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Marques J, Duarte-Ramos F, Ferreira MB, Lima R, Lopes C, Sokolova A, Tonin FS, Loureiro CC. Optimizing the use of systemic corticosteroids in severe asthma (ROSA II project): a national Delphi consensus study. Pulmonology 2023; 29:555-563. [PMID: 37543525 DOI: 10.1016/j.pulmoe.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023] Open
Affiliation(s)
- J Marques
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Lisboa Central, EPE, Lisboa, Portugal; CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal.
| | - F Duarte-Ramos
- Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisboa, Lisboa, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - M B Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - R Lima
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - C Lopes
- Departamento do Tórax, Hospital de Santa Maria, Lisbon, Portugal
| | - A Sokolova
- Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - F S Tonin
- ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; H&TRC - Health & Technology Research Center, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - C C Loureiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal; Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Gobira PH, LaMar J, Marques J, Sartim A, Silveira K, Santos L, Wegener G, Guimaraes FS, Mackie K, Lu HC, Joca S. CB1 Receptor Silencing Attenuates Ketamine-Induced Hyperlocomotion Without Compromising Its Antidepressant-Like Effects. Cannabis Cannabinoid Res 2023; 8:768-778. [PMID: 36067014 PMCID: PMC10771879 DOI: 10.1089/can.2022.0072] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction: The antidepressant properties of ketamine have been extensively demonstrated in experimental and clinical settings. However, the psychotomimetic side effects still limit its wider use as an antidepressant. It was recently observed that endocannabinoids are inolved in ketamine induced reward properties. As an increase in endocannabinoid signaling induces antidepressant effects, this study aimed to investigate the involvement of cannabinoid type 1 receptors (CB1R) in the antidepressant and psychostimulant effects induced by ketamine. Methods: We tested the effects of genetic and pharmacological inhibition of CB1R in the hyperlocomotion and antidepressant-like properties of ketamine. The effects of ketamine (10-20 mg/kg) were assessed in the open-field and the forced swim tests (FSTs) in CB1R knockout (KO) and wild-type (WT) mice (male and female), and mice pre-treated with rimonabant (CB1R antagonist, 3-10 mg/kg). Results: We found that the motor hyperactivity elicited by ketamine was impaired in CB1R male and female KO mice. A similar effect was observed upon pharmacological blockade of CB1R in WT mice. However, genetic CB1R deletion did not modify the antidepressant effect of ketamine in male mice submitted to the FST. Surprisingly, pharmacological blockade of CB1R induced an antidepressant-like effect in both male and female mice, which was not further potentiated by ketamine. Conclusions: Our results support the hypothesis that CB1R mediate the psychostimulant side effects induced by ketamine, but not its antidepressant properties.
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Affiliation(s)
- Pedro Henrique Gobira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jacob LaMar
- The Linda and Jack Gill Center for Biomolecular Science, Indiana University, Bloomington, Indiana, USA
| | - Jade Marques
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ariandra Sartim
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Kennia Silveira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Luana Santos
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gregers Wegener
- Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark
| | | | - Ken Mackie
- The Linda and Jack Gill Center for Biomolecular Science, Indiana University, Bloomington, Indiana, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
- Program in Neuroscience, Indiana University, Bloomington, Indiana, USA
| | - Hui-Chen Lu
- The Linda and Jack Gill Center for Biomolecular Science, Indiana University, Bloomington, Indiana, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
- Program in Neuroscience, Indiana University, Bloomington, Indiana, USA
| | - Sâmia Joca
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Marques J, Rocha JV, Soares P, Leite A, Duarte R, Nunes C. The effect of TB patient delay on loss to follow-up in Portugal. Int J Tuberc Lung Dis 2023; 27:537-542. [PMID: 37353867 DOI: 10.5588/ijtld.22.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: Early identification of TB cases, followed by treatment to completion, are essential for controlling and preventing the disease. Previous studies have found some factors associated with both loss to follow-up (LTFU) and patient delay. We aim to build a causal model to investigate the association between TB patient delay and LTFU.METHODS: Pulmonary TB cases were identified using the national surveillance system in Portugal between 2008 and 2017. A directed acyclic graph was used to identify the minimal set of variables to adjust for when studying the association between delay (exposure) and LTFU (outcome). Crude and adjusted hazard were estimated using Cox regression.RESULTS: Nearly 4% of the patients did not follow up treatment. There was no association between patient delay and LTFU, even after adjustment with the minimal set of covariates. Factors associated with a higher risk of LTFU were being younger, being unemployed, living in urban areas, having HIV and the abuse of alcohol and drugs.CONCLUSION: Patient delay was not associated with LTFU, while social conditions were. Future research should investigate the underlying reasons why patients discontinue TB treatment and use these findings to develop targeted interventions that can support patients in completing their treatment regimen.
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Affiliation(s)
- J Marques
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J V Rocha
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - P Soares
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A Leite
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal, Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - R Duarte
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal, Unidade de Investigação Clínica da ARS Norte, Porto, Portugal, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal, Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - C Nunes
- Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Comprehensive Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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Baz A, Mantovani S, Ramos RP, Santos B, Grecco L, Gonçalves G, Arakelyan M, Marques J, Franco A. Age-at-death assessed with Lamendin's original and population-specific models in a modern Brazilian osteological collection. J Forensic Odontostomatol 2022; 40:45-51. [PMID: 36623297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Estimating the age at death is a common procedure in the fields of forensic human identification and anthropological/archaeological investigations. Root translucency and periodontosis are regressive parameters used to estimate the age of adults, more specifically in Lamendin's method - established in 1992 in a French population. This study aimed to test the applicability and validity of Lamendin's method in a Brazilian osteological collection. METHODS The sample consisted of 74 single-rooted teeth obtained from 50 skeletal remains (mean age: 53.20 ± 16.17 years) from Southeast Brazil. Lamendin's method was applied to enable a comparison between chronological (CA) and estimated ages (EA). A new population-specific equation was designed for the studied sample and the outcomes were compared with those obtained with Lamendin's original equation. RESULTS The original methods led to a general underestimation of 11.32 years (8.83 years in males and 15.91 years in females). The method had a better performance among individuals between 40 and 59 years (mean differences between CA and EA: 4.8 years). The population-specific equation led to a mean overestimation of -2.04 years in males, and a mean underestimation of 3.77 years in females. Underestimations were considerably higher in other age groups. CONCLUSION Despite the apparent improvements, both the original and the population-specific equations revealed coefficients of concordance that were constantly low between CA and EA. These outcomes suggest restrictions to the application of Lamendin's method in the forensic field, especially for human identification. The method, however, seems to be applicable for anthropological/archaeological applications.
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Affiliation(s)
- A Baz
- Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
| | - S Mantovani
- Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
| | - R P Ramos
- Legal Medical Institute of Porto Velho, Civil Police of Rondônia, Porto Velho, Brazil
| | - B Santos
- Legal Medical Institute of Porto Velho, Civil Police of Rondônia, Porto Velho, Brazil
| | - L Grecco
- Laboratory of Human Anatomy, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
| | - G Gonçalves
- Laboratory of Human Anatomy, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
| | - M Arakelyan
- Department of Therapeutic Stomatology, Sechenov University, Russia
| | - J Marques
- Department of Dentistry, State University of Feira de Santana, Brazil
| | - A Franco
- Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
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Marques J, Bajouco M. Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease? Eur Psychiatry 2022. [PMCID: PMC9567696 DOI: 10.1192/j.eurpsy.2022.1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Wilson’s disease is a rare (1:30,000) autosomal recessive disorder of copper metabolism that is caused by mutations in the adenosine triphosphatase copper transporting beta (ATP7B) gene, located on chromosome 13. The reported percentage of patients with psychiatric symptoms as the presenting clinical feature is 10%-20%.
Objectives
To present and discuss a rare case admitted in the First Psychotic Episode Inpatient Unit (UIPEP) with pleiomorphic psychotic symptoms and low serum copper and ceruloplasmin and high 24h urine copper.
Methods
The data was collected through patient and family interviews, as well as from his medical record. We searched Pubmed using MeSH terms: psychotic disorders AND Hepatolenticular Degeneration.
Results
A twenty-two years old male, without known psychiatric history presented in the Emergency Department with a myriad of psychotic symptoms: motor stereotypes/mannerisms, paranoid delusions and auditory hallucinations. He was admitted in UIPEP, started low-dose antipsychotic medication with good response. As part of the implemented protocol, he did a battery of exams, including Brain CT-scan, EEG, ECG and blood and urine analysis, in which low serum copper and ceruloplasmin stood out, leveraging the suspicion of Wilson´s disease. Therefore, 24h urine copper was done, with 140 mcg/d (reference range < 40 mcg/d). Brain MRI was normal and no Kayser–Fleisher rings were seen by a consulting ophthalmologist.
Conclusions
Without proper treatment, Wilson’s disease is a progressive and fatal disease. Therefore, it’s of upmost importance to recognize the clinical signs that raise suspicion of this disorder, especially recent onset in young adult of miscellaneous psychotic symptoms with movement disorders.
Disclosure
No significant relationships.
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Mane FG, Flores R, Silva R, Conde I, Rodrigues C, Medeiros P, Oliveira C, Campos I, Ferreira AS, Costa J, Quina C, Braga C, Marques J. On- vs off-hours primary percutaneous coronary intervention: a single-centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In ST-segment elevation myocardial infarction (STEMI) patients, emergency medical system delays importantly affect outcomes. The effect of admission time in STEMI patients is dubious when percutaneous coronary intervention (PCI) is the preferred reperfusion strategy.
Aims
The authors aimed to retrospectively describe the association between admission time and STEMI patient's care standards and outcomes.
Methods
Characteristics and outcomes of 1222 consecutive STEMI patients treated in a PCI-centre were collected. On-hours were defined as admission on non-national-holidays from Monday to Friday from 8 AM to 6 PM. Time delays, in-hospital and one-year all-cause mortality were assessed.
Results
A total of 439 patients (36%) were admitted on-hours and 783 patients (64%) were admitted off-hours. Baseline characteristics were well-balanced between groups, including the percentage of patients admitted in cardiogenic shock (on-hours: 4.6% vs off-hours 4%; p=0.62).
Median emergency system dependent time to reperfusion (i.e. first-medical contact to reperfusion) did not differ between the two groups (on-hours: 120 min vs. off-hours 123 min, p=0.54). The authors observed no association between admission time and in-hospital mortality (on-hours: 5% vs. off-hours 4.9%, p=0.90) or 1-year mortality (on-hours: 10% vs. off-hours 10%, p=0.97).
In patients admitted directly in the PCI-centre, median time from first-medical contact to reperfusion (on-hours: 87 min vs off-hours: 88 min, p=0.54), in-hospital mortality (on-hours: 4% vs off-hours: 7%, p=0.30) and 1 year mortality (on-hours: 9% vs off-hours: 13%, p=0.27) did not differ between the two groups.
Survival analysis showed no survival benefit of on-hours PCI over off-hours PCI (HR 1.01; 95% CI [0.77–1.46], p=0.95).
Conclusion
In a contemporary well-organized emergency network, STEMI patients admission time in the PCI-centre was not associated with reperfusion delays or increased mortality.
Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve
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Affiliation(s)
- F G Mane
- Hospital de Braga, Braga, Portugal
| | - R Flores
- Hospital de Braga, Braga, Portugal
| | - R Silva
- Hospital de Braga, Braga, Portugal
| | - I Conde
- Hospital de Braga, Braga, Portugal
| | | | | | | | - I Campos
- Hospital de Braga, Braga, Portugal
| | - A S Ferreira
- ULSAM - Hospital de Santa Luzia, Internal Medicine, Viana do Castelo, Portugal
| | - J Costa
- Hospital de Braga, Braga, Portugal
| | - C Quina
- Hospital de Braga, Braga, Portugal
| | - C Braga
- Hospital de Braga, Braga, Portugal
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Oliveira CC, Vilela F, Flores R, Medeiros P, Pires C, Mane F, Braga C, Marques J, Costa J. ST-segment elevation myocardial infarction: are women being discriminated? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2789] [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
Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI) have improved, a gender disparity exists, with women showing higher mortality.
Objectives
To assess gender differences in presentation, management and in-hospital, at 30-days, 6-months and 1-year after STEMI mortality.
Methods
We collected data from 809 consecutive patients treated with primary PCI and compared the females versus males.
Results
Women were older than man (69,1±14,6 vs. 58,5±12,7 years; p<0.001) with higher prevalence of age over 75 years (36.7% vs. 11.7%; p<0.001), diabetes (30,6% vs. 18,5%; p=0.001), hypertension (60.5% vs. 45.9%; p=0.001), chronic kidney disease (3.4% vs. 0.6%; p=0.010) and acute ischemic stroke (6.8% vs. 3.0%; p=0.021). At presentation, women had more atypical symptoms, less chest pain (90.3% vs. 95.6%; p=0.014) and greater clinical severity (cardiogenic shock (10.7% vs. 5.4%; p=0.011). There were no differences in the symptom-first medical contact me (95.0 min vs. 80.5 min; p=0.215); however, women had longer time until reperfusion (264.0 min vs. 212.5 min; p=0.001) and were less likely to receive optimal medical therapy (aspirin-93.1% vs. 99.2%; p<0.001; P2Y12 inhibitors 91.9% vs. 98.2%; p<0.001; beta-blockers-90.8% vs. 95.1%; p=0.032; ACEIs- 88.1% vs. 94.8%; p=0.003). In-hospital mortality (9.6% vs. 3.5%; p=0.001), at 30-days (11.3% vs. 4.0%; p<0.001), 6-months (14.1% vs. 4.7%; p<0.001) and 1-year (16.4% vs. 6.3%; p<0.001) was significantly higher in women. The multivariate analysis identified age over 75 years (HR=4.25; 95% CI [1.67–10.77]; p=0.002), Killip class II (HR=8.80; 95% CI [2.72–28.41]; p<0.001), III (HR=5.88; 95% CI [0.99–34.80]; p=0.051) and IV (HR=9.60; 95% CI [1.86–48.59]; p=0.007), acute kidney injury (HR=2.47; 95% CI [1.00–6.13]; p=0.051) and days of hospitalization (HR=1.04; 95% CI [1.01–1.08]; p=0.030) but not female gender (HR=0.83; 95% CI [0.33–2.10]; p=0.690) as independent prognostic factors of mortality.
Conclusions
Compared to men, women with STEMI undergoing primary PCI have higher mortality rates. Our results suggest that this is not due to the gender itself, but due to the women worse risk profile, the higher reperfusion time related with system delays and the minor probability of receiving the recommended therapy. Efforts should be made to reduce these gender differences.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - F Vilela
- University of Minho - Life and Health Sciences Research Institute (ICVS), Braga, Portugal
| | - R Flores
- Hospital de Braga, Braga, Portugal
| | | | - C Pires
- Hospital de Braga, Braga, Portugal
| | - F Mane
- Hospital de Braga, Braga, Portugal
| | - C Braga
- Hospital de Braga, Braga, Portugal
| | | | - J Costa
- Hospital de Braga, Braga, Portugal
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Araujo Leite Medeiros P, Braga C, Campos I, Oliveira C, Pires C, Flores R, Mane F, Silva R, Costa J, Marques J, Braga C. Managing bifurcations: are two stents better than one? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2160] [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
Bifurcation percutaneous coronary intervention (PCI) is associated with a higher degree of complexity when compared with non-bifurcation procedures. Although 1-stent PCI remains the standard approach for most bifurcation lesions, data is constantly being published on 2-stent PCI.
Aim
To evaluate and compare the characteristics and outcomes of patients that underwent bifurcation PCI with one or two stents.
Methods
Single center, retrospective observational study including all patients who underwent bifurcation PCI between January 2015-December 2018. We defined two groups: 1-stent PCI group (1s-PCI) and 2-stent PCI group (2s-PCI). The 2s-PCI group included PCI patients with all the different techniques used in our center: provisional stenting with 2 stents, Cullote, crushing stent and DK Crush.
Results
1s-PCI group included 376 individuals and 2s-PCI group included 26. Overall baseline clinical characteristics were balanced between groups. There was no statistically significant difference in age (mean 64 vs 66; p=0.388), gender (79% vs 85% males; p=0.622) and comorbidities (hypertension, diabetes mellitus, hypercholesterolemia, chronic kidney disease, smoking and previous history of coronary artery disease). Also, there was no difference in clinical status (NSTEMI 36% vs 38%; stable disease 32% vs 42%; STEMI 28% vs 19%; unstable angina 5% vs 0%; p=0.419). Coronary angiography and lesion distribution were similar in both groups (p=0.367). However, radiation dose (median 90.5 [IQR=79] vs 156 [IQR=84] mGy cm2; p<0,001) and contrast volume (median 150 [IQR=100] vs 156 [IQR=83] ml; p<0,001) were significantly higher in 2s-PCI group. At 12-month follow-up, mortality rate was higher in 1s-PCI group, but without statistical significance (8% vs 4%; p=0.71); the same is true for acute myocardial infarction at 12 months (3% vs 0%; p=0.368). Target-lesion failure was only reported in 4 patients in the 1s-PCI group. Survival tests showed no significant difference between groups (χ2(1,n=402)=0.634; p=0.426).
Conclusion
Individuals that underwent 1s-PCI were overall similar to those who underwent 2s-PCI. Predictably, deploying more than 1 stent required more contrast volume and implied a higher radiation dose. We should note that our studied is greatly limited by the 2s-PCI group size, which may justify the lack of difference in the evaluated outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Braga
- Hospital de Braga, Braga, Portugal
| | - I Campos
- Hospital de Braga, Braga, Portugal
| | | | - C Pires
- Hospital de Braga, Braga, Portugal
| | - R Flores
- Hospital de Braga, Braga, Portugal
| | - F Mane
- Hospital de Braga, Braga, Portugal
| | - R Silva
- Hospital de Braga, Braga, Portugal
| | - J Costa
- Hospital de Braga, Braga, Portugal
| | | | - C Braga
- Hospital de Braga, Braga, Portugal
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Sartim AG, Marques J, Silveira KM, Gobira PH, Guimarães FS, Wegener G, Joca SR. Co-administration of cannabidiol and ketamine induces antidepressant-like effects devoid of hyperlocomotor side-effects. Neuropharmacology 2021; 195:108679. [PMID: 34157363 DOI: 10.1016/j.neuropharm.2021.108679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/02/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Although useful as a rapid-acting antidepressant drug, ketamine is known to induce psychotomimetic effects, which may interfere with its therapeutic use. Cannabidiol (CBD) is a non-psychostimulant compound from Cannabis sativa, which has shown promising antidepressant effects without inducing hyperlocomotion. AMPA receptor activation is involved in the antidepressant effect induced by ketamine, but its relevance for the effects of CBD is not known. Moreover, given that CBD has antipsychotic and antidepressant properties, it is unknown whether adding CBD to ketamine could potentiate the antidepressant properties of ketamine while also attenuating its psychostimulant effects. EXPERIMENTAL APPROACH S-Ketamine (2.5, 3, 5, 10, 30 mg/kg) and cannabidiol (3, 10, 30 mg/kg) were administered alone or in combination to male Swiss mice. Independent groups received NBQX (AMPA receptor antagonist) 5 min before administration of CBD or S-ketamine. The antidepressant-like effect was assessed in the forced swimming test (FST), and the open field test (OFT) evaluated the psychostimulant effect. KEY RESULTS CBD induced significant dose-dependent antidepressant effects without causing hyperlocomotion in the OFT. S-ketamine produced an antidepressant effect associated with hyperlocomotion in the higher dose. NBQX inhibited the antidepressant effect of both ketamine and CBD. Pretreatment with CBD (10 mg/kg) attenuated the ketamine-induced hyperlocomotion while preserving its antidepressant effect. CONCLUSION AND IMPLICATIONS: Similar to ketamine, the antidepressant-like effect elicited by CBD involves AMPA receptor activation. Additionally, CBD prevents the hyperlocomotion induced by S-ketamine without affecting its antidepressant-like effect. Our findings suggest that CBD and ketamine's combined administration can be a promising therapeutic strategy for achieving an appropriate antidepressant effect without unwanted side-effects. This article is part of the special issue on 'Cannabinoids'.
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Affiliation(s)
- A G Sartim
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - J Marques
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - K M Silveira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Denmark
| | - P H Gobira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - F S Guimarães
- Department of Pharmacology, School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, SP, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - G Wegener
- Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Denmark
| | - S R Joca
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Denmark; Department of Biomedicine, Aarhus University, Denmark.
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Marques Pires C, Medeiros P, Oliveira C, Flores R, Mane F, Silva R, Campos I, Azevedo P, Gaspar A, Pereira MA, Galvao CB, Antunes N, Marques J. Impact of Atrial Fibrillation type in Acute Coronary Syndrome and the antithrombotic strategy. Europace 2021. [DOI: 10.1093/europace/euab116.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Atrial fibrillation (AF) is an adverse prognostic factor during acute coronary syndrome (ACS). Current evidence recommends dual antithrombotic therapy (DAT), 1 antiplatelet drug and 1 anticoagulant drug, as the default strategy after nonST elevation ACS.
AIM
To identify the clinical differences and prognosis of AF type-new onset (nAF) or pre-existing (pFA)- during ACS, to evaluate antithrombotic strategy at hospital discharge (HD) and its impact on haemorrhagic and ischemic events.
METHODS
We performed a retrospective observational cohort study including 3241 patients (pts) with ACS (mean age 64 years, 77.5% male) admitted to a single center over a 6-year period, with 12-months follow-up.
RESULTS
AF rhythm was identified in 11.2% pts, of whom 63.2% presented nAF and 36.8% pAF.
When AF types where compared, pts with pAF had a higher prevalence of cardiovascular (Cv) comorbidities, including hypertension (p < 0.001), previous ACS (p = 0.03), valvular disease (p = 0.01) or stroke (p = 0.05), had greater left atrial diameter (p < 0.001) and were less likely to have significant coronary lesions (p = 0.05). Pts with nAF more frequently presented with STelevation ACS (p < 0.001) and had a lower Hemoglobin nadir (p < 0.001). The independent predictors of nAF in ACS were age (OR 1.1, p< =0.001), LVEF ≤ 40% (OR 2.2, p = 0.001), STelevation ACS (OR 2.6, p< =0.001) and previous valvular disease (OR 3.5, p< =0.01). Compared with the population without AF, nAF was a predictor of in-hospital death (OR 2.9, p = 0.027) and in-hospital composite endpoint (death, stroke, reinfarction and cardiogenic shock) (OR 2.5, p = 0.001) in multivariate analysis, but pAF wasn’t. During 12-months follow-up of pts with ACS and AF, there was no difference regarding death or follow-up composite endpoint (death, stroke and ACS) between the AF types.Regarding antithrombotic therapy, nAF pts were less often anticoagulated (p < 0.001) and pAF pts where more often treated with triple antithrombotic therapy (TAT) at HD (<0.001). Most of the pts with TAT stopped the second antiplatelet at agent 6-months (43.8%) or 12 months (25.5%) after HD. During 12-months follow-up, pts discharged with TAT had trend towards more haemorrhagic events (TAT 6.2% vs DAT2.7%,p = 0.69) and both groups had similar ischaemic events (death, ACS, stroke) (TAT 20.9% vs DAT23.7%,p = 0.714). In multivariate analysis the choice of TAT or DAT wasn’t a predictor of ischaemic events.
CONCLUSIONS
In ACS, pts with nAF had worst in-hospital outcomes than pts with pAF. Regarding antithrombotic strategy at HD pts with nFA were less often anticoagulated and less often treated with TAT. In our study the choice between DAT or TAT had no statistical impact on follow-up outcomes.
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Affiliation(s)
| | | | | | | | - F Mane
- Braga Hospital, Braga, Portugal
| | - R Silva
- Braga Hospital, Braga, Portugal
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Paulo MC, Marques J, Cardoso C, Coutinho J, Gomes R, Gomes-Bispo A, Afonso C, Bandarra NM. The development of a novel functional food: bioactive lipids in yogurts enriched with Aurantiochytrium sp. biomass. Food Funct 2021; 11:9721-9728. [PMID: 33063067 DOI: 10.1039/d0fo01884h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Western diets are poor in healthy n3 polyunsaturated fatty acids, such as docosahexaenoic acid. Since microalga Aurantiochytrium sp. is rich in docosahexaenoic acid, a functional food based on lean yogurt and this microalga was tested. This study entailed characterizing the lipid fraction and determining the fatty acid bioaccessibility. The tested yogurts (control and 2% w/w, Aurantiochytrium sp.) had differences. Docosahexaenoic acid was not detected in the control product, but it was the second most important fatty acid in Aurantiochytrium sp. and Aurantiochytrium yogurt, 29.7 ± 0.4% and 18.7 ± 2.0%, respectively. Based on the fatty acid profile only, an amount of 158.7 g of Aurantiochytrium yogurt in wet weight terms would be required to ensure an appropriate intake of healthy fatty acids. Generally, the fatty acid bioaccessibility was not high, remaining below 60-70% in almost all cases. Considering the docosahexaenoic acid bioaccessibility (44 ± 3%), an amount of 360.7 g of Aurantiochytrium yogurt would be advisable. A reasonable dietary prescription would be a daily consumption of 125 ml of Aurantiochytrium yogurt.
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Affiliation(s)
- M C Paulo
- Depsiextracta Tecnologias Biológicas Lda, Zona Industrial do Monte da Barca, lote 62, rua H, Coruche, Portugal
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12
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Marques J, Silva M, Laureano C. Mind the gap! the lack of concordance in diagnostic in liaison psychiatry in a portuguese hospital. Eur Psychiatry 2021. [PMCID: PMC9480313 DOI: 10.1192/j.eurpsy.2021.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionNeurosciences evolved very rapidly in last few years and helped the establishment of Liaison Psychiatry as a fundamental part of the general hospitals functioning. However, the use of this department by the other specialties still needs to be refined, as it is common to find wrong assessments in the referral of the patients.ObjectivesWe aim to study the concordance between the referral motives and the assessment by the psychiatry team.MethodsData was collected through the informatic registry. Contains patient data observed by a liaison psychiatrist in the period between 1st of July and 30th of September of 2020. In this period there were 80 requests, of which, 6 were refused for various reasons. We decided to study the concordance when one of these symptoms were in the request: anxious symptoms, depressive symptoms, psychotic symptoms and psychomotor agitation. 46 requests met this criteria.ResultsThe mean age was 63,3yo and 46% were older than 65yo. Most were women (54%) and 68% had history of psychiatry disorder. About 50% were requests from the Medicine wards. The concordance between the medical request and the psychiatry assessment was higher for psychomotor agitation (n=11; 64%) and depressive symptoms (n=23; 57%), but it was lower in anxious symptoms (n=3; 33%) and in psychotic symptoms (n=9; 33%). Most common diagnosis was delirium.ConclusionsNon-psychiatrist doctors appear to have more difficulty when assessing anxious and psychotic symptoms. Those concordance percentages are in line with recent research. Actions should be taken to improve this, like academic training and standardization of referral.DisclosureNo significant relationships.
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Campos I, Pereira J, Salome N, Pereira VH, Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Marques J, Vieira C. Asymptomatic severe aortic stenosis: what is the current role of exercise stress test and NT-proBNP in patient risk stratification. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.053] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Aortic stenosis (AS) is prevalent in the elderly population. When severe and the patient is symptomatic or left ventricular dysfunction arises, the prognosis deteriorates and valve replacement (AVR) is recommended. During the asymptomatic phase regular clinical evaluation is advised to detect early onset of symptoms and/or signs of myocardial maladaptation. Due to the inherent difficulties in the evaluation of symptoms, especially in the elderly, as well as the change in prognosis when symptoms appear (even if not perceived), it is crucial to evaluate the behavior of patients with effort and signs of myocardial injury.
Methods
An observational and retrospective study that included 74 patients followed at the Cardiology Service by severe AS (aortic valve area ≤ 1cm2 and/or aortic transvalvular mean gradient ≥40mmHg), who underwent exercise stress test (EST) and NT-proBNP evaluation for risk stratification. The outcome studied was hospitalization for heart failure (HF), or referral to SV, or death during the follow-up period. Independent predictors were obtained using multivariate Cox regression.
Results
Non-progression or decrease in systolic blood pressure (SBP) in EST is the only independent predictor of a short-term adverse event (p = 0.025). This parameter, NT-proBNP levels and interventricular septal thickness (IVS) were independent predictors of a medium (two (p = 0.025; p = 0.014; p = <0.001), three (p = 0.015; p = 0.007; p = 0.001) and four years (p = 0.007; p = 0.049; p = 0.005)) and a long term adverse event (p = 0.006; p = 0.028; p = 0.005).
Conclusion
In asymptomatic patients with severe AS, no progression or decrease in SBP in EST, increased NT-proBNP levels and thickness of IVS were independent predictors of hospitalization for HF, need for VS or death in short, medium and long term.
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Pereira
- University of Minho, Braga, Portugal
| | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - VH Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Oliveira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
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14
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Leiria-Pinto P, Marques J, Finelli E, Alves C, Alves M, Trincão D, Pinto N, Carreiro-Martins P, Papoila AL, Neuparth N. Cross-cultural validation of the Portuguese from Portugal version of the test for respiratory and asthma control in kids questionnaire. Eur Ann Allergy Clin Immunol 2020; 53:214-220. [PMID: 33182989 DOI: 10.23822/eurannaci.1764-1489.174] [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: 11/17/2022]
Abstract
Summary Objective. The Test for Respiratory and Asthma Control in Kids (TRACK) is a tool to assess asthma control in preschool children. This study aims to validate the Portuguese from Portugal version of the TRACK questionnaire. Methods. A prospective cohort study was carried out to assess their psychometric characteristics. Caregivers of 141 children under age 5 with asthma symptoms were enrolled. Results. Internal reliability was close to 0.70 (Cronbach's α). The test-retest reliability was 0.87. TRACK scores were different between well, partially, and non-controlled asthma groups (p less than 0.001). Patients rated as having better control showed an increase in TRACK scores. Conclusions. The Portuguese version of the TRACK questionnaire is accurate and reliable for monitoring asthma control. Its use may help to overcome challenges with the management of this age group.
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Affiliation(s)
- P Leiria-Pinto
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal.,CHRC/CEDOC, Integrated Pathophysiological Mechanisms Research Group, Comprehensive Health Research Center/Chronic Diseases Research Center, Nova Medical School, Lisbon, Portugal
| | - J Marques
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal.,CHRC/CEDOC, Integrated Pathophysiological Mechanisms Research Group, Comprehensive Health Research Center/Chronic Diseases Research Center, Nova Medical School, Lisbon, Portugal
| | - E Finelli
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal
| | - C Alves
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal
| | - M Alves
- Research Centre (CHULC), EPE, Lisbon, Portugal.,Centre of Statistics and its Applications (CEAUL), Lisbon, Portugal
| | - D Trincão
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal
| | - N Pinto
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal
| | - P Carreiro-Martins
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal.,CHRC/CEDOC, Integrated Pathophysiological Mechanisms Research Group, Comprehensive Health Research Center/Chronic Diseases Research Center, Nova Medical School, Lisbon, Portugal
| | - A L Papoila
- Research Centre (CHULC), EPE, Lisbon, Portugal.,Centre of Statistics and its Applications (CEAUL), Lisbon, Portugal
| | - N Neuparth
- Department of Immunoallergology, Hospital Dona Estefânia, University Hospital of Central Lisbon (CHULC), EPE, Lisbon, Portugal.,CHRC/CEDOC, Integrated Pathophysiological Mechanisms Research Group, Comprehensive Health Research Center/Chronic Diseases Research Center, Nova Medical School, Lisbon, Portugal
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15
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Campos I, Oliveira C, Medeiros P, Marques Pires C, Flores R, Mane F, Silva R, Braga C, Gaspar A, Marques J, Vieira C. What is the prognosis for patients who develop new-onset atrial fibrillation in the first 48 hours after an acute coronary syndrome? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0366] [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
Atrial fibrillation (AF) is a common complication in acute coronary syndrome (ACS). However, treating patients (pts) with new-onset AF (NOAF) after an ACS remains a challenge. Although it seems intuitive that pts who develop AF within the first 48h have increased morbidity and mortality, your prognosis is unclear because there are no robust studies in the literature to confirm this association.
Aim
To characterize the population of pts who developed NOAF in the first 48 hours after an ACS and to compare the prognosis between these pts and pts who didn't develop AF.
Methods
2916 ACS pts admitted consecutively in our coronary care unit during 6 years were analyzed retrospectively. Of these pts, 343 (11.7%) had AF within the first 48h, of which 99 (3.4%) had pre-existing AF and 243 (8.3%) presented NOAF. Pts were divided into two groups: group 1 -ACS pts who developed NOAF in the first 48h (n=243; 8.8%); group 2 – ACS pts who did not develop AF (n=2517; 91.2%). Pts with pre-existing AF were excluded (n=156; 5.4%). Primary endpoint were the occurrence of death at 6 months; follow-up was completed in 95.8% of pts.
Results
Group 1 pts were older (72±12 vs 62±13, p<0.001), with higher proportion of women (30,9% vs 20,9%, p<0.001), hypertensive (78,5% vs 60,7%, p<0.001), smokers (17,4% vs 32,6%, p<0.001), previous CABG (7,9% vs 3,8%, p=0.06) and stroke (10,7% vs 6,8%, p=0.035). Group 1 had a higher proportion of STEMI pts (58,5% vs 46,5%, p<0.001) and, during hospitalization, had more often respiratory infection (p<0.001), malignant arrhythmias (p<0.001), heart failure (p<0.001), stroke (p=0.001), higher values of NT-proBNP (p<0.001) increased C-reactive protein levels (p<0.001), leukocytes (p=0.020), peak of TropI (p=0.029) and creatinine (p<0.001). On echocardiography, group1 had greater LA diameter (45±6 VS 41±5mm, p<0.001), more frequent significant mitral regurgitation (13,9% vs 2,9%, p<0.001), worst LVEF (41±10% vs 46±10%, p<0.001) and a higher value of pulmonary artery pressure (39±12 vs 24±10, p<0.001). Group 1 were less likely to have undergone coronary revascularization (84% vs 74%, p=0.005). In multivariate analysis, age ≥75 (OR 1.05, p<0.001), LVEF ≤40% (OR 2.50, p<0.001), LA diameter (OR 1.59, p=0.027), more significant mitral regurgitation (OR 2.49, p=0.001) and Killip class >1 (OR 1.51, p=0.015) remained independent predictors of NOAF. In multivariate analysis and after adjusting for different baseline characteristics, pts with NOAF have the same risk of 6-months mortality compared to those who didn't develop AF [OR 1.03, p=0.91].
Conclusion
The incidence of NOAF was 8.8% in our population, which is similar to the literature. Age, LVEF, LA diameter, a significant mitral regurgitation and Killip class >1 were independent predictors of NOAF after ACS. Pts with NOAF in the first 48h after an ACS had worse clinical manifestations during hospitalization but no higher 6-months mortality risk.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Oliveira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Silva
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Braga
- Hospital de Braga, Cardiology, Braga, Portugal
| | - A Gaspar
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
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Leiria-Pinto P, Carreiro-Martins P, Peralta I, Marques J, Finelli E, Alves C, Belo J, Alves M, Papoila AL, Neuparth N. Factors associated with asthma control in 121 preschool children. J Investig Allergol Clin Immunol 2020; 31:471-480. [PMID: 32694095 DOI: 10.18176/jiaci.0630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE There are controversial data about risk factors for uncontrolled asthma in preschool children. Objective: This study aims to explore the association between clinical and functional parameters and the lack of asthma control in preschool children. METHODS Children 3-5 years-old with asthma and healthy controls were recruited. A questionnaire was used to identify the potential risk factors of uncontrolled asthma as defined by GINA (Global INitiative for Asthma) criteria. Lung function and bronchial reversibility were evaluated through impulse oscillometry (IOS) and spirometry. Adjusted odds ratios (OR) were estimated based on multivariable generalized additive regression models. The discriminative ability of the models was measured by the area under the receiver operating characteristic curve (AUC). RESULTS 121 children were included, 107 of which had asthma and 14 were healthy controls. Fifty-three patients (50%) had uncontrolled asthma. After adjustment, the variables associated with an increased risk of lack of control were: "More than 3 flare-ups in last 12 months", "moderate to severe rhinitis", "relative variation in post-bronchodilator FVC and FEV1". The AUC of the final models that included variation of FVC or FEV1 were 0.82 and 0.81, respectively. R5-20, R5-20% and AX z-score values of the healthy group were lower than those of children with asthma. CONCLUSION In preschool children, clinical and functional parameters are associated with uncontrolled asthma. More studies are needed to confirm usefulness of the IOS.
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Affiliation(s)
- P Leiria-Pinto
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal.,NOVA Medical School/Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - P Carreiro-Martins
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal.,NOVA Medical School/Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - I Peralta
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal
| | - J Marques
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal.,NOVA Medical School/Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - E Finelli
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal
| | - C Alves
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal
| | - J Belo
- Centro Hospitalar Universitário Cova da Beira
| | - M Alves
- Centro de Investigação, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal
| | - A L Papoila
- NOVA Medical School/Comprehensive Health Research Center (CHRC), Lisbon, Portugal.,Centro de Investigação, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal
| | - N Neuparth
- Immunoallergology Department, Hospital Dona Estefânia - CHULC, EPE, Lisbon, Portugal.,NOVA Medical School/Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Couto M, Marques J, Silva D, Paiva M, Jacinto T, Câmara R. What Physical Education Teachers Know About Asthma: Impact of a Training Course. J Investig Allergol Clin Immunol 2020; 29:392-394. [PMID: 31621632 DOI: 10.18176/jiaci.0413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Couto
- Immunoallergology - José de Mello Saúde, Portugal
| | - J Marques
- Imunoalergologia - Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - D Silva
- Serviço de Imunoalergologia - Centro Hospitalar São João, Porto, Portugal
| | - M Paiva
- Serviço de Imunoalergologia Dona Estefânia, Lisboa, Portugal
| | - T Jacinto
- Porto Health School, Polytechnic Institute of Porto, Porto, Portugal.,CINTESIS, Faculty of Medicine of University of Porto, Porto, Portugal
| | - R Câmara
- Unidade de Imunoalergologia, Hospital Dr. Nélio Mendonça, SESARAM EPE, Funchal, Portugal
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Campos I, Azevedo P, Pereia VH, Costeira-Pereira A, Salome N, Vieira C, Costa-Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Marques J. P1308 A peculiar case of an acute pulmonary embolism. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.752] [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
Cardiac tumors represent a challenging diagnosis, since the heart is an unusual site of metastasis from any malignancy.Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas but cardiac metastization from bladder urothelial carcinoma is an extremely rare event. Here, we report the case of an 82-year-old man in whom right ventricular extension of cardiac metastization was diagnosed after a pulmonary thromboembolism.
CASE REPORT DESCRIPTION
An 82-year-old male was admitted to our hospital with a history of cough with streaky hemoptysis, fever and anorexia for 2 weeks, and breathlessness on exertion for 2 day. He had a history of bladder urothelial carcinoma 3 months ago, with extensive areas of epidermoid differentiation, treated only surgically with cystectomy. On physical examination, he was afebrile with a blood pressure of 135/70, tachycardic at 115beats/min, and his respiratory rate was 26breaths/min. The room air oxygen saturation was 90%, and arterial blood gas analysis revealed hypoxemia with an elevated alveolo-arterial oxygen gradient. The blood test revealed a normocytic normochromic anemia and an elevated levels of D-dimer. The echocardiogram revealed a pediculated and mobile mass attached to the apex of the right ventricle. A CT pulmonary angiography was performed and found an acute and bilateral pulmonary thromboembolism, being the patient immediately hypocoagulated. It was also performed a cardiac MRI (with and without contrast) that showed a large mass in the RV. It was arising from the RV free wall and was occupying almost half of the RV (mid and apical cavity). It had irregular edges with intermediate enhancement on T1 images and is hyperintense on T2 stir images. There was some evidence of contrast uptake on T1 weighted contrast images. It did not seem to have a significant fatty component on T1 weighted images with fat saturation. The cardiac MRI features were consistent with tumorous involvement of the RV. As part of the work for primary cancer, a colonoscopy was performed which also showed the presence of metastases in the proximal sigmoid colon from the bladder urothelial carcinoma. During hospitalization, the echocardiogram was repeated, showing an increase in the mass previously described, extending to the trunk of the pulmonary artery. Soon after, our patient died suddenly after an episode of sudden dyspnea and hemodynamic instability.
CONCLUSION
We experienced a very uncommon case of a metastatic cardiac tumor from urothelial carcinoma. To the best of our knowledge, only a small number of cases were reported and the reason for the rarity of cardiac metastasis from urothelial carcinoma is unclear. Although the echocardiography has become the gold standard for the diagnosis of intracardiac masses, cardiac MRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, allowing a comprehensive characterization of such lesions.
Abstract P1308 Figure. pediculated and mobile mass (20x56mm) at
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - P Azevedo
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereia
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Oliveira CC, Quina C, Campos I, Rodrigues C, Medeiros P, Braga C, Costeira A, Marques J, Pinho P. P232 A cardiac thrombus... or maybe not. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.097] [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 61 years old female with history of rheumatic arthritis and Sjogren Syndrom resorted to the emergency room in December of 2017 for pleuritic chest pain and dyspnea. An angioCT showed a luminal filling defect at the left inferior pulmonary artery with extension to the segmentar vessels. A pulmonary embolism (PE) was diagnosed and the patient was admitted. The study performed, including transthoracic echocardiogram (TTE) was unremarkable. Patient was discharged after 15 days treated with a direct oral anticoagulant. Six months later she returned to the emergency room with the same complaints. A new angioCT showed reduction of the previous luminal filling defects, but a focal defect in the filling of the right atrium (RA) was visualized. A TTE showed a mass (17 mm) at the RA with apparent origin at the superior vena cava. A presumptive diagnostic of atrial thrombus was done and patient started therapy with vitamin K antagonist. Three months later, TTE was repeated and the mass was still present (19 mm). Five months later, the mass was still visualized at TTE (17 mm). A transesophagic echocardiogram confirmed the presence of a RA mass with 30x22 mm of major dimensions, with close relation with the interatrial septum suggestive of a tumor. A cardiac magnetic resonance revealed a RA mass without vascularization. A cardiac gated CT showed at the RA a low density nodular image of 26x22 mm at the axial plan, with an extension of 28 mm, adjacent to the posterior wall of the RA. After contrast administration, some areas did not had significant captation while some did, aspects compatible with a "pseudoenhancement" aspect. A positron tomography showed mild to moderate FDG captation at the RA. Meanwhile, patient was under anticoagulation for 2 years with no regression of the mass. For this reason, patient was oriented to cardiac surgery. The mass was resected and the histology revealed a RA myxoma.
Cardiac masses can be due to tumour, thrombus or vegetation. In this case, the mass was highly considered to be a thrombus due to the presence of multiple risk factors: prothrombotic disease and pulmonary embolism. However, the fact that the mass did not reduce with therapy raised suspicion of other diagnosis. Although rare, myxomas can be found in the RA, and should be included in the differential diagnosis of right-sided intracardiac masses. Although myxomas are histologically benign, potential for embolization and sudden death make surgical resection a priority. Its diagnosis has now increased with the use of echocardiogradiography, and has made it the main modality for the evaluation of myxomas. PE is the most dreaded and devastating complication of right-sided myxoma. In cases of RA myxomas, clinically evident PE events are uncommon. Nevertheless, there have been reports of embolization of thrombi or tumor fragments into the pulmonary vessels in cases of right in approximately 3.2% of myxoma patients.
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Affiliation(s)
| | - C Quina
- Hospital de Braga, Braga, Portugal
| | - I Campos
- Hospital de Braga, Braga, Portugal
| | | | | | - C Braga
- Hospital de Braga, Braga, Portugal
| | | | | | - P Pinho
- Sao Joao Hospital, Cardiothoracic Surgery, Porto, Portugal
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Campos I, Azevedo P, Costeira Pereira A, Salome N, Vieira C, Pereira VH, Costa Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Mare R, Marques J. P1314 A singular explanation of stroke in young adults. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Although primary cardiac tumors are rare, papillary fibroelastoma (PFE) is the most common benign neoplasm of cardiac valvular structures. Because patients are often asymptomatic the true prevalence is unknown, being most commonly recognized given the evolution of higher-resolution imaging technology. The clinical presentation of PFEs can diverge between being asymptomatic to symptomatic based on the serious complications that can occur, such as acute valve dysfunction or embolization, giving rise to a wide variety of presenting features including neurologic events, acute coronary syndrome, and distal embolic events. The location on the mitral valve does not occur frequently, with rare cases reported in the literature. Here, we present an unusual case of a 32-year-old male with an acute stroke secondary to a PFE in the mitral valve.
CASE REPORT DESCRIPTION
A 32-year-old male patient with a history of crohn"s disease was admitted to our emergency department with a transient sudden-onset aphasia associated with a right hemiparesis. At admission, these symptoms had completely resolved. On further questioning, the patient described another episode of transient right hemiparesis in the last year. On physical examination, the patient"s vital signs were stable. The patient was awake, alert, and oriented with full Glasgow Coma Scale. There was no focal neurological deficit on neurological examination and his cardiovascular examination was normal with no murmurs, added sounds or carotid bruit. A cranial CT showed no signs of acute intracranial disease. Head MRI showed multiple areas of restricted diffusion in the left frontal lobe consistent with acute stroke. As part of the workup to determine the cause of his embolic stroke, a transthoracic echocardiogram and transoesophageal echocardiography were performed, showing a spherical and highly mobilemass attached on the downstream side of the anterior mitral valve leaflet of approximately 1.1 cm in diameter, suggesting the diagnosis of PFE. A bubble study was negative which out ruled patent foramen ovale. After completing the rest of the workup, it was determined that PFE was likely the cause of his stroke. Cardiothoracic surgery was consulted and the patient underwent surgical resection. Histology confirmed the diagnosis of PFE. After 5 years the patient remains asymptomatic, without new embolic events.
DISCUSSION AND CONCLUSIONS
We present a special case that illustrates the importance of diagnosing primary cardiac tumours in a young patient presenting with acute stroke with minimal or no risk factors.Although primary cardiac tumours are rare, diagnosis and treatment at an early stage may prevent serious complications and reduce the morbidity and mortality of embolic stroke.
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - P Azevedo
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Mare
- Hospital de Braga, Neurology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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21
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Campos I, Galvao Braga C, Costeira-Pereira A, Salome N, Vieira C, Pereira VH, Costa-Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Marques J. P226 Caseous calcification of the mitral annulus: a silent cause of intracardiac mass. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.092] [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: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION
Caseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification with a central liquefaction necrosis, being an uncommon echocardiographic finding (0.5 to 1%) which may be mistaken for an intracardiac tumor, thrombus or vegetation. This chronic degenerative process can occurs at advanced ages, particularly in women, and patients with hypertension, chronic renal failure or calcium metabolism abnormalities. Since patients often remain asymptomatic, conservative treatment for this lesion is generally sufficient.
CASE REPORT
DESCRIPTION
We report a case of an 86-year-old female with a known history of hypertension and diabetes, who was referred to our department in order to investigate the diagnosis of an intracardiac mass visualized through a routine transthoracic echocardiography. She reported effort dyspnea, but refused to have other cardiovascular symptoms.
In order to study this intracardiac mass, the patient was submitted to a transthoracic echocardiogram that showed a rounded mass of 16 × 22 mm in the anterior mitral annulus, mainly in P1 scallop, not causing valve stenosis and with a mild mitral regurgitation. This prompted the need for transesophageal echocardiography which revealed a spheroid mass of heterogeneous content with calcification points, regular edges and with faint central echo-lucent area without acoustic shadowing, attached to the anterior mitral valve leaflet. No communication with any cardiac chamber could be detected. The mass did not determine any restriction to the opening of mitral valve cusps. A cardiac MRI was requested to complete the diagnostic evaluation revealing that the lesion was located at the base of the anterior leaflet. In the T1 and T2 sequences the mass was hypointense, whereas in the perfusion sequence, no contrast penetration was detected in the mass and in the late enhancement. These findings, as well as the presence of a calcified envelope in the cardiac computed tomography scan, confirmed the suspicion of caseous calcification of the mitral annulus.
DISCUSSION
AND CONCLUSIONS
We present an unusual case of caseous calcification of the mitral annulus in which the multi-modal approach was crucial to confirme the diagnosis. Although transthoracic echocardiography can be sensitive in the diagnosis of this entity, the diagnosis may sometimes still be inconclusive. Thus, multi-modality with transesophageal echocardiography, cardiac MRI or CT can lead to a definitive diagnosis, avoiding an mistaken diagnosis with the need of a surgical approach. Since this pathology is most frequently detected in asymptomatic patients, the patients should be treated medically and monitored clinically and echocardiographically for an early recognition of possible complications.
Abstract P226 Figure. Caseous calcification of mitral annulus
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Campos I, Vieira C, Salome N, Pereira VH, Costeira Pereira A, Bettencourt N, Costa Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Marques J. P725 An unexpected direction: a case report of a double aortic arch in an asymptomatic woman in adulthood. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.397] [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
Complete vascular rings represent about 0.5-2% of all congenital cardiovascular malformations, with the double aortic arch (DAA) being the most common of the complete vascular rings, causing tracheoesophageal compression. The right (posterior) arch is usually dominant (70%), although the two arches can have the same size (5%). The left (anterior) arch is dominant in only approximately 25% of cases. In most cases, this anomaly is diagnosed during childhood due to symptoms caused by oesophageal or tracheal compression. For this reason, case reports of adults are rare. This report describes a case of a 61-year-old woman with DAA with dominant left arch, diagnosed accidentallyby thoracic CT angiography.
Case Report Description
A 61 years old woman with a previous story of hypertension and type 1 diabetes presented to the emergency service with dyspnoea and thoracic pain. She also referred a history of intermittent dysphagia and cough with at least 12 years of progression. All the parameters of the physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm with no evidence of acute ischemia and her blood analyses did not show any abnormalitie. She also performed a thoracic CT angiography, which excluded signs of pulmonary embolism, but revealed a vascular ring suggesting a double aortic arch with permeability in both right and left arches as well as their collaterals. The Cardiac MRI was performed with the purpose of excluding ischemia, confirming the double aortic arch with left dominance. The right arch, posterior to the oesophagus and trachea, and the left arch, in an anterior position, showed an anatomic compression of the oesophagus as well as the proximal trachea, capable of eliciting the symptoms mentioned. Other congenital anomalies were excluded. The echocardiography did not demonstrate any additional cardiac malformation. Endoscopy shows a pulsatile extrinsic compression of the esophagus (aortic ring). The patient is currently being studied and closely monitored in the Cardiology consultation.
Discussion
The most common type of complete vascular ring is the double aortic arch, which accounts for 70% of the complete rings. In most cases, there are two permeable arches, usually with right dominance (70% of the cases). Rarely, both arches are symmetrical. Symptoms usually appear in the fifth month of life. In most cases, only supportive treatment is required.
Conclusion
This case illustrates the atypical features of this congenital malformation, namely the diagnosis during adulthood as well as the left dominance.
Abstract P725 Figure. A double aortic arch
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Campos I, Marques A, Sousa L, Fonseca S, Apolinario I, Costa Oliveira C, Veira C, Costeira Pereira A, Salome N, Pereira VH, Marques Pires C, Medeiros P, Marques J, Brandao I. P1313 A curious case of endocarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Nonbacterial thrombotic endocarditis (NBTE) is a rare form ofnoninfectious endocarditis in which a small sterile vegetations deposited on the heart valves (mostly aortic and mitral).It has been reported in every age group, most commonly affecting patients between the fourth and eighth decades of life with no sex predilection. Patients with advanced malignancy and those with systemic lupus erythematosus are the most common populations affected by NBTE, and they are typically asymptomatic until embolization occurs. Here, we report a case of a female patient with rheumatoid arthritis whose diagnosis was made prior to any thromboembolic event.
CASE REPORT DESCRIPTION
An 83-year-old female patient with a 10-year history of rheumatoid arthritis, was admitted for urinary tract infection with exacerbation of chronic renal disease and decompensated heart failure of unknown etiology. On physical examination, she was febrile (38,3ºC) with a blood pressure of 130/70 and pulse rate of 90 beats/min. Cardiac auscultation revealed a sistolic murmur of grade 1/4 in the fifth left intercostal space. A joint deformities in the hands were noted, such as interosseous atrophy and ulnar deviation. To evaluate this new sistolic murmur,the transthoracic echocardiogramwas performed and showed a vegetation in the mitral valve. Then, a transesophageal echocardiogram(TEE) was requested to better characterize this vegetation, showing a vegetation of 19x4mm involving the posterior cusp of the mitral valve leaflet, with moderate mitral regurgitation,being the hypothesis of infective endocarditis (IE) proposed. There were no other significant abnormalities in the remaining echocardiogram. Empirical antibiotic therapy to IE was initiated. The TEE was repeated after 4 weeks of antibiotic therapy with maintenance of the referred vegetation and mention of a smaller one (10x2mm). Clinical investigation didn’t show any infectious process. Hence, the hypothesis of NBTE was established. Anti-coagulation therapy was started immediately. The NBTE lesion disappeared in the follow-up echocardiography three months post anti-coagulation treatment.
CONCLUSION
Although NBTE is an uncommon and difficult diagnosis that requires a high degree of suspicion, its timely diagnosis is essential since it allows the prevention of thromboembolic events, resulting in a positive impact on patients" quality of life. In addition, the existence of this clinical condition may allow the diagnosis of another underlying disease, such as a hidden neoplasia. Thus, the authors believe that the sharing of this clinical case will allow a reflection on this entity emphasizing the importance in the hypotheses of vegetation diagnosis. From the authors" knowledge, from the available medical literature, the clinical case presented is one of the few NBTEs described in patients with rheumatoid arthritis, with mitral valve involvement and whose diagnosis was made before any thromboembolic event.
Abstract P1313 Figure. A vegetation of mitral valve
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - A Marques
- Hospital de Braga, Internal Medicine, Braga, Portugal
| | - L Sousa
- Hospital de Braga, Internal Medicine, Braga, Portugal
| | - S Fonseca
- Hospital de Braga, Cardiology, Braga, Portugal
| | - I Apolinario
- Hospital de Braga, Internal Medicine, Braga, Portugal
| | | | - C Veira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
| | - I Brandao
- Hospital de Braga, Internal Medicine, Braga, Portugal
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Oliveira CC, Vieira C, Campos I, Rodrigues C, Medeiros P, Flores R, Mane F, Braga C, Rocha S, Marques J. P644 A not so innocent athlete"s heart. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.326] [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
We report the case of a 17 years old athlete who resorted to the emergency service for palpitations and dizziness during exercising. He mentioned two episodes of syncope associated with exercise in the last 6 months. He was tachycardic (200 bpm) and hypotensive (85/56 mmHg). The electrocardiogram showed regular wide complex tachycardia with left bundle branch block morphology with superior axis restored to sinus rhythm after electrical cardioversion. In sinus rhythm, it showed T-wave inversion in V1-V5. Patient was admitted for study. Transthoracic echocardiography demonstrated mild enlargement and dysfunction of the right ventricle (RV) with global hypocontractility (FAC of 29%). The cardiac magnetic resonance (CMR revealed a RV end-diastolic volume indexed to surface body area of 180 mL/m2, global hypocinesia and RV dyssynchrony, subepicardial late enhancement in the distal septum and in the middle segment of the infero-septal wall. The patient underwent genetic study which showed a mutation in the gene that encodes the desmocolin-2 protein (DSC-2) involved in the pathogenesis of arrhythmogenic right ventricular cardiomyopathy (ARVC). According to the 2010 modified Task Force criteria for this diagnosis, the patient presented 4 major criteria for ARVC (characteristic ventricular tachycardia, repolarization and morphofunctional changes and the presence of pathogenic mutation) and the diagnosis was made. Thus, given the clinical presentation, it was implanted a subcutaneous cardioverter and patient is currently in follow-up at the Cardiology service.
ARVC is present in 1 to 1000-5000 people and is responsible for 20% of all sudden cardiac deaths, especially in athletes. Diagnosis is based on structural, functional, electrophysiological and genetic criteria reflecting underlying histological changes. This case shows and reviews the essential characteristics to the disease recognition and, therefore, to the prevention of its most feared complication: sudden cardiac death.
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Affiliation(s)
| | - C Vieira
- Hospital de Braga, Braga, Portugal
| | - I Campos
- Hospital de Braga, Braga, Portugal
| | | | | | - R Flores
- Hospital de Braga, Braga, Portugal
| | - F Mane
- Hospital de Braga, Braga, Portugal
| | - C Braga
- Hospital de Braga, Braga, Portugal
| | - S Rocha
- Hospital de Braga, Braga, Portugal
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Oliveira CC, Vieira C, Rodrigues C, Campos I, Medeiros P, Flores R, Mane F, Braga C, Salgado A, Marques J. P1261 A heart with red flags. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.713] [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 67 years old woman with a previous history of hypertension, atrial fibrillation (AF) and known severe concentric hypertrophy (more pronounced at the interventricular septum) with moderate pulmonary hypertension and diastolic dysfunction of the left ventricle (LV) resorted to the urgency service for weight loss, asthenia and dyspnea for minor efforts. Her physical examination was innocent. Her ECG showed AF and low voltage in limb and precordial leads. Patient was admitted at the Cardiology Department for investigation. A new TTE revealed fast progression of the hypertrophic pattern (IVS 26 mm, and posterior wall 18 mm) with a rest outflow tract gradient of 18 mmHg; free right ventricular wall was also hypertrophied with 12 mm and a type II diastolic dysfunction was present. A complete investigation for ventricular hypertrophy and constitutional syndrome was done. CMR demonstrated preserved biventricular systolic function, LV hypertrophy with septal predominance (24 mm) with elevated myocardial mass indexed to body mass (114 g/m2) and late difuse subendocardial gadolinium enhancement. (99m)Tc -DPD scintigraphy was negative for ATTR; Anderson-Fabry disease was excluded by genetic testing. Blood analysis revealed a normocytic/ normochromic anemia and a disproportional ratio of free light immunoglobulin chains K/λ, with a predominance of lambda chains. β2-microglobulin was also elevated. 24 hours urine analyses were normal. The hypothesis of non-secretor multiple myeloma (MM) with light chain immunoglobulin amyloidosis (AL) was then admitted. The patient underwent bone marrow and salivary gland biopsies which confirmed MM and deposition of amyloid, respectively. The FISH analyses demonstrated a delection of RB1 gene on 13q14.3 sequence and of TP53 on 17p13.1, both associated with a poorly prognosis in MM. The patient was referred for oncology where she is currently undergoing chemotherapy for MM and AL amyloidosis.
Amyloidosis represents a large spectrum of systemic diseases. Heart failure may be its first sign. This case reflects the diagnostic work-up in the presence of a hypertrophic LV pattern as well as the importance of high clinical suspicious and early diagnosis. While AL amyloidosis occurs in isolation, 10% of patients with multiple myeloma develop systemic AL amyloid with cardiac involvement. The distinction between these entities is not only semantic, but has extremely important prognosis and therapeutic considerations.
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Affiliation(s)
| | - C Vieira
- Hospital de Braga, Braga, Portugal
| | | | - I Campos
- Hospital de Braga, Braga, Portugal
| | | | - R Flores
- Hospital de Braga, Braga, Portugal
| | - F Mane
- Hospital de Braga, Braga, Portugal
| | - C Braga
- Hospital de Braga, Braga, Portugal
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Campos I, Galvao Braga C, Costa J, Quina Rodrigues C, Costa Oliveira C, Medeiros P, Marques Pires C, Vieira C, Marques J. P6522Overcoming anatomic challenges to transradial access in STEMI patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Transradial access is associated with fewer access-related complications, earlier discharge and lower mortality, being the preferred route to perform coronary angiogram and interventions due to its safety and cost effectiveness in STEMI patients. However, the radial artery is smaller, more superficial and thinner than the femoral artery and a percentage of patients ranging from 14% to 27% have a radial artery that is smaller than a 6-French introducer, which sometimes makes angioplasty difficult.
Purpose
This study reports our initial experience with the 5F straight (STR) flush catheter, which can be used as a “child” type rapid exchange catheter inside the 6F guiding catheter, creating a distal tip transition, facilitating angioplasty in transradial coronary interventions when the radial artery is small, tortuous or as severe spasm that impedes advancement of guiding catheter after successful angiography with 5F catheter.
Methods
We analysed, retrospectively, 1510 STEMI patients (pts) admitted in our catheterization laboratory, from August of 2010 to October 2017. Of these patients, 95 (6.3%) pts with problems in advancing a 6F guiding catheter, were submitted to this technique and a direct crossover to a femoral approach was performed in 36 pts (2.4%). This technique consists in the use of longer 5F STR flush catheter in order to overcome the larger distal tip of the 6F guiding catheter through the radial access, employing a 5-in-6 F technique.
Results
In 89 of 95 patients (93.7%), this new technique was successful, with a mean reperfusion time since arrival to the catheterization laboratory of 24.5±9.9 minutes. Of the pts submitted to this technique the majority were female 51 (57.3%) and the mean age was 67±14.3 years. Angioplasties were performed in the left main (2; 2.3%), left anterior descending (36; 40.4%), left circumflex artery (8; 9.0%), right coronary artery (40; 44.9%), right posterior descending artery (1; 1.1%) and obtuse marginal branch (2; 2.3%). No complications in arterial access were seen. Throughout these years of study, the need for crossover to femoral approach has decreased with the learning of this technique. The time until reperfusion since catheterization laboratory arrival was 29.3±9.5 minutes when there was a crossover, being statistically higher than with the radial procedure with the STR technique (p<0.017).
Conclusion
This new technique may be a simple and useful approach to perform primary PCI through transradial access in patients with small diameter radial arteries, allowing a reduction of crossover to femoral access, which translates into a lower risk of vascular complications and shorter reperfusion time, that may influence the prognosis of STEMI patients.
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - J Costa
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Campos I, Costa-Oliveira C, Medeiros P, Marques Pires C, Flores R, Ferreira AS, Galvao Braga C, Costa J, Vieira C, Marques J. P5521Door-to-balloon time and mortality of a PCI centre: how crucial can 30 minutes be for our STEMI patients? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
STEMI time delays have been presented as an indicator of quality of care. Considering the system delay, the guidelines of European Society of Cardiology (ESC) and American Heart Association (AHA) for the management of STEMI patients (pts) diverge regarding the maximum time from STEMI diagnosis to wire crossing in pts presenting at primary PCI (pPCI) hospitals (≤60min versus ≤90min, respectively).
Objective
To compare the prognosis between pts presenting at pPCI hospital with maximum time from STEMI diagnosis to wire crossing of ≤60min and patients with times between 61 and 90min.
Methods
The records of 1679 STEMI pts admitted consecutively in our coronary care unit during six years were analysed retrospectively. Of this pts, 341 (20%) were admitted directly in a PCI centre and 1338 (80%) were rescued by an emergency medical system or presented to a non-PCI centre. Pts that presented at PCI centre were divided into two groups: group 1 – STEMI pts with maximum time from STEMI diagnosis to wire crossing of ≤60min (n=202,69%); group 2 – STEMI pts with times 61–90 min (n=91,31%). Pts with time from STEMI diagnosis to wire crossing >90min were excluded. Primary endpoints were the occurrence of death at 6 months and 1 year; follow-up was completed in 98% of pts.
Results
Group 2 pts were older (60±14 vs 67±143, p<0.001), with higher proportion of women (14.9% vs 25.3%; p=0.026), hypertension (45.5% vs 61.5%, p=0.035), diabetes (17.1 vs 24.4%, p=0.005) and presented more frequently Killip 4 at admission (2.1% vs 12.5%, p=0.003). Group 1 pts had higher proportion of smokers (62.2% vs 49.4%, p=0.03). Patient delay was statistically higher in group 2 (Mdn (h) 3.8±3.5 vs 5±2, p<0.001), as was the system delay (Mdn (min) 45±9 vs 74±8, p<0.001). In-hospital mortality (3.8% vs 5.1%, p=0.42) wasn't different between groups, but at 1-month (3.8% vs 10.3%, p=0.05), 6-months (4.4% vs 12.8%, p=0.02) and 1-year mortality (5% vs 15.4%, p=0.008) was higher in group 2. In multivariate analysis and after adjusting for different baseline characteristics, pts who complied with the recommended times according to the 2017 ESC guidelines had lower risk mortality at 1 year compared to group 2 [HR 0.42, 95% CI (0.23–0.74), p=0.006].
Conclusion
In patients presenting at this PCI centre, complying with the 2017 ESC STEMI guidelines in order to reduce the system delay to ≤60min was crucial, since pts who were reperfused within this recommended time had lower mortality rates.
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - J Costa
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Campos I, Costa Oliveira C, Marques Pires C, Medeiros P, Flores R, Galvao Braga C, Costa J, Vieira C, Marques J. P1723Predictors of in-hospital mortality in STEMI patients complicated by cardiogenic shock treated with primary percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0478] [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
Cardiogenic shock (CS) is an uncommon complex syndrome in patients (pts) with acute myocardial infarction (AMI). However, it remains the most serious complication and the most common cause of in-hospital mortality, with mortality rates ranging from 40% to 60%. The majority of pts are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for percutaneous coronary intervention (PCI) remains unknown.
Objective
The aim of the present study was to evaluate pts with STEMI and cardiogenic shock undergoing pPCI, in order to establish the timing of CS onset, mortality rates and predictors of in-hospital mortality.
Methods
The records of 1679 STEMI pts admitted, consecutively, in our coronary care unit during six years were analysed retrospectively. Of this pts, 137 (8%) developed CS based on clinical criteria. Univariate and multivariate logistic regression analyses were used to identify independent predictors of in-hospital mortality. Primary endpoint was the occurrence of death at 30 days and 1 year; follow-up was completed in 100% of patients. Statistical analysis was performed using SPSS 20.0.
Results
The sample was formed by 90 (65.7%) men and 47 (34.3%) women, with mean age of 67±15 years. The incidence of CS was 8%. The majority of this pts (48%) were transferred from a non-PCI centre, 27% were rescued by an emergency medical system and 26% were admitted directly at a PCI centre. Around of 39% of pts had to be resuscitated before coronary intervention. Regarding the timing of CS onset, 66% of pts had CS on admission and 34% developed late CS. The left anterior descending artery was the most affected artery (47%), and 55% of the patients had multivessel disease. All-cause in-hospital and 1 year mortality was 45% and 53%, respectively. A multivariate analysis identified age >75 (HR 1.1, p=0.002), eGFR <60 ml/min/1.73 m2 (HR 2.2, p=0.02), left ventricular dysfunction (LVEF<40%) (HR 2.1, p=0.027), resuscitation before PCI (HR 1.2, p=0.045), and Intra-Aortic Balloon Pump (IABP) implantation after PCI (HR 4.4, p=0.026) as independent predictors of in-hospital mortality.
Conclusion
Despite the therapeutic advances and early revascularization have substantially improved the survival of pts with STEMI and CS, the in-hospital mortality is still significant. This study identified age, acute renal failure, left ventricular dysfunction, resuscitation before PCI, and IABP implantation after PCI as independent predictors of in-hospital mortality in patients with cardiogenic shock due to AMI. Consequently, only the timing of IABP insertion was the only modifiable factor predicting in-hospital mortality in our study, and its implantation before PCI can be considered to improve the outcome of these patients. These results should motivate the search for potentially modifiable factors that can lead to better results in the prognosis of these patients.
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - J Costa
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Pepe B, Silva B, Dias B, Marques C, Loja D, Fortunato D, Castro F, Melo F, Mousinho H, Palma I, Barriga J, Freitas J, Marques J, Miranda J, Revez M, Amaro P, Bizarro P, Belo A, Ferreira J, Póvoa P, Seromenho V. ‘BLS in medical curriculum: strengthening the survival chain’. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Oliveira J, Sousa F, Coutinho F, Campos S, Castro M, Marques J, Carvalho G, Negrão L, Almeida e Sousa L, Águas F. Ultrasound accuracy in Granulosa Cell Tumors diagnosis. Australas J Ultrasound Med 2019. [DOI: 10.1002/ajum.12157] [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: 11/06/2022] Open
Affiliation(s)
- J. Oliveira
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Portugal Clinical Academic Center of Coimbra Coimbra Portugal
| | - F. Sousa
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - F. Coutinho
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - S. Campos
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - M.G. Castro
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - J. Marques
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - G. Carvalho
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - L. Negrão
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - L. Almeida e Sousa
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - F. Águas
- Department of Gynaecology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
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Correia AT, Rebelo D, Marques J, Nunes B. Effects of the chronic exposure to cerium dioxide nanoparticles in Oncorhynchus mykiss: Assessment of oxidative stress, neurotoxicity and histological alterations. Environ Toxicol Pharmacol 2019; 68:27-36. [PMID: 30870693 DOI: 10.1016/j.etap.2019.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/24/2019] [Accepted: 02/21/2019] [Indexed: 06/09/2023]
Abstract
Cerium dioxide nanoparticles (CeO2-NPs) have a variety of uses, especially in the production of solar panels, oxygen pumps, gas sensors, computer chips and catalytic converters. Despite their worldwide use, the few published studies demonstrate that metallic nanoparticles, in general, are still not properly characterized in terms of their potencial ecotoxicological effects. CeO2-NPs, in particular, have demonstrated extreme antioxidant activity, but their in vivo toxicity is still unknown. This work intended to characterize the chronic toxicity (28 days) of three different ecologically relevant concentrations (0.1, 0.01, and 0.001 μg/L) of CeO2-NPs in the rainbow trout (Oncorhynchus mykiss), in terms of biomarkers of oxidative stress [activity of the enzymes glutathione S-transferases (GSTs) and catalase (CAT)] and neurotoxicity [activity of the enzyme acetylcholinesterase (AChE)], as well as histological alterations in liver and gills. In the hereby study, GSTs activity was increased in gills of fish exposed to the highest CeO2-NPs level. Moreover, a potential anti-oxidant response was also reported, with a significant increase of CAT activity observed in livers of the same fish. AChE, however, was not significantly altered in fish eyes. Individuals exposed to CeO2-NPs also presented marked changes in the gills (e.g. epithelial lifting, intercellular edema, lamellar hypertrophy and hyperplasia, secondary lamella fusion and aneurysms) and liver (e.g. hepatocyte vacuolization, pyknotic nucleus, enlargement of sinusoids and hyperemia). The semi-quantitative analysis (organs pathological index) also showed the establishment of a dose-effect relationship. Further studies about the ecotoxicological effects of the CeO2-NPs have yet to be conducted, considering their properties, as the aggregation chemistry and the ratio of its redox state, which may affect their availability to the organism and their toxicity in the environment and biota.
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Affiliation(s)
- A T Correia
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR/CIMAR), Rua dos Bragas 289, 4050-123 Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa (UFP), Rua Carlos da Maia 296, 4200-150, Porto, Portugal
| | - D Rebelo
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR/CIMAR), Rua dos Bragas 289, 4050-123 Porto, Portugal; Departamento de Biologia, Universidade de Aveiro, Campus de Santiago, 3810-193 Aveiro, Portugal
| | - J Marques
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR/CIMAR), Rua dos Bragas 289, 4050-123 Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa (UFP), Rua Carlos da Maia 296, 4200-150, Porto, Portugal
| | - B Nunes
- Departamento de Biologia, Universidade de Aveiro, Campus de Santiago, 3810-193 Aveiro, Portugal; Centro de Estudos do Ambiente e do Mar (CESAM), Universidade de Aveiro, Campus de Santiago, 3810-193 Aveiro, Portugal.
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Azevedo C, Teles T, Cunha R, Marques J, Semião M, Ferreira V, Sandra A, Agostinho E, Paulo M, Rui B. “Projeto Stop infeção” a way to prevent surgical site infection in colorectal surgery in Centro Hospitalar Cova da Beira – Portugal. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Duraes Campos I, Ferreira AS, Galvao Braga C, Costa J, Quina Rodrigues C, Oliveira C, Rodrigues C, Medeiros P, Vieira C, Marques J. P3183Does complying guidelines matter? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3183] [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)
| | - A S Ferreira
- University of Minho, School of Medicine, Braga, Portugal
| | | | - J Costa
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - C Oliveira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Rodrigues
- Hospital de Braga, Cardiology, Braga, Portugal
| | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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Quina-Rodrigues C, Gaspar A, Oliveira C, Campos I, Abreu G, Arantes C, Martins J, Braga CG, Vieira C, Salgado A, Azevedo P, Pereira MA, Marques J. P4615Pulse pressure: an independent predictor of in-hospital cardiovascular mortality in acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4615] [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)
| | - A Gaspar
- Hospital de Braga, Braga, Portugal
| | | | - I Campos
- Hospital de Braga, Braga, Portugal
| | - G Abreu
- Hospital de Braga, Braga, Portugal
| | | | | | | | - C Vieira
- Hospital de Braga, Braga, Portugal
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Marinho V, Marques J, Santos M, Alves P, Correia M, Capinha J, Matos V, Goncalves F, Pego P. P5545To heparin or not to heparin - That is the radial question. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5545] [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)
- V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Marques
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Santos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Correia
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Capinha
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - V Matos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - F Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Pego
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Silva J, Ramos M, Azevedo A, Salgado D, Costa I, Marques J. Primary central nervous system germ cell tumours: A single institution retrospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx366.034] [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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Gaspar A, Lourenco A, Pereira M, Azevedo P, Marques J, Leite-Moreira A. P5561Remote ischaemic conditioning in ST elevation myocardial infarction as adjuvant to primary angioplasty: preliminary results of a randomized clinical trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Quina-Rodrigues C, Gaspar A, Abreu G, Arantes C, Campos I, Martins J, Braga C, Vieira C, Salgado A, Azevedo P, Pereira M, Marques J. P5552Protective effect of obesity in acute myocardial infarction: evidence of the “obesity paradox”. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pereira V, Arantes C, Silva A, Marques P, Moreira P, Marques J. P4517The central autonomic nervous system response to stress is altered in patients with Takotsubo cardiomyopathy: a case-control study using fMRI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Agnello M, Marques J, Cen L, Mittermuller B, Huang A, Chaichanasakul Tran N, Shi W, He X, Schroth RJ. Microbiome Associated with Severe Caries in Canadian First Nations Children. J Dent Res 2017; 96:1378-1385. [PMID: 28709393 DOI: 10.1177/0022034517718819] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [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: 01/09/2023] Open
Abstract
Young Indigenous children in North America suffer from a higher degree of severe early childhood caries (S-ECC) than the general population, leading to speculation that the etiology and characteristics of the disease may be distinct in this population. To address this knowledge gap, we conducted the first microbiome analysis of an Indigenous population using modern molecular techniques. We investigated the caries-associated microbiome among Canadian First Nations children with S-ECC. Thirty First Nations children <72 mo of age with S-ECC and 20 caries-free children were recruited in Winnipeg, Canada. Parents or caregivers completed a questionnaire on general and dental health, diet, and demographics. The plaque microbiome was investigated by sequencing the 16S rRNA gene. Sequences were clustered into operational taxonomic units and taxonomy assigned via the Human Oral Microbiome Database, then analyzed at the community level with alpha and beta diversity measures. Compared with those who were caries free, children with S-ECC came from households with lower income; they were more likely to live in First Nations communities and were more likely to be bottle-fed; and they were weaned from the bottle at a later age. The microbial communities of the S-ECC and caries-free groups did not differ in terms of species richness or phylogenetic diversity. Beta diversity analysis showed that the samples significantly clustered into groups based on caries status. Twenty-eight species-level operational taxonomic units were significantly different between the groups, including Veillonella HOT 780 and Porphyromonas HOT 284, which were 4.6- and 9-fold higher, respectively, in the S-ECC group, and Streptococcus gordonii and Streptococcus sanguinis, which were 5- and 2-fold higher, respectively, in the caries-free group. Extremely high levels of Streptococcus mutans were detected in the S-ECC group. Overall, First Nations children with S-ECC have a significantly different plaque microbiome than their caries-free counterparts, with the S-ECC group containing higher levels of known cariogenic organisms.
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Affiliation(s)
- M Agnello
- 1 School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - J Marques
- 2 College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - L Cen
- 1 School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - B Mittermuller
- 2 College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,3 Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - A Huang
- 2 College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - W Shi
- 1 School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - X He
- 1 School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
| | - R J Schroth
- 2 College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,3 Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,4 Oral Health Program and Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, Canada
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Marinho M, Covelo V, Marques J, Bragança M. HIV/AIDS “worried well”–When the “virus” leads to a significant illness, even in its absence. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionManagement of HIV/AIDS “worried well” people is among the most complex and challenging psychiatric problems in HIV care.ObjectivesTo provide an overview of HIV/AIDS “worried well”.MethodsLiterature review based on PubMed/Medline, using the keywords “HIV” and “worried well”.ResultsThe HIV/AIDS “worried well” are those individuals who are intensely worried about being infected with HIV, despite overwhelming evidence to the contrary. Indeed, they will rapidly return with the renewed conviction that the physician has “got it wrong” or “missed something”. So, they tend to over-utilize health care services. Seven HIV/AIDS “worried well” sub-groups have been identified: those with past sex or drug use history; those with relationship problems; the partners/spouse of those at risk; couples in individual or family life transitions; past history of psychological problems; misunderstanding of health education material; and pseudo and factitious AIDS. These patients have several striking consistencies in their presenting phenomenology and background features and usually have psychiatric problems associated. The authors will analyze all these aspects. Currently there are no guidelines to deal with this clinical condition, however cognitive-behavioral therapy along with selective serotonin reuptake inhibitors has been an effective approach. It is also important to ensure follow-up discussion to these patients, especially where unresolved life issues may cause future vulnerability in absence of intervention.ConclusionsPatients may express their concerns about HIV infection by several ways, directly or indirectly, and psychiatrists need to be aware of this reality, which causes much suffering as well as severe monetary loss.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Marinho M, Mota-Oliveira M, Marques J, Bragança M. Psychosis Induced by Interferon-α–A Limitation of Treatment. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionPsychosis is an uncommon but serious complication of treatment with interferon-α, a cytokine frequently used to treat several infectious and malignant diseases.ObjectivesTo provide an overview of interferon-α-induced psychosis.MethodsLiterature review based on PubMed/MEDLINE, using the keywords “interferon-α” and “psychosis”.ResultsPsychotic symptoms usually emerge between 6 to 46 weeks and on average 3 months after the start of interferon-α treatment, occurring most frequently in the form of persecutory, guilt or grandeur delusions and auditory hallucinations. Often they are accompanied by mood symptoms, anxiety, attention disturbances and insomnia. Many factors are known to increase the risk of psychiatric effects as a whole associated with interferon-α. Pathogenesis of interferon-induced psychosis remains unclear, however several theories have been discussed, namely the overlap influence of biological vulnerability and the cytokine's action on the brain. Dopaminergic, opioid, serotoninergic and glutaminergic pathways as well as hypothalamic-pituitary-adrenal axis hypersensitivity are some of the hypotheses raised about the underlying cause of that susceptibility. Psychosis management usually includes stopping interferon-α and introducing antipsychotics with minimal antidopaminergic effects and at the lowest possible dose, due to the increased risk of extrapyramidal reactions in these patients.ConclusionThe decision to use interferon-based treatments in psychiatric patients should be highly individualized. Early recognition and adequate treatment of interferon-induced psychosis might prevent subsequent emergence of serious debilitating symptoms. Thus, it is very important that medical and psychiatric treatment teams work closely together and are familiar with this important subject.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Marinho M, Marques J, Bragança M. Postictal psychosis – A complex challenge. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionPatients with epilepsy have 6–12 times higher risk of suffering from psychosis, with a prevalence of about 7–8%, and the coexistence of these two conditions is associated with increased morbidity and mortality. The psychosis of epilepsy is generally split into two groups: interictal psychoses and postictal psychosis (PIP), and the latter has been estimated to represent 25% of all types. However, many of these episodes remain under-recognized and/or are often misdiagnosed.ObjectivesTo provide an overview of PIP.MethodsLiterature review based on PubMed/Medline, using the keywords “epilepsy” and “psychosis”.ResultsPIP has been recognized since the 19th century, when Esquirol described postictal “fury”. Although its etiology and pathogenesis remain poorly understood, several risk factors and etiopathogenic mechanisms have been suggested and analysed. An essential step in PIP management is its accurate and early diagnosis. Generally, before the onset of PIP there is a lucid period of one to six days after the seizure(s). PIP frequently has a polymorphic presentation, tends to be affect-laden and symptoms often fluctuate. It is of limited duration and frequently responds very rapidly to low doses of benzodiazepines and antipsychotics. However, the propensity of the antipsychotics to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptics are important considerations. Recurrence rates range 25% to 50%.ConclusionsGiven the negative impact of PIP in morbidity and mortality among these patients, it is crucial that neurologists and psychiatrists are able to adequately recognize and treat this clinical condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Marinho M, Marques J, Bragança M. Depression Among Cancer Patients–A Reality Where Therapeutic Nihilism Cannot be Accepted. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IntroductionCancer is a life-threatening disease, characterized by a great deal of uncertainty and unpredictability. Thus, several stressors and emotional upheavals pervade the everyday life of cancer patients and can lead to the development of depression.ObjectivesTo review the recent research related to depression in cancer patients.MethodsLiterature review based on PubMed/MEDLINE, using the keywords “cancer” and “depression”.ResultsIt is estimated that 20–25% of cancer patients meet the criteria for major depressive syndrome at some point in their illness. Depression is associated with a negative impact on treatment adhesion, cancer progression and quality of life, besides increasing suicide risk. However, it is often unrecognized and untreated. Importantly, the mistaken belief that depressive symptoms are expected in this group, the overlap between the neurovegetative symptoms of depression, the somatic symptoms of cancer and its treatment, as well as the effects of comorbid diseases make the diagnosis of major depression so complex in these patients. Some of the most helpful diagnostic indicators are feelings of hopelessness, worthlessness, excessive guilt, loss of self-esteem, and wishes to die. The several risk factors for the development of depression in cancer patients can be divided into four broad categories, namely cancer-related factors, cancer treatment-related factors, psychiatric history, and social factors. Effective management of depression consists in a combination of psychotherapy and psychopharmacology.ConclusionDepression in cancer patients has serious consequences, however appropriate psychiatric intervention can do it over. Thus, its early recognition and appropriate management is imperative.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Marinho M, Novais C, Marques J, Bragança M. Efavirenz and Neuropsychiatric Effects–When the Treatment Complicates Matter Further. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionEfavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in the treatment of HIV infection. Although highly effective, efavirenz is associated with causing neuropsychiatric side effects in approximately 50% of patients.ObjectivesTo provide an overview of efavirenz-induced neuropsychiatric effects.MethodsLiterature review based on PubMed/Medline.ResultsThe neuropsychiatric side effects of efavirenz usually begin quickly, commonly peak in the first two weeks after the start of therapy, and can include depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, paranoia, psychosis. Generally, these events are mild to moderate in severity and time limited, however, in a small number of cases, are late, persistent or intolerable. They are often associated with a negative impact on treatment adhesion. Some factors are known to increase the risk of neuropsychiatric effects in HIV-positive patients. The behavioral effects of efavirenz appear to be dose-dependent and mediated predominately by the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD). Importantly, the efavirenz-induced neuropsychiatric effects may be difficult to distinguish from HIV-related neuropsychiatric symptoms, preexisting mental disorder or substance use. The neuropsychiatric effects should be treated with non-pharmacologic or pharmacologic interventions, according to severity. The psychiatric status of patients should be closely monitored for at least the first 6 to 12 months of treatment.ConclusionTaking into account the high rates of neuropsychiatric side effects, it is crucial that the physicians are familiar with this important subject, and the decision to initiate efavirenz in psychiatric patients is individualized.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Herranz-Aparicio J, Marques J, Almendros-Marqués N, Gay-Escoda C. Retrospective study of the bone morphology in the posterior mandibular region. Evaluation of the prevalence and the degree of lingual concavity and their possible complications. Med Oral Patol Oral Cir Bucal 2016; 21:e731-e736. [PMID: 27694785 PMCID: PMC5116115 DOI: 10.4317/medoral.21256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In order to choose the appropriate implant size and to prevent complications, an oral surgeon must know the size and shape of the mandible. In the posterior mandibular region, a lingual undercut is often found and could represent a difficulty hard to manage if a lingual or buccal perforation occur. A large series of computed tomography (CT) images of the mandibular first molar was evaluated and the bone morphology, the prevalence and the degree of the lingual concavity in the first molar region were studied. MATERIAL AND METHODS One hundred and fifty-one computed tomography (CT) examinations of patients were retrospectively evaluated to determine anatomical variations in bone morphology in the submandibular fossa region. RESULTS A total of 151 subjects were included, consisting of 64 males (M) (42.4%) and 87 females (F) (57.6%). The under-cut type ridge was present in 64.2% of the cases. The concavity angle was 66.6 ± 8.9° (M) and 71.6 ± 8.4° (F) and the linear concavity depth 4.5 ± 2.3 mm (M) and 3.1 ± 1.7 mm (F) (p>0.05). CONCLUSIONS Mandibles with any lingual concavity present a potential increased risk of lingual cortical perforation during implant placement surgery. CT imaging allows characterizing the anatomy of the submandibular fossa and provides other important information for the preoperative assessment of the posterior mandible for dental implants placement.
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Martins AMDV, Almeida G, Marques J, Castro MDL, Cadilha S. Abstract PR388. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492778.77010.98] [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: 11/05/2022]
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Palomo-Piñon S, Paniagua_Sierra J, Limon F, Mejia O, Alvarez C, Perez C, Chapa L, Zavala J, Cortes L, Lopez J, Jimenez G, Blanco W, Delgado J, Martinez M, Marques J. PM040 Addressing High Blood Pressure Control in Primary Care Office in Mexico. First Report of the IMSS HBP Collaborative Group. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.267] [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] Open
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Marinho M, Amaral A, Pereira E, Marques J, Bragança M. Anxiety Among Hiv-Infected Patients – When Anxiety Is A Disorder and not Simply A Natural Reaction to a Life-Threatening IIIness. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionHIV infection is a chronic disease characterized by a great deal of uncertainty and unpredictability, being anxiety disorders a frequent psychiatric problem.ObjectiveTo provide an overview of anxiety in HIV-infected patients.MethodsLiterature review based on PubMed/Medline, using the keywords “HIV” and “anxiety disorders”.ResultsHIV-infected individuals can experience symptoms of anxiety across the spectrum of anxiety disorders. Adjustment disorder with anxious mood is the most common diagnosis, followed by generalized anxiety disorder and panic disorder. Some patients present with these disorders prior to notification, others develop them during the course of their illness, mainly at key moments. In HIV-infected patients, anxiety can be a manifestation of side effects of medication; a symptom of an illness associated with HIV disease; or, most commonly, the psychological response to the stressors of the illness. In fact, many issues are responsible for the anxiety experienced by people living with HIV. The authors will analyze them. Besides the distress of anxiety disorders, these lead to a decrease in adherence to antiretroviral treatments, resulting in adverse progression of HIV disease and increased risk of mortality. Importantly, however, appropriate psychiatric intervention can do it over.ConclusionsCareful diagnosis and treatment of anxiety disorders in the context of HIV disease is even important, given the serious effects if untreated. Thus, anxiety should never be seen simply as a natural reaction to a life-threatening illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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