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Kikuchi J, Hoyt K, Ballas D, Chou B, Fashokun T, Lawani P, Roque D, Tropez-Martin J, Chen C. Addressing surgical training inequities: city-wide collaboration in gynecologic surgical skills simulation for resident education. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.107] [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: 11/01/2022]
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2
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Yoder A, Wang S, Roque D, Son C, Ludwig M, Chiao E, Levinson K, Lin L. Cervical Cancer Outcomes in Women Living With HIV in the Age of Anti-Retroviral Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2593] [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]
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Laiz I, Plecha S, Teles-Machado A, González-Ortegón E, Sánchez-Quiles D, Cobelo-García A, Roque D, Peliz A, Sánchez-Leal RF, Tovar-Sánchez A. The role of the Gulf of Cadiz circulation in the redistribution of trace metals between the Atlantic Ocean and the Mediterranean Sea. Sci Total Environ 2020; 719:134964. [PMID: 31837879 DOI: 10.1016/j.scitotenv.2019.134964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
The GoC shelf waters present much higher concentrations of dissolved Cu, Cd, and Zn than other coastal areas, constituting an important source of these elements onto its neighbouring basins, i.e., the Atlantic Ocean and the Mediterranean Sea. In this study we assessed the role of the GoC surface currents in the trace metals transport. For this purpose, ten dissolved (<0.22 µm) trace metals were sampled (Ag, Cd, Co, Cu, Fe, Mo, Ni, Pb, Zn, V) along the GoC continental shelf, and their spatial and temporal distribution was interpreted according to the surface circulation. Results show that the complex surface circulation over the shelf confines the metals concentration mainly along the inner shelf and determines their transport patterns: under southeastward currents, Cd, Co, Cu, Ni, and Pb are transported toward the Mediterranean Sea; under northwestward countercurrents, Cd, Co, Cu, Fe, Ni, and Zn are transported toward the southern and, occasionally, the western Portuguese shelf; under variable currents, Ag, Cd, Co, Cu, Fe, Pb, and Zn tend to accumulate near their source. Considering that some of these metals have not been analysed before in this region (Ag, Mo, V), or that the spatial distribution of certain metals (Ag, Fe, Mo, Pb, V) has not been interpreted in terms of the ocean circulation, this work could be considered as a baseline study for future comparisons.
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Affiliation(s)
- I Laiz
- Department of Applied Physics, Instituto Universitario de Investigación Marina (INMAR), University of Cadiz, Campus de Excelencia Internacional/Global del Mar (CEI·MAR), E-11510 Puerto Real, Cadiz, Spain.
| | - S Plecha
- Instituto Dom Luiz, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal.
| | - A Teles-Machado
- Instituto Dom Luiz, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal.
| | - E González-Ortegón
- Instituto de Ciencias Marinas de Andalucía ICMAN-CSIC, E-11510 Puerto Real, Cadiz, Spain; Campus de Excelencia Internacional del Mar (CEIMAR), Spain.
| | - D Sánchez-Quiles
- Instituto de Ciencias Marinas de Andalucía ICMAN-CSIC, E-11510 Puerto Real, Cadiz, Spain.
| | - A Cobelo-García
- Instituto de Investigaciones Marinas IIM-CSIC, 36208 Vigo, Pontevedra, Spain.
| | - D Roque
- Instituto de Ciencias Marinas de Andalucía ICMAN-CSIC, E-11510 Puerto Real, Cadiz, Spain.
| | - A Peliz
- Instituto Dom Luiz, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal.
| | - R F Sánchez-Leal
- Spanish Institute of Oceanography, Cadiz Oceanographic Centre, 11006 Cadiz, Spain.
| | - A Tovar-Sánchez
- Instituto de Ciencias Marinas de Andalucía ICMAN-CSIC, E-11510 Puerto Real, Cadiz, Spain.
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Ferreira J, Morais J, Ferreira H, Roque D, Beringuilho M, Faria D, Freitas A, Morais C. 93 A hemodynamic challenge in assessment of echocardiographic mitral regurgitation severity. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Mitral regurgitation severity is, in accordance to current recommendations, typically evaluated by echocardiography. Several hemodynamic factors may influence this evaluation, especially systemic arterial blood pressure at the time of echocardiographic evaluation.
A 71-year-old woman was admitted in our Cardiology ward with acute decompensated heart failure. She had been previously admitted about 3 months earlier by acute decompensated heart failure, and at that time, admission transthoracic echocardiography (TTE) demonstrated mitral regurgitation, which was evaluated as severe. Systolic systemic arterial blood pressure at the time of that TTE was registered as 135mmHg. For further evaluation of mitral regurgitation mechanism, the patient underwent transoesophageal echocardiography (TEE), and in that exam mitral regurgitation was assessed as only moderate. For that exam, patient was sedated with 5mg of intravenous Midazolam, a drug with known secondary hypotensive effect. Although systemic arterial blood pressure was not described in the TEE report, retrospective analysis of nursery blood pressure records showed that patient was hypotensive during exam with systolic arterial blood pressure of 80-90mmHg. Patients was discharged, and in actual admission, concern was raised that mitral regurgitation could have been underestimated in previous TEE due to reduced afterload caused by the hypotensive effect of sedation. It was then decided to repeat TEE, and, in order to counterpose the hypotensive effect of Midazolam, TEE was performed under intravenous continuous infusion of Phenylephrine, a selective α-1 receptor antagonist with a significant vasopressor effect and minimal effect on cardiac contractility. Systolic systemic arterial blood pressure during this exam was recorded as 135-140mmHg. In this exam mitral regurgitation was confirmed as severe and patient was patient was oriented for mitral valve surgery.
DIscussion
This case illustrates the importance of assessment of hemodynamic status of the patient during echocardiographic evaluation of mitral regurgitation severity, and presents a pharmacological strategy to compensate hypotensive effects of sedative agents used during TEE.
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Affiliation(s)
- J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - J Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - H Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Faria
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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Ferreira J, Freitas A, Gomes R, Faria D, Beringuilho M, Roque D, Morais C. P235 A happy ending for a dancing thrombus on the right atrium. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.100] [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
A 62-year-old male, was admitted in the emergency department with chest discomfort and dyspnea for the last 2 days; he also referred pain on the right leg. He had been submitted to prostatic surgery 1 month before and since then he reduced is usual physical activity. At admission he was normotensive, with sinus tachycardia, with elevated D-Dimers and hypoxemia and hypocapnia on arterial blood gas analysis. Transthoracic echocardiogram (TTE) was performed and it showed dilation of right ventricle with diastolic left ventricular "D-shape" compatible with right ventricle pressure overload. Furthermore, it was visible a large and filiform thrombus on the right atrium, causing procidency into the right ventricle through the tricuspid valve during diastole (image top-left and top-right). Patient was hemodynamically stable at that time, and the case was promptly discussed with cardiothoracic surgery. The decision was to adopt a conservative strategy, and non-fractioned heparin (NFH) perfusion was initiated accordingly to local protocol.
Patient remained hemodynamically stable, and, after 24h of treatment with NFH echocardiographic re-evaluation showed disappearance of the thrombus previously seen of the right chambers (image bottom-left). Angio-TC scan of thorax performed at that time showed extensive bilateral pulmonary thromboembolism, but with normal perfusion of the pulmonary artery trunk and both right and left pulmonary arteries. After 48h of NFH the patient started oral anticoagulation. The rest of the admission was unremarkable apart from a respiratory tract infection successfully treated with piperacillin-tazobactam.
Pre-discharge TTE performed 12 days after admission showed no dilation of the right ventricle, with normal systolic function (image bottom-right), as well as no evidence of pulmonary arterial hypertension.
Discussion
Large right atrial thrombus in the setting of PTE is a clinical situation in which there is no consensus regarding clinical management. In most cases, management is dictated by haemodynamic status of the patient. In the setting of a hemodynamically stable patient, systemic anticoagulation can be an option. Surgery, fibrinolysis and percutaneous aspiration have also been advocated. Successful treatment of right heart thrombus with anticoagulation alone has been reported, but there are also reports of unsuccess with that strategy. This is a case of a successful treatment with anticoagulation alone and so, we currently consider that the choice of treatment strategy based on hemodynamic status continues to be the wisest strategy to adopt.
Abstract P235 Figure. Thrombus before and after
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Affiliation(s)
- J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - R Gomes
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - D Faria
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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Ferreira J, Freitas A, Loureiro J, Beringuilho M, Faria D, Roque D, Morais C. P862 A conservative strategy for a frequently fatal post-myocardial infarction mechanical complication. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.507] [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
A 88-year-old female was admitted for an anterior ST-segment elevation myocardial infarction (STEMI). Patient had a history of intermittent chest pain for 2 days with worsening on the day of admission. Electrocardiogram (ECG) at admission showed ST-segment elevation on leads from V2 to V6 and leads DI and aVL. Initial observation on the emergency department was described as unremarkable apart from the chest pain. Aspirin and Ticagrelor loading doses were administered and patient underwent emergent coronary angiography, which showed left anterior descendent artery occlusion after the emergence of second diagonal branch. Coronary angioplasty of this lesion was tried, with a total of 3 drug-eluted stents implantation but with no success as in the end there was no reflow of the artery.
Patient was then admitted on cardiac intensive care unit, and on observation at that time there was a remarking holosystolic murmur. Transthoracic echocardiogram showed (apart from left ventricle systolic disfunction with akinesia of the apical segments as well as middle segments of the interventricular septum (IVS) and anterior wall) an apical IVS defect with a left to right shunt with a gradient of around 50mmHg evaluated by Doppler, and no signs of right ventricle overload. Case was promptly discussed with cardiothoracic surgery and it was decided that she was not a candidate to urgent surgical intervention. Patient had an initial evolution in Killip class II, and remained hemodynamically stable for the rest of the admission, having no signs of heart failure on discharge at 17 days later. Serial ETTs during admission and at discharge were similar to the evaluation performed at admission.
In the meanwhile, during admission, case was discussed in multidisciplinary heart team with cardiothoracic surgery and interventional cardiology. Given the favourable evolution and comorbidities and frailty of the patient it was decided to adopt a conservative strategy with medical follow-up, only considering intervention if there was worsening of heart failure. Until now, with 4 months follow-up, patient remains in New York Heart Association (NYHA) functional class I.
Discussion
Post-myocardial infarction ventricular septal defect (VSD) is a complication that, regardless of the treatment strategy has a high mortality rate, especially when patient presents in cardiogenic shock. However, when patient is stable and especially when comorbidities imposes a high interventional risk medical treatment can be an option. So far, this is a successful case of a medically managed post-myocardial infarction VSD.
Abstract P862 Figure. Ventricular Septal Defect
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Affiliation(s)
- J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - J Loureiro
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Faria
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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Ferreira J, Faria D, Augusto J, Teixeira P, Beringuilho M, Roque D, Ferreira H, Morais C. P872 A case of transient atrioventricular block: the role of cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
A 42-year old man with no relevant past medical history presented to the emergency department for recurrent transient loss of consciousness in the last 12 hours. 3 weeks earlier he had flu-like symptoms which spontaneously resolved.
Physical examination revealed altered mental state, heart rate 30 beats per minute, respiratory rate 30 cycles per minute, blood pressure 70/40mmHg and basal lung rales on pulmonary auscultation. Blood gas analysis revealed hyperlactacidemia with hypocapnia.
Electrocardiogram showed third-degree atrioventricular block. Atropine was administrated (total dose 3mg) with no rate response. Transcutaneous pacing was initiated followed by a temporary transvenous pacemaker, removed after 72 hours.
Transthoracic echocardiogram revealed compromised left ventricular systolic function (ejection fraction by Simpson’s method 45%) due to septal dyskinesia and reduced global longitudinal strain (-11%).
Blood analysis revealed erythrocyte sedimentation rate 20mm/hr, C-reactive protein 2.43mg/dL and negative high-sensitivity troponin T (9.44ng/L). Rheumatologic screening was negative. Coronary computed tomography angiography revealed normal epicardial coronaries.
Cardiac magnetic resonance imaging (CMRI) performed 7 days after admission revealed preserved left ventricular systolic function (ejection fraction 51%). Late gadolinium enhancement showed scared myocardium in the medium and basal segments of the interventricular septum, compatible with subacute myocarditis.
Due to the history of recurrent syncope, a permanent pacemaker was inserted. The patient was discharged the day after. No further syncope occurred. In last pacemaker follow-up, 9 months after presentation, patient had 0% auricular and ventricular pacing and 100% sensing over the previous 6 months.
Discussion
Transient atrioventricular block is a well-known complication of myocarditis when there is involvement of the conduction system by the inflammatory reaction. However, in rare cases it can persist or recur. CMRI plays an important role in these cases. Gadolinium-enhanced CMRI can be used to access the extent of inflammation and cellular edema and delayed-enhanced CMRI can also be used to quantify scarring which has important prognostic value. CMRI can also play a crucial role in excluding infiltrative disorders with conduction system involvement. Also, in these patients, the transient aspect of atrioventricular block poses a challenge when deciding about permanent pacemaker insertion.
Abstract P872 Figure. Magnetic Ressonance IVS
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Affiliation(s)
- J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Faria
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - J Augusto
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - P Teixeira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - H Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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8
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Ferreira J, Beringuilho M, Faria D, Roque D, Ferreira H, Augusto J, Freitas A, Morais J, Morais C. P1366 Low-flow, low-gradient severe aortic stenosis: might mitral regurgitation be a culprit? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
According to current guidelines, given a patient with low-gradient (aortic valve maximum velocity < 4m/s and/or aortic valve mean gradient <40mmHg), aortic valve area (AVA) < 1cm2 and low-flow (stroke volume (SV) < 35mL/min/m2), with preserved left ventricle function (ejection fraction (EF) ≥50%), an integrated approach for assessment of aortic stenosis severity is proposed. We aimed to investigate whether mitral regurgitation can play a role in those cases, possibly being responsible for low antegrade systolic flow.
Methods
We retrospectively analysed 121 consecutive transthoracic echocardiograms (TTEs) of patients with severe aortic stenosis, with AVA < 1.0cm2 as assessed by continuity equation. Patients with low ejection fraction (< 50%) were excluded. We therefore included 84 patients (females 53,6%, mean age 79,1+-10 years). Stroke volume was assessed by Doppler at the left ventricle outflow tract (LVOT). We then compared the prevalence of more than mild mitral regurgitation among patients with low-gradient and low-flow and the other patients.
Results
15 patients had both low-gradient, low-flow and preserved ejection fraction. There was a significant association regarding the presence of more than mild mitral regurgitation among these patients (p = 0.028, OR = 4.7, CI 95% 1.1-20.1). In these patients, it was also observed a higher prevalence of atrial fibrillation (p = 0.03, OR = 6.9, CI 95% 1.74-27.1), lower longitudinal systolic function of right ventricle as measured by TAPSE (16.6 vs 21.5mm, p = 0.028), and a tendency towards higher left atrial volume (113 vs 87mL, p = 0.06).
Conclusions
Given the findings that the prevalence of more than mild mitral regurgitation is higher in patients with severe aortic stenosis as assessed by AVA with both low-gradient, low-flow and preserved ejection fraction, we suggest that the presence of more than mild mitral regurgitation should be considered on the approach of aortic stenosis classification of these patients.
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Affiliation(s)
- J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Faria
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - H Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - J Augusto
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - J Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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Ferreira J, Freitas A, Gardete S, Simoa G, Ferreira H, Simoes J, Beringuilho M, Faria D, Roque D, Morais C. P1298 A conservative strategy for an uncommon complication of endocarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.742] [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
A 64-year-old man was admitted for aortic valve prosthesis endocarditis. He had relevant personal medical history of mechanical aortic valve implantation 6 years before, coronary arterial disease with bypass graft surgery, chronic kidney disease on haemodialysis (with a need to implantation of long-duration haemodialysis catheter due to arteriovenous fistula thrombosis), Diabetes mellitus type 2 for 20 years, peripheral artery disease and ischemic stroke 2 years before.
He presented with a medical history of fever without evident clinical origin. From the diagnostic workup there were 4 blood cultures positive for methicillin-resistant Staphylococcus epidermidis. The bacteraemia was considered to be originated from the haemodialysis catheter and a new one was implanted. Transthoracic echocardiogram (TTE) at admission showed aortic anterior annulus dissection with an extensive dehiscence area (figure top-left). Subsequent evaluations showed fistulisation of the pseudoaneurysm to the right ventricle outflow tract (RVOT) (figure top-right and bottom-left) and the pulmonary trunk (PT) (figure bottom-right), as well as images compatible with vegetations at the septal cuspid of the pulmonary valve (figure yellow arrow). Furthermore, there was compromised right ventricle longitudinal systolic function and moderate tricuspid regurgitation with an estimated systolic pulmonary artery pressure of 80mmHg. Left ventricle systolic function was preserved and prothesis had no obstruction.
Case was discussed with cardiothoracic surgery from 2 centres and both considered that the surgical risk was too high. Patient was treated in a conservative way with rifampicin and gentamicin for 15 days and also with vancomycin ad eternum (after haemodialysis sessions). Blood cultures at discharge were negative. He remained hemodynamically stable and with no evidence of heart failure during admission.
Subsequent ambulatory clinical and echocardiographic monitoring was unremarkable in regarding to endocarditis, with no evidence of progression of endocarditis as well as no signs or symptoms of heart failure.
Patient died 10 months later due to sepsis originated on a lower limb infection of irreversibly ischemic tissue (patient had refused amputation before).
Discussion
Infective endocarditis of mechanical prosthesis has different presentations depending on the involvement of prosthesis and periprosthetic structures, and it is associated with high morbidity and mortality. Pseudoaneurysm of the intervalvular fibrosa is an uncommon complication, furthermore when complicating with dissection to near structures such as RVOT and the PT in this case. Treatment is mainly surgical, however, in this case the surgical risk was too high due to comorbidities and a conservative strategy was adopted. It seems that it was a reasonable strategy as the patient evolution was unremarkable when regarding endocarditis. Unfortunately, he ended up dying from probably unrelated complications.
Abstract P1298 Figure. Pseudoaneurysm with fistulization
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Affiliation(s)
- J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - S Gardete
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - G Simoa
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - H Ferreira
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - J Simoes
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Faria
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
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10
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Candeias Faria D, Freitas P, Simoes J, Santos AR, Santos M, Oliveira A, Roque D, Ferreira J, Beringuilho M, Bicho Augusto J. P5018Prognosis of pulmonary embolism 30-day mortality risk based on five admission parameters: the PoPE score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary embolism (PE) is a serious and potentially fatal form of venous thromboembolism. The Pulmonary Embolism Severity Index (PESI), and its simplified version (sPESI), are widely used for risk stratification and mortality prediction, however, the elevated number of parameters make them difficult to use an apply in everyday practice.
Purpose
To provide a simple and easy-to-perform sensible score based on five clinical and metabolic parameters obtained in arterial blood gas (ABG) at admission: Altered Mental State (AMS), Shock Index (SI), Partial Pressure of Oxygen/Fraction of Inspired Oxygen ratio (PaO2/FiO2), blood pH and arterial lactate concentration (Lac), and to compare its performance to predict 30-day (early) mortality.
Material and methods
In retrospective multicentric observational case-control study, 1037 patients with confirmed PE were admitted in a 24-month period. We evaluated medical charts in order to calculate PESI and sPESI risk scores. Multivariate analysis was performed to identify clinical and ABG independent predictors of all-cause mortality. Discriminative power was accessed by Receiver Operating Characteristic (ROC) curve.
Results
A total of 1037 patients were included in the final analysis. Mean age was 69.5 +16.6 years, 39.5% (n=410) were males. Median length of stay was 11.0 [IQR 7.0–18.0] days. Early mortality was 12.6% (n=131). SI and Lac were significantly higher in patients with early mortality (0.81 [IQR 0.66–1.01] vs 0.68 [IQR 0.57–0.82], and 2.63 [IQR 1.60–4.64] mmol/L vs 1.32 [IQR 1.00–1.90] mmol/L, respectively, p<0.0001 for both). PaO2/FiO2and pH were significantly lower in patients with early mortality (231 +120 vs 303 +103, and 7.39 +0.14 vs 7.43 +0.07, respectively, p<0.0001 for both). There was a significantly higher proportion of patients with altered mental status (Glasgow Coma Scale <15) in patients with early mortality (55.0% vs 18.5%, c2(1)=85.3, p<0.0001). Multivariate analysis is summarized in Table 1. Stratified analysis was based on the approximate cut-off value for the last quartile of SI (0.85) and Lac (2.50 mmol/L) and for the first quartile of PaO2/FiO2 (250) and pH (7.35). Based on the similar beta coefficient values for each variable, we attributed 1 point in the presence of each following conditions: GCS <15, SI >0.85, PaO2/FiO2<250, pH <7.35 and Lac >2.50 mmol/L with a total PoPE scorerange 0–5. The PoPE score yielded a good prognostic performance in predicting in-hospital death using ROC analysis (AUC 0.806, 95% CI 0.767–0.845, p<0.0001). The PoPE score performance was superior when compared with PESI (AUC 0.806 vs 0.695, AUC difference 0.111, p<0.0001) and sPESI (AUC 0.806 vs 0.622, p<0.0001) – Figure 1. A PoPEscore of 1 has a sensitivity of 93% and a specificity of 48% in predicting early all-cause mortality.
Conclusions
The PoPE scoreproves an easy and simple tool with good performance which can predict early eraly 30-day mortality in patients admitted for PE.
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Affiliation(s)
- D Candeias Faria
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Cardiologia, Lisboa, Portugal
| | - J Simoes
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - A R Santos
- Hospital de Santa Cruz, Cardiologia, Lisboa, Portugal
| | - M Santos
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - A Oliveira
- Hospital de Santa Cruz, Cardiologia, Lisboa, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - M Beringuilho
- Hospital de Santa Cruz, Cardiologia, Lisboa, Portugal
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11
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Dias Ferreira Reis JP, Strong C, Roque D, Morais L, Mendonca T, Modas PD, Farto E Abreu P, Almeida M, Cacela D, Morais C, Mendes M, Cruz Ferreira R, Bravo Baptista S, Raposo L, Ramos R. P3633Should we continue to routinely revascularize patients during valve surgery in optimal medical therapy era? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0491] [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
Optimal management of stable obstructive coronary artery disease (CAD) in patients (pts) undergoing heart valve surgery remains controversial. The aim of the present study is to evaluate the effective prognostic role of CABG in pts undergoing valve surgery who had concomitant CAD.
Methods
We conducted a retrospective multicenter survival analysis using multivariable Cox models and Kaplan-Meier curves of consecutive pts undergoing valve surgery with or without concomitant CABG between January 2015 and February 2017.
Results
From 1196 consecutive pts undergoing valvular surgery in 3 portuguese centers, 257 (21.5%) were found to have obstructive CAD (55.6% male, mean age 74±8 y.o., mean follow-up time 16±8 months, aortic valve disease 78.8%). No coronary revascularization (R) was attempted in 177 pts, complete R was achieved in 40 and R was anatomically incomplete in the remaining 40 pts. Age (75 vs 77.3 y.o.; p=0.202), multivessel disease (46.3% vs 53.8%, p=0.270), aortic valve disease (91.0% vs 92.5%, p=0.683), left ventricular ejection fraction <40% (11.8% vs 19.4%, p=0.272) were comparable between nonrevascularized and revascularized pts; SYNTAX score was low and also similar in both groups (7±12 vs 7±5, p=0.856). Left main disease (8.5% vs 17.5%, p=0.034) and EUROSCORE IIrisk score (2.3±2 vs 3.2±2, p=0.011) was higher for those with any revascularization. Non-revascularized pts had significantly lower all-cause mortality at follow up than those with any R (10.2% vs 21.2%, p=0.016). However, both in-hospital (4% vs 7.5%, p=0.230) and cardiovascular mortality (6.9% vs 7.1%, p=1.00) were similar. In a multivariate analysis, independent predictors for all-cause mortality were: any surgical R (HR 4.52, CI95% 2.09–9.78), baseline atrial fibrillation (HR 2.51, CI95% 1.07–5.90), left main disease (HR 3.153, CI95% 1.26–7.90) and peripheral artery disease (HR 2.95, CI95% 1.036–8.421). All-cause mortality for pts with obstructive CAD was higher than in pts with no CAD (13.6% vs 6.2, p<0.001). Interestingly, however, after multivariable adjustment, complete R was not found to be protective as compared to no R (HR 0.79, IC 0.31–2.06, p=0.633)
Kaplan-Meier Plots
Conclusion
Significant CAD is associated with worse outcomes in pts undergoing valve surgery. In this study, standard angiographically-guided R was not associated with improved results. Randomized controlled trials are needed to further assess risk stratification and the role of coronary R of stable CAD in this setting.
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Affiliation(s)
| | - C Strong
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - L Morais
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | - P D Modas
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Farto E Abreu
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | | | - S Bravo Baptista
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - L Raposo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
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12
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Carvalho Mendonca TJ, Strong C, Roque D, Morais L, Reis JP, Daniel PM, Abreu P, Almeida M, Cacela D, Morais C, Mendes M, Ferreira RC, Baptista SB, Raposo L, Ramos R. P3628Contemporary coronary artery disease prevalence in a valvular heart disease population undergoing surgery. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0486] [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
Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Older studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently.
Objectives
The goal of this study is to evaluate the baseline characteristics, prevalence of CAD and treatment strategies in a contemporary population with valvular heart disease (VHD) referred for valve surgery.
Methods
In a national multicentre registry, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine coronary angiogram were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70% (≥50% for left main artery). The prognostic impact of the different valve disease and CAD treatment strategies were assessed.
Results
1175 patients (mean age 72.5±10.1; male 49.2%) fulfilled the clinical or echocardiographic indication for valve surgery by European guidelines. Valvular disease prevalence was: aortic stenosis (66.7%), aortic regurgitation (6.6%), mitral stenosis (6%), mitral regurgitation (19.2%), tricuspid regurgitation (7.5%). Mean follow-up time was 29.06±18.46 months. Prevalence of comorbidities was: Diabetes Mellitus (DM) 26%, chronic obstructive pulmonary disease (COPD) 5.7% and chronic kidney disease (CKD) 23.4%. Mean Euroscore II was 2.6%. Obstructive CAD was present in 27.3% patients. Mean Syntax score was 10.2 (<22 in 88%, 23–32 in 10.2% and >33 in 1.8%). Left main artery and 3-vessel disease were found in 13.1% and 11.8% of patients with CAD, respectively. Valvular surgery was ultimately performed in 80.3%. In patients with CAD, 57.3% were revascularized. All-cause mortality rate during follow-up was 12.9%, with 7.8% from cardiovascular causes. In univariate analysis DM, COPD, CKD, NYHA class, obstructive CAD and no surgery (p<0.05) were associate with mortality on follow up. In multivariate analysis obstructive CAD (OR 2.36, 95% CI 1.53–3.65, p<0.01) and no surgery (OR 6.05, 95% CI 3.95–9.30, p<0.01) persisted as independent all-cause mortality predictors.
Conclusion
In a contemporary cohort of patients with VHD and surgical indication, CAD prevalence is lower (27.3%) than described in literature. Mortality rates were higher in patients with obstructive CAD, worse NYHA functional class and in those who never underwent surgery.
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Affiliation(s)
| | - C Strong
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - L Morais
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - J P Reis
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - P M Daniel
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - P Abreu
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - R C Ferreira
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - S B Baptista
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - L Raposo
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
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13
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Candeias Faria D, Santos M, Roque D, Ferreira J, Beringuilho M, Augusto J. P6410Eligibility and preference of extended antithrombotic therapy for secondary prevention after an acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1004] [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 and purpose
Recent randomized controlled trials (RCTs) have evaluated the benefit of extended antithrombotic therapy in secondary prevention of Acute Coronary Syndromes (ACS). However, the numerous and strict enrollment criteria may limit the validity and reproducibility of the published results in clinical practice. We aimed to estimate the eligibility for participation in RCTs of a group of patients followed up for ACS.
Methods
We applied the enrollment criteria of 2 RCTs (PEGASUS [low-dose ticagrelor – 60mg twice daily] and COMPASS [low-dose rivaroxaban – 2.5mg twice daily) to 780patients with history of ACS.
Results
A total of 938 patients admitted for ACS during 30months. Mean age was 68.8±10.3 years, 70.4% (n=660) males. Baseline characteristics are summarised in Table 1. Median length of stay was 6.0 (IQR 3.0–11.0 days). In-hospital mortality was 7.9%. Mortality after discharge within 12 months was 9.7%. A total of 780 patients were screened for trial enrollment after 12 months of follow-up. The proportion of patients fulfilling the trial enrollment criteria were 32.1% for PEGASUS and 35.9% for COMPASS. 41.6% of patients were eligible for at least one RCT. The main reasons for ineligibility for RCTs were the presence of comorbidities for PEGASUS and bleeding risk for COMPASS (Figure 1). Patients not fulfilling enrollment criteria for any RCT (58.4%) were older (71.4±9.7 vs 65.2±10.2 years, p<0.0001), more likely to have worse renal function (CrCl 47.8±28.8 vs 73.9±21.2 ml/min/1.73m2, p<0.0001), less left ventricular ejection fraction (44.4±11.4 vs 51.9±7.5%, p<0.0001) and had longer length of stay (7 IQR 4–13 vs 5 IQR 3–8 days, p<0.0001). The main differences in eligible and ineligible patients in both RCTs are summarised in Table 2.
Baseline characteristics and differences
Conclusions
Patients enrolled in RCTs are only partly representative of the real world population with history of ACS, mainly due to the higher prevalence of comorbidities and bleeding risk factors in this population. It is uncertain if these patients still benefit from theses therapies as in the published RCTs.
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Affiliation(s)
- D Candeias Faria
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - M Santos
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - J Augusto
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
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14
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Candeias Faria D, Ribeiro R, Sousa Uva M, Roque D, Ferreira A, Freitas A, Magno P, Santos M, Gouveia R, Augusto J. 352Unnusual left ventricular aneurysms. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez126.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Candeias Faria
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - R Ribeiro
- Hospital Prof Fernando da Fonseca EPE, Medicina IV, Amadora, Portugal
| | - M Sousa Uva
- Hospital de Santa Cruz, Cardiologia, Lisboa, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Cardiologia, Lisboa, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - P Magno
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - M Santos
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - R Gouveia
- Hospital de Santa Cruz, Anatomia Patológica, Lisboa, Portugal
| | - J Augusto
- University College London, London, United Kingdom of Great Britain & Northern Ireland
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15
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Candeias Faria D, Ferreira J, Beringuilho M, Augusto J, Roque D, Santos M, Morais C. P974Atrial fibrillation stroke and bleeding risk scores as predictors of mortality at 3 years follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Candeias Faria
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - J Ferreira
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - M Beringuilho
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - J Augusto
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - M Santos
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
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16
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Candeias Faria D, Bicho Augusto J, Roque D, Freitas A, Morais C. P859Doppler derived mitral deceleration time of E wave as a new predictor of atrial fibrillation recurrence after DC cardioversion. Europace 2018. [DOI: 10.1093/europace/euy015.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Candeias Faria
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - J Bicho Augusto
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - A Freitas
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal
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17
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Santos C, Augusto JB, Santos M, Ferreira H, Martins N, Faria D, Roque D, Urzal J, Faustino M, Faustino N, Madeira F, Morais C. P1520Evaluation of a score to predict the need for permanent pacemaker in the emergency department based on atrioventricular blocking drugs and kalemia. Europace 2017. [DOI: 10.1093/ehjci/eux158.146] [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: 11/13/2022] Open
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18
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Ferreira H, Augusto JB, Santos M, Martins N, Santos C, Faria D, Roque D, Urzal J, Faustino M, Cabanelas N, Madeira F, Morais C. P1076Validation of a score to predict the need for permanent pacemaker in the emergency department in patients with atrioventricular blocking drugs. Europace 2017. [DOI: 10.1093/ehjci/eux151.255] [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: 11/14/2022] Open
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19
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Bellone S, Roque D, Cocco E, Gasparrini S, Bortolomai I, Buza N, Abu-Khalaf M, Silasi DA, Ratner E, Azodi M, Schwartz PE, Rutherford TJ, Pecorelli S, Santin AD. Downregulation of membrane complement inhibitors CD55 and CD59 by siRNA sensitises uterine serous carcinoma overexpressing Her2/neu to complement and antibody-dependent cell cytotoxicity in vitro: implications for trastuzumab-based immunotherapy. Br J Cancer 2012; 106:1543-50. [PMID: 22531721 PMCID: PMC3341945 DOI: 10.1038/bjc.2012.132] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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] [Indexed: 12/21/2022] Open
Abstract
Background: We evaluated the expression of CD46, CD55 and CD59 membrane-bound complement-regulatory
proteins (mCRPs) in primary uterine serous carcinoma (USC) and the ability of small
interfering RNA (siRNA) against these mCRPs to sensitise USC to complement-dependent
cytotoxicity (CDC) and antibody (trastuzumab)-dependent cellular cytotoxicity (ADCC)
in vitro. Methods: Membrane-bound complement-regulatory proteins expression was evaluated using real-time
PCR (RT–PCR) and flow cytometry, whereas Her2/neu expression and
c-erbB2 gene amplification were assessed using immunohistochemistry, flow
cytometry and fluorescent in-situ hybridisation. The biological effect of
siRNA-mediated knockdown of mCRPs on HER2/neu-overexpressing USC cell lines was
evaluated in CDC and ADCC 4-h chromium-release assays. Results: High expression of mCRPs was found in USC cell lines when compared with normal
endometrial cells (P<0.05). RT–PCR and FACS analyses demonstrated that
anti-mCRP siRNAs were effective in reducing CD46, CD55 and CD59 expression on USC
(P<0.05). Baseline complement-dependent cytotoxicity (CDC) against USC
cell lines was low (mean±s.e.m.=6.8±0.9%) but significantly
increased upon CD55 and CD59 knockdown (11.6±0.8% and
10.7±0.9%, respectively, P<0.05). Importantly, in the absence
of complement, both CD55 and CD59, but not CD46, knockdowns significantly augmented ADCC
against USC overexpressing Her2/neu. Conclusion: Uterine serous carcinoma express high levels of the mCRPs CD46, CD55 and CD59. Small
interfering RNA inhibition of CD55 and CD59, but not CD46, sensitises USC to both CDC
and ADCC in vitro, and if specifically targeted to tumour cells, may
significantly increase trastuzumab-mediated therapeutic effect in vivo.
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Affiliation(s)
- S Bellone
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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20
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Roque D, Kottapally M, Nahab F. A Transient Loss of British Charm: A Case of Foreign Accent Syndrome and Proposed Neuroanatomical Pathway (P02.050). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.050] [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: 11/15/2022] Open
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21
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Roque D, Bellone S, Betti M, Silasi D, Ratner E, Azodi M, Schwartz P, Rutherford T, Pecorelli S, Santin A. Mammaglobin B (SCGB2A1)-specific CD8+ cytotoxic T lymphocytes (CTL) are highly effective in killing autologous chemotherapy resistant ovarian cancer cells: Implications for SCGB2A1 dendritic cell-based therapeutic vaccines. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.078] [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: 11/24/2022]
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22
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Grow WB, Moreb JS, Roque D, Manion K, Leather H, Reddy V, Khan SA, Finiewicz KJ, Nguyen H, Clancy CJ, Mehta PS, Wingard JR. Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant 2002; 29:15-9. [PMID: 11840139 DOI: 10.1038/sj.bmt.1703332] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2001] [Accepted: 07/24/2001] [Indexed: 11/08/2022]
Abstract
Despite new antifungal treatment strategies, invasive aspergillosis (IA) remains a principal cause of infectious mortality after bone marrow transplantation (BMT). We reviewed the medical records of 93 allogeneic and 149 autologous transplant recipients during a 20 month period, with attention to cases of proven or probable IA. No autologous transplant recipient developed IA, whereas IA was seen in 15.1% of allogeneic recipients (including two of five patients with a prior history of IA despite prophylaxis), for an overall incidence of 5.8%. The median time to occurrence was 92 days post transplant, with no de novo cases developing prior to engraftment. Survival 100 days from diagnosis was 29%. Risk factors for the development of IA included > or = 21 days of corticosteroid therapy of >or= 1mg/kg/day and post-transplant cytomegalovirus (CMV) infection. These two risk factors were statistically linked. Our data illustrate a shift toward a later occurrence of post-transplant IA, suggesting a need for close, prolonged surveillance in the outpatient environment. The contributory role of protracted corticosteroid use is also highlighted. These data have important implications in an era of alternate donor transplants and more intense immunosuppression. Established strategies implementing newer, less toxic antifungal agents as prophylaxis in high-risk patients are needed.
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Affiliation(s)
- W B Grow
- University of Florida College of Medicine, Shands Hospital, Gainesville, FL 32610-0277, USA
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23
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Polsky FI, Roque D, Hill PE. Hyporeninemic hypoaldosteronism complicating primary autonomic insufficiency. West J Med 1993; 159:185-7. [PMID: 8212689 PMCID: PMC1022230] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- F I Polsky
- Division of Nephrology, St Elizabeth Hospital Medical Center, Youngstown, Ohio
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