1
|
Teixeira A, Sousa-Silva M, Chícharo A, Oliveira K, Moura A, Carneiro A, Piairo P, Águas H, Sampaio-Marques B, Castro I, Mariz J, Ludovico P, Abalde-Cela S, Diéguez L. Isolation of acute myeloid leukemia blasts from blood using a microfluidic device. Analyst 2024; 149:2812-2825. [PMID: 38644740 DOI: 10.1039/d4an00158c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Acute myeloid leukemia (AML) is the most common form of acute leukemia in adults and associated with poor prognosis. Unfortunately, most of the patients that achieve clinical complete remission after the treatment will ultimately relapse due to the persistence of minimal residual disease (MRD), that is not measurable using conventional technologies in the clinic. Microfluidics is a potential tool to improve the diagnosis by providing early detection of MRD. Herein, different designs of microfluidic devices were developed to promote lateral and vertical mixing of cells in microchannels to increase the contact area of the cells of interest with the inner surface of the device. Possible interactions between the cells and the surface were studied using fluid simulations. For the isolation of leukemic blasts, a positive selection strategy was used, targeting the cells of interest using a panel of specific biomarkers expressed in immature and aberrant blasts. Finally, once the optimisation was complete, the best conditions were used to process patient samples for downstream analysis and benchmarking, including phenotypic and genetic characterisation. The potential of these microfluidic devices to isolate and detect AML blasts may be exploited for the monitoring of AML patients at different stages of the disease.
Collapse
Affiliation(s)
- Alexandra Teixeira
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Campus Gualtar, 4710-057 Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maria Sousa-Silva
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
- RUBYnanomed LDA, Praça Conde de Agrolongo, 4700-312 Braga, Portugal
| | - Alexandre Chícharo
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
| | - Kevin Oliveira
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
| | - André Moura
- CENIMAT|i3N, Department of Materials Science, NOVA School of Science and Technology, Campus de Caparica, NOVA University of Lisbon and CEMOP/UNINOVA, 2829-516 Caparica, Portugal
| | - Adriana Carneiro
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
- IPO Experimental Pathology and Therapeutics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Paulina Piairo
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
| | - Hugo Águas
- CENIMAT|i3N, Department of Materials Science, NOVA School of Science and Technology, Campus de Caparica, NOVA University of Lisbon and CEMOP/UNINOVA, 2829-516 Caparica, Portugal
| | - Belém Sampaio-Marques
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Campus Gualtar, 4710-057 Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Isabel Castro
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Campus Gualtar, 4710-057 Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Mariz
- Department of Oncohematology, Portuguese Institute of Oncology Francisco Gentil Porto, Portugal
| | - Paula Ludovico
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Campus Gualtar, 4710-057 Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sara Abalde-Cela
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
| | - Lorena Diéguez
- International Iberian Nanotechnology Laboratory (INL), Avda. Mestre José Veiga, 4715-310 Braga, Portugal.
| |
Collapse
|
2
|
Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
Collapse
Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
| |
Collapse
|
3
|
Romano M, Mariz J. Point of care ultrasound in internal medicine in Portugal - where we are and where we should go? Eur J Intern Med 2023; 111:138-139. [PMID: 36725400 DOI: 10.1016/j.ejim.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Miguel Romano
- Unidade Local de Saúde do Alto Minho, Internal Medicine, Viana Do Castelo, Portugal; School of Medicine of University of Minho, Braga, Portugal.
| | - José Mariz
- School of Medicine of University of Minho, Braga, Portugal; Hospital de Braga, Emergency Department, Braga, Portugal
| |
Collapse
|
4
|
Santos E Silva A, Sequeira M, Santos MI, Silva L, Mariz J. Diagnostic Point-of-Care Ultrasound (POCUS) for Abdominal Pain: A Case of Tumefactive Sludge. Cureus 2023; 15:e34506. [PMID: 36874328 PMCID: PMC9984119 DOI: 10.7759/cureus.34506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Biliary sludge is an extremely viscous sediment, consisting essentially of calcium bilirubinate granules and cholesterol crystals, which, due to its high viscosity, has poor and slow movement, leading to a mass-like configuration called tumefactive biliary sludge. Tumefactive sludge was first described with the advent of ultrasonography in the 1970s and is an uncommon intraluminal lesion of the gallbladder (GB). The differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. Ultrasonography is the election method for the screening of GB diseases, with diagnostic accuracy exceeding 90%. The point-of-care ultrasound (POCUS) has shown a major improvement in the evaluation of hepatobiliary diseases. POCUS allows the detection of GB wall thickness, pericholestatic fluid, sonographic Murphy's sign, and dilatation of the common bile duct. The authors present a case of abdominal pain caused by the presence of tumefactive sludge in the GB, in which POCUS helped establish the diagnosis and therapeutic guidance.
Collapse
Affiliation(s)
- Ana Santos E Silva
- Internal Medicine, Unidade Local de Saúde do Litoral Alentejano, Santiago do Cacém, PRT
| | - Mafalda Sequeira
- Serviço de Medicina Interna, Hospital Garcia de Orta, Almada, PRT
| | | | - Luciana Silva
- Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, PRT
| | - José Mariz
- Emergency, Hospital de Braga, Braga, PRT
| |
Collapse
|
5
|
Caroselli C, Blaivas M, Marcosignori M, Tung Chen Y, Falzetti S, Mariz J, Fiorentino R, Pinto Silva R, Gomes Cochicho J, Sebastiani S, Carlini M, Polati E, Simonini V, Malagola S, Raffaldi I, Longo D. Early Lung Ultrasound Findings in Patients With COVID-19 Pneumonia: A Retrospective Multicenter Study of 479 Patients. J Ultrasound Med 2022; 41:2547-2556. [PMID: 35040507 PMCID: PMC9015547 DOI: 10.1002/jum.15944] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/16/2021] [Revised: 12/10/2021] [Accepted: 12/23/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) holds the promise of an accurate, radiation-free, and affordable diagnostic and monitoring tool in coronavirus disease 2019 (COVID-19) pneumonia. We sought to evaluate the usefulness of LUS in the diagnosis of patients with respiratory distress and suspicion of interstitial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, in comparison to other imaging modalities. METHODS This was a multicenter, retrospective study. LUS was performed, on Emergency Department (ED) arrival of patients presenting for possible COVID-19 evaluation, by trained emergency physicians, before undergoing conventional radiologic examination or while waiting for the report. Scans were performed using longitudinal transducer orientation of the lung regions. CXR was interpreted by radiologists staffing ED radiology. Subjects were divided into two group based on molecular test results. LUS findings were compared to COVID test results, nonlaboratory data, and other imaging for each patient. Categorical variables were expressed as percentages and continuous variables as median ± standard error. RESULTS A total of 479 patients were enrolled, 87% diagnosed with SARS-CoV-2 by molecular testing. COVID positive and COVID negative patients differed with respect to sex, presence of fever, and white blood cells count. Most common findings on lung point of care ultrasound (POCUS) for COVID-positive patients were B-lines, irregular pleural lines, and small consolidation. Normal chest X-ray was found in 17.89% of cases. CONCLUSIONS This 479 patient cohort, with COVID-19, found LUS to be noninferior to chest X-ray (CXR) for diagnostic accuracy. In this study, COVID-positive patients are most likely to show B lines and sub-pleural consolidations on LUS examination.
Collapse
Affiliation(s)
- Costantino Caroselli
- Acute Geriatric UnitGeriatric Emergency Room and Aging Research Centre INRCA‐IRCCSAnconaItaly
| | - Michael Blaivas
- Department of MedicineUniversity of South Carolina School of MedicineColumbiaSouth CarolinaUSA
| | - Matteo Marcosignori
- Emergency DepartmentAzienda Ospedaliero Universitaria, Ospedali RiunitiAnconaItaly
| | - Yale Tung Chen
- Internal Medicine DepartmentHospital Universitario Puerta de Hierro, MajadahondaMadridSpain
| | - Sara Falzetti
- Geriatric DepartmentSchool of Specialization in Geriatrics, University of Ancona, School of Medicine and SurgeryAnconaItaly
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS)School of Medicine, University of MinhoBragaPortugal
- ICVS/3B’s—PT Government Associate LaboratoryBragaPortugal
- Emergency DepartmentHospital de BragaBragaPortugal
- Clinic Academic Center—2CABragaPortugal
| | | | | | - Joana Gomes Cochicho
- Department of Internal MedicineHospital Doutor José Maria GrandePortalegrePortugal
| | - Simone Sebastiani
- Transplant Surgery UnitAzienda Ospedaliero Universitaria di VeronaVeronaItaly
| | - Mauro Carlini
- Anesthesia and Intensive Care DepartmentMagalini Hospital‐ULSS 9 ScaligeraVillafranca di VeronaItaly
| | - Enrico Polati
- Emergency and Intensive Care DepartmentAzienda Ospedaliero Universitaria di VeronaVeronaItaly
| | | | | | - Irene Raffaldi
- Emergency DepartmentRegina Margherita Children HospitalTurinItaly
| | - Daniele Longo
- Medical DepartmentAPSSTrentoItaly
- Department of Diagnostics and Public HealthSchool of Medicine and Surgery, Università di VeronaVeronaItaly
| |
Collapse
|
6
|
Soares PR, Maia A, Fernandes JR, Faustino D, Campos AL, Almeida LR, Mariz J. Point-of-Care Ultrasound Protocol for Insertion and Confirmation of Central Venous Catheter Placement. Cureus 2022; 14:e29259. [PMID: 36277575 PMCID: PMC9578662 DOI: 10.7759/cureus.29259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
|
7
|
Martínez-Cuadrón D, Serrano J, Mariz J, Gil C, Tormo M, Martínez-Sánchez P, Rodríguez-Arbolí E, García-Boyero R, Rodríguez-Medina C, Martínez-Chamorro C, Polo M, Bergua J, Aguiar E, Amigo ML, Herrera P, Alonso-Domínguez JM, Bernal T, Espadana A, Sayas MJ, Algarra L, Vidriales MB, Vasconcelos G, Vives S, Pérez-Encinas MM, López A, Noriega V, García-Fortes M, Chillón MC, Rodríguez-Gutiérrez JI, Calasanz MJ, Labrador J, López JA, Boluda B, Rodríguez-Veiga R, Martínez-López J, Barragán E, Sanz MA, Montesinos P. Characteristics and Outcomes of Adult Patients in the PETHEMA Registry with Relapsed or Refractory FLT3-ITD Mutation-Positive Acute Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14112817. [PMID: 35681796 PMCID: PMC9179309 DOI: 10.3390/cancers14112817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
This retrospective study investigated outcomes of 404 patients with relapsed/refractory (R/R) FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) acute myeloid leukemia (AML) enrolled in the PETHEMA registry, pre-approval of tyrosine kinase inhibitors. Most patients (63%) had received first-line intensive therapy with 3 + 7. Subsequently, patients received salvage with intensive therapy (n = 261), non-intensive therapy (n = 63) or supportive care only (n = 80). Active salvage therapy (i.e., intensive or non-intensive therapy) resulted in a complete remission (CR) or CR without hematological recovery (CRi) rate of 42%. More patients achieved a CR/CRi with intensive (48%) compared with non-intensive (19%) salvage therapy (p < 0.001). In the overall population, median overall survival (OS) was 5.5 months; 1- and 5-year OS rates were 25% and 7%. OS was significantly (p < 0.001) prolonged with intensive or non-intensive salvage therapy compared with supportive therapy, and in those achieving CR/CRi versus no responders. Of 280 evaluable patients, 61 (22%) had an allogeneic stem-cell transplant after they had achieved CR/CRi. In conclusion, in this large cohort study, salvage treatment approaches for patients with FLT3-ITD mutated R/R AML were heterogeneous. Median OS was poor with both non-intensive and intensive salvage therapy, with best long-term outcomes obtained in patients who achieved CR/CRi and subsequently underwent allogeneic stem-cell transplant.
Collapse
Affiliation(s)
- David Martínez-Cuadrón
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
- Correspondence: ; Tel.: +34-96-1244925
| | - Josefina Serrano
- Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica Córdoba (IMIBIC), 14004 Córdoba, Spain;
| | - José Mariz
- IPO (Istituto Portugues Oncologia), 4200-072 Porto, Portugal;
| | - Cristina Gil
- Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Mar Tormo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Pilar Martínez-Sánchez
- Hospital Universitario 12 de Octubre, Complutense University, i+12, CNIO, 28041 Madrid, Spain; (P.M.-S.); (J.M.-L.)
| | | | | | | | | | - Marta Polo
- Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Juan Bergua
- Hospital San Pedro Alcántara, 10003 Cáceres, Spain;
| | | | - María L. Amigo
- Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain;
| | - Pilar Herrera
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | | | - Teresa Bernal
- Hospital Universitario Central de Asturias, 33011 Asturias, Spain;
| | - Ana Espadana
- Hospital de Coimbra, 3400-091 Coimbra, Portugal;
| | - María J. Sayas
- Hospital Universitario Doctor Peset, 46017 Valencia, Spain;
| | - Lorenzo Algarra
- Hospital General Universitario de Albacete, 02006 Albacete, Spain;
| | - María B. Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.B.V.); (M.C.C.)
| | | | - Susana Vives
- ICO-Hospital Germans Trias i Pujol, Badalona, José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | | | | | - Víctor Noriega
- Complejo Hospitalario Universitario A Coruña, 15006 La Coruna, Spain;
| | | | - María C. Chillón
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.B.V.); (M.C.C.)
| | | | | | | | - Juan A. López
- Complejo Hospitalario Ciudad de Jaén, 23007 Jaén, Spain;
| | - Blanca Boluda
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Rebeca Rodríguez-Veiga
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Complutense University, i+12, CNIO, 28041 Madrid, Spain; (P.M.-S.); (J.M.-L.)
| | - Eva Barragán
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Miguel A. Sanz
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (B.B.); (R.R.-V.); (E.B.); (M.A.S.); (P.M.)
| | | |
Collapse
|
8
|
Kwak LW, Sancho JM, Cho SG, Nakazawa H, Suzumiya J, Tumyan G, Kim JS, Menne T, Mariz J, Ilyin N, Jurczak W, Lopez Martinez A, Samoilova O, Zhavrid E, Yañez Ruiz E, Trneny M, Popplewell L, Ogura M, Kim WS, Lee SJ, Kim SH, Ahn KY, Buske C. Efficacy and Safety of CT-P10 Versus Rituximab in Untreated Low-Tumor-Burden Follicular Lymphoma: Final Results of a Randomized Phase III Study. Clin Lymphoma Myeloma Leuk 2021; 22:89-97. [PMID: 34686445 DOI: 10.1016/j.clml.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This double-blind, parallel-group, active-controlled phase III trial (NCT02260804) assessed CT-P10 and rituximab safety and efficacy in patients with previously untreated low-tumor-burden follicular lymphoma (LTBFL), including after a single switch from rituximab to CT-P10. PATIENTS AND METHODS LTBFL patients were randomized (1:1) to receive CT-P10 or rituximab (375 mg/m2 intravenously; day 1 of 4 7-day cycles). Patients achieving disease control entered a 2-year maintenance period. CT-P10 or rituximab were administered every 8 weeks (6 cycles) in year 1; all patients could receive CT-P10 (every 8 weeks; 6 cycles) in year 2. Secondary endpoints (reported here) were overall response rate (ORR) during the study period, progression-free survival (PFS), time to progression (TTP), and overall survival (OS). Safety and immunogenicity were evaluated. RESULTS Between November 9, 2015 and January 4, 2018, 258 patients were randomized (130 for CT-P10; 128 for rituximab). ORR was similar between groups over the study period (CT-P10: 88%; rituximab: 87%). After 29.2 months' median follow-up, median PFS, TTP, and OS were not estimable; 24-month Kaplan-Meier estimates suggested similarity between groups. Overall, 114 (CT-P10: 88%), and 104 (rituximab: 81%) patients experienced treatment-emergent adverse events. The single switch was well tolerated. CONCLUSION These updated data support therapeutic similarity of CT-P10 and rituximab and support the use of CT-P10 monotherapy for previously untreated LTBFL.
Collapse
Affiliation(s)
| | - Juan-Manuel Sancho
- Hematology Department, The Catalan Institute of Oncology-The Josep Carreras Leukemia Research Institute, Hospital Germans Trias i Pujol, Carretera Canyet, Badalona, 08916, Spain
| | - Seok-Goo Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Hideyuki Nakazawa
- Department of Hematology, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Junji Suzumiya
- Shimane University Hospital, Innovative Cancer Center/Oncology-Hematology, Izumo, Shimane 693-8501, Japan
| | - Gayane Tumyan
- Division of Hematology and Bone Marrow Transplantation, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Science, Moscow, 115478, Russia
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, 03722, South Korea
| | - Tobias Menne
- Northern Institute for Cancer Care, Newcastle University, NE7 7DN, UK
| | - José Mariz
- Department of Onco-Hematology, Portuguese Institute of Oncology, Rua Dr Antonio Bernardino de Almeida, Porto, 4200-072, Portugal
| | - Nikolai Ilyin
- Russian Research Center for Radiology and Surgical Technologies, Ministry of Health of the Russian Federation, p. Pesochny, 197758, Russia
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, 331-115 Kraków, Poland
| | - Aurelio Lopez Martinez
- Department of Hematology, Hospital Arnau de Vilanova, Valencia, Comunidad Valenciana, 46015, Spain
| | - Olga Samoilova
- Department of Hematology, Nizhniy Novgorod Region Clinical Hospital, Nizhniy Novgorod, 603126, Russia
| | - Edvard Zhavrid
- N. N. Alexandrov Republican Scientific and Practical Centre of Oncology and Medical Radiology, Lesnoy, Minsk, 223040, Belarus
| | - Eduardo Yañez Ruiz
- Department of Internal Medicine, Oncology-Hematology Unit, School of Medicine, Universidad de la Frontera, Temuco, 4780000, Chile
| | - Marek Trneny
- Department of Medicine, Charles University, 128 08, Czech Republic
| | - Leslie Popplewell
- Toni Stephenson Lymphoma Cancer Center and Department of Hematology and Hematopoietic Cell Transplantation, Duarte, CA 91010
| | - Michinori Ogura
- Department of Hematology and Oncology, Kasugai Municipal Hospital, Aichi 486-8510, Japan
| | - Won-Seog Kim
- Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, South Korea
| | | | | | | | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, 89081 Ulm, Germany.
| |
Collapse
|
9
|
Ribeiro T, Marques A, Ferreira G, Castro C, Tavares M, Espírito-Santo A, Moreira C, Mariz J. Semiquantitative analysis of interim 18F-FDG PET is superior in predicting outcome in Hodgkin lymphoma patients compared to visual analysis. Rev Esp Med Nucl Imagen Mol 2021; 40:281-286. [PMID: 34425968 DOI: 10.1016/j.remnie.2020.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the prognostic value of interim PET (PETi) in adult HL patients, comparing visual with semiquantitative analysis. MATERIAL AND METHODS Retrospective analysis of Hodgkin's lymphoma (HL) patients diagnosed between 2012 and 2016 in the Onco-hematology Department of Instituto Português de Oncologia - Porto (median follow-up: 46.5 months [2.6-66.4]). Fifty-eight patients with available PET at diagnosis (PET0) and PETi data were included. PETi scans were analyzed according to Deauville 5-point scale (5-PS), and cut-off values for changes in maximum standardized uptake value [SUVmax], peak SUV [SUVpeak], metabolic tumour volume [MTV] and total lesion glycolysis index [TLG] between PETi and PET0 were computed using ROC analysis. Visual and semiquantitative data were compared with each other in the prediction of patient outcomes. RESULTS Semiquantitative analysis obtained a higher sensitivity for persistent/relapsed disease compared to the 5-PS (70% vs. 10%, respectively), but lower specificity. It also demonstrated better predictive performance for response to first-line therapy (negative predictive value >92%). The positive predictive value was similar for all five measurements. At 60 months of follow-up, there was a significant difference between the progression free survival (PFS) curves of patients with positive and negative PETi according to ΔSUVmax (56.9% vs. 88.0%, p<0.05), ΔSUVpeak (55.9% vs. 88.1%, p<0.05), ΔMTV (35.3% vs. 88.7%, p<0.05), and ΔTLG (42.4% vs. 88.1%, p<0.05). Statistical significance was not reached when considering 5-PS results. DISCUSSION PETi interpretation according to a semiquantitative approach appears to discriminate HL patients better than the visual 5-PS analysis. This could allow better detection of persistent or early relapsed disease, while a negative PETi result could support de-escalating therapy intensity.
Collapse
Affiliation(s)
- T Ribeiro
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - A Marques
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - G Ferreira
- Nuclear Medicine Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - C Castro
- Epidemiology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - M Tavares
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - A Espírito-Santo
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - C Moreira
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - J Mariz
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| |
Collapse
|
10
|
Rodríguez-Arbolí E, Martínez-Cuadrón D, Rodríguez-Veiga R, Carrillo-Cruz E, Gil-Cortés C, Serrano-López J, Bernal Del Castillo T, Martínez-Sánchez MDP, Rodríguez-Medina C, Vidriales B, Bergua JM, Benavente C, García-Boyero R, Herrera-Puente P, Algarra L, Sayas-Lloris MJ, Fernández R, Labrador J, Lavilla-Rubira E, Barrios-García M, Tormo M, Serrano-Maestro A, Sossa-Melo CL, García-Belmonte D, Vives S, Rodríguez-Gutiérrez JI, Albo-López C, Garrastazul-Sánchez MP, Colorado-Araujo M, Mariz J, Sanz MÁ, Pérez-Simón JA, Montesinos P. Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study. Transplant Cell Ther 2021; 27:311.e1-311.e10. [PMID: 33836871 DOI: 10.1016/j.jtct.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.
Collapse
Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | | | | | - Estrella Carrillo-Cruz
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Cristina Gil-Cortés
- Department of Hematology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Josefina Serrano-López
- Department of Hematology, Reina Sofía University Hospital/Maimónides Biomedical Research Institute of Córdoba (IMIBIC)/University of Córdoba, Córdoba, Spain
| | | | | | - Carlos Rodríguez-Medina
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Belén Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC- CB16/12/00233 and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Juan Miguel Bergua
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Celina Benavente
- Department of Hematology, Hospital Clínico San Carlos, Madrid, Spain
| | - Raimundo García-Boyero
- Department of Hematology, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Lorenzo Algarra
- Department of Hematology, Hospital General de Albacete, Albacete, Spain
| | | | - Rosa Fernández
- Department of Hematology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jorge Labrador
- Department of Hematology and Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Mar Tormo
- Deparment of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | | | | | | | - Susana Vives
- Department of Hematology - ICO Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Badalona , Spain
| | | | - Carmen Albo-López
- Department of Hematology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - José Mariz
- Department of Hematology, Instituto Português de Oncologia do Porto FG, Porto, Portugal
| | - Miguel Ángel Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain.
| | - Pau Montesinos
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | | |
Collapse
|
11
|
Couto ME, Oliveira I, Domingues N, Viterbo L, Martins Â, Moreira I, Espírito-Santo A, Chacim S, Moreira C, Pereira D, Henrique R, Mariz J. Gastric Diffuse Large B-Cell Lymphoma: A Single-Center 9-Year Experience. Indian J Hematol Blood Transfus 2021; 37:492-496. [PMID: 33424149 PMCID: PMC7778395 DOI: 10.1007/s12288-020-01391-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022] Open
Abstract
Gastric diffuse large B cell lymphoma (DLBCL) represents the majority of all gastric lymphomas. We report a series of gastric DLBCL diagnosed and treated in a single center, between 2010 and 2018 (included). We retrospectively analyzed the population demographic features, treatment outcomes and survival. One-hundred-and-one patients were studied, 50.5% males and median age of 64 years [23–94]. Lugano staging was I in 16.8%, II1 in 20.8%, II2 in 10.9%, IIE in 13.9% and IV in 34.7% of cases. Twenty percent had Helicobacter pylori infection. R-CHOP-like therapy was used as first line in 96.9% of the patients. A complete response was achieved in 80% after first line therapy. At 3-years of follow-up (FU), 54% were in complete remission. The mean FU time was 73.6 months. Median overall survival and median progression free survival were not reached. We identified seven factors with negative impact in survival: age above 65 years-old (p < 0.01), ECOG 2–3 (p < 0.01), B symptoms (p = 0.001), bulky disease (p = 0.003), IPI 3–4 (p = 0.001), more than 3 treatment lines (p < 0.01), absence of response to first line treatment (p < 0.01). This study demonstrates that gastric DLBCL is a potentially curable disease with R-CHOP-like therapy, entailing long term survival and comparing well with other published series.
Collapse
Affiliation(s)
- Maria Eduarda Couto
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Isabel Oliveira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Nelson Domingues
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Luísa Viterbo
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ângelo Martins
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ilídia Moreira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ana Espírito-Santo
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Sérgio Chacim
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Cláudia Moreira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Dulcineia Pereira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - José Mariz
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| |
Collapse
|
12
|
Portugal-Nunes C, Castanho TC, Amorim L, Moreira PS, Mariz J, Marques F, Sousa N, Santos NC, Palha JA. Iron Status is Associated with Mood, Cognition, and Functional Ability in Older Adults: A Cross-Sectional Study. Nutrients 2020; 12:E3594. [PMID: 33238615 PMCID: PMC7700455 DOI: 10.3390/nu12113594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023] Open
Abstract
Several conditions are risk factors for iron deficiency (ID), some of which are highly prevalent in older individuals. Despite the amount of evidence pointing for a role of ID in cognition, mood and physical functional ability, the research addressing these associations in older individuals is still scarce. In the present study, 162 older community-dwelling individuals (29.53% classified as ID) were enrolled in a cross-sectional analysis and characterized regarding cognition, mood, functional ability, general nutritional intake and iron status. Assessment of iron status was performed using several blood biomarkers. Storage and erythropoiesis dimensions were positively associated with memory, along with an interaction (moderator effect) between iron storage and nutritional status. A more depressed mood was negatively associated with (iron) transport, transport saturation and erythropoiesis dimensions, and functional tiredness was positively associated with the erythropoiesis dimension. These observations indicate that lower iron status is associated with depressive mood, functional tiredness and poorer memory ability, with the latter moderated by nutritional status. These findings suggest that using iron as a continuous variable may be useful in finding associations with iron homeostasis, eventually missed when iron levels are considered within the usual classification groups.
Collapse
Affiliation(s)
- Carlos Portugal-Nunes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Liliana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Associação Centro de Medicina P5 (ACMP5), 4710-057 Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
- Emergency Department, Intermediate Care Unit (EDIMCU), Hospital de Braga, 4710-243 Braga, Portugal
| | - Fernanda Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Associação Centro de Medicina P5 (ACMP5), 4710-057 Braga, Portugal
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| |
Collapse
|
13
|
Cunha Pereira T, Rb-Silva R, Félix Soares R, Domingues N, Mariz J. Case Report: Cryptococcal meningitis in Hodgkin's Lymphoma patient receiving brentuximab-vedotin therapy. F1000Res 2020; 9:687. [PMID: 33024550 PMCID: PMC7512028 DOI: 10.12688/f1000research.24816.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
Cryptococcus neoformans infections occur mostly in immunodeficient individuals, being the most common opportunistic fungal central nervous system (CNS) infection in HIV seropositive patients. Moreover, other conditions affecting host immunity, such as hematologic malignancies, organ transplantation and immunosuppressive drugs are implicated as risk factors. The authors present a case of a 48-year-old male with Hodgkin Lymphoma for 26 years and submitted to several lines of treatment, diagnosed with cryptococcal meningitis while on therapy with brentuximab. The patient presented with positive cerebral spinal fluid (CSF) cryptococcal antigen plus positive blood cultures. He was put under induction antifungal treatment with liposomal amphotericin B and flucytosine, as well as corticosteroid therapy with dexamethasone with headache improvement and a favorable clinical evolution. There are no reported cases of cryptococcal meningoencephalitis under CD30-directed monoclonal antibody. Furthermore, this case illustrates the risk of
Cryptococcus neoformans infection in immunocompromising conditions other than HIV, underlining the need of considering this differential diagnosis when physicians face an opportunistic neuroinfection.
Collapse
Affiliation(s)
- Tatiana Cunha Pereira
- Medical Oncology Department, Instituto Português Oncologia de Coimbra Francisco Gentil E. P. E., Coimbra, Portugal
| | - Rita Rb-Silva
- Onco-Hematology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Rita Félix Soares
- Medical Oncology Department, Instituto Português Oncologia de Coimbra Francisco Gentil E. P. E., Coimbra, Portugal
| | - Nelson Domingues
- Onco-Hematology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - José Mariz
- Onco-Hematology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| |
Collapse
|
14
|
Silva R, Gonçalves D, Cabral JP, Gomes B, Teixeira J, Mariz J. Triple POCUS: A New Approach to an Old Problem. Eur J Case Rep Intern Med 2019; 5:000938. [PMID: 30756067 PMCID: PMC6346822 DOI: 10.12890/2018_000938] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/23/2022] Open
Abstract
Pulmonary embolism (PE) is the most serious and life-threatening clinical presentation of venous thromboembolism, and difficult to diagnose. Triple point-of-care-ultrasonography (POCUS) of the lung, heart and leg veins is a multiorgan approach that may help to evaluate patients suspected of having PE, in combination with existing protocols and computed tomographic pulmonary angiography (CTPA). We present the case of a 26-year-old man with sudden onset of dyspnoea and swelling of the leg with a Well's score of 9. With CTPA unavailable at the time of presentation, triple POCUS showed subpleural consolidations and a venous thrombus in a popliteal vein. A diagnosis of deep vein thrombosis with PE was made and the appropriate treatment was started immediately. Although triple POCUS has less sensitivity and specificity than CTPA, it could be very useful in some clinical settings. LEARNING POINTS In a patient with suspected pulmonary embolism, the best diagnostic strategy is to combine clinical assessment, plasma D-dimer measurement and computed tomographic pulmonary angiography (CTPA).Triple point-of-care ultrasonography of the lung, heart and leg veins may improve clinical assessment of pulmonary embolism if CTPA is unavailable or contraindicated.Point-of-care ultrasonography should be incorporated as the fifth pillar of the physical examination.
Collapse
Affiliation(s)
- Rafael Silva
- Internal Medicine, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Diana Gonçalves
- Internal Medicine, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - João Pina Cabral
- Internal Medicine, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Bráulio Gomes
- Internal Medicine, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Jorge Teixeira
- Emergency Department, Hospital de Braga, Braga, Portugal
| | - José Mariz
- Emergency Department, Hospital of Braga/Medical School of University of Minho, Braga, Portugal
| |
Collapse
|
15
|
Ogura M, Sancho JM, Cho SG, Nakazawa H, Suzumiya J, Tumyan G, Kim JS, Lennard A, Mariz J, Ilyin N, Jurczak W, Lopez Martinez A, Samoilova O, Zhavrid E, Yañez Ruiz E, Trneny M, Popplewell L, Coiffier B, Buske C, Kim WS, Lee SJ, Lee SY, Bae YJ, Kwak LW. Efficacy, pharmacokinetics, and safety of the biosimilar CT-P10 in comparison with rituximab in patients with previously untreated low-tumour-burden follicular lymphoma: a randomised, double-blind, parallel-group, phase 3 trial. Lancet Haematol 2018; 5:e543-e553. [PMID: 30389036 DOI: 10.1016/s2352-3026(18)30157-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Studies in patients with rheumatoid arthritis and advanced follicular lymphoma have shown that CT-P10, a rituximab biosimilar, has equivalent or non-inferior efficacy and pharmacokinetics to rituximab. We aimed to assess the therapeutic equivalence of single-agent CT-P10 and rituximab in patients with newly diagnosed low-tumour burden follicular lymphoma. METHODS In this ongoing, randomised, double-blind, parallel-group, active-controlled, phase 3 trial, adult patients (≥18 years) with stage II-IV low-tumour-burden follicular lymphoma were randomly assigned (1:1) using an interactive web or voice response system stratified by region, stage, and age to CT-P10 or US-sourced rituximab. Patients received CT-P10 or rituximab (375 mg/m2 intravenous) on day 1 of four 7-day cycles (induction period). Patients who had disease control after the induction period continued to a maintenance period of CT-P10 or rituximab administered every 8 weeks for six cycles and, if completed, a second year of maintenance therapy of additional CT-P10 (every 8 weeks for six cycles) was offered. The study was partially unmasked after database lock (Feb 23, 2018) for all data up to 7 months (before cycle 3 of the maintenance period). The primary endpoint was the proportion of patients who achieved an overall response by 7 months in the intention-to-treat population. Efficacy equivalence was shown if the two-sided 90% CIs for the treatment difference in the proportion of responders between CT-P10 and rituximab was within the equivalence margin of 17%. This trial is registered with ClinicalTrials.gov, number NCT02260804. FINDINGS Between Nov 9, 2015, and Jan 4, 2018, 402 patients were assessed for eligibility, of whom 258 were randomly assigned: 130 to CT-P10 and 128 to rituximab. 108 (83%) of 130 patients assigned to CT-P10 and 104 (81%) of 128 assigned to rituximab achieved an overall response by month 7 (treatment difference estimate 1·8%; 90% CI -6·43 to 10·20). Therapeutic equivalence was shown (90% CIs were within the prespecified margin of 17%). The most common grade 3 or 4 treatment-emergent adverse events were decreased neutrophil count (two grade 3 in the CT-P10 group) and neutropenia (one in each group); all other grade 3 or 4 treatment-emergent adverse events occurred in one patient each. Six (5%) of 130 patients who received CT-P10 and three (2%) of 128 who received rituximab experienced at least one treatment-emergent serious adverse event. INTERPRETATION CT-P10 was equivalent to rituximab in terms of efficacy and was well tolerated. CT-P10 monotherapy is suggested as a new therapeutic option for patients with low-tumour-burden follicular lymphoma. FUNDING Celltrion, Inc.
Collapse
MESH Headings
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/pharmacokinetics
- Antibodies, Monoclonal, Murine-Derived/pharmacology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Biosimilar Pharmaceuticals/adverse effects
- Biosimilar Pharmaceuticals/pharmacokinetics
- Biosimilar Pharmaceuticals/pharmacology
- Biosimilar Pharmaceuticals/therapeutic use
- Disease-Free Survival
- Double-Blind Method
- Female
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/metabolism
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Rituximab/adverse effects
- Rituximab/pharmacokinetics
- Rituximab/pharmacology
- Rituximab/therapeutic use
- Safety
- Treatment Outcome
- Tumor Burden/drug effects
Collapse
Affiliation(s)
- Michinori Ogura
- Department of Haematology and Oncology, Kasugai Municipal Hospital, Kasugai, Japan; School of Medicine, Fujita Medical University, Toyoake, Japan
| | - Juan Manuel Sancho
- Hematology Department, The Catalan Institute of Oncology-The Josep Carreras Leukaemia Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Seok-Goo Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hideyuki Nakazawa
- Department of Hematology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Junji Suzumiya
- Shimane University Hospital, Innovative Cancer Center/Oncology-Hematology, Izumo, Japan
| | - Gayane Tumyan
- Division of Hematology and Bone Marrow Transplantation, N N Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Anne Lennard
- Northern Institute for Cancer Care, Newcastle University, Newcastle-upon-Tyne, UK
| | - José Mariz
- Department of Onco-Hematology, Portuguese Institute of Oncology, Porto, Portugal
| | - Nikolai Ilyin
- Russian Research Center for Radiology and Surgical Technologies, Ministry of Health of the Russian Federation, St Petersburg, Russia
| | - Wojciech Jurczak
- Department of Haematology, Jagiellonian University, Kraków, Poland
| | | | - Olga Samoilova
- Department of Hematology, Nizhniy Novgorod Region Clinical Hospital, Nizhniy Novgorod, Russia
| | - Edvard Zhavrid
- N N Alexandrov Republican Scientific and Practical Centre of Oncology and Medical Radiology, Minsk, Belarus
| | - Eduardo Yañez Ruiz
- Department of Internal Medicine, Universidad de la Frontera, Temuco, Chile
| | - Marek Trneny
- Department of Medicine, Charles University, General Hospital in Prague, Prague, Czech Republic
| | - Leslie Popplewell
- Toni Stephenson Lymphoma Center and Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | - Christian Buske
- Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - Won-Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Larry W Kwak
- Toni Stephenson Lymphoma Center and Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.
| |
Collapse
|
16
|
Pêgo JM, Cerqueira JJ, Bessa J, Pereira VH, Gomes S, Mariz J, Sousa R, Morgado P, Sousa N. Fifteen Years of Experience from a Medical School' Clinical Skills Laboratory. ACTA MEDICA PORT 2017; 30:85-92. [PMID: 28527474 DOI: 10.20344/amp.8408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/03/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Medical Education has evolved being defined as a continuum of the medical training from the pre- to the post-graduate period and through a lifetime of medical practice that is mirrored in the competencies framework that several international institutions have established. This creates a challenge to educational institutions (pre- and post-graduate) that traditionally take separate pathways. MATERIAL AND METHODS The present report is a description of the efforts carried by the School of Medicine of the University of Minho to implement a strategy of teaching/learning methods that follows modern standards towards constructive alignment of the medical curriculum, from the pre- to the post-graduate. The faculty members responsible for these activities make a narrative self-report of the activities developed and where available quantitative data from participant surveys are presented. RESULTS In order to achieve a constructive alignment of educational/assessment strategies several steps were taken that focused on the revision of the learning goals, teaching methodologies and assessment strategies. This implicated the investment in the training/certification of faculty, acquisition of simulation tools and a dedicated infrastructure. Alumni were a fundamental cornerstone as voluntary faculty contributing to pre-graduate training, but also training their own scholar skills. Overall, courses are rate with a high rate of satisfaction among course participants. DISCUSSION Setting up the present teaching/learning environment of the School of Medicine of the University of Minho required a collective effort of the faculty, as well a progressive investment in both acquisition of equipment and training of staff. These human and material efforts, however, lead to an excellent return in learning outcomes. CONCLUSION The main conclusion is that the constructive alignment of educational and assessment strategies towards the medical education continuum needs reflective thinking on the learners' needs. The secondary gain of these initiatives is to provide opportunities for junior doctors to practice teaching.
Collapse
Affiliation(s)
- José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - João José Cerqueira
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - João Bessa
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - Vitor Hugo Pereira
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - Sara Gomes
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - Rita Sousa
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. Portugal; ICVS/3Bs - PT Government Associate Laboratory. Braga/Guimarães. Portugal
| |
Collapse
|
17
|
Mariz J, Costa Castanho T, Teixeira J, Sousa N, Correia Santos N. Delirium Diagnostic and Screening Instruments in the Emergency Department: An Up-to-Date Systematic Review. Geriatrics (Basel) 2016; 1:geriatrics1030022. [PMID: 31022815 PMCID: PMC6371145 DOI: 10.3390/geriatrics1030022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/07/2016] [Accepted: 08/26/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emergency care systems are at the core of modern healthcare and are the "point-of-entry/admission" into the hospital for many older/elderly patients. Among these, it is estimated that 15% to 30% will have delirium on admission and that over 50% will develop it during their stay. However, appropriate delirium diagnostic and screening still remains a critical area of need. The goal of this review is to update the field, exploring target areas in screening methods for delirium in the Emergency Department (ED), and/or acute care units, in the older population. METHODS A systematic review was conducted to search screening/diagnostic methods for delirium in the ED and/or acute care units within the ED. RESULTS Seven different scales were identified. Of the identified instruments, the Confusion Assessment Method (CAM) for the Intense Care Unit (CAM-ICU) was the most widely used. Of note, a brief two-step approach for delirium surveillance was defined with the Delirium Triage Screen (DTS) and the Brief Confusion Assessment Method (bCAM), and the diagnostic accuracy of the Richmond Agitation-Sedation Scale (RASS) for delirium had a good sensitivity and specificity in older patients. CONCLUSION The CAM-ICU appears as the potential reference standard for use in the ED, but research in a global approach of evaluation of actual and past cognitive changes is still warranted.
Collapse
Affiliation(s)
- José Mariz
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal.
- Emergency Department, Hospital de Braga, 4710-243 Braga, Portugal.
- Clinical Academic Center-Braga, 4710-243 Braga, Portugal.
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal.
- Clinical Academic Center-Braga, 4710-243 Braga, Portugal.
| | - Jorge Teixeira
- Emergency Department, Hospital de Braga, 4710-243 Braga, Portugal.
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal.
- Clinical Academic Center-Braga, 4710-243 Braga, Portugal.
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal.
- Clinical Academic Center-Braga, 4710-243 Braga, Portugal.
| |
Collapse
|
18
|
Castanho TC, Amorim L, Moreira PS, Mariz J, Palha JA, Sousa N, Santos NC. Assessing Cognitive Function in Older Adults Using a Videoconference Approach. EBioMedicine 2016; 11:278-284. [PMID: 27515687 PMCID: PMC5049917 DOI: 10.1016/j.ebiom.2016.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of communication technologies is an emerging trend in healthcare and research. Despite efficient, reliable and accurate neuropsychological batteries to evaluate cognitive performance in-person, more diverse and less expensive and time consuming solutions are needed. Here we conducted a pilot study to determine the applicability of a videoconference (VC, Skype®) approach to assess cognitive function in older adults, using The Telephone Interview for Cognitive Status-Modified - Portuguese version (TICSM-PT). METHODS After inclusion and exclusion criteria, 69 individuals (mean age=74.90±9.46years), selected from registries of local health centers and assisted-living facilities, were assessed on cognitive performance using videoconference, telephone and in-person approaches. FINDINGS The videoconference administration method yielded comparable results to the traditional application. Correlation analyses showed high associations between the testing modalities: TICSM-PT VC and TICSM-PT telephone (r=0.885), TICSM-PT VC and MMSE face-to-face (r=0.801). Using the previously validated threshold for cognitive impairment on the TICSM-PT telephone, TICSM-PT VC administration presented a sensitivity of 87.8% and a specificity of 84.6%. INTERPRETATION Findings indicate for the range of settings where videoconference approaches can be used, and for their applicability and acceptability, providing an alternative to current cognitive assessment methods. Continued validation studies and adaptation of neuropsychological instruments is warranted.
Collapse
Affiliation(s)
- Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Liliana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal; Emergency Department, Intermediate Care Unit (EDIMCU), Hospital de Braga, Braga, Portugal
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal.
| |
Collapse
|
19
|
Portugal-Nunes C, Castanho T, Amorim L, Moreira P, Mariz J, Marques F, Sousa N, Santos N, Palha J. SUN-PP079: Iron Status and Its Association with Cognition, Mood and Functional Ability in Older Adults: A Cross-Sectional Study. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30230-2] [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: 10/23/2022]
|
20
|
Brito MDD, Martins Â, Andrade J, Guimarães J, Mariz J. Histiocitose de Largerhans no Adulto: Experiência de Dois Hospitais Portugueses. ACTA MEDICA PORT 2014. [DOI: 10.20344/amp.5360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<strong>Introduction:</strong> Langerhans cell histiocytosis is a heterogeneous disease, more frequently diagnosed during childhood. Between 1/2001 and 12/2013, 20 adult patients were admitted at both Hospitals. This work aimed at ccharacterizing this population.<br />Material and Methods: Retrospective study, review of clinical records.<br /><strong>Results:</strong> 16 patients were eligible to analysis. The median age at diagnosis was 34 years (15-48); 10 males and 6 females. The referral motive was: respiratory complaints – 37.5%; bone changes – 37.5%; dental complaints - 25%; constitutional symptoms - 19%; mucocutaneous lesions – 6% and one patient (6%) was accidentally diagnosed after a thyroidectomy. The tissue of histological diagnosis was: bone - 50%; pulmonary tissue – 37.5%; liver, genital mucosa and thyroid - 6%, respectively. Staging was: single organ involvement (uni/multifocal) - 69% and multisystem disease in 31%. Clinical re-evaluation of these cases is being done at the moment. The median follow up was 5 years (1 month – 11 years) and the overall survival was 92%. Currently 19% are alive without signs of disease; 44% are alive with disease; 25% are under treatment and 12% died.<br /><strong>Discussion:</strong> These results agree with published literature. Considering the actual guidelines 56% patients were incompletely staged, which probably lead to suboptimal treatment. There is heterogeneity of clinical procedures aiming at staging and treatment of these patients.<br /><strong>Conclusion:</strong> The diagnosis of adulthood Langerhans cell histiocytosis is difficult considering the diversity of clinical behavior. Frequently this also leads to diagnosis delay. Prospective international clinical trials enrolling adult patients are important.<br /><strong>Keywords:</strong> Adult; Histiocytosis, Langerhans-Cell.
Collapse
|
21
|
Brito MD, Martins Â, Henrique R, Mariz J. Enteropathy-associated T cell lymphoma as a complication of silent celiac disease. Hematol Rep 2014; 6:5612. [PMID: 25568762 PMCID: PMC4274481 DOI: 10.4081/hr.2014.5612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/02/2014] [Accepted: 11/13/2014] [Indexed: 01/16/2023] Open
Abstract
Celiac disease is an autoimmune disorder in which a genetic predisposition and the ingestion of wheat gluten triggers a deleterious immune response. This response is complex and may lead to manifestations other than enteropathyha: hepatitis, dermatitis and neuropathy. There is higher risk for neoplasia. We observed an atypical case, corresponding to a 69-year old female presenting with complicated celiac disease. The patient was referred following the histological examination of an enterectomy specimen, which unexpectedly revealed an enteropathy-associated T cell lymphoma in a background of celiac disease. Patient’s previous medical history comprised several abdominal surgical procedures, without other prior symptoms suggestive of celiac disease. Indeed, the patient was obese and no signs of malabsortion were apparent. This case draws our attention to clinically silent celiac disease, which represents a diagnostic challenge. Thus, this should be kept in mind whenever a patient presents with abdominal relapsing complications, otherwise unexplained.
Collapse
Affiliation(s)
| | | | - Rui Henrique
- Department of Pathology, Portuguese Institute of Oncology of Porto , Portugal
| | | |
Collapse
|
22
|
de Brito MD, Martins É, Andrade J, Guimarães J, Mariz J. [Adulthood Langerhans cell histiocytosis: experience of two Portuguese hospitals]. ACTA MEDICA PORT 2014; 27:726-730. [PMID: 25641287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/07/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Langerhans cell histiocytosis is a heterogeneous disease, more frequently diagnosed during childhood. Between 1/2001 and 12/2013, 20 adult patients were admitted at both Hospitals. This work aimed at characterizing this population. MATERIAL AND METHODS Retrospective study, review of clinical records. RESULTS 16 patients were eligible to analysis. The median age at diagnosis was 34 years (15-48); 10 males and 6 females. The referral motive was: respiratory complaints - 37.5%; bone changes - 37.5%; dental complaints - 25%; constitutional symptoms - 19%; mucocutaneous lesions - 6% and one patient (6%) was accidentally diagnosed after a thyroidectomy. The tissue of histological diagnosis was: bone - 50%; pulmonary tissue - 37.5%; liver, genital mucosa and thyroid - 6%, respectively. Staging was: single organ involvement (uni/multifocal) - 69% and multisystem disease in 31%. Clinical re-evaluation of these cases is being done at the moment. The median follow up was 5 years (1 month - 11 years) and the overall survival was 92%. Currently 19% are alive without signs of disease; 44% are alive with disease; 25% are under treatment and 12% died. DISCUSSION These results agree with published literature. Considering the actual guidelines 56% patients were incompletely staged, which probably lead to suboptimal treatment. There is heterogeneity of clinical procedures aiming at staging and treatment of these patients. CONCLUSION The diagnosis of adulthood Langerhans cell histiocytosis is difficult considering the diversity of clinical behavior. Frequently this also leads to diagnosis delay. Prospective international clinical trials enrolling adult patients are important.
Collapse
Affiliation(s)
| | - Éngelo Martins
- Serviço de Onco-hematologia. Instituto Português de Oncologia. Porto. Portugal
| | | | - José Guimarães
- Serviço Hematologia. Hospital de SÉo JoÉo. Porto. Portugal
| | - José Mariz
- Serviço de Onco-hematologia. Instituto Português de Oncologia. Porto. Portugal
| |
Collapse
|
23
|
Mariz J, Santos NC, Afonso H, Rodrigues P, Faria A, Sousa N, Teixeira J. Risk and clinical-outcome indicators of delirium in an emergency department intermediate care unit (EDIMCU): an observational prospective study. BMC Emerg Med 2013; 13:2. [PMID: 23360089 PMCID: PMC3563452 DOI: 10.1186/1471-227x-13-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 09/27/2012] [Accepted: 01/24/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Identification of delirium in emergency departments (ED) is often underestimated; within EDs, studies on delirium assessment and relation with patient outcome in Intermediate Care Units (IMCU) appear missing in European hospital settings. Here we aimed to determine delirium prevalence in an EDIMCU (Hospital de Braga, Braga, Portugal) and assessed routine biochemical parameters that might be delirium indicators. METHODS The study was prospective and observational. Sedation level was assessed via the Richmond Agitation-Sedation Scale and delirium status by the Confusion Assessment Method for the ICU. Information collected included age and gender, admission type, Charlson Comorbidity Index combined condition score (Charlson score), systemic inflammatory response syndrome criteria (SIRS), biochemical parameters (blood concentration of urea nitrogen, creatinine, hemoglobin, sodium and potassium, arterial blood gases, and other parameters as needed depending on clinical diagnosis) and EDIMCU length of stay (LOS). Statistical analyses were performed as appropriate to determine if baseline features differed between the 'Delirium' and 'No Delirium' groups. Multivariate logistic regression was performed to assess the effect of delirium on the 1-month outcome. RESULTS Inclusion and exclusion criteria were met in 283 patients; 238 were evaluated at 1-month for outcome follow-up after EDIMCU discharge ("good" recovery without complications requiring hospitalization or institutionalization; "poor" institutionalization in permanent care-units/assisted-living or death). Delirium was diagnosed in 20.1% patients and was significantly associated with longer EDIMCU LOS. At admission, Delirium patients were significantly older and had significantly higher blood urea, creatinine and osmolarity levels and significantly lower hemoglobin levels, when compared with No Delirium patients. Delirium was an independent predictor of increased EDIMCU LOS (odds ratio 3.65, 95% CI 1.97-6.75) and poor outcome at 1-month after discharge (odds ratio 3.51, CI 1.84-6.70), adjusted for age, gender, admission type, presence of SIRS criteria, Charlson score and osmolarity at admission. CONCLUSIONS In an EDIMCU setting, delirium was associated with longer LOS and poor outcome at 1-month post-discharge. Altogether, findings support the need for delirium screening and management in emergency settings.
Collapse
Affiliation(s)
- José Mariz
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | | | | | | | | | | | | |
Collapse
|
24
|
Almeida M, Queiroz L, Domingues N, Espírito-Santo A, Oliveira I, Oliveira Â, Moreira I, Viterbo L, Mariz J. Aplastic Anemia: A Single Institution Experience. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
25
|
Pendlebury S, Rothwell PM, Mariz J, Mehta Z. POS05 Impairment on Montreal Cognitive Assessment in transient ischaemic attack and stroke patients with normal Mini-Mental State Examination score is clinically relevant. J Neurol Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.205] [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: 11/03/2022]
|