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D'Amelio M, Costa C. Clarifying the role of D1 receptor signalling in Alzheimer's-related epilepsy commentary on Szabo et al. (2024). Eur J Neurosci 2024. [PMID: 38648886 DOI: 10.1111/ejn.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Marcello D'Amelio
- Unit of Molecular Neurosciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Cinzia Costa
- Section of Neurology, S.M. della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Goenaga-Mafud LC, Vollet-Filho JD, Costa C, Inada NM, Netto AS, Kurachi C, Bagnato VS. A proof-of-principle for decontamination of transplantation kidney through UV-C exposition of the perfusate solution. Sci Rep 2024; 14:5715. [PMID: 38459094 PMCID: PMC10923919 DOI: 10.1038/s41598-024-55574-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/25/2024] [Indexed: 03/10/2024] Open
Abstract
Kidney transplantation is a common yet highly demanding medical procedure worldwide, enhancing the quality of life for patients with chronic kidney disease. Despite its prevalence, the procedure faces a shortage of available organs, partly due to contamination by microorganisms, leading to significant organ disposal. This study proposes utilizing photonic techniques associated with organ support machines to prevent patient contamination during kidney transplantation. We implemented a decontamination system using ultraviolet-C (UV-C) irradiation on the preservation solution circulating through pigs' kidneys between harvest and implant. UV-C irradiation, alone or combined with ultrasound (US) and Ps80 detergent during ex-vivo swine organ perfusion in a Lifeport® Kidney Transporter machine, aimed to reduce microbiological load in both fluid and organ. Results show rapid fluid decontamination compared to microorganism release from the organ, with notable retention. By including Ps80 detergent at 0.5% during UV-C irradiation 3 log10 (CFU mL-1) of Staphylococcus aureus bacteria previously retained in the organ were successfully removed, indicating the technique's feasibility and effectiveness.
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Affiliation(s)
- L C Goenaga-Mafud
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil.
| | - J D Vollet-Filho
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - C Costa
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - N M Inada
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - A S Netto
- Department of Animal Science, College of Animal Science and Food Engineering, University of São Paulo, Pirassununga, SP, Brazil
| | - C Kurachi
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
| | - V S Bagnato
- São Carlos Institute of Physics, University of São Paulo, São Carlos, SP, Brazil
- Biomedical Engineering, Texas A&M University College of Engineering, College Station, TX, USA
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3
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Dell'Isola GB, Verrotti A, Sciaccaluga M, Dini G, Ferrara P, Parnetti L, Costa C. Cannabidiol: metabolism and clinical efficacy in epileptic patients. Expert Opin Drug Metab Toxicol 2024; 20:119-131. [PMID: 38465404 DOI: 10.1080/17425255.2024.2329733] [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: 12/12/2023] [Accepted: 03/08/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The landscape of epilepsy treatment has undergone a significant transformation with the emergence of cannabidiol as a potential therapeutic agent. Epidiolex, a pharmaceutical formulation of highly purified CBD, garnered significant attention not just for its therapeutic potential but also for being the first cannabis-derived medication to obtain approval from regulatory bodies. AREA COVERED In this narrative review the authors explore the intricate landscape of CBD as an antiseizure medication, deepening into its pharmacological mechanisms and clinical trials involving various epileptic encephalopathies. This exploration serves as a comprehensive guide, shedding light on a compound that holds promise for individuals contending with the significant challenges of drug-resistant epilepsy. EXPERT OPINION Rigorous studies highlight cannabidiol's efficacy, safety profile, and potential cognitive benefits, warranting further exploration for its approval in various drug-resistant epilepsy forms. As a promising therapeutic option, cannabidiol not only demonstrates efficacy in seizure control but also holds the potential for broader enhancements in the quality of life, especially for patients with epileptic encephalopathies.
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Affiliation(s)
| | | | - Miriam Sciaccaluga
- Section of Neurology, Laboratory of Experimental Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- "Mauro Baschirotto" Institute for Rare Diseases - BIRD Foundation Onlus, Longare, Vicenza, Italy
| | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | - Pietro Ferrara
- Unit of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | - Lucilla Parnetti
- Section of Neurology, Laboratory of Experimental Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cinzia Costa
- Section of Neurology, Laboratory of Experimental Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Sena F, Portugal PV, Dentinho MT, Paulos K, Costa C, Soares DM, Oliveira A, Ramos H, Alves SP, Santos-Silva J, Bessa RJB. Effects of sunflower oil infusions of Asparagopsis taxiformis on in vitro ruminal methane production and biohydrogenation of polyunsaturated fatty acids. J Dairy Sci 2024; 107:1472-1484. [PMID: 37944809 DOI: 10.3168/jds.2023-23506] [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: 03/19/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
Asparagopsis taxiformis inhibits ruminal methane (CH4) production due to its bromoform (CHBr3) content. The immersion of A. taxiformis in edible vegetable oils allows the extraction and stabilization of the highly volatile CHBr3 in the oil phase. The objectives of this study were to explore the effects of adding sunflower oils with increasing concentrations of CHBr3 on in vitro ruminal methanogenesis and biohydrogenation. Five batches of 48-h in vitro incubations were performed in 14 fermentation bottles, using rumen inocula collected shortly after the slaughter of young crossbred bulls and 1 g of dry matter (DM) from a total diet of mixed feed without added oil (control) or with 60 μL of sunflower oil per gram of DM as the substrate. The treatments were the CHBr3 content in the oil added: 0 μg (B0), 25 μg (B25), 50 μg (B50), 75 μg (B75), 100 μg (B100), and 150 μg (B150) of CHBr3 per gram of substrate DM. Organic matter (OM) degradability, total gas, CH4, volatile fatty acids (VFA), long-chain fatty acids, and dimethyl acetals (DMA) were analyzed at the end of each incubation. Data were analyzed with a model considering the treatments as the fixed effect and the run as a random block and using orthogonal contrasts. Degradability of OM was higher in the control group and was unaffected by CHBr3 concentration. Total gas production per gram of degraded OM was unaffected by treatments and averaged 205 ± 29.8 mL/g. Methane (mL) production decreased linearly with increasing CHBr3 concentrations, with 33%, 47%, and 87% reductions for B75, B100, and B150, respectively. Total VFA concentration was unaffected by oil inclusion but was reduced by 20% in CHBr3-containing treatments, although without any dose-response pattern. The molar percentage of acetate decreased linearly, whereas propionate and butyrate increased linearly with the increasing CHBr3 dosage. Including oil in the diet decreased the branched-chain fatty acids and DMA content. Increasing CHBr3 concentrations did not affect branched-chain fatty acids, but linearly increased most of the identified DMA. Adding oil to the control diet increased the 18:2n-6, whereas increasing the concentration of CHBr3 had no effect on 18:2n-6 but decreased linearly the 18:0 and increased the trans-18:1 isomers. The results obtained provide evidence that oil immersions of A. taxiformis can successfully inhibit ruminal production of CH4 in vitro at doses of 100 and 150 μg/g DM, and simultaneously modulate biohydrogenation.
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Affiliation(s)
- F Sena
- Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. da Universidade Técnica, 1300-477 Lisboa, Portugal; Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
| | - P V Portugal
- Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Polo de Investigação de Santarém, Instituto Nacional de Investigação Agrária e Veterinária (INIAV-Santarém), 2005-048 Vale de Santarém, Portugal
| | - M T Dentinho
- Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Polo de Investigação de Santarém, Instituto Nacional de Investigação Agrária e Veterinária (INIAV-Santarém), 2005-048 Vale de Santarém, Portugal; Laboratório Associado para Ciência Animal e Veterinária (AL4AnimalS), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
| | - K Paulos
- Polo de Investigação de Santarém, Instituto Nacional de Investigação Agrária e Veterinária (INIAV-Santarém), 2005-048 Vale de Santarém, Portugal
| | - C Costa
- Polo de Investigação de Santarém, Instituto Nacional de Investigação Agrária e Veterinária (INIAV-Santarém), 2005-048 Vale de Santarém, Portugal
| | - D M Soares
- Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. da Universidade Técnica, 1300-477 Lisboa, Portugal; Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Laboratório Associado para Ciência Animal e Veterinária (AL4AnimalS), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Terraprima-Ambiental, Centro de Negócios do Porto Alto, Fração S, Avenida das Nações Unidas, nº 97, 2135-199 Samora Correia, Portugal
| | - A Oliveira
- SeaExpert Ltd., Travessa do Farrobim 15, 9900-361 Horta, Faial, Azores, Portugal
| | - H Ramos
- SeaExpert Ltd., Travessa do Farrobim 15, 9900-361 Horta, Faial, Azores, Portugal
| | - S P Alves
- Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. da Universidade Técnica, 1300-477 Lisboa, Portugal; Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Laboratório Associado para Ciência Animal e Veterinária (AL4AnimalS), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
| | - J Santos-Silva
- Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Polo de Investigação de Santarém, Instituto Nacional de Investigação Agrária e Veterinária (INIAV-Santarém), 2005-048 Vale de Santarém, Portugal; Laboratório Associado para Ciência Animal e Veterinária (AL4AnimalS), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
| | - R J B Bessa
- Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. da Universidade Técnica, 1300-477 Lisboa, Portugal; Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal; Laboratório Associado para Ciência Animal e Veterinária (AL4AnimalS), Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal.
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Bellingacci L, Canonichesi J, Sciaccaluga M, Megaro A, Mazzocchetti P, Di Mauro M, Costa C, Di Filippo M, Pettorossi VE, Tozzi A. Locally Synthetized 17-β-Estradiol Reverses Amyloid-β-42-Induced Hippocampal Long-Term Potentiation Deficits. Int J Mol Sci 2024; 25:1377. [PMID: 38338656 PMCID: PMC10855267 DOI: 10.3390/ijms25031377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Amyloid beta 1-42 (Aβ42) aggregates acutely impair hippocampal long-term potentiation (LTP) of synaptic transmission, and 17β-estradiol is crucial for hippocampal LTP. We tested whether boosting the synthesis of neural-derived 17β-estradiol (nE2) saves hippocampal LTP by the neurotoxic action of Aβ42. Electrophysiological recordings were performed to measure dentate gyrus (DG) LTP in rat hippocampal slices. Using a pharmacological approach, we tested the ability of nE2 to counteract the LTP impairment caused by acute exposure to soluble Aβ42 aggregates. nE2 was found to be required for LTP in DG under physiological conditions. Blockade of steroid 5α-reductase with finasteride, by increasing nE2 synthesis from testosterone (T), completely recovered LTP in slices treated with soluble Aβ42 aggregates. Modulation of the glutamate N-methyl-D aspartate receptor (NMDAR) by memantine effectively rescued the LTP deficit observed in slices exposed to Aβ42, and memantine prevented LTP reduction observed under the blocking of nE2 synthesis. nE2 is able to counteract Aβ42-induced synaptic dysfunction. This effect depends on a rapid, non-genomic mechanism of action of nE2, which may share a common pathway with glutamate NMDAR signaling.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alessandro Tozzi
- Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy; (L.B.); (J.C.); (M.S.)
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Costa C, Nardi Cesarini E, Eusebi P, Franchini D, Casucci P, De Giorgi MF, Calvello C, Paolini Paoletti F, Romoli M, Parnetti L. Incidence and Risk Factors Epilepsy in Patients with Dementia: A Population-Based Study Using Regional Healthcare Databases in Umbria. J Alzheimers Dis 2024; 98:1533-1542. [PMID: 38607757 DOI: 10.3233/jad-231309] [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] [Indexed: 04/14/2024]
Abstract
Background Dementia is prevalent among the elderly, also representing a risk for seizures/epilepsy. Estimations of epilepsy risk in dementia patients are not widely available. Objective Our research aims to ascertain the incidence of epilepsy and its associated risk factors in subjects with dementia in the Umbria region, based on data from healthcare databases. Methods In this retrospective study based on the healthcare administrative database of Umbria, we identified all patients diagnosed with dementia from 2013 to 2017, based on ICD-9-CM codes. For epilepsy ascertainment, we used a validated algorithm that required an EEG and the prescription of one or more anti-seizure medications post-dementia diagnosis. A case-control analysis was conducted, matching five non-dementia subjects by gender and age to each dementia patient. Cox proportional hazards models were then utilized in the analysis. Results We identified 7,314 dementia cases, also including 35,280 age- and sex-matched control subjects. Out of patients with dementia, 148 individuals (2.02%) were diagnosed with epilepsy. We observed a progressive increase in the cumulative incidence of seizures over time, registering 1.45% in the first year following the diagnosis, and rising to 1.96% after three years. Analysis using Cox regression revealed a significant association between the development of epilepsy and dementia (HR = 4.58, 95% CI = 3.67-5.72). Additional risk factors were male gender (HR = 1.35, 95% CI = 1.07-1.69) and a younger age at dementia onset (HR = 1.03, 95% CI=1.02-1.04). Conclusions Dementia increases epilepsy risk, especially with early onset and male gender. Clinicians should have a low threshold to suspect seizures in dementia cases.
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Affiliation(s)
- Cinzia Costa
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
| | - Elena Nardi Cesarini
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
- UOC Neurologia, Ospedali Riuniti Marche Nord, Fano-Pesaro, Italy
| | - Paolo Eusebi
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
| | - David Franchini
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Carmen Calvello
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
- UOC Neurologia, SM Goretti, Latina, Italy
| | - Federico Paolini Paoletti
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy
| | - Lucilla Parnetti
- Department of Medicine and Surgery, Neurology Clinic, University of Perugia, S.M. Misericordia Hospital, Perugia, Italy
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Longman K, Frampas C, Lewis H, Costa C, Nilforooshan R, Chambers M, Bailey M. Noninvasive drug adherence monitoring of antipsychotic patients via finger sweat testing. Front Chem 2023; 11:1245089. [PMID: 37720721 PMCID: PMC10500062 DOI: 10.3389/fchem.2023.1245089] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Collection of finger sweat is explored here as a rapid and convenient way of monitoring patient adherence to antipsychotic drugs. Finger sweat samples (n = 426) collected from patients receiving treatment with clozapine, quetiapine and olanzapine were analysed by liquid chromatography mass spectrometry, including a subgroup of patients with paired plasma samples. Finger sweat samples were also analysed from a negative control group and patients who had handled antipsychotic medication only. The finger sweat test (based on the detection of parent drug in one donated sample) was 100% effective in monitoring adherence within commonly prescribed dosing ranges. In comparison to participants who handled the medication only, the test could distinguish between contact and administration through monitoring of the drug metabolite, or the level of parent drug. Additionally, in a subgroup of patients prescribed clozapine, a statistically significant correlation was observed between the mass of parent drug in finger sweat and plasma concentration. The finger sweat technology shows promise as a dignified, noninvasive method to monitor treatment adherence in patients taking antipsychotics.
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Affiliation(s)
- K. Longman
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
| | - C. Frampas
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
| | - H. Lewis
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
| | - C. Costa
- Surrey Ion Beam Centre, University of Surrey, Guildford, United Kingdom
| | - R. Nilforooshan
- Abraham Cowley Unit, St Peter’s Hospital, Surrey and Borders Partnership NHS Foundation Trust, Chertsey, United Kingdom
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - M. Chambers
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - M. Bailey
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, United Kingdom
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Costa C, Oliver KL, Calvello C, Cameron JM, Imperatore V, Tonelli L, Colavito D, Franceschetti S, Canafoglia L, Berkovic SF, Prontera P. IRF2BPL: A new genotype for progressive myoclonus epilepsies. Epilepsia 2023; 64:e164-e169. [PMID: 36810721 DOI: 10.1111/epi.17557] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/14/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
The progressive myoclonus epilepsies (PMEs) are a heterogeneous group of neurodegenerative disorders, typically presenting in late childhood. An etiologic diagnosis is achieved in about 80% of patients with PME, and genome-wide molecular studies on remaining, well-selected, undiagnosed cases can further dissect the underlying genetic heterogeneity. Through whole-exome sequencing (WES), we identified pathogenic truncating variants in the IRF2BPL gene in two, unrelated patients presenting with PME. IRF2BPL belongs to the transcriptional regulators family and it is expressed in multiple human tissues, including the brain. Recently missense and nonsense mutations in IRF2BPL were found in patients presenting with developmental delay and epileptic encephalopathy, ataxia, and movement disorders, but none with clear PME. We identified 13 other patients in the literature with myoclonic seizures and IRF2BPL variants. There was no clear genotype-phenotype correlation. With the description of these cases, the IRF2BPL gene should be considered in the list of genes to be tested in the presence of PME, in addition to patients with neurodevelopmental or movement disorders.
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Affiliation(s)
- Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia-S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Karen L Oliver
- Department of Medicine (Austin Health), Epilepsy Research Centre, University of Melbourne, Heidelberg, Victoria, Australia
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Carmen Calvello
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia-S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Jillian M Cameron
- Department of Medicine (Austin Health), Epilepsy Research Centre, University of Melbourne, Heidelberg, Victoria, Australia
| | - Valentina Imperatore
- Medical Genetics Unit, Maternal-Infantile Department, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Laura Tonelli
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Silvana Franceschetti
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Canafoglia
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Samuel F Berkovic
- Department of Medicine (Austin Health), Epilepsy Research Centre, University of Melbourne, Heidelberg, Victoria, Australia
| | - Paolo Prontera
- Medical Genetics Unit, Maternal-Infantile Department, S. Maria della Misericordia Hospital, Perugia, Italy
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Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, Meletti S, Nobili L, Operto FF, Romigi A, Russo E, Di Bonaventura C. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol 2023; 14:1182304. [PMID: 37483446 PMCID: PMC10359664 DOI: 10.3389/fneur.2023.1182304] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Glutamate is the brain's main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies-especially those produced from 2017 onwards-on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists.
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Affiliation(s)
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Neurological Clinic, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome ‘Tor Vergata”, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Meletti
- Neurology Department, University Hospital of Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Romigi
- Sleep Medicine Center, Neurological Mediterranean Institute IRCCS Neuromed, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Romoli M, Costa C. Cardiovascular risk factors for epilepsy and dementia. Nat Rev Neurol 2023; 19:391-392. [PMID: 37253853 DOI: 10.1038/s41582-023-00826-x] [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] [Indexed: 06/01/2023]
Affiliation(s)
- Michele Romoli
- Department of Neuroscience, Bufalini Hospital - AUSL Romagna, Cesena, Italy
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy.
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Parrales-Bravo C, Friedrichsdorf SP, Costa C, Paiva JB, Iglesias-Linares A. Does endodontics influence radiological detection of external root resorption? an in vitro study. BMC Oral Health 2023; 23:221. [PMID: 37069535 PMCID: PMC10108466 DOI: 10.1186/s12903-023-02871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/10/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND External root resorption (ERR) has a multifactorial etiology and is difficult to diagnose, which means that is continues to be of research interest. This work mainly aims to determine whether external root resorption can be differentially detected in root-filled versus non-endodontically treated teeth using digital periapical radiography (DPR) and cone-beam computed tomography (CBCT). METHODS The Checklist for Reporting In-vitro Studies (CRIS) guidelines were followed throughout this study. This experiment highlights the preparation and generation of standardized synthetic teeth measured on three-dimensional records converted into Digital Imaging and Communication on Medicine (DICOM) file format. Twelve replicate maxillary incisors were randomized into two groups: (G1) six non-endodontically treated, and (G2) six endodontically treated teeth. In both groups, actual tooth lengths of all specimens were measured and compared with measurements obtained using DPR and CBCT. Simulated ERR lesions [0.12, 0.18, 0.20 mm × 0.5 mm depth in the mesial, distal and palatal apical regions] were created progressively, radiographic images were recorded, and 24 DPRs and 96 CBCTs were obtained in total. Eight blinded, previously calibrated researchers made a total of 1920 measurements (using Horos Software). Data were analyzed using the Shapiro-Wilk, ANOVA, Kruskal-Wallis and Wilcoxon rank post-hoc tests [Bonferroni correction in multiple comparison tests (p < 0.05)]. RESULTS ICC values for intra- and inter-examiner agreement were appropriate. DPR overestimated ERR detection compared to the actual and CBCT measurements [Mean diff = 0.765 and 0.768, respectively]. CBCT diagnosis of ERR lesions in specimens without root canal treatment was significantly more accurate than DPR diagnoses on both non-endodontically and endodontically-treated specimens [p = 0.044; p = 0.037, respectively]. There was an 18.5% reduction in sensitivity in all DPR diagnoses made on endodontic teeth versus those made on non-endodontically treated teeth. For the smallest ERR lesions, this sensitivity was even more marked, with 27.8 and 25% less sensitivity, respectively. CONCLUSIONS The results of this study highlight that both CBCT and DPR are good diagnostic methods for ERR. Nevertheless, root canal filling material influences diagnostic capability in ERR. The clinical significance was that the presence of intracanal material reduces the detection and diagnosis of ERR by DPR in teeth with root canal treatment.
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Affiliation(s)
- C. Parrales-Bravo
- School of Dentistry, University of Guayaquil, Guayaquil, Ecuador
- School of Dentistry, Complutense, BIOCRAN Research Group, Complutense University of Madrid, Madrid, Spain
| | | | - C. Costa
- School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - J. B. Paiva
- School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - A. Iglesias-Linares
- School of Dentistry, Complutense, BIOCRAN Research Group, Complutense University of Madrid, Madrid, Spain
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12
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Burgos DF, Sciaccaluga M, Worby CA, Zafra-Puerta L, Iglesias-Cabeza N, Sánchez-Martín G, Prontera P, Costa C, Serratosa JM, Sánchez MP. Epm2a R240X knock-in mice present earlier cognitive decline and more epileptic activity than Epm2a -/- mice. Neurobiol Dis 2023; 181:106119. [PMID: 37059210 DOI: 10.1016/j.nbd.2023.106119] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023] Open
Abstract
Lafora disease is a rare recessive form of progressive myoclonic epilepsy, usually diagnosed during adolescence. Patients present with myoclonus, neurological deterioration, and generalized tonic-clonic, myoclonic, or absence seizures. Symptoms worsen until death, usually within the first ten years of clinical onset. The primary histopathological hallmark is the formation of aberrant polyglucosan aggregates called Lafora bodies in the brain and other tissues. Lafora disease is caused by mutations in either the EPM2A gene, encoding laforin, or the EPM2B gene, coding for malin. The most frequent EPM2A mutation is R241X, which is also the most prevalent in Spain. The Epm2a-/- and Epm2b-/- mouse models of Lafora disease show neuropathological and behavioral abnormalities similar to those seen in patients, although with a milder phenotype. To obtain a more accurate animal model, we generated the Epm2aR240X knock-in mouse line with the R240X mutation in the Epm2a gene, using genetic engineering based on CRISPR-Cas9 technology. Epm2aR240X mice exhibit most of the alterations reported in patients, including the presence of LBs, neurodegeneration, neuroinflammation, interictal spikes, neuronal hyperexcitability, and cognitive decline, despite the absence of motor impairments. The Epm2aR240X knock-in mouse displays some symptoms that are more severe that those observed in the Epm2a-/- knock-out, including earlier and more pronounced memory loss, increased levels of neuroinflammation, more interictal spikes and increased neuronal hyperexcitability, symptoms that more precisely resemble those observed in patients. This new mouse model can therefore be specifically used to evaluate how new therapies affects these features with greater precision.
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Affiliation(s)
- Daniel F Burgos
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain; Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid 28029, Spain
| | - Miriam Sciaccaluga
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy; Fondazione Malattie Rare Mauro Baschirotto BIRD Onlus, Longare (VI), Italy
| | - Carolyn A Worby
- University of California at San Diego, 9500 Gilman Drive, La Jolla CA92093-0721, USA
| | - Luis Zafra-Puerta
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain; Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid 28029, Spain; Fondazione Malattie Rare Mauro Baschirotto BIRD Onlus, Longare (VI), Italy
| | - Nerea Iglesias-Cabeza
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Gema Sánchez-Martín
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Paolo Prontera
- Medical Genetics Unit, S. Maria della Misericordia Hospital, Perugia 06132, Italy
| | - Cinzia Costa
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy
| | - José M Serratosa
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Marina P Sánchez
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain.
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13
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Esteves Caldeira L, Limão R, Brás R, Pedro E, Costa C. A real-world characterization of a cohort with eosinophilic esophagitis: looking for severity biomarkers. Eur Ann Allergy Clin Immunol 2023. [PMID: 36975751 DOI: 10.23822/eurannaci.1764-1489.292] [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] [Indexed: 03/29/2023]
Abstract
Summary Background. Eosinophilic esophagitis (EoE) is an immune-mediated chronic esophageal disease, with frequent association with atopy. A validated non/minimally invasive biomarker of disease severity has not been identified. We aimed to determine if sensitization to airborne and food allergens correlates with disease severity, and to evaluate the association between clinical and laboratory characteristics with the severity of EoE. Methods. Retrospective study of EoE patients observed in a differentiated center, 2009-2021. The association between patients' diagnosis age, disease duration before diagnosis, sensitization to airborne/food allergens, serum total IgE and peripheral blood eosinophil values and severe clinical disease (presence of symptoms with a significant impact on quality of life and/or ≥ 1 hospital admission due to EoE complications, namely severe dysphagia, food impaction or esophageal perforation) and histological severe disease (≥ 55 eos/hpf and/or microabscesses in esophageal biopsies) was evaluated. Results. 92 patients were observed, 83% male, 87% atopic. There was a mean delay in diagnosis of 4 years (range 0-31). 84% had aeroallergen sensitization and 71% food sensitization. Food impaction and dysphagia were the most frequent symptoms, and severe clinical disease was observed in 55%. Histologically, 37% had severity criteria. Patients with severe clinical disease had a significantly longer mean disease duration before diagnosis than patients without severe clinical disease (79 vs 15 months, p = 0.021). Patients who described food impaction were significantly older at time of diagnosis than those who have never had impaction (18 vs 9 years, p less than 0.001). There was no significant association (p less than 0.05) between sensitization, serum total IgE and peripheral blood eosinophil values and clinical or histological severity. Conclusions. An older age at diagnosis and a longer disease duration before diagnosis appear to be useful for predicting EoE clinical severity. Despite having been demonstrated a high prevalence of allergic disease, the presence of sensitization to airborne and/or food allergens do not seem to be useful for predicting clinical or histological severity.
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Affiliation(s)
- L Esteves Caldeira
- Department of Immunoallergology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - R Limão
- Department of Immunoallergology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - R Brás
- Department of Immunoallergology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - E Pedro
- Department of Immunoallergology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - C Costa
- Department of Immunoallergology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- University Clinic of Immunoallergology, Medicine Faculty of Lisbon, Lisbon, Portugal
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Costa C, Baldassini WA, Leal MS, Meirelles PRL, Castilhos AM, Nascimento Júnior NG, Silveira JPF, Pariz CM, Roça RO, Factori MA, Silva MGB. Carcass, meat quality traits, and economic analysis of Nellore bulls fed with finishing feedlot diets containing mechanically processed corn silage. Trop Anim Health Prod 2023; 55:121. [PMID: 36933162 DOI: 10.1007/s11250-023-03525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
Effects of mechanical processing (MP) of corn silage and its inclusion in feedlot diets on carcass and meat quality traits of Nellore (Bos indicus) were analyzed. Seventy-two bulls aged approximately 18 months and with an initial average body weight of 392.8 ± 22.3 kg were used. The experimental design was a 2 × 2 factorial arrangement, considering the concentrate-roughage (C:R) ratio (40:60 or 20:80), MP of silage and their interactions. After slaughter, hot carcass weight (HCW), pH, temperature, backfat thickness (BFT), and ribeye area (REA), yields of meat cuts (tenderloin, striploin, ribeye steak, neck steak, and sirloin cap), meat quality traits and economic analysis were evaluated. A lower final pH was found in the carcasses of animals consuming diets containing MP versus unprocessed silage (pH = 5.81 versus 5.93). Carcass variables (HCW, BFT, and REA) and meat cut yields were not affected by treatments. The C:R 20:80 increased the intramuscular fat (IMF) content by approximately 1%, without affecting moisture, ash, and protein contents. Meat/fat color (L*, a* and b*) and Warner-Bratzler shear force (WBSF) were similar among treatments. The results indicated that the MP of corn silage in finishing diets can provide better carcass pH results in Nellore bulls, without negatively influencing carcass weight, fatness, and meat tenderness (WBSF). The IMF content of meat was slightly improved using a C:R 20:80 and lower total costs per arroba produced (3.5%), daily costs per animal/day (4.2%), and cost per ton of feeds (5.15%) were found with MP silage.
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Affiliation(s)
- C Costa
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil.
| | - W A Baldassini
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - M S Leal
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - P R L Meirelles
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - A M Castilhos
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - N G Nascimento Júnior
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - J P F Silveira
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - C M Pariz
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - R O Roça
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - M A Factori
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
| | - M G B Silva
- Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Departamento de Melhoramento e Nutrição Animal, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Prof. Dr. Valter Maurício Correa, Botucatu, São Paulo, 18618-681, Brazil
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15
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Aronica E, Ciusani E, Coppola A, Costa C, Russo E, Salmaggi A, Perversi F, Maschio M. Epilepsy and brain tumors: Two sides of the same coin. J Neurol Sci 2023; 446:120584. [PMID: 36842341 DOI: 10.1016/j.jns.2023.120584] [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: 09/29/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
Epilepsy is the most common symptom in patients with brain tumors. The shared genetic, molecular, and cellular mechanisms between tumorigenesis and epileptogenesis represent 'two sides of the same coin'. These include augmented neuronal excitatory transmission, impaired inhibitory transmission, genetic mutations in the BRAF, IDH, and PIK3CA genes, inflammation, hemodynamic impairments, and astrocyte dysfunction, which are still largely unknown. Low-grade developmental brain tumors are those most commonly associated with epilepsy. Given this strict relationship, drugs able to target both seizures and tumors would be of extreme clinical usefulness. In this regard, anti-seizure medications (ASMs) are optimal candidates as they have well-characterized effects and safety profiles, do not increase the risk of developing cancer, and already offer well-defined seizure control. The most important ASMs showing preclinical and clinical efficacy are brivaracetam, lacosamide, perampanel, and especially valproic acid and levetiracetam. However, the data quality is low or limited to preclinical studies, and results are sometimes conflicting. Future trials with a prospective, randomized, and controlled design accounting for different prognostic factors will help clarify the role of these ASMs and the clinical setting in which they might be used. In conclusion, brain tumor-related epilepsies are clear examples of how close, multidisciplinary collaborations among investigators with different expertise are warranted for pursuing scientific knowledge and, more importantly, for the well-being of patients needing targeted and effective therapies.
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Affiliation(s)
- Eleonora Aronica
- Amsterdam UMC location the University of Amsterdam, Department of (Neuro)Pathology Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Emilio Ciusani
- Department of Research and Technology, Fondazione IRCCS Istituto Neurologico C. Besta Milan, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University of Naples, Naples, Italy
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Emilio Russo
- Science of Health Department, Magna Grecia University, Catanzaro, Italy
| | - Andrea Salmaggi
- Department of Neurosciences, Unit of Neurology, Presidio A. Manzoni, ASST Lecco, Italy
| | | | - Marta Maschio
- Center for tumor-related epilepsy, UOSD Neurooncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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Carrarini C, Calisi D, De Rosa MA, Di Iorio A, D'Ardes D, Pellegrino R, Gazzina S, Pilotto A, Arighi A, Carandini T, Cagnin A, Mozzetta S, Gallucci M, Bonifati DM, Costa C, D'Antonio F, Bruno G, Cipollone F, Babiloni C, Padovani A, Onofrj M, Bonanni L. QEEG abnormalities in cognitively unimpaired patients with delirium. J Neurol Neurosurg Psychiatry 2023; 94:251-254. [PMID: 36261290 PMCID: PMC9985751 DOI: 10.1136/jnnp-2022-330010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 02/16/2023]
Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Matteo Alessandro De Rosa
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, off-Campus Semmelweis, University of Lugano, Lugano, Switzerland
| | - Stefano Gazzina
- Neurophysiology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Arighi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Carandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annachiara Cagnin
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Stefano Mozzetta
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Maurizio Gallucci
- Cognitive Impairment Center, Marca Trevigiana Local Unit of Health and Social Services 2, Treviso, Italy
| | - Domenico Marco Bonifati
- Unit of Neurology, Department of Neuro-cardio-vascular, Ospedale Santa Maria di Ca Foncello, Treviso, Italy
| | - Cinzia Costa
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabrizia D'Antonio
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Roma, Italy
| | - Giuseppe Bruno
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology, University of Rome La Sapienza, Rome, Italy.,San Raffaele Cassino Hospital, Cassino, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
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Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar M, Leppik I, Kwan P, Akamatsu N, Cretin B, O'Dwyer R, Kraemer G, Piccenna L, Faught E. The epidemiology of epilepsy in older adults: A narrative review by the ILAE Task Force on Epilepsy in the Elderly. Epilepsia 2023; 64:586-601. [PMID: 36625133 DOI: 10.1111/epi.17494] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/23/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023]
Abstract
In an aging world, it is important to know the burden of epilepsy affecting populations of older persons. We performed a selective review of epidemiological studies that we considered to be most informative, trying to include data from all parts of the world. We emphasized primary reports rather than review articles. We reviewed studies reporting the incidence and prevalence of epilepsy that focused on an older population as well as studies that included a wider age range if older persons were tabulated as a subgroup. There is strong evidence that persons older than approximately 60 years incur an increasing risk of both acute symptomatic seizures and epilepsy. In wealthier countries, the incidence of epilepsy increases sharply after age 60 or 65 years. This phenomenon was not always observed among reports from populations with lower socioeconomic status. This discrepancy may reflect differences in etiologies, methods of ascertainment, or distribution of ages; this is an area for more research. We identified other areas for which there are inadequate data. Incidence data are scarcer than prevalence data and are missing for large areas of the world. Prevalence is lower than would be expected from cumulative incidence, possibly because of remissions, excess mortality, or misdiagnosis of acute symptomatic seizures as epilepsy. Segmentation by age, frailty, and comorbidities is desirable, because "epilepsy in the elderly" is otherwise too broad a concept. Data are needed on rates of status epilepticus and drug-resistant epilepsy using the newer definitions. Many more data are needed from low-income populations and from developing countries. Greater awareness of the high rates of seizures among older adults should lead to more focused diagnostic efforts for individuals. Accurate data on epilepsy among older adults should drive proper allocation of treatments for individuals and resources for societies.
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Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Section of Neurology, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Istituto di Ricovero e Cura a Caraterre Scientifico, San Gerardo Foundation, University of Milan-Bicocca, Monza, Italy
| | - Monica Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Naoki Akamatsu
- Division of Neurology, Neuroscience Center, Fukuoka Samo Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology of the University Hospitals of Strasbourg, Strasbourg, France
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | | | - Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
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Piccenna L, O'Dwyer R, Leppik I, Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar MB, Akamatsu N, Cretin B, Krämer G, Faught E, Kwan P. Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the elderly. Epilepsia 2023; 64:567-585. [PMID: 36266921 DOI: 10.1111/epi.17426] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
Older adults represent a highly heterogeneous population, with multiple diverse subgroups. Therefore, an individualized approach to treatment is essential to meet the needs of each unique subgroup. Most comparative studies focusing on treatment of epilepsy in older adults have found that levetiracetam has the best chance of long-term seizure freedom. However, there is a lack of studies investigating other newer generation antiseizure medications (ASMs). Although a number of randomized clinical trials have been performed on older adults with epilepsy, the number of participants studied was generally small, and they only investigated short-term efficacy and tolerability. Quality of life as an outcome is often missing but is necessary to understand the effectiveness and possible side effects of treatment. Prognosis needs to move beyond the focus on seizure control to long-term patient-centered outcomes. Dosing studies with newer generation ASMs are needed to understand which treatments are the best in the older adults with different comorbidities. In particular, more high-level evidence is required for older adults with Alzheimer's disease with epilepsy and status epilepticus. Future treatment studies should use greater homogeneity in the inclusion criteria to allow for clearer findings that can be comparable with other studies to build the existing treatment evidence base.
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Affiliation(s)
- Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Neuroscience Platform, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Azienda Socio Sanitaria Territoriale (ASST) - San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - Monica B Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Naoki Akamatsu
- Department of Neurology, Fukuoka Sanno Hospital, International University of Health and Welfare School of Medicine, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology, Strasbourg University Hospitals, Strasbourg, France
| | | | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Silva MIT, Brás R, Paulino M, Cabral Duarte F, Pereira Santos MC, Costa C. Clinical characterization of peach allergic patients and respective molecular sensitization profile with ALEX®2 macroarray. Eur Ann Allergy Clin Immunol 2023. [PMID: 36786343 DOI: 10.23822/eurannaci.1764-1489.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- M I T Silva
- Department of Immunoallergology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Clinical Immunology Lab, Faculty of Medicine, Instituto de Medicina Molecular João Lobo Antunes, University of Lisbon, Lisbon, Portugal
| | - R Brás
- Department of Immunoallergology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- University Clinic of Immunoalergology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - M Paulino
- Department of Immunoallergology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - F Cabral Duarte
- Department of Immunoallergology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - M C Pereira Santos
- Clinical Immunology Lab, Faculty of Medicine, Instituto de Medicina Molecular João Lobo Antunes, University of Lisbon, Lisbon, Portugal
- University Clinic of Immunoalergology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - C Costa
- Department of Immunoallergology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- University Clinic of Immunoalergology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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20
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Dentinho M, Paulos K, Costa C, Costa J, Fialho L, Cachucho L, Portugal A, Almeida J, Rehan I, Belo A, Jerónimo E, Santos-Silva J. Silages of agro-industrial by-products in lamb diets – Effect on growth performance, carcass, meat quality and in vitro methane emissions. Anim Feed Sci Technol 2023. [DOI: 10.1016/j.anifeedsci.2023.115603] [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: 02/16/2023]
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21
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Costa C, Lemos MS, Azevedo LF, Paneque M. Service provision of genetics health care in Portugal. J Community Genet 2023; 14:101-113. [PMID: 36414927 PMCID: PMC9947200 DOI: 10.1007/s12687-022-00617-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
In recent decades, genetics has undergone important technological advances. The rapid shift to genomics has made a strong impact on health systems around the world. In Portugal, this huge increase in consultations and typologies of genetic tests has joined the serious limitations of the few existing genetics services. The following study aims to characterize the current state of the network of genetics services in Portugal regarding its functioning, main challenges, and opportunities. Five semi-structured interviews were conducted, corresponding to 83.33% of the directors of the public genetics services of the National Health Service. Four thematic categories emerged from the analysis: (1) specialty and technical developments, (2) structural difficulties, (3) potentialities, and (4) future directions. The developments are due to the emergence of more comprehensive genetic applications, specific protocols and patient referral standards, and accreditation of services. The main difficulties encountered in the functioning of the services were difficulty in obtaining funding, lack of human resources, service overload, and lack of exclusive time for training and research. The potentialities mentioned were the establishment of multidisciplinary teams and the best articulation with specialists from other areas. Among the various future directions pointed out, better management of patients' waiting lists, the importance of research, the simplification of test request procedures, and the creation of specialized units inside the genetic services, were reported. The results showed several gaps in the practice of medical genetics that should be addressed with the development of public policies for the recognition and restructuring of medical genetics in health care.
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Affiliation(s)
- C. Costa
- grid.5808.50000 0001 1503 7226i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226IBMC - Institute of Molecular and Cellular Biology, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226CGPP - Center for Predictive and Preventive Genetics, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226FMUP - Faculty of Medicine, University of Porto, Porto, Portugal
| | - M. S. Lemos
- grid.5808.50000 0001 1503 7226FPCEUP - Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226CPUP - Center of Psychology, University of Porto, Porto, Portugal
| | - L. F. Azevedo
- grid.5808.50000 0001 1503 7226MEDCIDS - Faculty of Medicine, Department of Community Medicine, Health Information and Decision Sciences, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226CINTESIS@RISE - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - M. Paneque
- grid.5808.50000 0001 1503 7226i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226IBMC - Institute of Molecular and Cellular Biology, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226CGPP - Center for Predictive and Preventive Genetics, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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22
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Moniati F, Costa C, Chatzimatthaiou C, Chatzimatthaiou M. 1200 EFFECT OF BALANCE TRAINING AFTER HIP FRACTURE SURGERY: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED STUDIES. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.004] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Hip Fracture Surgery (HFS) can result in balance impairment which is associated with an increased risk of falls in the elderly as well as limitations in their mobility. Balanced Training (BT) is a rehabilitation method used aiming to minimize the balance impairments post HFS. BT options include stepping, balance task-specific exercise, standing on one leg, yoga. Our main outcome is to evaluate the effect of BT on the physical functioning of elderly patients post an HFS.
Methods
We conducted a systematic review using the PubMed-Medline, Cochrane Library and Embase databases to locate randomized controlled trials which compared BT with standard care post HFS. The Cochrane’ Library Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used as our template for the review.
Results
Overall, nine randomised controlled trials were selected, comprising a total of 712 patients, all aged 65 years of age and older. With regards to the type of BT rehabilitation: four trials used step-ups (n=500), three trials used balance task-specific exercise (n=170) and two studies used standing on one leg (n=42). The BT group demonstrated improvement in physical functioning post HFS compared to the control group (Standardised Mean Difference (SMD) = 0.410). Moreover, all functional parameters which include, lower limb strength, performance task and health related quality of life, were also improved in the BT group.
Conclusion
Evidently, the results demonstrate an improvement of physical functioning by BT post HFS. Furthermore, the positive effects on all functioning parameters were apparent. As a result, the implementation of BT in postoperative rehabilitation programs in elderly patients with hip fractures should be considered.
Reference
[1] Monticone M, Ambrosini E, Brunati R, et al. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil. 2018;32:340–351.
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Affiliation(s)
- F Moniati
- Barts and the London School of Medicine and Dentistry
| | - C Costa
- Barts and the London School of Medicine and Dentistry
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23
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Costa C, Moniati F. 1199 PREVENTION AND TREATMENT OF CRITICAL ILLNESS ACQUIRED WEAKNESS IN THE ELDERLY. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.035] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Critical Illness Acquired weakness (ICU-Acquired Weakness (ICU-AW)) is an umbrella term used to describe Critical Illness Myopathy (CIM) and Critical Illness Polyneuropathy (CIP). The condition exerts high prevalence in the elderly admitted in the ICU and is associated with deteriorating patient outcomes, namely mortality and morbidity. The prevalence of the syndrome is highly variable in the current literature hindering our ability to objectively quantify the scale of the problem. Moreover, several preventative methods and treatment for ICU-AW as a result of sarcopenia have been proposed in literature with some of them providing favourable outcomes.
Objectives
1. Evaluate the prevalence of ICU-AW in the elderly through a systematic review; and 2. Explore the treatment options currently available.
Methods
We conducted a systematic review using the PubMed, Embase and Cochrane databases to explore the current studies available on the diagnosis of ICU-AW syndromes. Cochrane’s Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was our template.
Results
Overall, twenty-one studies (1544 patients) were included. The minimum reported prevalence is 20%, whereas the maximum is 76%. The overall median prevalence was 52% (Q1: 32% and Q3: 61%) with an interquartile range (IQR) of 29%. The highest IQR was found in studies using clinical examination (IQR=37%) whereas the lowest in studies using electrophysiological assessment (IQR= 21%). Moreover, several preventative measures for ICU-AW were identified and analyzed namely: nutritional alterations (high protein dies), glucose control, early mobilization, neuromuscular electrical stimulation and the ABCDEF bundle.
Conclusion
The variability in the diagnostic modalities used to measure the syndrome as well as the inconsistency in the diagnostic parameters within each modality prevent us from objectively quantifying the prevalence of ICU-AW. With regards to treatment early mobilization protocols offer promising evidence.
Reference
Vanhorebeek, Latronico, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637-53.
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Affiliation(s)
- C Costa
- Barts and the London School of Medicine and Dentistry
| | - F Moniati
- Barts and the London School of Medicine and Dentistry
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24
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Sciaccaluga M, Ruffolo G, Palma E, Costa C. Traditional and Innovative Anti-seizure Medications Targeting Key Physiopathological Mechanisms: Focus on Neurodevelopment and Neurodegeneration. Curr Neuropharmacol 2023; 21:1736-1754. [PMID: 37143270 PMCID: PMC10514539 DOI: 10.2174/1570159x21666230504160948] [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: 09/03/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Despite the wide range of compounds currently available to treat epilepsy, there is still no drug that directly tackles the physiopathological mechanisms underlying its development. Indeed, antiseizure medications attempt to prevent seizures but are inefficacious in counteracting or rescuing the physiopathological phenomena that underlie their onset and recurrence, and hence do not cure epilepsy. Classically, the altered excitation/inhibition balance is postulated as the mechanism underlying epileptogenesis and seizure generation. This oversimplification, however, does not account for deficits in homeostatic plasticity resulting from either insufficient or excessive compensatory mechanisms in response to a change in network activity. In this respect, both neurodevelopmental epilepsies and those associated with neurodegeneration may share common underlying mechanisms that still need to be fully elucidated. The understanding of these molecular mechanisms shed light on the identification of new classes of drugs able not only to suppress seizures, but also to present potential antiepileptogenic effects or "disease-modifying" properties.
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Affiliation(s)
- Miriam Sciaccaluga
- Section of Neurology, S.M. della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli 1, Perugia, 06129, Italy
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Istituto Pasteur—Fondazione Cenci Bolognetti, University of Rome, Sapienza, Rome, 00185, Italy
- IRCCS San Raffaele Roma, Rome, 00166, Italy
| | - Eleonora Palma
- Department of Physiology and Pharmacology, Istituto Pasteur—Fondazione Cenci Bolognetti, University of Rome, Sapienza, Rome, 00185, Italy
- IRCCS San Raffaele Roma, Rome, 00166, Italy
| | - Cinzia Costa
- Section of Neurology, S.M. della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli 1, Perugia, 06129, Italy
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25
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Perriello VM, Falini L, Ruggeri L, Innocente A, Ballanti S, Costa C, Di Filippo M, Gargaro M, Fallarino F, Falini B. CAR T cell-driven cerebrospinal fluid cytokine storm with confounding neurological picture in chemorefractory primary cardiac lymphoma. Am J Hematol 2023; 98:212-219. [PMID: 36346356 DOI: 10.1002/ajh.26777] [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: 09/16/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Vincenzo Maria Perriello
- Institute of Hematology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenza Falini
- Institute of Hematology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Loredana Ruggeri
- Institute of Hematology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessandra Innocente
- Institute of Hematology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Stelvio Ballanti
- Institute of Hematology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marco Gargaro
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Brunangelo Falini
- Institute of Hematology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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26
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Esteves Caldeira L, Paulino M, Coutinho C, Neto M, Pereira Barbosa M, Costa C. Clinical experience of a specialized urticaria outpatient clinic from a Portuguese UCARE. Eur Ann Allergy Clin Immunol 2023; 55:9-18. [PMID: 33949172 DOI: 10.23822/eurannaci.1764-1489.209] [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] [Indexed: 01/14/2023]
Abstract
Summary Background. Chronic urticaria (CU) is a frequent disease, with a prevalence of at least 1%. It is characterized by pruritic wheals, angioedema or both for a period longer than 6 weeks. Objective. Identify the demographic, clinical, laboratory and therapeutic profile of patients treated in a Portuguese Urticaria Center of Reference and Excellence (UCARE) and compare it with international series. Methods. Retrospective analysis of database of patients observed in a specialized urticaria outpatient clinic, from January 2017 through September 2019, of a UCARE center in Portugal. Demographic and clinical features, laboratory findings and pharmacological treatment were obtained from the records. Descriptive analyses were performed for all variables. Chi square and fisher's exact tests were applied to analyze the independence of variables and the fit of distribution. P less than 0.05 was considered significant. Results. During this period, 477 patients were observed, of whom 429 (90%) were diagnosed with chronic urticaria. Mean age (years) at the onset of symptoms was 43.7 (standard deviation (SD) 17.6, range 6-88) and at diagnosis 46.7 (SD 17.8, range 6-88) resulting in an average diagnostic delay of 3 years (range 0-25). Median follow-up period since first attendance in the specialized outpatient clinic was 1.7 years (interquartile range (IQR) 0.79, range 0.1-2.75) . Concerning the whole group of CU patients, 347 (81%) had chronic spontaneous urticaria (CSU) - 79% female, 39 (9%) had isolated chronic inducible urticaria (CIndU) and 43 (10%) had CSU with CIndU. Autologous serum skin test (ASST) was done in 76 patients (positive in 24 (32%)) and basophil activation test (BAT) was done in 38 (positive in 13 (34%)). At the moment of study, 204 (48%) of CU patients were medicated with a second-generation H1-antihistamine (sgAH) daily (first-line therapy), 99 (23%) with sgAH up to four times the standard dose (second-line therapy) and 126 (29%) with omalizumab (third-line therapy). Additionally, 7 (2%) patients were completing a short course of systemic corticosteroids for management of disease exacerbation. Disease control was achieved in 316 of CSU patients (81%). Conclusions. Referral to a specialized urticaria outpatient clinic is important for a proper assessment of the disease and adequately symptom control.
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Affiliation(s)
- L Esteves Caldeira
- Immunoallergology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
| | - M Paulino
- Immunoallergology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
| | - C Coutinho
- Immunoallergology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
| | - M Neto
- Immunoallergology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
| | - M Pereira Barbosa
- Immunoallergology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
- University Clinic of Immunoallergology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - C Costa
- Immunoallergology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisbon, Portugal
- University Clinic of Immunoallergology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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27
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Varandas C, Esteves Caldeira L, Silva SL, Costa C, Limão R, Silva MI, Lopes A, Caiado J, Cosme J, Alonso E, Marcelino J, Cabral Duarte F, Fernandes NP, Neto M, Pedro E, Branco Ferreira M, Spínola Santos A. Hereditary angioedema: 24 years of experience in a Portuguese Reference Center. Eur Ann Allergy Clin Immunol 2022. [PMID: 36515257 DOI: 10.23822/eurannaci.1764-1489.278] [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: 12/15/2022]
Abstract
Summary Hereditary angioedema (HAE) poses a high burden of disease, being its epidemiological and clinical data heterogeneous among countries, with no recent published studies concerning Portuguese patients. Therefore, we aimed to raise awareness of HAE and to contribute to clinical knowledge. An observational, descriptive, retrospective, and cross-sectional study was performed, that included a cohort of 126 patients followed in a single Portuguese Center. We observed a high prevalence of HAE-C1-INH type II (45.2% of patients). Most HAE patients (67.4%) presented the initial manifestations of the disease before adulthood, at a mean age of 12.6 ± 8.4 years. However, we found a long delay in HAE diagnosis, especially in those without family history (mean 20.7 ± 17.3 years). Stress was the most common trigger, followed by trauma and infection. Symptoms involving different systems were increasingly reported with increased disease duration. Cutaneous symptoms (95.0%) were more frequent, followed by gastrointestinal (80.7%), and respiratory symptoms (50.4%). HAE symptoms led to abdominal surgery in 22 (17.5%) patients and induced laryngeal edema requiring intubation/tracheostomy in 8 (6.3%) patients. Most patients were under long-term prophylaxis, mainly with attenuated androgens (62.7% of patients).The correct distinction between HAE and other common causes of angioedema is critical, allowing reduction of diagnostic delay, improvement of adequate management, and ultimately improving outcomes and quality of life of HAE patients.
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Affiliation(s)
- C Varandas
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - L Esteves Caldeira
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - S L Silva
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - C Costa
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - R Limão
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - M I Silva
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - A Lopes
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - J Caiado
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - J Cosme
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - E Alonso
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - J Marcelino
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - F Cabral Duarte
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - N P Fernandes
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - M Neto
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - E Pedro
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
| | - M Branco Ferreira
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - A Spínola Santos
- Department of Immunoallergology, Santa Maria Hospital, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Lisboa, Lisbon, Portugal
- Immunoallergology University Clinic, Faculty of Medicine, Lisbon University, Lisbon, Portugal
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Romigi A, Costa C, Sen A, Giorgi FS. Editorial: Epilepsy in older adults: From physiopathology to improvements in diagnosis and management. Front Neurol 2022; 13:1063299. [PMID: 36388177 PMCID: PMC9665049 DOI: 10.3389/fneur.2022.1063299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Andrea Romigi
- Sleep Medicine Center, IRCCS Neuromed Istituto Neurologico Mediterraneo, Pozzilli, Italy,*Correspondence: Andrea Romigi
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia-S. Maria della Misericordia Hospital, Perugia, Italy
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,Oxford Epilepsy Research Group, National Institute of Health and Care Research (NIHR) Biomedical Research Centre, Nueld Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Filippo Sean Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Leo A, Tallarico M, Sciaccaluga M, Citraro R, Costa C. Epilepsy and Alzheimer's Disease: Current Concepts and Treatment Perspective on Two Closely Related Pathologies. Curr Neuropharmacol 2022; 20:2029-2033. [PMID: 35524669 PMCID: PMC9886839 DOI: 10.2174/1570159x20666220507020635] [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] [Received: 10/22/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 11/22/2022] Open
Abstract
The literature on epileptic seizures in Alzheimer's disease has significantly increased over the past decades. Remarkably, several studies suggest a bi-directional link between these two common neurological diseases, with either condition carrying a nearly 2-fold risk of contracting the other in comparison to healthy subjects. In this respect, evidence from both clinical and preclinical studies indicates that epileptogenesis and neurodegeneration possibly share common underlying mechanisms. However, the precise association between epileptogenesis and neurodegeneration still needs to be fully elucidated. Targeted intervention to reduce abnormal network hyperexcitability might constitute a therapeutic strategy to postpone the onset of later neurodegenerative changes and consequent cognitive decline by many years in patients. By virtue of this, an early diagnosis and treatment of seizures in patients with Alzheimer's disease should be pursued. To date, no guidelines are available for treating epileptic activity in this context, largely due to the paucity of studies sufficient to answer the related questions. Accordingly, clinical trials are mandatory, not only to inform clinicians about symptomatic management of seizures in Alzheimer's disease patients but also to detect if treatment with antiseizure medications could have disease-modifying effects. Moreover, it will be fundamental to expand the application of animal models of Alzheimer's disease to comorbid conditions, such as epilepsy both to reveal the mechanisms underlying seizure onset and to better define their role in cognitive decline. Such models could also be useful to identify pharmacological compounds having therapeutically effectiveness as well as reliable early biomarkers for seizures in Alzheimer's disease.
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Affiliation(s)
- Antonio Leo
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy;
| | - Martina Tallarico
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy;
| | - Miriam Sciaccaluga
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia, Italy
| | - Rita Citraro
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy; ,Address correspondence to this author at the Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Viale Europa – Germaneto 88100 Catanzaro, Italy; Tel: +39 0961 3694191; Fax: +39 0961 3694192; E-mail:
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, Santa Maria Della Misericordia Hospital, Perugia, Italy
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Calvao J, Braga M, Brandao M, Campinas A, Alexandre A, Amador AF, Costa C, Carvalho MM, Pinto RA, Proenca T, Silva JC, Pires-Morais G, Silva MP, Brochado B, Macedo F. Acute total occlusion of the unprotected left main coronary artery – patient characteristics and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1488] [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
Background
Acute total occlusion of the unprotected left main coronary artery (ATOLMCA) is a dramatic entity with very high mortality. Owing to its infrequency, there is limited and inconsistent data regarding this population.
Purpose
To describe the clinical presentation, short- and long-term outcomes of patients with ATOLMCA.
Methods
This retrospective multicentric cohort study included all patients presenting with acute (<12h) myocardial infarction (MI) due to ATOLMCA (Thrombolysis In Myocardial Infarction - TIMI=0) between January 2008 and December 2020 in three tertiary hospitals.
Results
In the period of the study, 11,036 emergent coronary angiographies were performed in the participating centers, 59 of which were ATOLMCA (0.5%). Mean age of patients at the time of the event was 61.2 (±12.2) years. Seventy-three percent were male. At presentation, 72.9% of patients were in cardiogenic shock, and aborted cardiac arrest occurred in 27.1%. Right dominance was present in all patients except one, who had a balanced dominance. Primary percutaneous coronary intervention (PCI) was performed in 89.8% of the patients, with angiographic success being achieved in 55.6% of the procedures. Overall, the in-hospital mortality rate was 57.6%. Mortality was significantly higher in patients without angiographic criteria for PCI success (87.5 vs 36.7%, p<0.001). Among survivors, 91.7% were still alive at 1-year and 66.7% at 5 years of follow-up.
Conclusion
Patients with ATOLMCA have a dismal prognosis. Most patients present with cardiogenic shock, and a significant number develop cardiac arrest during the acute phase. Despite medical care, in-hospital mortality is high. Patients with left dominance may not even reach the hospital. Among survivors, long term outcomes are reasonable. Further studies are needed in order to improve the management and outcomes of patients with ATOLMCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Calvao
- Sao Joao Hospital , Porto , Portugal
| | - M Braga
- Sao Joao Hospital , Porto , Portugal
| | - M Brandao
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - A Campinas
- Hospital Center of Porto , Porto , Portugal
| | | | | | - C Costa
- Sao Joao Hospital , Porto , Portugal
| | | | - R A Pinto
- Sao Joao Hospital , Porto , Portugal
| | - T Proenca
- Sao Joao Hospital , Porto , Portugal
| | - J C Silva
- Sao Joao Hospital , Porto , Portugal
| | - G Pires-Morais
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - M P Silva
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - B Brochado
- Hospital Center of Porto , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital , Porto , Portugal
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De Almeida JPL, Martinho S, Rosa J, Campos G, Cunha M, Ferreira M, Costa C, Marinho V, Goncalves L. Does my TAVR patient have cardiac amyloidosis? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1685] [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
Aortic stenosis (AS) is highly age-related, and its prevalence is increasing rapidly in high-income countries. There are 2 major types of amyloid protein responsible for cardiac amyloidosis (CA) - transthyretin (TTR) and immunoglobulin lightchain (AL). Previous cohorts report an incidence ranging from 9 to 16% for the presence of CA in patients with AS referred for TAVR. These patients appear to have a similar prognosis to those with lone AS when undergoing TAVR, but a trend toward worse prognosis if left treated. We aimed to investigate the prevalence of CA in patients with severe AS referred for TAVR in the Portuguese population.
Methods
We prospectively recruited 60 consecutive patients referred for TAVR at our tertiary center between November 2020 and May 2021. 59 patients agreed to participate and signed an informed consent, approved by the local Ethics Commission. All patients performed coronary angiogram, echocardiogram, thoracic abdominal pelvic CT scan, ECG, bone scintigraphy (99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid [DPD]) and blood and urine monoclonal immunoglobulin testing. (Figure 1).
Results
About half (54.2%) of patients were male, average age was 82 years and the prevalence of ischemic heart disease and cardiovascular risk factors was high. About one third of patients had atrial fibrillation and 27.1% were pacemaker carriers. Echocardiographic baseline findings were: maximum aortic valve gradient 72.77±18.18 mmHg; mean aortic valve gradient 43.49±11.60; aortic valve area 0.65±0.15 cm2; interventricular septum thickness 1.30±0.23 cm; left ventricular ejection fraction (LVEF) 52.06±11.35%; E/E' 14.63±7.5; tricuspid annular plane systolic excursion 19.2±4mm; right ventricle/ right atrial gradient 38.1±14.32mmHg.
CA was diagnosed in 6 (10.2%) patients. Perugini grade was 1 (n=3) and 3 (n=3). One patient (Perugini grade = 3) was found to have plasma cell dyscrasia, producing monoclonal IgG Kappa protein. CA patients were all male, older (86.5 vs 81.30 years, p=0.049), more frequently pacemaker carriers (66.7 vs 22.6%, p=0.041) and had a tendency to have a thicker interventricular septum (1.48 vs 1.28 cm, p=0.065).
Conclusions
We show that in the Portuguese population, the prevalence of CA in severe AS patients referred for TAVI is in line with what is observed in other countries. This has important consequences regarding the diagnosis and management of these patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Martinho
- University Hospitals of Coimbra , Coimbra , Portugal
| | - J Rosa
- University Hospitals of Coimbra , Coimbra , Portugal
| | - G Campos
- University Hospitals of Coimbra , Coimbra , Portugal
| | - M Cunha
- University Hospitals of Coimbra , Coimbra , Portugal
| | - M Ferreira
- University Hospitals of Coimbra , Coimbra , Portugal
| | - C Costa
- University Hospitals of Coimbra , Coimbra , Portugal
| | - V Marinho
- University Hospitals of Coimbra , Coimbra , Portugal
| | - L Goncalves
- University Hospitals of Coimbra , Coimbra , Portugal
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Alves Pinto R, Martins Carvalho M, Proenca T, Costa C, Amador AF, Calvao J, Marques C, Cabrita A, Santos L, Pinho A, Oliveira C, Paiva M, Silva JC, Macedo F. Percutaneous valve commissurotomy in mitral stenosis patients: a 20 years follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1564] [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
Background
Percutaneous valve commissurotomy (PMC) is a viable alternative to mitral valve surgery in the treatment of patients with clinically significant mitral stenosis (MS). Although rheumatic MS incidence has decreased in developed countries, it remains a prevalent healthcare problem in Cardiology clinics
Purpose
To evaluate the early and long-term results of PMC in patients with rheumatic MS and to compare long-term events between patients with and without pulmonary hypertension (PH).
Methods
We retrospectively analysed all consecutive patients between 1991 and 2008 with clinically significant rheumatic MS undergoing PMC. Clinical and echocardiographic data were collected at baseline and during long-term follow-up. MACE was a composite of adverse events defined as all-cause mortality, mitral valve re-intervention or hospitalization for a cardiovascular cause.
Results
A total of 124 patients were enrolled: 87% were female, with a mean age at the time of repair of 46±11 year-old and a mean follow-up of 20±6 years. Before the procedure, 34% were in NYHA class ≥ III and 81% had a Wilkins score ≤8; all patients had preserved biventricular systolic function, 83% presented PH, mean transvalvular gradient (TVG) and mitral valve area (MVA) were 12.8 mmHg and 1.0 cm2, respectively. Most of the procedures were successful (91%) and without complications (94%), with a mean MVA improvement of 0.9 cm2 and reduction of 8.5 mmHg in TVG and 9.7 mmHg in pulmonary artery systolic pressure (PASP) after PMC.
During long-term follow-up, 42% of patients were submitted to re-intervention (most of them surgically) and 24% died. In patients non-submitted to re-intervention, TVG and PASP remained similar with early post-procedure evaluation (p=0.109 and p=0.777, respectively), while MVA reduced over time, yet still statistically superior to baseline MVA (1.6 cm2 vs 1.0 cm2, p<0.001). Concerning time-to-event analysis, approximately 80% of patients kept uneventful after 10 years; after 30 years, more than 20% continued MACE-free and approximately 50% were alive. Regarding PH presence at time of PMC, there was no significant difference in MACE events and all-cause mortality between the two groups (Log Rank, p=0,846 and p=0.661, respectively).
Conclusion
PMC was safe and effective in clinically significant rheumatic MS. After a long-term follow-up patients maintained the reduction in TVG and PASP and a smaller but significative improvement in MVA. Most of the patients were free from adverse events after 10 years and half were alive after 30 years. There was no difference in all-cause mortality and in a composite of all-cause death, mitral valve re-intervention or cardiovascular hospitalization concerning PH presence.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - T Proenca
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - C Costa
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - A F Amador
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - J Calvao
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - C Marques
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - A Cabrita
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - L Santos
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - A Pinho
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - C Oliveira
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - M Paiva
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - J C Silva
- Sao Joao Hospital, Cardiology , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital, Cardiology , Porto , Portugal
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Marques C, Cabrita A, Maia Araujo P, Proenca T, Pinto R, Carvalho M, Costa C, Amador AF, Calvao J, Pinho A, Oliveira C, Santos L, Cruz C, Macedo F. Patient delay in acute myocardial infarction: a long journey still ahead. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1473] [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
Background
It is overly known that time delays in acute myocardial infarction (AMI) strongly influence its outcomes. Patient delay (PD) is repeatedly pointed out as the longer one in this context, as well as it is the less modifiable one by organizational measures. Therefore, it is crucial to understand the reasons for longer PD in our population, to define proper strategies to improve PD and, ultimately, AMI-outcomes.
Methods
In this six-month prospective study of patients (pts) admitted in a tertiary hospital due to type-1 AMI, 194 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured interview within 48h after admission and review of medical records.
Results
Our work spotted several aspects significantly influencing PD in AMI context (Figure 1). Concerning pts cardiovascular background, a trend towards a shorter PD was found in pts with at least one cardiovascular risk factor (CVRF) (p=0,08) and with a previous history of AMI (p=0,08). Regarding clinical presentation, a significantly shorter PD was found in pts presenting with associated symptoms (p=0,02), higher chest pain intensity (chest pain intensity ≥7 vs <7 in a 0–10 scale; p=0,03) and symptoms onset on weekdays rather than weekends (p=0,003). Regarding pts knowledge, significant differences were found when pts recognized their symptoms as AMI, presenting a shorter PD in this context (p=0,006). Curiously, pts ability to correctly identify AMI symptoms, when asked, or to acknowledge their CVRF (when present), did not influence PD. Considering sociodemographic factors, higher incomes (p=0,03) and non-rural residence (p=0,03) significantly translated into shorter PD. No differences were found in PD according to pts age, gender or educational level. After this initial univariate analysis, multiple linear regression was performed to identify possible predictors of PD. Four variables were identified: pts ability to recognize their symptoms as AMI (β −0.199; 95% CI: −277 to −34,87; p=0.012), living in a non-rural residence (β 0.154; 95% CI: 0.12–161.44; p=0.05), presenting associated symptoms (β −0.194; 95% CI: −257.43 to −28.84; p=0.014) and occurrence of symptoms on weekdays (β 0.170; 95% CI: 12.73–259.49; p=0.031) predicted shorter patient delays.
Conclusion
Our study clearly points to the need for increasing public awareness and educational measures, mainly in pts living in rural areas, in order to: 1) Improve pts knowledge about AMI symptoms, clarifying that atypical symptoms can happen; 2) Reinforce the importance of shortening AMI time delays, clearly explaining the concept “time is muscle”.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Marques
- Sao Joao Hospital , Porto , Portugal
| | - A Cabrita
- Sao Joao Hospital , Porto , Portugal
| | | | - T Proenca
- Sao Joao Hospital , Porto , Portugal
| | - R Pinto
- Sao Joao Hospital , Porto , Portugal
| | | | - C Costa
- Sao Joao Hospital , Porto , Portugal
| | | | - J Calvao
- Sao Joao Hospital , Porto , Portugal
| | - A Pinho
- Sao Joao Hospital , Porto , Portugal
| | | | - L Santos
- Sao Joao Hospital , Porto , Portugal
| | - C Cruz
- Sao Joao Hospital , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital , Porto , Portugal
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Costa C, Ferraz AL, Ferreira AR, Roncon-Albuquerque R. Management of fulminant myocarditis: peripheral venoarterial extracorporeal membranous oxygenation and associated complications. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1695] [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
Background
Fulminant Myocarditis (FM) leads to cardiogenic shock with multi-organic dysfunction, being peripheral venoarterial extracorporeal membranous oxygenation (VA-ECMO) a rescue technique. Despite growing experience, it is still related with several complications. We aim to appraise the management of patients with FM and the adverse events associated to VA-ECMO.
Methods
We conducted a retrospective study in a ECMO centre in Portugal, which included 15 patients diagnosed with FM and managed on VA-ECMO from 2008 to 2018. Hemorrhage or infection on cardiac device site, cardiac tamponade, limb ischemia, ischemic stroke, cerebral hemorrhage, severe hemolysis and accidental decannulation were considered major complications.
Results
For sample characteristics and resumed complications, see Table. Inotropic and mechanical ventilation support were transversal to all, with only one patient extubated before decannulation. Six patients received renal replacement therapy, whom half recovered renal function and the remaining died. VA-ECMO operated on average for 8,5 days (range, 1 to 20 days). 3 patients had concomitant Impella heart pump and one of them had a third assistance device with Intra-Aortic Ballon pump.
Major complications were observed in 9 patients (60%), being ischemic stroke the most common. Limb ischemia, observed in 5 patients, related with longer duration of VA-ECMO support (limb ischemia vs non-limb ischemia; 12,8±4,9 vs. 6,8±6,5 days). Two patients presented hemorrhage on cardiac assistance device site, and 1 patient had a cardiac tamponade, all with fatal outcome. Infection on cardiac site, cerebral hemorrhage, severe hemolysis and accidental decannulation were not observed.
Conclusion
The most common complications were ischemic stroke and limb ischemia, both not apparently related with mortality. Differently, hemorrhage on cardiac site and cardiac tamponade were less frequent but presented ominous outcome. Overall, adverse events can be serious and hinder recovery and discharge.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Costa
- Sao Joao Hospital , Porto , Portugal
| | - A L Ferraz
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
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Battazza ML, Galhardo I, Costa C. SEU DIREITO NO TRATAMENTO: UMA VIDA SEM SANGRAMENTO - DIA MUNDIAL DA HEMOFILIA 2022. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.1021] [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: 11/07/2022] Open
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Costa C, Matos T, López-Presa D, Miguéns J, do Vale S. Thyrotropin-secreting microadenoma and the importance of a prompt diagnosis: A case report. Hippokratia 2022; 26:157-160. [PMID: 37497534 PMCID: PMC10367952] [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] [Indexed: 07/28/2023]
Abstract
Background The prevalence of thyrotropin-secreting pituitary adenomas, most being macroadenomas, is one to two cases per million inhabitants. Their differential diagnosis may be challenging, especially for microadenomas. Case description We present the case of a 50-year-old male with progressive neck enlargement, hot sudorific hands, anorexia, diarrhea, and weight loss over the preceding three months. Laboratory evaluation revealed high thyroid hormones, predominantly high free triiodothyronine of 7.74 pg/mL (reference range 2.3-4.2), with a non-suppressed thyroid stimulating hormone (TSH) of 1.73 µIU/mL (reference range 0.55-4.78). A high level of suspicion directed additional evaluation that revealed a high total alpha-subunit of glycoprotein hormones (αGS) and αGS/TSH ratio. Magnetic resonance imaging revealed a six mm pituitary lesion. A microthyrotropinoma was diagnosed, and long-acting octreotide was initiated before surgery for symptomatic control. Endoscopic transnasal transsphenoidal tumor resection was performed months later. The patient was in remission one year after surgery with no pituitary deficits. Conclusions Reaching an accurate diagnosis on time is crucial for deciding the optimal therapeutic approach and preventing and decreasing the frequency of endocrine and neurological complications. HIPPOKRATIA 2022, 26 (4):157-160.
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Affiliation(s)
- C Costa
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - T Matos
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - D López-Presa
- Pathology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - J Miguéns
- Neurosurgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - S do Vale
- Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Endocrinology Department, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Duarte X, Oliveira J, Teixeira J, Madureira J, Costa C. P02-08 The influence of cryopreservation on yH2AX levels. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Silvério-António M, Martinho J, Melo AT, Guimarães F, Santos Oliveira D, Pestana Lopes JM, Saraiva A, Gago L, Gomes Correia AM, Fernandes AL, Dinis SP, Nicolau R, Silva SP, Costa C, Beirão T, Furtado A, Azevedo Abreu PM, Afonso C, Peixoto D, Dourado E, Khmelinskii N. POS0901 INTERSTITIAL LUNG DISEASE IN MIXED CONNECTIVE TISSUE DISEASE: CLINICAL AND SEROLOGICAL ASSOCIATIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3620] [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: 11/03/2022]
Abstract
BackgroundMixed connective tissue disease (MCTD) is a rare systemic rheumatic disease characterized by the expression of autoantibodies targeting the U1-ribonucleoprotein and overlapping clinical features of systemic sclerosis, systemic lupus erythematosus, and inflammatory myopathies. Interstitial lung disease (ILD) is present in 47% to 78% of patients and has been associated with higher mortality rates. Associations of ILD with Raynaud’s phenomenon, dysphagia, anti-Ro52 antibodies, and a scleroderma pattern on nailfold capillaroscopy have been reported in MCTD patients.ObjectivesThis study aims to identify clinical and serological associations and independent predictors of ILD for patients with MCTD.MethodsMulticenter retrospective study using data collected from clinical records. Adult patients who underwent lung computed tomography (CT) and met at least one of four MCTD diagnostic criteria (Sharp, Alarcón-Segovia, Kasukawa, or Kahn criteria) were included. Univariate analysis was performed using Chi-Square, Fischer’s Exact, and Mann-Whitney tests, as appropriate. Multivariate analysis was performed using binary logistic regression modelling. The linearity of the continuous variables concerning the logit of the dependent variable was assessed via the Box-Tidwell procedure. Cases with missing information and outliers were excluded from the multivariate analysis to fulfil all assumptions necessary to assure the validity of the regression.ResultsFifty-seven patients, of whom 37 were Caucasian (64.9%) and 48 were females (84.2%), with a mean age of 39.4±14.0 years, were included. Twenty-seven patients had ILD (47.4%), of whom 22 had nonspecific interstitial pneumonia (81.5%), 4 had usual interstitial pneumonia (14.8%), and 1 had lymphoid interstitial pneumonia (3.7%) pattern on CT. Among patients with ILD, 13 were asymptomatic (48.1%), while 14 had respiratory symptoms (51.9%), including dyspnea (N=13, 48.1%), cough (N=7, 25.9%), and pleuritic chest pain (N=1, 3.7%). Pulmonary function tests were performed in 22 patients (81.5%), 20 of whom had a restrictive pattern (90.9%).In the univariate analysis, lymphadenopathy at disease onset (22.2% vs 3.3%, p=0.045) and esophageal involvement at any time point (40.7% vs 16.7%, p=0.043), were associated with ILD.The binary logistic regression model predicting ILD included 56 patients, and the model explained 36.5% (Nagelkerke R2) of the variance in ILD and correctly classified 75% of all cases. Older age at diagnosis (OR 1.10/year, 95%CI: 1.00-1.12, p=0.046) and lymphadenopathy at disease onset (OR 19.65, 95%CI: 1.91-201.75, p=0.012) were identified as predictors of ILD in MCTD patients, irrespective of sex and esophageal involvement.ConclusionOlder age at diagnosis and lymphadenopathy at disease onset were independent predictors of ILD in MCTD. Therefore, these factors should be considered when evaluating MCTD patients, especially at the time of diagnosis. To the best of our knowledge, this is the largest study ever describing predictors of ILD for MCTD patients.References[1]Fagundes MN, Caleiro MT, Navarro-Rodriguez T, Baldi BG, Kavakama J, Salge JM, Kairalla R, Carvalho CR. Esophageal involvement and interstitial lung disease in mixed connective tissue disease. Respir Med. 2009 Jun;103(6):854-60. doi: 10.1016/j.rmed.2008.12.018. Epub 2009 Feb 6. PMID: 19201182.[2]Gunnarsson R, Aaløkken TM, Molberg Ø, Lund MB, Mynarek GK, Lexberg AS, Time K, Dhainaut AS, Bertelsen LT, Palm O, Irgens K, Becker-Merok A, Nordeide JL, Johnsen V, Pedersen S, Prøven A, Garabet LS, Gran JT. Prevalence and severity of interstitial lung disease in mixed connective tissue disease: a nationwide, cross-sectional study. Ann Rheum Dis. 2012 Dec;71(12):1966-72. doi: 10.1136/annrheumdis-2011-201253. Epub 2012 May 1. PMID: 22550317Disclosure of InterestsNone declared
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Costa P, Costa C. Retroperitoneal Ewing Sarcoma: a challenging diagnosis. Radiología (English Edition) 2022; 64:490-493. [DOI: 10.1016/j.rxeng.2021.10.002] [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: 05/19/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
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Guimarães F, Silvério-António M, Martinho J, Melo AT, Santos Oliveira D, Pestana Lopes JM, Saraiva A, Gago L, Gomes Correia AM, Fernandes AL, Dinis SP, Nicolau R, Silva SP, Costa C, Beirão T, Furtado A, Azevedo Abreu PM, Khmelinskii N, Afonso C, Peixoto D. AB0655 Clinical and immunological features of a Portuguese cohort of Mixed Connective Tissue Disease. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.617] [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: 11/04/2022]
Abstract
BackgroundVarious nationwide studies have been already published to better understand Mixed Connective Tissue Disease (MCTD) (1,2). However, Portuguese data is not available.ObjectivesTo characterize clinical and immunological features of a Portuguese cohort of patients with MCTD.MethodsRetrospective, multicenter study including adult-onset patients with clinical diagnosis of MCTD and fulfilling at least one of the following classification criteria: Sharp, Kasukawa, Alarcón-Segovia or the Kahn’s criteria. Positivity to other autoantibodies besides anti-U1-RNP were allowed. SPSS was used for statistical analysis and significance level was defined as 2-sided p<.05.ResultsA total of 98 patients were included, with a mean age at diagnosis and disease duration of 40.5±13.7 and 7.0±6.5 years, respectively. Most patients were female (87.8%) and Caucasian (70.4%). Raynaud’s phenomenon (96.9%), arthralgia/arthritis (94.9/74.5%) and puffy fingers (60.2%) were the most common and early manifestations. Gastroesophageal (GE), respiratory and muscular involvement were also prevalent, mostly during the follow up, affecting 30.6%, 34.7% and 43.9% of the patients, respectively. Clinical and immunological characteristics are described in Table 1. Males were older at symptom’s onset (65.0 VS 46.7, p=.035), having more respiratory involvement (OR=4.5, 95% CI 1.3-16.4), and positivity to anti-ACPA (OR=20.0, 95% CI: 3.1-129.4). GE involvement occurred more often in Caucasian patients (OR=3.8; 95% CI: 1.0-14.1), while anemia of chronic diseases (OR=2.7; 95% CI: 1.0-7.2), myositis (OR=3.6; 95% CI: 1.3-9.9) and constitutional symptoms (OR=3.2; 95% CI: 1.2-8.3) were more frequent in Afro-American patients, whose were also younger at disease (34.1 VS 50.6, p=.01). After a median follow-up time of 4 (IQR 8) years, 4 deaths occurred (4.1%), mostly (75%) due to infectious complications.Table 1.Clinical and immunological characteristicsClinical ManifestationsAt presentationFollow-upMucocutaneous systemRaynaud’s phenomenon, n (%)85 (86.7)95 (96.9)Puffy hands, n (%)48 (49.0)59 (60.2)SSc-like, n (%)43 (44.8)59 (60.8)SLE-like, n (%)28 (28.9)35 (35.7)Musculoskeletal systemArthralgia/Arthritis, n (%)/n (%)81 (82.7) / 56 (57.1)93 (94.9) / 73 (74.5)Myositis, n (%)26 (25.6)43 (43.9)Hematological system, n (%)46 (46.9)70 (71.4)Respiratory system, n (%)14 (14.3)34 (34.7)Cardiovascular system3 (3.1)4 (4.1)Pulmonary hypertension*2 (2.0)15 (15.3)Gastroesophageal involvement, n (%)11 (11.2)30 (30.6)Renal involvement, n (%)2 (2.0)10 (10.2)Neurological involvement, n (%)6 (6.3)14 (14.3)Constitutional symptoms, n (%)26 (26.5)30 (30.6)Immunological characteristicsAnti-dsDNA, n (%)21 (21.4)Anti-smith antibody, n (%)21 (21.4)Anti-Ro/SSA, n (%)31 (31.6)Anti-La/SSB, n (%)7 (7.1)Anti-centromere, n (%)3 (4.1)Rheumatoid Factor, n (%)39 (39.8)Anti- anti-citrullinated protein antibodies, n (%)6 (6.1)Antiphospholipid antibodies, n (%)7 (7.1)Myositis antibodies, n (%)9 (9.2)Complement activation, n (%)27 (27.6)Hypergammaglobulinemia, n (%)51 (52.0)Legend: Anti-dsDNA: anti-double stranded deoxyribonucleic acid antibody; SLE: systemic lupus erythematosus, SSc: systemic sclerosis. *No information regarding cardiac catheterism, then compatible alterations in the echocardiogram.ConclusionRaynaud’s phenomenon, puffy fingers and arthritis were the most common manifestations in Portuguese patients, with similar proportions found in literature (1,2). However, we reported some differences in mucocutaneous, renal and serosa involvement and higher prevalence of probable pulmonary hypertension (1,2), which may be explained by the heterogeneity of the inclusion criteria. Except for respiratory, myositis, GE and constitutional symptoms, there were no differences regarding gender and ethnicity.Here, we characterize the largest cohort of MCTD in Portugal.References[1]Cappelli S, et al. Semin Arthritis Rheum. 2012 Feb;41(4):589–98.[2]Alves MR et al. Clin Exp Med. 2020 May;20(2):159–66.Disclosure of InterestsNone declared
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Melo AT, Silvério-António M, Martinho J, Dourado E, Guimarães F, Santos Oliveira D, Pestana Lopes JM, Saraiva A, Gago L, Gomes Correia AM, Fernandes AL, Dinis SP, Nicolau R, Silva SP, Costa C, Beirão T, Furtado A, Azevedo Abreu PM, Afonso C, Peixoto D, Khmelinskii N. AB0688 Predictors of muscle involvement in Portuguese patients with mixed connective tissue disease. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2947] [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: 11/03/2022]
Abstract
BackgroundMixed connective tissue disease (MCTD) is a rare heterogeneous disease, characterized by overlapping features of classic connective tissue diseases. Myositis may be present in up to two-thirds of patients with MCTD and it is included in all diagnostic criteria available. Although some possible associations have been reported, to the best of our knowledge, no independent predictors of MCTD-related myositis have been described.ObjectivesTo identify clinical and laboratorial predictors for muscular involvement in a cohort of Portuguese patients with MCTD.MethodsMulticentre retrospective cohort study including adult-onset patients with a clinical diagnosis of MCTD and fulfilling at least one of the following diagnostic criteria: Sharp, Kasukawa, Alarcón-Segovia or Kahn criteria. Myositis was defined as proximal muscle weakness, creatine kinase elevation, electromyography (EMG) suggestive changes or a positive muscular biopsy. Univariate analysis was performed using Chi-Square, Fischer’s Exact Test and Mann-Whitney Test, as appropriate. Multivariate analysis was performed using binary logistic regression modelling. The linearity of the continuous variables concerning the logit of the dependent variable was assessed via the Box-Tidwell procedure. Cases with missing information and outliers were excluded from the multivariate analysis to fulfil all assumptions necessary to assure the validity of the regression.ResultsA total of 98 patients were included, 43 (44.3%) of whom had muscular involvement at any time of the disease course. Concerning patients with MCTD-related myositis, the mean age at diagnosis was 34.8±12.5 years and the mean disease duration of 4.1±4.9 years. The majority of patients were female (90.7%) and of European ancestry (66.7%).EMG was performed in 24 patients, of whom 10 (41.7%) had a myopathic pattern. Seventeen patients were submitted to a muscular biopsy, of whom 8 (47.1%) had histological myositis features. Capillaroscopy was performed in 24 patients and 12 (50%) had a scleroderma pattern.African ancestry and leukopenia were positively associated with myositis at disease onset. Furthermore, fever at the onset of disease, younger age at diagnosis and shorter disease duration were positively associated with the occurrence of myositis at any phase of the disease.The multivariate analyses predicting myositis at diagnosis included 54 patients and at any time of the disease included 90 patients. These models explained 37.8% and 26.9% (Nagelkerke R2) of the variance in myositis and correctly classified 79.6% and 73.3% of all cases, respectively.African ancestry (OR 8.39, 95%CI: 1.43-49.37, p=0.019), leukopenia (OR 6.24, 95%CI: 1.32-29.48, p=0.021) and younger age at diagnosis (OR 1.07/year, 95%CI: 1.01-1.14, p=0.035) were identified as independent predictors of myositis at diagnosis. Fever (OR 6.51, 95%CI: 1.23-34.37, p=0.027) was an independent predictor of muscular involvement at any time of the disease in MCDT patients.ConclusionAfrican ancestry, leukopenia and younger age at diagnosis are independent predictors of myositis at presentation in MCTD patients, while fever is an independent predictor of myositis at any time of the disease. While evaluating patients with MCTD, these predictive factors should be considered.References[1]Ciang NCO, Pereira N, Isenberg DA. Mixed connective tissue disease-enigma variations? Rheumatol. 2017 Mar 1;56(3):326–33.[2]Hall S, Hanrahan P. Muscle involvement in mixed connective tissue disease. Rheum Dis Clin North Am. 2005 Aug;31(3):509–17, vii.Disclosure of InterestsNone declared
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Lattanzi S, Ascoli M, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Manfredi Basili L, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongiorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Donato F, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Teresa Faedda M, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gasparini S, Gazzina S, Teresa Giallonardo A, Sean Giorgi F, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Kiferle L, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Meletti S, Milano C, Nilo A, Orlando B, Paladin F, Grazia Pascarella M, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Rosa Pisani L, Placidi F, Pollicino P, Porcella V, Puligheddu M, Quadri S, Paolo Quarato P, Quintas R, Renna R, Rum A, Michele Salamone E, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Elisabetta Vaudano A, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures. Epilepsia 2022; 63:e42-e50. [PMID: 35278335 PMCID: PMC9311068 DOI: 10.1111/epi.17223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Canafoglia
- Department of Epileptology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
- Department of Health Sciences Università degli Studi Milan Italy
| | | | | | - Valentina Chiesa
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center Spedali Civili Brescia Italy
| | - Giuseppe Didato
- Epilepsy Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta" Milan Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Martina Fanella
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Massimo Gangitano
- Department of Biomedicine Neuroscience, and advanced Diagnostic (BIND) University of Palermo Palermo Italy
| | - Angela La Neve
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Oriano Mecarelli
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Elisa Montalenti
- Epilepsy Center AOU Città della Salute e della Scienza di Torino Turin Italy
| | - Alessandra Morano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences University of Turin Turin Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine Neurological Clinic University of Pisa Pisa, Pisa Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | | | - Eleonora Rosati
- Department Neurology 2 Careggi University Hospital Florence Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Centre Niguarda Hospital Milan Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
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Meneses Alves T, Martins M, Cunha A, Costa C, Ferreira L, Carreira L, Guedes-Martins L, Braga J. 128 Termination of pregnancy for fetal abnormality in a portuguese tertiary care hospital: Two-year retrospective study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Irelli EC, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Ascoli M, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Basili LM, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Faedda MT, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gazzina S, Giallonardo AT, Giorgi FS, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Milano C, Meletti S, Nilo A, Orlando B, Paladin F, Pascarella MG, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Pisani LR, Placidi F, Pollicino P, Porcella V, Pradella S, Puligheddu M, Quadri S, Quarato PP, Quintas R, Renna R, Rizzo GR, Rum A, Salamone EM, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Vaudano AE, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Seizure 2022; 97:37-42. [DOI: 10.1016/j.seizure.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
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DiFrancesco JC, Labate A, Romoli M, Chipi E, Salvadori N, Galimberti CA, Perani D, Ferrarese C, Costa C. Clinical and Instrumental Characterization of Patients With Late-Onset Epilepsy. Front Neurol 2022; 13:851897. [PMID: 35359649 PMCID: PMC8963711 DOI: 10.3389/fneur.2022.851897] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is classically considered a childhood disease. However, it represents the third most frequent neurological condition in the elderly, following stroke, and dementia. With the progressive aging of the general population, the number of patients with Late-Onset Epilepsy (LOE) is constantly growing, with important economic and social consequences, in particular for the more developed countries where the percentage of elderly people is higher. The most common causes of LOE are structural, mainly secondary to cerebrovascular or infectious diseases, brain tumors, trauma, and metabolic or toxic conditions. Moreover, there is a growing body of evidence linking LOE with neurodegenerative diseases, particularly Alzheimer's disease (AD). However, despite a thorough characterization, the causes of LOE remain unknown in a considerable portion of patients, thus termed as Late-Onset Epilepsy of Unknown origin (LOEU). In order to identify the possible causes of the disease, with an important impact in terms of treatment and prognosis, LOE patients should always undergo an exhaustive phenotypic characterization. In this work, we provide a detailed review of the main clinical and instrumental techniques for the adequate characterization of LOE patients in the clinical practice. This work aims to provide an easy and effective tool that supports routine activity of the clinicians facing LOE.
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Affiliation(s)
- Jacopo C. DiFrancesco
- Department of Neurology, ASST S. Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano - Bicocca, Monza, Italy
- *Correspondence: Jacopo C. DiFrancesco
| | - Angelo Labate
- Neurophysiopathology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images (BIOMORF), University of Messina, Messina, Italy
| | - Michele Romoli
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicola Salvadori
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Daniela Perani
- Nuclear Medicine Unit and Division of Neuroscience, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST S. Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano - Bicocca, Monza, Italy
| | - Cinzia Costa
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Cinzia Costa
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Martins De Carvalho M, Proenca T, Pinto RA, Costa I, Torres S, Resende CX, Grilo PD, Amador AF, Costa C, Calvao J, Cabrita A, Marques C, Sousa C, Paiva M, Macedo F. Breast cancer patients presenting with cardiotoxicity - risk factors and role of cardioprotective drugs. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.020] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Recent advances in cancer treatment have led to improved survival, albeit with cardiovascular adverse effects being some of the most frequent and feared consequences. Patient’s risk stratification, prevention and treatment are still to be fully elucidated. Our aim was to evaluate the risk and therapy of cardiotoxicity (CT) secondary to cancer treatment in a subset of patients with breast cancer (BC).
Methods
We collected a retrospective cohort of female with BC treated with conventional chemotherapy (CHT) and/or anti-HER2-targeted therapies (AHT) referred to Cardio-oncology consultation from January 2017 to March 2020. All patients were evaluated before CHT and at least at 3, 6 and 12-months with echocardiogram and cardiac biomarkers, namely high sensitivity troponin I (hs-cTnI) and brain natriuretic peptide (BNP). CT was defined as left ventricle ejection fraction (LVEF) under 50% or decline of at least 10% in LVEF during follow-up. As cardioprotective drugs (CPD) we considered renin-angiotensin-aldosterone system inhibitors and beta-blockers.
Results
A total of 203 women were enrolled, with mean age 50.9 ± 10.9 year-old. As for the cardiovascular risk factors, 23.5% had hypertension, 32.4% dyslipidaemia, 9.8% diabetes and 33.0% were smokers or previous smokers. The majority of patients had a high or very-high CT risk score (98.5% with score ≥ 5) and 35.5% were already on CPD before CHT. All patients were submitted to CHT: anthracyclines (AC) and AHT were applied to 83.8% and 41.7% of patients, respectively, with 27.9% of patients on both therapies; 81.4% were submitted to radiotherapy (RT). At presentation, all patients had normal cardiac function with mean LVEF of 62.9% and mean global longitudinal strain (GLS) of -19.4; mean hs-cTnI and BNP were 3.3 ng/L and 33.4 pg/mL, respectively. During a median follow-up of 16 months, 8.5% of patients developed CT, leading to initiation or titration of CPD in 76.9% and treatment interruption in 23.5%; most of them recovered (88.2%). During treatment there was a significantly increase of hs-cTnI (mean 19.7 ng/L at 3 months, p < 0.001) and a decrease of GLS and LVEF at 12 months (decrease of 1.1 and 2.2%, respectively, both p < 0.001). Both AHT and AHT plus AC were significantly associated with CT (p = 0.002 and p < 0.001, respectively), with an extremely high prevalence in the latter group (19.6%). Nor CVRF neither RT raised the risk of CT. Although patients on CPD did not had lower prevalence of CT (5.6% vs 10.2%, p = 0.268), its initiation was associated with a higher rate of cardiac function recovery (100.0% vs 66.7%, p = 0.057).
Conclusion
Patients submitted to AHT or AHT plus AC were at higher risk of developing CT. This and the significant LVEF decline during follow-up highlight the importance of long-term-monitoring of these patients. CPD seemed to be associated with cardiac recovery, although this finding needs further validation.
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Affiliation(s)
| | | | - RA Pinto
- Sao Joao Hospital, Porto, Portugal
| | - I Costa
- Sao Joao Hospital, Porto, Portugal
| | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | | | - PD Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | | | | | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - M Paiva
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Calvao J, Costa C, Amador A, Pinto R, Carvalho M, Proenca T, Marques C, Cabrita A, Grilo P, Resende C, Torres S, Sousa C, Macedo F. Impact of severe mitral annular calcification on mitral regurgitation after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.215] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequent in patients with aortic stenosis, and its presence is associated with increased cardiovascular morbidity and mortality. Not infrequently, it is associated with significant morphologic and functional abnormalities of the mitral valve apparatus.
Purpose
The aim of this work is to evaluate the relationship between severe MAC and the presence and development of significant mitral regurgitation after TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019. Clinical, echocardiographic and procedure-related data were collected until a follow-up of 6 months. Statistical analysis was conducted on IBM SPSS® Statistics software. Descriptive statistics were calculated for all variables. Sample T-test, Chi-square and Wilcoxon sign test were used. A p-value < 0.05 was considered significant. The presence and severity of MAC was defined according to echocardiographic data. Severe MAC was defined by the presence of calcification of more than half of the mitral annular circumference.
Results
A total of 343 patients were enrolled in the study. The mean age of the population was 80 ± 8 years, 45% were male. Mean functional area was 0.75 ± 0.18 cm2, mean transvalvular pressure gradient was 48 ± 15 mmHg and the mean left ventricular ejection fraction (LVEF) was 54 ± 14%. MAC was detected in 231 (67%) patients. In 44 (19%) of these patients, MAC was graded as severe. Patients with severe MAC tended to have higher prevalence of moderate (27.3 vs 20.4%, p = 0.30) as well as severe (4.5 vs 1.8%, p = 0.24) mitral regurgitation at baseline. After TAVI, the prevalence of moderate mitral regurgitation at 6 months was similar between both groups (22.5 vs 20.4%, p = 0.76). Although not reaching statistical significance, patients with severe MAC had higher prevalence of severe mitral regurgitation at 6 months post-procedure (12.2 VS 5.0%, p = 0.07) as well as higher incidence of worsening of mitral regurgitation (34.2 vs 23.7%, p = 0.16). The proportion of patients that had improvement (13.2 vs 15.0%, p = 0.76) or no change (52.6 vs 61.3%, p = 0.31) in the degree of mitral regurgitation was similar in both groups.
Conclusion
The presence of severe MAC at baseline echocardiography in patients undergoing TAVI may be associated with worsening of mitral regurgitation after the procedure. These patients tend to have higher prevalence of severe mitral regurgitation post-TAVI. Further studies are needed in order to further elucidate this association.
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Affiliation(s)
- J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | | | | | - P Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Costa C, Calvao J, Amador A, Proenca T, Carvalho M, Pinto R, Marques C, Cabrita A, Grilo PD, Resende CX, Torres S, Sousa C, Macedo F. Can aortic calcium score predict new conduction disturbances in pos-transcatheter aortic valve implantation? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.217] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Transcatheter aortic valve implantation (TAVI) may be the first line treatment for severe aortic stenosis according to overall patient characteristics. Semi-quantitative Agatston score (AS), which quantifies aortic calcium by cardiac computed tomography (CCT), has knowledgeable practical and clinical implications, and is performed in TAVI diagnostic workup. Since conduction disturbances continue to be the most frequent complication, further refinements are required to predict high-risk patients.
Purpose
To access if aortic AS relates with new conduction disturbances and permanent pacemaker (PPM) implantation in patients undergoing TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019; patients with previous permanent pacemaker (PPM) or had no aortic AS were excluded. Clinical and electrocardiogram (ECG) data were collected at admission and after the procedure. All categorical variables are reported as numbers and percentages. Continuous variables were analyzed using the two-tailed unpaired Student’s t-test and are reported as mean values and the standard deviation. Statistical analysis was performed using the IBM SPSS.
Results
172 patients with a mean age 79 ± 9.1 years old were included (see table 1 for baseline characteristics). AS was on average 3008 ± 2262 (see table 2 for remaining diagnostic workup and procedure characteristics).
Comparing AS with new conduction disturbances, no statistically significant difference was found for new complete left branch block (LBBB) (no vs new LBBB, AS: 3179 ± 2555 vs 2637 ± 1388, p= 0,15) and with new complete atrioventricular block (AVB) (no vs new AVB, AS: 2834 ± 1520 vs 4485 ± 5285, p = 0.2). Considering PPM implantation after TAVI, there was a tendency for higher AS and PPM implantation (no vs PPM implantation, AS: 2756 ± 1451 vs 4242 ± 4310, p = 0.07).
In patients who had pre-ballooning, there was no difference relating to AS; however, in patients who had no pre-ballooning there was a trend to higher AS and PPM implantation (no vs PPM implantation, AS: 2417 ± 1301 vs 4616 ± 4969, p = 0.06). No statistically significant difference was found when comparing earlier (Portico, CoreValve Evolut R) vs newer valves (CoreValve Evolut Pro; Edward Sapiens 3; Accurate Neo).
Conclusion
Aortic calcium measured by Agatston score did not show a correlation with new LBBB or new AVB after TAVI. Nevertheless, it seems to be a trend for higher AS and PPM implantation; this was more noticeable when pre-ballooning was not performed. Further studies are needed in order to further elucidate this association. Abstract Figure. Patients baseline characteristics Abstract Figure. TAVI diagnostic workup and procedure
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Affiliation(s)
- C Costa
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | | | | | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | - PD Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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BRANCO C, Cardoso A, Costa C, Silva B, Sant'Ana M, Outerelo C, Gameiro J. POS-558 Hypoalbuminemia and one-year mortality in haemodialysis patients with heart failure: a cohort analysis. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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50
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Costa C, Nardi Cesarini E, Eusebi P, Franchini D, Casucci P, De Giorgi M, Calvello C, Romoli M, Parnetti L, Calabresi P. Incidence and Antiseizure Medications of Post-stroke Epilepsy in Umbria: A Population-Based Study Using Healthcare Administrative Databases. Front Neurol 2022; 12:800524. [PMID: 35095743 PMCID: PMC8790124 DOI: 10.3389/fneur.2021.800524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Post-stroke epilepsy (PSE) requires long-term treatment with antiseizure medications (ASMs). However, epidemiology of PSE and long-term compliance with ASM in this population are still unclear. Here we report, through population-level healthcare administrative data, incidence, risk factors, ASM choice, and ASM switch over long-term follow-up. Materials and Methods: This is a population-based retrospective study using Umbria healthcare administrative database. Population consisted of all patients with acute stroke, either ischaemic or hemorrhagic, between 2013 and 2018. ICD-9-CM codes were implemented to identify people with stroke, while PSE was adjudicated according to previously validated algorithm, such as EEG and ≥1 ASM 7 days after stroke. Results: Overall, among 11,093 incident cases of acute stroke (75.9% ischemic), 275 subjects presented PSE, for a cumulative incidence of 2.5%. Patients with PSE were younger (64 vs. 76 years), more frequently presented with hemorrhagic stroke, and had longer hospital stay (15.5 vs. 11.2 days) compared with patients without PSE. Multivariable Cox proportional hazards models confirmed that PSE associated with hemorrhagic stroke, younger age, and longer duration of hospital stay. Levetiracetam was the most prescribed ASM (55.3%), followed by valproate and oxcarbazepine. Almost 30% of patients prescribed with these ASMs switched treatment during follow-up, mostly toward non-enzyme-inducing ASMs. About 12% of patients was prescribed ASM polytherapy over follow-up. Conclusions: Post-stroke epilepsy is associated with hemorrhagic stroke, younger age, and longer hospital stay. First ASM is switched every one in three patients, suggesting the need for treatment tailoring in line with secondary prevention.
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Affiliation(s)
- Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, Santa Maria della (S.M.) Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Elena Nardi Cesarini
- Neurology Clinic, Department of Medicine and Surgery, Santa Maria della (S.M.) Misericordia Hospital, University of Perugia, Perugia, Italy.,UOC Neurologia, Ospedale di Senigallia, Senigallia, Italy
| | - Paolo Eusebi
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | - David Franchini
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Carmen Calvello
- Neurology Clinic, Department of Medicine and Surgery, Santa Maria della (S.M.) Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Michele Romoli
- Neurology Clinic, Department of Medicine and Surgery, Santa Maria della (S.M.) Misericordia Hospital, University of Perugia, Perugia, Italy.,Neurology and Stroke Unit, "Maurizio Bufalini" Hospital, Cesena, Italy
| | - Lucilla Parnetti
- Neurology Clinic, Department of Medicine and Surgery, Santa Maria della (S.M.) Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Paolo Calabresi
- Neurologia, Dipartimento Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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