto
- Nephrology and Infectious Diseases Research Group, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), University of Porto, 4200-135 Porto, Portugal; (J.M.); (L.P.); (R.N.); (I.C.-F.); (J.M.F.)
- Nephrology Department, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
| | - Inês Castro-Ferreira
- Nephrology and Infectious Diseases Research Group, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), University of Porto, 4200-135 Porto, Portugal; (J.M.); (L.P.); (R.N.); (I.C.-F.); (J.M.F.)
- Nephrology Department, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
| | - Sandra Martins
- Centro Hospitalar de São João and EPI Unit, Clinical Pathology Department, Institute of Public Health, University of Porto, 4200-319 Porto, Portugal;
| | - João Miguel Frazão
- Nephrology and Infectious Diseases Research Group, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), University of Porto, 4200-135 Porto, Portugal; (J.M.); (L.P.); (R.N.); (I.C.-F.); (J.M.F.)
- Nephrology Department, Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
| | - Catarina Carvalho
- Nephrology and Infectious Diseases Research Group, Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), University of Porto, 4200-135 Porto, Portugal; (J.M.); (L.P.); (R.N.); (I.C.-F.); (J.M.F.)
- Correspondence: ; Tel.: +351-226-074900; Fax: +351-226-094567
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Pina Cabral J, Sousa DL, Carvalho C, Girao A, Pacheco Mendes A, Pina R. Caffeine Intoxication: Unregulated, Over-the-Counter Sale of Potentially Deadly Supplements. Cureus 2022; 14:e21045. [PMID: 35155012 PMCID: PMC8824417 DOI: 10.7759/cureus.21045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/15/2022] Open
Abstract
Caffeine is an integral part of beverages, food, and medications. Severe intoxication of caffeine is rare, and reports are even scarcer. However, over-the-counter, unregulated sale of performance-enhancing compounds, such as caffeine, turns high-dose consumption into a real concern. Severe intoxication may be fatal, usually by malignant cardiac arrhythmia. We report a case of a 23-year-old university student who accidentally consumed about 100 times the amount present in an expresso of anhydrous caffeine.
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Marinho AS, Barbosa-Sequeira J, Carvalho C, Carvalho F, Paupério G. PLEURAL METASTASIS OF A PEDIATRIC OSTEOSARCOMA. Port J Card Thorac Vasc Surg 2022; 28:55-57. [PMID: 35334173 DOI: 10.48729/pjctvs.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 06/14/2023]
Abstract
Osteosarcoma is the most common primary bone tumor in children and young adults. Although osteosarcoma is a tumor with a great metastatic potential, mainly to the lung; pleural metastasis in patients with osteosarcoma are rarely reported. We present a case of 16 years-old male with a pleural metastasis of a tibial osteosarcoma diagnosed 4years earlier. He was submitted to a left thoracotomy and intra-operatively a pleural mass and a left upper lobe lesion was identified. Video-assisted resection of the extra-pulmonary mass and a wedge resection of the left upper lobe lesion was performed. The surgery was uneventful. The patient is clinically well, asymptomatic, maintains active surveillance.
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Affiliation(s)
- Ana Sofia Marinho
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Barbosa-Sequeira
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Carvalho
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Fátima Carvalho
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Gonçalo Paupério
- Deparment of Thoracic Surgery, Instituto Português de Oncologia do Porto, Porto, Portugal
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Neto R, Pereira L, Magalhães J, Quelhas-Santos J, Martins S, Carvalho C, Frazão JM. Sclerostin and DKK1 circulating levels associate with low bone turnover in patients with chronic kidney disease Stages 3 and 4. Clin Kidney J 2021; 14:2401-2408. [PMID: 34754436 PMCID: PMC8572981 DOI: 10.1093/ckj/sfab081] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/09/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
Background Disordered mineral and bone metabolism is a common complication of chronic kidney disease (CKD). Bone biopsy remains the gold standard tool for evaluating renal osteodystrophy (ROD), but it is an invasive procedure. Despite a growing interest in the ability of newer bone biomarkers to discriminate between different forms of ROD, data on pre-dialysis patients are scarce. Methods A cross-sectional study was conducted in a cohort of 56 patients with CKD Stages 3 and 4. Participants underwent a transiliac bone biopsy after a course of double tetracycline labelling. Circulating levels of Wnt signalling inhibitors sclerostin and Dickkopf-1 (DKK1), soluble receptor activator of nuclear factor-κB ligand (sRANKL) and osteoprotegerin were measured and correlated with histomorphometric analysis results. Results Most patients had abnormal bone histology and low-turnover bone disease was the predominant form of ROD. Characteristics associated with high bone turnover were worse renal function, lower serum calcium and higher intact parathyroid hormone and fibroblast growth factor-23 levels. Patients with low bone turnover, on the other hand, presented with higher sclerostin along with lower DKK1 and sRANKL levels. In the multivariable logistic regression analysis, sclerostin and DKK1 levels were independently associated with low-turnover bone disease. Conclusions Our results suggest that circulating levels of Wnt signalling inhibitors sclerostin and DKK1 are predictive of low-turnover bone disease in patients not yet on dialysis. Further research is needed to assess the performance of these bone turnover biomarkers, compared with histomorphometric analysis, in the diagnosis and treatment monitoring of ROD.
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Affiliation(s)
- Ricardo Neto
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
| | - Luciano Pereira
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
| | - Juliana Magalhães
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
| | | | - Sandra Martins
- Department of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Catarina Carvalho
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
| | - João Miguel Frazão
- Institute for Innovation and Health Research (I3S), Institute of Biomedical Engineering (INEB), Nephrology and Infectious Diseases Research Group, University of Porto, Porto, Portugal
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Pereira IR, Carvalho C, Paulo S, Martinho JP, Coelho AS, Paula AB, Marto CM, Carrilho E, Botelho MF, Abrantes AM, Marques Ferreira M. Apical Sealing Ability of Two Calcium Silicate-Based Sealers Using a Radioactive Isotope Method: An In Vitro Apexification Model. Materials (Basel) 2021; 14:ma14216456. [PMID: 34771981 PMCID: PMC8585189 DOI: 10.3390/ma14216456] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022]
Abstract
The aim of this study was to evaluate and compare the sealing ability of two calcium silicate-based sealers (TotalFill BC RRM Fast Set Putty and White ProRoot MTA) when used as apical plugs in immature teeth through nuclear medicine. Single-rooted extracted teeth (n = 34) had their crowns and root tip sectioned to obtain 14 mm long root segments to simulate an in vitro apexification model. Were created two experimental groups, namely MTA (n = 12) and BC (n = 12), and two control groups, PG (positive group, n = 5) and NG (negative group, n = 5). On the 4th day after placing the respective apical plug, the apical portions of the teeth were submerged in a solution of sodium pertechnetate (99mTcNaO4) for 3 h. Statistical analysis showed a significant difference between the MTA group and the controls (p < 0.05). The BC group had a significant difference regarding the negative control (p < 0.001) but showed no statistical significance regarding the positive control (p = 0.168). There was a statistically significant difference (p = 0.009) between the BC group (7335.8 ± 2755.5) and the MTA group (4059.1 ± 1231.1), where the last showed less infiltration. Within the limitations of this study, White ProRoot MTA had a significantly better sealing ability than TotalFill BC RRM Fast Set Putty.
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Affiliation(s)
- Inês Raquel Pereira
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
| | - Catarina Carvalho
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
| | - Siri Paulo
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
| | - José Pedro Martinho
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana Sofia Coelho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Anabela Baptista Paula
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Carlos Miguel Marto
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Eunice Carrilho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Maria Filomena Botelho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Biophysics, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana Margarida Abrantes
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, Institute of Biophysics, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Manuel Marques Ferreira
- Faculty of Medicine, Institute of Endodontics, University of Coimbra, 3000-075 Coimbra, Portugal; (I.R.P.); (C.C.); (S.P.); (J.P.M.)
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal; (A.S.C.); (A.B.P.); (C.M.M.); (E.C.); (M.F.B.); (A.M.A.)
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-484-183
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Abstract
Abstract
Odemira, in the southeast litoral of Portugal, has 33% of migrant citizens, mostly from Southeast Asia, going up to 50% counting transient citizens. Most of them do not speak English, making communication with health services difficult. They tend to live in overcrowded houses with unsanitary conditions. With the emergence of the COVID-19 pandemic, all the above resulted in high incidence and ineffective contact tracing (CT), testing and isolation by the public health teams. It was essential to develop strategies to manage and control outbreaks, and also to achieve health equity. Our experience can be useful for other countries in dealing with their multicultural communities. This intervention started in march 2020 and is still ongoing. The aims were to improve the accuracy of epidemiological surveys (ES) and CT, to more easily stop transmission, to develop the communication skills of health professionals and to improve migrant's healthcare access. For this, the focus was on digital written communication tools (Whatsapp, translation apps). It was created a toolkit to guide ES and CT tailored to the migrant population, with tips and best practices, and used translated information materials about preventive COVID-19 measures. Workshops were led with health professionals. It was stablished work with local NGOs, creating social media campaigns during crucial events (Holi holliday). As results. it was achieved a better ES output, more accurate CT and better transmission control, with noticeable differences between march 2020 and now. The relationship with this community improved, having better access to services and their needs met. Health professionals reported being more at ease dealing with these patients. Our experience shows it's possible to communicate effectively despite language and cultural barriers, that cultural knowledge is important in advancing public health goals and that multidisciplinary and intersectoral work is essential to effective interventions.
Key messages
This intervention allowed us to achieve a better output of epidemiological surveys, more accurate contact tracing and were more effective in breaking transmission chains and controlling outbreaks. It was achieved a better understanding and relationship with this community, with better ability to respond to their needs and promoting their access to healthcare.
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Affiliation(s)
- J Neto
- Public Health Unit, Litoral Alentejo Local Health Unit E.P.E., Santiago do Cacém, Portugal
| | - C Carvalho
- Public Health Unit, Litoral Alentejo Local Health Unit E.P.E., Santiago do Cacém, Portugal
| | - S Letras
- Public Health Unit, Litoral Alentejo Local Health Unit E.P.E., Santiago do Cacém, Portugal
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Rison SCG, Dostal I, Ahmed Z, Raisi-Estabragh Z, Carvalho C, Lobo M, Patel R, Antoniou M, Boomla K, McManus RJ, Robson JP. Protocol design and preliminary evaluation of the REAL-Health Triple Aim, an open-cohort CVD-care optimisation initiative. Eur Heart J 2021. [PMCID: PMC8524644 DOI: 10.1093/eurheartj/ehab724.3170] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Effective treatment of cardiovascular disease (CVD) in primary care could be improved. We aim to assess the efficacy of a scalable treatment optimisation programme in unselected community populations in South East England, with the triple aim of improved blood pressure control in people with hypertension, increased high-intensity statin use in people with CVD and reduced gastrointestinal bleeding in patients on antithrombotic medication.
Method
This observational study comprises an open cohort of approximately 200,000 adults at high cardiovascular risk registered with general practitioners in five South East England Clinical Commissioning Groups (CCGs). An intervention programme is planned in four of these CCGs with a further non-intervention CCG acting as a control group. The intervention will consist of: clinical guidelines and educational outreach; virtual patient-reviews software; peer-performance “dashboards” and, where available, financial incentives.
The study will examine 3 primary outcomes: 1. Diagnosed hypertension with a blood pressure <140/90mmHg; 2. Diagnosed CVD on a high-intensity statin; 3. A cardiovascular indication for antithrombotic therapy with one or more factors for increased risk of gastrointestinal bleeding (e.g. age ≥65) on gastroprotection. A further 17 secondary outcomes related to these three aims will be assessed.
Analysis
We will use an interrupted time series analysis over 18 months, representing the pre-implementation, implementation and the post-implementation phases with comparison to the control CCG and applicable national Quality and Outcomes Framework and national prescribing statistics (e.g. OpenPrescribing). Secondary outcomes include an equity impact analysis with results stratified by age, gender, ethnic group and index of deprivation.
Preliminary data
We present preliminary data on Key Performance Indicators (KPIs) collected from 191 GP practices including [percentage achievement on 01/09/2019, on 01/09/2020]: 1. Patients with hypertension and most recent blood pressure ≤140/90mmHg [68.7%, 60.6%]. 2. Patients eligible for treatment with a high-intensity statin on such treatment [53.8%, 55.8%]. 3. Patients on antithrombotics with ≥1 risk factors for gastrointestinal bleeding on gastroprotection [59.0%, 60.1%]. We also present our virtual patient-review software tool and outcome visualisation dashboard.
Conclusion
The REAL-Health Triple Aim initiative is a large-scale primary care cardiovascular risk reduction initiative which was launched almost contemporaneously with the United Kingdom's first SARS-CoV-2 related lockdown. Preliminary data justify the need for the Triple Aim initiative and give us an insight on the impact of the pandemic on its implementation.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Barts CharityBritish Heart Foundation
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Affiliation(s)
- S C G Rison
- Queen Mary University of London, Clinical Effectiveness Group, London, United Kingdom
| | - I Dostal
- Queen Mary University of London, Clinical Effectiveness Group, London, United Kingdom
| | - Z Ahmed
- Queen Mary University of London, Clinical Effectiveness Group, London, United Kingdom
| | | | - C Carvalho
- Queen Mary University of London, Clinical Effectiveness Group, London, United Kingdom
| | - M Lobo
- William Harvey Research Institute, London, United Kingdom
| | - R Patel
- Barts Heart Centre, London, United Kingdom
| | - M Antoniou
- Barts Heart Centre, London, United Kingdom
| | - K Boomla
- Queen Mary University of London, Clinical Effectiveness Group, London, United Kingdom
| | - R J McManus
- University of Oxford, Nuffield Department of Primary Care Health Science, Oxford, United Kingdom
| | - J P Robson
- Queen Mary University of London, Clinical Effectiveness Group, London, United Kingdom
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Abstract
Abstract
Background
Hypertension and hypercholesterolaemia are major modifiable risk factors for cardiovascular diseases (CVD) with available effective and low-cost treatments. However, their suboptimal treatment remains widespread. We characterise treatment gaps in a large urban population and quantify the potential long-term health and economic impact with optimised use.
Methods
We studied 1 million UK urban residents served by 123 primary care practices in 2019. We categorised antihypertensive treatment in adults with diagnosed hypertension, and statin treatment in adults with diagnosed CVD, into optimal, suboptimal and not treated following UK clinical guidelines. A long-term CVD model was used to project cardiovascular events avoided, years of life and quality-adjusted life years (QALYs) gained, and healthcare costs saved with optimised treatments for individual patients accounting for their socio-demographic characteristics and risk factors.
Results
21,954 (24%, mean age 59 years; 49% female) of the 91,828 adults with hypertension were either suboptimally treated (20%) or untreated (4%) and 9,062 (38%, mean age 69 years; 43% female) of the 23,723 adults with CVD were either suboptimally treated (24%) or untreated (14%). Per 1000 patients (95% CI) optimised over lifespan, hypertension treatment would prevent 154 (72–230) major vascular events (MVEs, including heart attack, stroke or arterial revascularisation) and 69 (28–103) vascular deaths, and gain 769 (436–1038) QALYs for those sub-optimally treated, and prevent 138 (68–201) MVEs and 50 (21–76) vascular deaths, and gain 674 (386–920) QALYs for those not treated; statin treatment would prevent 68 (46–88) MVEs and 17 (12–21) vascular deaths, and gain 145 (113–178) QALYs for those sub-optimally treated, and prevent 260 (190–319) MVEs and 55 (40–68) vascular deaths, and gain 535 (412–651) QALYs for those not treated (Figure). Hospital cost savings net of medication costs were about £1100 per person over their remaining lifespan.
Conclusion
Optimising preventive cardiovascular treatments in UK primary care is likely to cost-effectively reduce cardiovascular risk and improve life expectancy, while reducing population inequalities.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Barts Charity, British Heart Foundation, and Health Data Research UK Predicted benefits from optimisation
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Affiliation(s)
- R Wu
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - S Rison
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - Z Raisi-Estabragh
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - I Dostal
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - C Carvalho
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - J Robson
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
| | - B Mihaylova
- Queen Mary University of London, Institute of Population Health Sciences, London, United Kingdom
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Assunção R, Boué G, Alvito P, Brazão R, Carmona P, Carvalho C, Correia D, Fernandes P, Lopes C, Martins C, Membré JM, Monteiro S, Nabais P, Thomsen ST, Torres D, Pires SM, Jakobsen LS. Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months-A Case Study under the RiskBenefit4EU Project. Nutrients 2021; 13:nu13093127. [PMID: 34579004 PMCID: PMC8467172 DOI: 10.3390/nu13093127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022] Open
Abstract
Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk–benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.
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Affiliation(s)
- Ricardo Assunção
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (P.A.); (R.B.); (C.M.)
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
- IUEM, Instituto Universitário Egas Moniz, Egas Moniz-Cooperativa de Ensino Superior, CRL, 2829-511 Caparica, Portugal
- Correspondence: ; Tel.: +351-21-751-9219
| | - Géraldine Boué
- INRAe, Oniris, Secalim, 44307 Nantes, France; (G.B.); (P.F.); (J.-M.M.)
| | - Paula Alvito
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (P.A.); (R.B.); (C.M.)
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Roberto Brazão
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (P.A.); (R.B.); (C.M.)
| | - Paulo Carmona
- Food Risks Unit, Economic and Food Safety Authority (ASAE), 1649-038 Lisboa, Portugal; (P.C.); (S.M.); (P.N.)
| | - Catarina Carvalho
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (C.C.); (D.T.)
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal; (D.C.); (C.L.)
| | - Daniela Correia
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal; (D.C.); (C.L.)
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Paulo Fernandes
- INRAe, Oniris, Secalim, 44307 Nantes, France; (G.B.); (P.F.); (J.-M.M.)
| | - Carla Lopes
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal; (D.C.); (C.L.)
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Carla Martins
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (P.A.); (R.B.); (C.M.)
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
| | | | - Sarogini Monteiro
- Food Risks Unit, Economic and Food Safety Authority (ASAE), 1649-038 Lisboa, Portugal; (P.C.); (S.M.); (P.N.)
| | - Pedro Nabais
- Food Risks Unit, Economic and Food Safety Authority (ASAE), 1649-038 Lisboa, Portugal; (P.C.); (S.M.); (P.N.)
| | - Sofie T. Thomsen
- Division for Diet, Disease Prevention and Toxicology, The National Food Institute, Technical University of Denmark, 2800 Kgs Lyngby, Denmark; (S.T.T.); (S.M.P.); (L.S.J.)
| | - Duarte Torres
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (C.C.); (D.T.)
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal; (D.C.); (C.L.)
| | - Sara M. Pires
- Division for Diet, Disease Prevention and Toxicology, The National Food Institute, Technical University of Denmark, 2800 Kgs Lyngby, Denmark; (S.T.T.); (S.M.P.); (L.S.J.)
| | - Lea S. Jakobsen
- Division for Diet, Disease Prevention and Toxicology, The National Food Institute, Technical University of Denmark, 2800 Kgs Lyngby, Denmark; (S.T.T.); (S.M.P.); (L.S.J.)
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42
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Bramatti I, Branco V, Carvalho C. Effect of thimerosal over hypoxia-related factors in glioblastoma. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00609-3] [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: 10/20/2022]
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43
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Carvalho C, Correia D, Severo M, Afonso C, Bandarra NM, Gonçalves S, Lourenço HM, Graça Dias M, Oliveira L, Nabais P, Carmona P, Monteiro S, Borges M, Lopes C, Torres D. 1243Quantitative risk-benefit assessment of fish and seafood consumption scenarios to support recommendations. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.113] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Fish/seafood consumption has health benefits, namely due to its omega-3 fatty acids levels and risks due to methylmercury contamination. This study aims to quantify the health impact of hypothetical scenarios of fish/seafood consumption through a risk-benefit assessment and provide support for recommendations, using Portuguese food consumption data.
Methods
We used data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n = 5811) to estimate the mean exposure to methylmercury and EPA+DHA in the current and alternative scenarios. Alternative scenarios were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (predatory vs low-mercury species) or its frequency (1-7x/week). The overall scenarios’ impact was quantified using Disability-Adjusted Life Years (DALYs).
Results
About 14% of the Portuguese population exceeds the methylmercury tolerable weekly intake, and this prevalence is higher among small children (36.6%). Nevertheless, if the fish/seafood consumption increased to once a day, ≈11450 DALYs could be prevented each year. However, such a scenario would result in higher risk for pregnant women (1398 extra DALYs). Moreover, excluding predatory species consumption resulted in small but significant health gains (-1078 DALYs).
Conclusions
For the general population, the maximum health gains are obtained by consuming fish/seafood up to 7x/week, but among children and pregnant women, the frequency should be limited to 3-5x/week. All population should preferably choose non-predatory species.
Key messages
Daily fish consumption results in the highest overall populational health gain, but children and pregnant women need to limit it to 3-5x/week, due to methylmercury exposure.
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Affiliation(s)
- Catarina Carvalho
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Daniela Correia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Cláudia Afonso
- Division of Aquaculture, Upgrading, and Bioprospecting (DivAV), Portuguese Institute for the Sea and Atmosphere (IPMA, IP), Algés, Portugal
- CIIMAR, Centro Interdisciplinar de Investigação Marinha e Ambiental, Universidade do Porto, Porto, Portugal
| | - Narcisa M. Bandarra
- Division of Aquaculture, Upgrading, and Bioprospecting (DivAV), Portuguese Institute for the Sea and Atmosphere (IPMA, IP), Algés, Portugal
- CIIMAR, Centro Interdisciplinar de Investigação Marinha e Ambiental, Universidade do Porto, Porto, Portugal
| | - Susana Gonçalves
- Division of Aquaculture, Upgrading, and Bioprospecting (DivAV), Portuguese Institute for the Sea and Atmosphere (IPMA, IP), Algés, Portugal
| | - Helena M. Lourenço
- Division of Aquaculture, Upgrading, and Bioprospecting (DivAV), Portuguese Institute for the Sea and Atmosphere (IPMA, IP), Algés, Portugal
- CIIMAR, Centro Interdisciplinar de Investigação Marinha e Ambiental, Universidade do Porto, Porto, Portugal
| | - M. Graça Dias
- Departamento de Alimentação e Nutrição, Instituto Nacional de Saúde Doutor Ricardo Jorge, IP (INSA, IP), Lisboa, Portugal
| | - Luísa Oliveira
- Departamento de Alimentação e Nutrição, Instituto Nacional de Saúde Doutor Ricardo Jorge, IP (INSA, IP), Lisboa, Portugal
| | - Pedro Nabais
- Divisão de Riscos Alimentares, Autoridade de Segurança Alimentar e Económica, Lisboa, Portugal
| | - Paulo Carmona
- Divisão de Riscos Alimentares, Autoridade de Segurança Alimentar e Económica, Lisboa, Portugal
| | - Sarogini Monteiro
- Divisão de Riscos Alimentares, Autoridade de Segurança Alimentar e Económica, Lisboa, Portugal
| | - Marta Borges
- Divisão de Alimentação Humana, Direção-Geral de Alimentação e Veterinária, Lisboa, Portugal
| | - Carla Lopes
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Duarte Torres
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentos da Universidade do Porto, Portugal
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44
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Neto J, Carvalho C, Almeida P. A comparative study on indirect costs of suicide in Portugal: productivity loss as an additional way to approach healthcare prioritization. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab120.096] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Suicide and voluntary self-harm (SVSA) accounted for 0.95% of all deaths in Portugal in 2017. Economic evaluation includes indirect costs analysis, relating to Years of Life Lost (YLL) and premature death. This study aimed to estimate and compare the indirect costs from loss of productivity due to SVSA and 12 other causes of death in 2017.
Methods
YLL were adapted to the working age (18–66 years-old) ‘Years of Productivity Lost’ (YPL) adjusting the groups 15–19 years-old and under, and disregarding the ages over 66 years-old. The causes of death were based on the European Shortlist. The loss of productivity from deaths was estimated from the YPL and the ‘Apparent Productivity of Work’, with an annual discount rate of 3%, translated into % of Gross Domestic Product (GDP) in 2017. The calculations were performed for the SVSA and for 12 causes of death selected from national Priority Health Programs. The INE and Pordata databases for the year 2017 were used. Calculations were performed using Microsoft Excel for Office 365 software version 2102.
Results
The estimated costs from loss of productivity by SLAV deaths in 2017 represented approximately 0.16% of GDP. It is the third highest among the 13 causes of death analyzed, ranking behind malignant neoplasm of larynx/trachea/bronchi/lung and ischaemic heart disease.
Conclusions
Prioritization of health resources may benefit by integrating lost productivity concepts with other indicators. Limitations include predictable increase of retirement age in the future and the oversimplified calculation of productivity costs. Future studies may include sensitivity assessments and other relevant variables.
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Affiliation(s)
- J Neto
- Unidade de Saúde Pública, Unidade Local de Saúde do Litoral Alentejano E.P.E
| | - C Carvalho
- Unidade de Saúde Pública, Unidade Local de Saúde do Litoral Alentejano E.P.E
| | - P Almeida
- Independent Researcher, BSc in Economics, MSc in Finance
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45
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Meiburger KM, Zahnd G, Faita F, Loizou CP, Carvalho C, Steinman DA, Gibello L, Bruno RM, Marzola F, Clarenbach R, Francesconi M, Nicolaides AN, Campilho A, Ghotbi R, Kyriacou E, Navab N, Griffin M, Panayiotou AG, Gherardini R, Varetto G, Bianchini E, Pattichis CS, Ghiadoni L, Rouco J, Molinari F. Carotid Ultrasound Boundary Study (CUBS): An Open Multicenter Analysis of Computerized Intima-Media Thickness Measurement Systems and Their Clinical Impact. Ultrasound Med Biol 2021; 47:2442-2455. [PMID: 33941415 DOI: 10.1016/j.ultrasmedbio.2021.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
Common carotid intima-media thickness (CIMT) is a commonly used marker for atherosclerosis and is often computed in carotid ultrasound images. An analysis of different computerized techniques for CIMT measurement and their clinical impacts on the same patient data set is lacking. Here we compared and assessed five computerized CIMT algorithms against three expert analysts' manual measurements on a data set of 1088 patients from two centers. Inter- and intra-observer variability was assessed, and the computerized CIMT values were compared with those manually obtained. The CIMT measurements were used to assess the correlation with clinical parameters, cardiovascular event prediction through a generalized linear model and the Kaplan-Meier hazard ratio. CIMT measurements obtained with a skilled analyst's segmentation and the computerized segmentation were comparable in statistical analyses, suggesting they can be used interchangeably for CIMT quantification and clinical outcome investigation. To facilitate future studies, the entire data set used is made publicly available for the community at http://dx.doi.org/10.17632/fpv535fss7.1.
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Affiliation(s)
- Kristen M Meiburger
- PolitoBIOmed Lab, Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy.
| | - Guillaume Zahnd
- Computer Aided Medical Procedures, Technische Universität München, München, Germany
| | - Francesco Faita
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Christos P Loizou
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | | | - David A Steinman
- Biomedical Simulation Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Lorenzo Gibello
- Dipartimento di Scienze Chirurgiche, University of Torino, Torino, Italy
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; INSERM U970, Paris Cardiovascular Research Centre-PARCC and Université de Paris, Paris, France
| | - Francesco Marzola
- PolitoBIOmed Lab, Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy
| | | | - Martina Francesconi
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Aurelio Campilho
- INESC Technology and Science, Porto, Portugal; FEUP-Faculty of Engineering, University of Porto, Porto, Portugal
| | - Reza Ghotbi
- INSERM U970, Paris Cardiovascular Research Centre-PARCC and Université de Paris, Paris, France
| | - Efthyvoulos Kyriacou
- Department of Computer Science and Engineering, Frederick University, Limassol, Cyprus
| | - Nassir Navab
- Computer Aided Medical Procedures, Technische Universität München, München, Germany; Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maura Griffin
- The Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
| | - Andrie G Panayiotou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Rachele Gherardini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gianfranco Varetto
- Dipartimento di Scienze Chirurgiche, University of Torino, Torino, Italy
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Constantinos S Pattichis
- Department of Computer Science and Biomedical Engineering Research Center, University of Cyprus, Nicosia, Cyprus
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - José Rouco
- Research Center of Information and Communication Technologies, UDC, A Coruña, Spain; Department of Computer Science, University of A Coruña, A Coruña, Spain
| | - Filippo Molinari
- PolitoBIOmed Lab, Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy
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Carvalho C, Marinho AS, Barbosa-Sequeira J, Correia MR, Carvalho F, Banquart-Leitão J, Morgado H. Pediatric burns with cyanoacrylate glue - an inconspicuous danger. J Burn Care Res 2021; 42:1047-1049. [PMID: 33909045 DOI: 10.1093/jbcr/irab063] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burns are a common cause of pediatric injury and represent significant morbidity and mortality in this age group. In children, most burns are thermal, resulting from exposure to a hot surface, liquid, or fire. Cyanoacrylate is a liquid compound commonly found in households, mainly in "superglue" and nail glue. This compound solidifies through an exothermic reaction that is magnified when in contact with certain fibers that act as catalysts, such as cotton. In these circumstances, intense heat is produced in the contact area, potentially causing severe thermal burns. Despite its widespread availability, there is a paucity of safety information about cyanoacrylate and its role as a cause for burns. In the literature, only 18 cases of cyanoacrylate burns are reported in children. We present 2 cases of pediatric burns with cyanoacrylate and a review of the literature.
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Affiliation(s)
- Catarina Carvalho
- Masters in Medicine, Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
| | - Ana Sofia Marinho
- Masters in Medicine, Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
| | - Joana Barbosa-Sequeira
- Masters in Medicine, Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
| | - Mário Rui Correia
- Masters in Medicine, Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
| | - Fátima Carvalho
- Masters in Medicine, Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
| | - José Banquart-Leitão
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
| | - Hélder Morgado
- Department of Pediatric Surgery, Centro Hospitalar Universitário do Porto. Rua da Maternidade, Porto, Portugal
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Maricoto T, Santos D, Carvalho C, Teles I, Correia-de-Sousa J, Taborda-Barata L. Assessment of Poor Inhaler Technique in Older Patients with Asthma or COPD: A Predictive Tool for Clinical Risk and Inhaler Performance. Drugs Aging 2020; 37:605-616. [PMID: 32602039 DOI: 10.1007/s40266-020-00779-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Older patients with asthma or chronic obstructive pulmonary disease (COPD) are particularly susceptible to inhaler technique errors and poor clinical outcomes. Several factors may influence their risk, but most studies are inconsistent and contradictory. We developed a tool for the major predictors of individual risk in these patients. DESIGN, SETTING AND PARTICIPANTS In this multicentre, cross-sectional study, several demographic, socioeconomic and clinical characteristics were collected as potential predictors. Clinical features and inhaler technique performance were the main outcomes. Linear and logistic regression models were set up to identify significant variables. Subgroup analysis was performed according to age, cognitive performance and different types of inhalers. RESULTS We included 130 participants, mean age of 74.4 (± 6.4) years. Mean years of device use were 5.8 (± 7.3). Inhaler errors affected 71.6% (95% CI 64-78.5) and critical mistakes 31.1% (95% CI 24-38.8). There were respiratory comorbidities in 82.3% of participants, and 56.2% had moderate to severe disease. A predictive score of misuse probability was developed for clinical practice, including points attributable to cognitive score, adherence and having received previous education on a placebo device. Other significant variables of individual risk were having respiratory allergies or comorbidities, smoking status, depression and educational level. Worse performance was detected in cognitively impaired patients older than 75 years who were using dry powder inhalers (DPI). Lung function was associated with smoking load, incorrect dose activation and absent end pause after inhalation. CONCLUSIONS Individual risk assessment in older individuals should focus on inhaler technique performance (mainly on dose activation and end pause) and adherence, smoking, respiratory comorbidities and cognitive impairment. Placebo device training provided by doctors seems to best suit these patients.
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Affiliation(s)
- Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal.
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- USF Aveiro-Aradas, Praceta Rainha D. Leonor, 3800, Aveiro, Portugal.
| | - Duarte Santos
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Catarina Carvalho
- Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Inês Teles
- Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS)/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal
| | - Luís Taborda-Barata
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
- CACB-Clinical Academic Center of Beiras, Covilhã, Portugal
- Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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49
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Correia D, Fernandes B, Ponte A, Marques M, Couto-Gonçalves S, Rolim L, Nobre-Góis I, Carvalho C, Casalta-Lopes J, Borrego M. PO-0977: Hypofractionated external beam radiation therapy for breast cancer: real-life outcomes. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00995-6] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carvalho C, Alba S, Harris R, Abubakar I, Van Hest R, Correia AM, Gonçalves G, Duarte R. Completeness of TB notification in Portugal, 2015: an inventory and capture-recapture study. Int J Tuberc Lung Dis 2020; 24:1186-1193. [PMID: 33256888 DOI: 10.5588/ijtld.20.0094] [Citation(s) in RCA: 2] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Despite the steady decline in the last few decades, Portugal remains the Western European country with the highest TB notification rates. The aim of this study was to estimate the completeness of notification to the National Tuberculosis Programme (NTP) Surveillance System (SVIG-TB) in 2015.METHODS: We implemented an inventory study and a three-source log-linear capture-recapture analysis using two additional data sources that were deterministic and probabilistically linked: the national notifiable diseases surveillance system (Sistema Nacional de Vigilância Epidemiológica SINAVE) and the national hospital discharge database (Grupos de Diagnósticos Homogéneos GDH).RESULTS: We identified 2328 unique probable/confirmed TB cases across the three data sources. We found a positive dependency between SVIG-TB and SINAVE (incidence rate ratio IRR 8.9, 95%CI 6.6-12.0) and between GDH and SINAVE (IRR 2.6, 95%CI 2.0-3.4). After adjusting for these dependencies, we estimated that 266 cases (95%CI 198-358) were not reported, indicating a notification (to SVIG-TB) completeness rate of 77.0%.CONCLUSION: True incidence rate of TB in Portugal in 2015 could have been as high as 26.1 per 100 000. This could be an overestimation because of false-positive cases recorded in both SINAVE and GDH or on a smaller scale, false non-matches. Studies aimed at validating potentially false-positive cases should be implemented to address these limitations.
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Affiliation(s)
- C Carvalho
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - S Alba
- Royal Tropical Institute, KIT Health, Amsterdam, The Netherlands
| | - R Harris
- National Infection Service, Public Health England, London
| | - I Abubakar
- Institute for Global Health, University College of London, London, UK
| | - R Van Hest
- Department of Tuberculosis Control, Regional Public Health Service (GGD) Groningen, Groningen, The Netherlands
| | - A M Correia
- Braga Health Centre Group, Portuguese Northern Regional Health Administration Cávado I, Braga
| | - G Gonçalves
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - R Duarte
- EPIUnit, Institute of Public Health, University of Porto (ISPUP), Porto, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
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