1
|
Silva B, Pereira CA, Cidade-Rodrigues C, Chaves C, Melo A, Gomes V, Silva VB, Araújo A, Machado C, Saavedra A, Figueiredo O, Martinho M, Almeida MC, Morgado A, Almeida M, Cunha FM. Development and internal validation of a clinical score to predict neonatal hypoglycaemia in women with gestational diabetes. Endocrine 2024:10.1007/s12020-024-03815-2. [PMID: 38602617 DOI: 10.1007/s12020-024-03815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Gestational diabetes (GD) is a risk factor for neonatal hypoglycaemia (NH), but other factors can increase this risk. OBJECTIVES To create a score to predict NH in women with GD. METHODS Retrospective study of women with GD with a live singleton birth between 2012 and 2017 from the Portuguese GD registry. Pregnancies with and without NH were compared. A logistic regression was used to study NH predictors. Variables independently associated with NH were used to score derivation. The model's internal validation was performed by a bootstrapping. The association between the score and NH was assessed by logistic regression. RESULTS We studied 10216 pregnancies, 410 (4.0%) with NH. The model's AUC was 0.628 (95%CI: 0.599-0.657). Optimism-corrected c-index: 0.626. Points were assigned to variables associated with NH in proportion to the model's lowest regression coefficient: insulin-treatment 1, preeclampsia 3, preterm delivery 2, male sex 1, and small-for-gestational-age 2, or large-for-gestational-age 3. NH prevalence by score category 0-1, 2, 3, 4, and ≥5 was 2.3%, 3.0%, 4.5%, 6.0%, 7.4%, and 11.5%, respectively. Per point, the OR for NH was 1.35 (95% CI: 1.27-1.42). A score of 2, 3, 4, 5 or ≥6 (versus ≤1) had a OR for NH of 1.67 (1.29-2.15), 2.24 (1.65-3.04), 2.83 (2.02-3.98), 3.08 (1.83-5.16), and 6.84 (4.34-10.77), respectively. CONCLUSION Per each score point, women with GD had 35% higher risk of NH. Those with ≥6 points had 6.8-fold higher risk of NH compared to a score ≤1. Our score may be useful for identifying women at a higher risk of NH.
Collapse
Affiliation(s)
- Bruna Silva
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
| | - Catarina A Pereira
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | | | - Catarina Chaves
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Anabela Melo
- Gynaecology and Obstetrics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Vânia Gomes
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Vânia Benido Silva
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Alexandra Araújo
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Cláudia Machado
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Ana Saavedra
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Odete Figueiredo
- Gynaecology and Obstetrics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Mariana Martinho
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Maria Céu Almeida
- Gynaecology and Obstetrics Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Ana Morgado
- Gynaecology and Obstetrics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Margarida Almeida
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Filipe M Cunha
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| |
Collapse
|
2
|
Cidade-Rodrigues C, Chaves C, Melo A, Novais-Araújo A, Figueiredo O, Gomes V, Morgado A, Almeida MC, Martinho M, Almeida M, Cunha FM. Association between foetal sex and adverse neonatal outcomes in women with gestational diabetes. Arch Gynecol Obstet 2024; 309:1287-1294. [PMID: 36869939 DOI: 10.1007/s00404-023-06979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
AIMS Foetal male sex is associated with adverse perinatal outcomes. However, studies evaluating the impact of foetal sex on perinatal outcomes in women with gestational diabetes (GDM) are scarce. We studied whether male new-born sex is associated with neonatal outcomes, in women with GDM. METHODS This is a retrospective study based on the national Portuguese register of GDM. All women with live-born singleton pregnancies between 2012 and 2017 were eligible for study inclusion. Primary endpoints under analysis were neonatal hypoglycaemia, neonatal macrosomia, respiratory distress syndrome (RDS) and neonatal intensive care unit (NICU) admission. We excluded women with missing data on the primary endpoint. Pregnancy data and neonatal outcomes between female and male new-borns were compared. Multivariate logistic regression models were built. RESULTS We studied 10,768 new-borns in mothers with GDM, 5635 (52.3%) male, 438 (4.1%) had neonatal hypoglycaemia, 406 (3.8%) were macrosomic, 671 (6.2%) had RDS, and 671 (6.2%) needed NICU admission. Male new-borns were more frequently small or large for gestational age. No differences were observed on maternal age, body mass index, glycated haemoglobin, anti-hyperglycaemic treatment, pregnancy complications or gestational age at delivery. In the multivariate regression analysis, male sex was independently associated with neonatal hypoglycaemia [OR 1.26 (IC 95%: 1.04-1.54), p = 0.02], neonatal macrosomia [1.94 (1.56-2.41), p < 0.001], NICU admission [1.29 (1.07-1.56), p = 0.009], and RDS [1.35 (1.05-1.73, p = 0.02]. CONCLUSIONS Male new-borns have an independent 26% higher risk of neonatal hypoglycaemia, 29% higher risk of NICU admission, 35% higher risk of RDS, and almost twofold higher risk of macrosomia, compared to female new-borns.
Collapse
Affiliation(s)
- Catarina Cidade-Rodrigues
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal
| | - Catarina Chaves
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal
| | - Anabela Melo
- Gynecology and Obstetrics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Alexandra Novais-Araújo
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal
| | - Odete Figueiredo
- Gynecology and Obstetrics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Vânia Gomes
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal
| | - Ana Morgado
- Gynecology and Obstetrics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - M Céu Almeida
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mariana Martinho
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal
| | - Margarida Almeida
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal
| | - Filipe M Cunha
- Endocrinology Department, Centro Hospitalar Tâmega e Sousa, Avenida Do Hospital Padre Américo 210, Guilhufe, 4564-007, Penafiel, Portugal.
| |
Collapse
|
3
|
Valente SA, Lopes GR, Ferreira I, Galrinho MF, Almeida M, Ferreira P, Cruz MT, Coimbra MA, Passos CP. Polysaccharide-Based Carriers for Pulmonary Insulin Delivery: The Potential of Coffee as an Unconventional Source. Pharmaceutics 2023; 15:pharmaceutics15041213. [PMID: 37111698 PMCID: PMC10144660 DOI: 10.3390/pharmaceutics15041213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/24/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Non-invasive routes for insulin delivery are emerging as alternatives to currently painful subcutaneous injections. For pulmonary delivery, formulations may be in powdered particle form, using carriers such as polysaccharides to stabilise the active principle. Roasted coffee beans and spent coffee grounds (SCG) are rich in polysaccharides, namely galactomannans and arabinogalactans. In this work, the polysaccharides were obtained from roasted coffee and SCG for the preparation of insulin-loaded microparticles. The galactomannan and arabinogalactan-rich fractions of coffee beverages were purified by ultrafiltration and separated by graded ethanol precipitations at 50% and 75%, respectively. For SCG, galactomannan-rich and arabinogalactan-rich fractions were recovered by microwave-assisted extraction at 150 °C and at 180 °C, followed by ultrafiltration. Each extract was spray-dried with insulin 10% (w/w). All microparticles had a raisin-like morphology and average diameters of 1-5 µm, which are appropriate for pulmonary delivery. Galactomannan-based microparticles, independently of their source, released insulin in a gradual manner, while arabinogalactan-based ones presented a burst release. The microparticles were seen to be non-cytotoxic for cells representative of the lung, specifically lung epithelial cells (A549) and macrophages (Raw 264.7) up to 1 mg/mL. This work shows how coffee can be a sustainable source of polysaccharide carriers for insulin delivery via the pulmonary route.
Collapse
Affiliation(s)
- Sara A Valente
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Guido R Lopes
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Isabel Ferreira
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Miguel F Galrinho
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Margarida Almeida
- CICECO, Department of Materials and Ceramic Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Paula Ferreira
- CICECO, Department of Materials and Ceramic Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Maria T Cruz
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Manuel A Coimbra
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Cláudia P Passos
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| |
Collapse
|
4
|
Laganà M, Cosentini D, Grisanti S, Remde H, Almeida M, Pusceddu S, Deutschbein T, Fagundes G, Pereira A, Grana C, Fazio N, Corssmit E, Bongiovanni A, Canu L, Kim E, Habra M, Jimenez C, Berruti A. 31P Bone metastases and skeletal related events in pheochromocytoma and paraganglioma patients: International, retrospective study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101052] [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: 04/05/2023] Open
|
5
|
Colombo S, Alonso A, Real R, Goswami R, Suarez MC, Ogueta S, Almeida M, Adhikary L, Malmierca MG, de Melo IS. Improvement of monoclonal antibody stability by modulating trace metal iron concentration in cell culture media: A case study. Process Biochem 2023. [DOI: 10.1016/j.procbio.2022.12.013] [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: 12/23/2022]
|
6
|
Aires Fernandes A, Pereira C, Almeida M, Soares C. Basal ganglia calcification: pseudohypoparathyroidism with short fourth metacarpals. Pract Neurol 2023; 23:249-250. [PMID: 36593114 DOI: 10.1136/pn-2022-003647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Affiliation(s)
- André Aires Fernandes
- Department of Neurology, Centro Hospitalar de São João EPE, Porto, Portugal .,Department of Clinic Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Catarina Pereira
- Department of Endocrinology, Centro Hospitalar Tamega e Sousa EPE, Porto, Portugal
| | - Margarida Almeida
- Department of Endocrinology, Centro Hospitalar Tamega e Sousa EPE, Porto, Portugal
| | - Carolina Soares
- Department of Neurology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Clinic Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
7
|
Almeida M, Ramos C, Maciel L, Basto-Pereira M, Leal I. Meaning in life, meaning-making and posttraumatic growth in cancer patients: Systematic review and meta-analysis. Front Psychol 2022; 13:995981. [PMID: 36570997 PMCID: PMC9784472 DOI: 10.3389/fpsyg.2022.995981] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction The purpose of this systematic review and meta-analysis is to assess the association between meaning in life (MiL), meaning-making and posttraumatic growth (PTG) in the context of cancer. Methods A systematic search was conducted in eighteen electronic databases. The screening and selection process followed the PRISMA guidelines. For the purpose of the meta-analysis, the correlation coefficients between meaning in life and posttraumatic growth were extracted from the included studies. The effect size (r) was calculated using the restricted maximum-likelihood estimator, a random-effects model. Heterogeneity was assessed through the Q statistic, I2 index and forest plot, while publication bias was analyzed with the use of the funnel plot and Egger's test. Results 889 records were considered according to the inclusion criteria. A total of nine articles, published between 2006 and 2021, were included in the systematic review. More than half were published in the last five years. The sample was mostly diagnosed with breast cancer. The meta-analysis included five articles (N = 844) and the results indicate a significant moderate correlation between meaning in life and posttraumatic growth (r = 0.43, 95% IC [0.36, 0.50]). Discussion In conclusion, there is a clear association between meaning in life and posttraumatic growth in cancer patients. Future research should explore this relationship further, in order to better assist and guide meaning centered interventions that can potentiate a positive adjustment and possibly growth from the cancer experience.
Collapse
Affiliation(s)
- Margarida Almeida
- Ispa – Instituto Universitário, Lisbon, Portugal,*Correspondence: Margarida Almeida,
| | - Catarina Ramos
- LabPSI – Laboratório de Psicologia Egas Moniz, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Caparica, Portugal
| | - Laura Maciel
- WJCR – William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| | - Miguel Basto-Pereira
- WJCR – William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| | - Isabel Leal
- WJCR – William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| |
Collapse
|
8
|
Rodrigues J, Sá A, Fontes R, Barbosa A, Barbosa-Martins J, Oliveira C, Peixoto M, Santos S, Rocha J, Almeida M, Carvalho C, Queiroz L, Fernandes R, Faustino I, Portela C, Coutinho C, Nabiço R. Anxiety and depression screening during neoadjuvant chemotherapy treatment in early breast cancer patients: a multicenter longitudinal observational study. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
9
|
Presume J, Gomes D, Albuquerque F, Aguiar C, Almeida M, Ribeiras R, Uva MS, Ferreira J. 30-day outcomes of P2Y12 inhibitor pretreatment in patients with STEMI submitted to primary PCI – systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1394] [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
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of antithrombotic therapy in patients with ST-segment elevation myocardial infarction (STEMI). Yet, there is uncertainty surrounding the optimal timing for the initiation of the P2Y12 inhibitor. This study aims to evaluate the effectiveness and safety of P2Y12 pretreatment by means of a systematic review and meta-analysis of studies in primary percutaneous coronary intervention (PCI) in STEMI.
Methods
We performed a systematic search of electronic databases Pubmed, CENTRAL and Scopus until March of 2021. Studies were considered eligible if they were: a) comparing P2Y12 inhibitor upstream administration vs. treatment during PCI; b) patients enrolled for STEMI and submitted to primary PCI. Studies with patients treated with fibrinolysis or medical therapy only were excluded. Major clinical outcomes included 30-day occurrence of all-cause death, definite stent thrombosis and re-infarction. Thrombolysis in myocardial infarction (TIMI) flow-grade pre-PCI and post-PCI, in-hospital cardiogenic shock and major bleeding events were analysed.
Results
Out of 2193 articles, 18 studies were included (1 randomized clinical trial [RCT] and 17 observational studies [non-RCT]), with a total of 76,836 patients, 52,181 in the pretreatment arm. At 30 days, pretreatment was associated with a reduction in definite stent thrombosis (1 RCT & 4 Non-RCT: OR 0.40; 95% CI 0.18–0.90), but no significant reduction in all-cause death (1 RCT & 7 Non-RCT: OR 0.77; 95% CI 0.56–1.04) or re-infacrtion (1 RCT & 4 Non-RCT: OR 0.73; 95% CI 0.49–1.09). Regarding in-hospital outcomes, pretreatment showed a significant reduction in the occurrence of cardiogenic shock (5 Non-RCT: 0.62; 95% CI 0.51–0.79), major bleeding events (1 RCT & 14 Non-RCT: 0.83; 95% CI 0.75–0.92) and in the number of patients with TIMI flow <3 postPCI (1 RCT & 8 Non-RCT: 0.82; 95% CI 0.73–0.93). Pretreatment was not associated with lower number of patients with TIMI flow <3 pre-PCI (1 RCT & 5 Non-RCT: 0.85; 95% CI 0.66–1.09).
Conclusion
Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with lower risk for definite stent thrombosis and cardiogenic shock, but was not associated with lower all-cause death or re-infarction.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- J Presume
- Hospital de Santa Cruz , Lisbon , Portugal
| | - D Gomes
- Hospital de Santa Cruz , Lisbon , Portugal
| | | | - C Aguiar
- Hospital de Santa Cruz , Lisbon , Portugal
| | - M Almeida
- Hospital de Santa Cruz , Lisbon , Portugal
| | - R Ribeiras
- Hospital de Santa Cruz , Lisbon , Portugal
| | - M S Uva
- Hospital de Santa Cruz , Lisbon , Portugal
| | - J Ferreira
- Hospital de Santa Cruz , Lisbon , Portugal
| |
Collapse
|
10
|
Presume J, Gomes D, Strong C, Tralhao A, Aguiar C, Trabulo M, Almeida M, Ferreira J, Mendes M. Prognostic impact of aborted cardiac arrest in patients with acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1323] [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
Aborted cardiac arrest (ACA) during the acute ischaemic phase is a relatively frequent but often undervalued complication of acute myocardial infarction (AMI). The aim of this study was to evaluate the clinical and prognostic impact of aborted cardiac arrest in AMI patients and investigate its correlation with infarct size.
Methods
We conducted a single-centre retrospective study enrolling consecutive patients admitted for AMI, from January 2016 to December 2018. ACA was defined as the need for advanced life support measures and defibrillation, either out-of-hospital or in-hospital, up until culprit vessel revascularisation. Infarct size was estimated using peak serum troponin T, impact on left ventricular ejection fraction (LVEF ≤50%) and echocardiographic wall motion index (WMI). Clinical outcomes included cardiogenic shock (SCAI C or more), need for mechanical circulatory support (MCS), major bleeding events (BARC ≥3) during in-hospital phase and all-cause mortality during follow-up.
Results
A total of 571 patients were included (65±13 years old, 72% male). Overall, 237 had anterior STEMI, 39 patients (6,8%) suffered ACA (21 out of hospital), 60 progressed into cardiogenic shock throughout the hospitalisation, 7 needed MCS, and 52 had BARC ≥3 bleeding. During a mean follow-up of 32 months, 96 patients died.
ACA was significantly associated with higher peak serum troponin T (4802 [1950; 9420] vs 2659 [555; 6708] ng/L – p=0.004), higher proportion of patients with reduced or mildly reduced LVEF (60% vs. 36.5%, p=0.018) and higher WMI (1.7 [1.4; 2.3] vs. 1.5 [1.2; 1.8], p=0.016). Moreover, ACA was also associated with higher risk of cardiogenic shock occurrence (64.1% vs. 6.6%, p<0.001 – OR 25.357 (12.115–53.073)), higher need for MCS (7.9% vs 0.8%, p<0.001 – OR 11.271 (2.427–52.343)) and higher incidence of BARC ≥3 bleeding events (28.2% vs. 8.4%, p<0.001 – OR 4.705 (2.185–10.128)) – Table 1.
On univariate Cox regression, ACA showed significant association with all cause death, which remained highly significant after multivariable adjustment (OR 2.431 (1.181; 5.002); p=0.016).
Conclusion
The occurrence of aborted cardiac arrest in patients with AMI was associated with increased morbidity and mortality. This may be driven by a larger area of arrhythmia prone ischemic myocardium.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- J Presume
- Hospital de Santa Cruz , Lisbon , Portugal
| | - D Gomes
- Hospital de Santa Cruz , Lisbon , Portugal
| | - C Strong
- Hospital de Santa Cruz , Lisbon , Portugal
| | - A Tralhao
- Hospital de Santa Cruz , Lisbon , Portugal
| | - C Aguiar
- Hospital de Santa Cruz , Lisbon , Portugal
| | - M Trabulo
- Hospital de Santa Cruz , Lisbon , Portugal
| | - M Almeida
- Hospital de Santa Cruz , Lisbon , Portugal
| | - J Ferreira
- Hospital de Santa Cruz , Lisbon , Portugal
| | - M Mendes
- Hospital de Santa Cruz , Lisbon , Portugal
| |
Collapse
|
11
|
Dias Ferreira Reis JP, Brizido C, Madeira S, Ramos R, Almeida M, Cacela D. Coronary sinus reducer device for the treatment of refractory angina therapy. A multicentric initial experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The coronary sinus Reducer device (CSRD) emerged as a complementary therapy in patients with severe angina refractory to optimal medical therapy and not amenable to revascularization. Our aim was to assess the safety and efficacy of the CSRD in a real-world setting.
Methods
Twenty-six patients with refractory angina (RA), evidence of myocardial ischemia attributable to the left coronary artery unsuitable for revascularization were treated with the CSRD at two centres between May 2017 and July 2019. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at 6-month follow-up, were a reduction in CCS class, improvement in quality of life (QoL) assessed using the short version of the Seattle Angina Questionnaire (SAQ-7) and reduction in anti-anginal therapy.
Results
Twenty-three patients had end-stage CAD without revascularization targets and 3 patients had microvascular disease without epicardial stenosis. Procedural success was achieved 23 patients, with 2 device/procedural-related complications and one anatomically-related failure to deliver the device. Ultimately 25 patients implanted the device and entered the efficacy analysis. Eighteen patients (75.0%) had at least 1 reduction in CCS class, 41.7% had at least 2 class reductions, and 16.7% became asymptomatic, with a mean reduction of CCS class of 1.3±0.2 (p=0.001) at 6-month follow-up. All SAQ-7 domains improved, namely physical limitation (p=0.001), angina frequency (p=0.005) and QoL (p=0.006). There was a mean reduction of anti-ischemic drugs from 3.4±1.1 to 2.9±1.2 (p=0.010).
Conclusion
In this real-world, multicentric experience, implantation of the CSRD was associated with improvement of angina and QoL in patients with RA.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
| | - C Brizido
- Hospital de Santa Cruz , Lisbon , Portugal
| | - S Madeira
- Hospital de Santa Cruz , Lisbon , Portugal
| | - R Ramos
- Hospital de Santa Marta , Lisbon , Portugal
| | - M Almeida
- Hospital de Santa Cruz , Lisbon , Portugal
| | - D Cacela
- Hospital de Santa Marta , Lisbon , Portugal
| |
Collapse
|
12
|
Pereira D, Almeida M, Facão M, Pinto AN, Silva NA. Probabilistic shaped 128-APSK CV-QKD transmission system over optical fibres. Opt Lett 2022; 47:3948-3951. [PMID: 35913355 DOI: 10.1364/ol.456333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
In this Letter we present a discrete modulated, continuous variables quantum key distribution implementation using two probabilistically shaped, 128-symbol, amplitude and phase shift keying constellations. At Bob's detection side, a polarization diverse, true heterodyne receiver architecture is implemented for symbol recovery. We demonstrate experimentally that our system is capable of achieving security against collective attacks, while using accessible, telecom-grade material, and of functioning for an indefinitely long period of time at distances in excess of 185 km, in the asymptotic regime.
Collapse
|
13
|
Junça-Silva A, Almeida M, Gomes C. The Role of Dogs in the Relationship between Telework and Performance via Affect: A Moderated Moderated Mediation Analysis. Animals (Basel) 2022; 12:ani12131727. [PMID: 35804626 PMCID: PMC9264855 DOI: 10.3390/ani12131727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary In this research, we conducted a study with an overall sample of 401 individuals to test a mediating model between telework, positive affect, and self-reported job performance. Additionally, we analyzed whether dogs’ physical closeness and emotional attachment would moderate this mediating path. The results showed that telework was significantly and positively related to positive affect, which in turn, increased self-reported job performance. Moreover, the mediation model was moderated by the dog’s physical closeness while working and emotional attachment to them, in such a way that the relationship between telework on self-reported job performance, via positive affect was strengthened when the owner‘s physical and emotional closeness to their dogs was higher. In sum, telework might be an efficient strategy to improve performance among employees who have dogs at home, because working with them nearby, when emotionally attached to them, are factors that enhance the individual‘s self-perceived performance in telework. Abstract Although there is evidence that pets may help individuals facing significant daily stressors, and that they may enhance the well-being of their owners, little is known about the benefits of pets for job performance. Since the COVID-19 pandemic crisis, teleworking was a strategy implemented in many countries to reduce the virus widespread and to assure organizational productivity. Those who work from home and who own pets may work close to them. Based on the conservation of resources theory, this study aimed to analyze whether positive affect mediated the relationship between telecommuting and self-reported job performance and if psychological and physical closeness to the pet would moderate this relationship in such a way that it would be stronger for those who worked closer to their pet, and who were more emotionally attached to them. For this study, we collected data from 81 teleworkers who did not own pets, and from 320 teleworkers who owned pets. Both answered an online questionnaire. Findings: Results from the study showed the existence of significant differences between those who owned and who did not own pets regarding positive affect and performance, in which those who owned pets reported higher levels of positive affect and self-reported performance and perceived telework more positively. Moreover, positive affect mediated the relationship between telework and self-reported job performance. Furthermore, emotional and physical closeness moderated the mediating effect. This study contributes to a better understanding of the human-animal interaction and how pets can be a personal resource able to change their owners‘ affective experiences and job performance while they are working from home. The findings demonstrate that telework may be a suitable organizational strategy for pet-owners.
Collapse
Affiliation(s)
- Ana Junça-Silva
- ISCTE–IUL, Business Research Unit, Lisbon University Institute, Avenida das Forças Armadas, 1649-026 Lisboa, Portugal
- Instituto Politécnico de Tomar, Escola Superior de Gestão de Tomar, Quinta do Contador, Estrada da Serra, 2300-313 Tomar, Portugal;
- Correspondence: or
| | - Margarida Almeida
- Instituto Politécnico de Tomar, Escola Superior de Gestão de Tomar, Quinta do Contador, Estrada da Serra, 2300-313 Tomar, Portugal;
| | - Catarina Gomes
- CIPES, Centro de Investigação em Política, Economia e Sociedade, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande, 376, 1749-024 Lisboa, Portugal;
- Escola de Ciências Económicas e das Organizações, Universidade Lusófona de Humanidades e Tecnologias, 1749-024 Lisboa, Portugal
- TRIE: Centro de Investigação Transdisciplinar Para o Empreendedorismo e Inovação Ecossistémica, Universidade Lusófona de Humanidades e Tecnologias, 1749-024 Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
| |
Collapse
|
14
|
Jesus S, Costa A, Simões G, Dias Dos Santos G, Almeida M, Alcafache J, Garrido P. TOO MUCH OF NOT ENOUGH: Exploring Lack of Fear and Its Consequences. Eur Psychiatry 2022. [PMCID: PMC9567032 DOI: 10.1192/j.eurpsy.2022.1900] [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: 12/02/2022] Open
Abstract
Introduction Fear is an unpleasant emotional response to perceiving a threat causing physiological changes. Humans feel fear for positive motives, as it plays a crucial role in our survival. Just as the right balance in life is ideal, pathological fear is often described in one of its exaggerations, of having too much. However, lack of fear or “hypophobia” can be just as devastating and debilitating. This can be demonstrated in the analogy between those who feel no pain who also demonstrate increased risk and decreased life expectancy. Objectives The authors aim to explore the concept of fear, discussing currently known physiological mechanisms in order to explain the effects that alterations of these mechanisms can have on fear responses, namely lack of fear, and subsequently the consequence of this on mental health. Methods A brief non-systematized literature review was performed based on works most pertinent to the topic discussed. Results Muted fear responses have been mentioned in the literature, principally associated with medical conditions affecting the physiological fear pathways, including Urbach-Wiethe disease. Amygdala damage provokes abnormal fear reactions and reduced fear experience. This appears to be similar to what is seen in psychopathy, where abnormalities in the limbic system produce abnormal fear responses. Conclusions Any extreme can cause havoc on a well-balanced machine. Just as the excess of fear results in mental issues such as anxiety, a lack of fear can also be debilitating. Those demonstrating less fear could help investigators better understand mental health disorders that have been demonstrated to be mediated by similar processes. Disclosure No significant relationships.
Collapse
|
15
|
Jesus S, Costa A, Simões G, Dias Dos Santos G, Almeida M, Garrido P. YOU’VE BEEN CATFISHED: An exploration of social deception on online platforms. Eur Psychiatry 2022. [PMCID: PMC9566174 DOI: 10.1192/j.eurpsy.2022.1477] [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
Life is a stage in which we are all actors and online we can choose who we want to be. Catfishing is a modern phenomenon in which individuals present themselves online as someone they are not as a means of engaging with others through an idealized avatar. This term has gained prominence since its portrayal in documentary and television series. With the emergence of catfishing, an expectation of betrayal in online relationships is anticipated with increasing caution being exercised by those that engage in online forums.
Objectives
The authors aim to explore this phenomenon and explore what personality traits might be associated with those who engage in catfishing others and in those that fall for the dupe.
Methods
A review of the recent literature on the topic with focus on that which is most relevant to the theme was included.
Results
The literature demonstrates that catfishing is an increasing trend as our online social interaction also increases. Catfishing appears to exist on a scale, where approximately 80% of the online population engage in some form, by means of amplifying their social status. Those with low self-esteem, poor self-worth with and a need to connect and to be validated were most susceptible.
Conclusions
The internet permits anonymity where trading “real world” skins with digital ones creating avatars in order to seek what is desired. Catfishing raises questions about the nature of the human self and the role it plays in deception. Understanding how patients use the internet may provide insight into how personality acts on a stage of total anonymity.
Disclosure
No significant relationships.
Collapse
|
16
|
Jesus S, Costa A, Simões G, Almeida M, Garrido P. MURDEROUS MYTHOMANIA: Psychopathology of lying – Apropos a Clinical Case. Eur Psychiatry 2022. [PMCID: PMC9567703 DOI: 10.1192/j.eurpsy.2022.1829] [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: 11/26/2022] Open
Abstract
Introduction The capacity for lying is a common human phenomenon with evolutionary explanations, in which one seeks to deceive usually to avoid harmful or undesired consequences. The spectrum of lies is vast and varies from the content to the motivation. Pathological lying has the potential to affect mental evaluations thus motivating an important discussion regarding this behaviour. Objectives The authors aim to explore the psychopathological concept and spectrum of pathological lies, from their underlying motives to their implications and challenges in psychiatric diagnosis with recourse to a clinical case example. Methods A review of pertinent literature on the topic with focus on that which is most relevant to the theme was included. The authors present the clinical case of a middle-aged female who presented with mythomania which included the fabrication of having attempted murder. Results The literature demonstrates a relationship between compulsive lying and personality disorders. Head trauma and other central nervous system issues may also play a role. Some traits may facilitate the detection of deception, such as dramatic and unmotivated constructs with a positive self-portrayal. The clinical case description correlates the personality factors associated with mythomania, namely antisocial personality disorder, differing from the typical presentation as her fabrications portrayed her negatively. Conclusions The implication of pathological lying is that it may interfere with mental assessment thus altering, by way of deception, the psychiatric evaluation as lies may be difficult to detect upon a first evaluation. The psychiatrist should be alerted to the possibility of fabrication when dealing with a patient with predisposing factors. Disclosure No significant relationships.
Collapse
|
17
|
Costa A, Jesus S, Almeida M, Alcafache J. Psychogenic epidemic - mass hysteria phenomena in Portugal. Eur Psychiatry 2022. [PMCID: PMC9567156 DOI: 10.1192/j.eurpsy.2022.999] [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 Mass hysteria also called mass psychogenic illness (MPI), defined as a social phenomenon, consists of collective anxiety due to a perceived threat and can culminate in a cascade of symptoms suggestive of organic disease without an identifiable cause. Its history dates back to the 14th century and impacts people from all cultures and regions of the world. Before the 20thcentury, MPI emerged across Europe, often in socially isolated convents, in highly stressful environments. Objectives
The aim of this study is to explore the available literature on mass hysteria phenomena in Portugal, historical origins, applications and eventual position in modern psychiatric semiology. Methods Non-systematic review of literature published in Medline/Pubmed. Search terms included: mass hysteria, nocebo, groupthink, emotional contagion. Results
In Portugal two great phenomena of mass hysteria were described. In 1917, the “sun miracle” occurred, where thousands of individuals reported having seen the sun rotating in the sky and changing its size and colours. Years later, more than 300 students from 14 schools described the same symptoms: dizziness, dyspnea and rash, without an identifiable cause. In common these young people had “sugar strawberries”. In May 2006, the young people in the television series were infected with a vírus, and clinical picture was similar to that presented by young people in real life. For the first time, a fictional illness on television triggered an illness in real life. Conclusions More studies should be carried out on these phenomena as their early recognition can have a tremendous impact on the ease of identification, diagnosis and treatment. Disclosure No significant relationships.
Collapse
|
18
|
Costa A, Jesus S, Almeida M, Alcafache J. Folie à deux: contagious mental illness? Report of a clinical case. Eur Psychiatry 2022. [PMCID: PMC9567602 DOI: 10.1192/j.eurpsy.2022.2053] [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
Folie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists.
Objectives
The aim of this article is to report a clinical case of folie à deux, between na inducer son and an induced mother. Review the nosological significance of folie à deux and to explore the disorder among patients with psychosis.
Methods
Search in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion.
Results
We presente a case of folie à deux between na inducer son 28 years old and the induced, his mother. They were found to be sharing similiar delusional beliefs. The patient has assumed the role of “man of the house” since his father’s death.
Conclusions
Many years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists. Its recognition and correct referral for a rare diagnosis, such as folie a deux, are extremely important.
Disclosure
No significant relationships.
Collapse
|
19
|
Cardoso T, Rodrigues PP, Nunes C, Almeida M, Cancela J, Rosa F, Rocha-Pereira N, Ferreira I, Seabra-Pereira F, Vaz P, Carneiro L, Andrade C, Davis J, Marçal A, Friedman ND. Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients. Ann Intensive Care 2021; 11:180. [PMID: 34950977 PMCID: PMC8702585 DOI: 10.1186/s13613-021-00966-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important. Methods Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included. Results There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p < 0.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic. Conclusions To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00966-7.
Collapse
Affiliation(s)
- T Cardoso
- Intensive Care Unit (UCIP) and Hospital Infection Control Committee, Hospital de Santo António, Oporto University Hospital Center, University of Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - P P Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences & CINTESIS, Faculty of Medicine, University of Porto, Rua Dr. Plácido Costa, s/n, 4200-450, Porto, Portugal
| | - C Nunes
- Intensive Care Unit and Hospital Infection Control Committee, Hospital de Bragança, Northeastern Local Health Unit, Av. Abade Baçal, 5301-852, Bragança, Portugal
| | - M Almeida
- Neurocritical Care Unit and Hospital Infection Control Committee, Hospital de São Marcos, Sete Fontes - São Vitor, 4710-243, Braga, Portugal.,Intensive Care Unit (UCIP), Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - J Cancela
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal
| | - F Rosa
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal
| | - N Rocha-Pereira
- Infectious Diseases Department, São João Hospital Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - I Ferreira
- Internal Medicine Department, Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - F Seabra-Pereira
- Intensive Care Unit (UCIP), Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Intensive Care Unit and Internal Medicine Department, Hospital da Prelada, Rua de Sarmento de Beires, 4250-449, Porto, Portugal
| | - P Vaz
- Internal Medicine Department and Hospital Infection Control Committee, Hospital de Bragança, Northeastern Local Health Unit, Av. Abade Baçal, 5301-852, Bragança, Portugal
| | - L Carneiro
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal
| | - C Andrade
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal.,Internal Medicine Department, Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - J Davis
- Department of Renal Medicine, Barwon Health, Geelong, VIC, 3220, Australia
| | - A Marçal
- Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal.,Internal Medicine Department, Hospital de Santo António, Oporto University Hospital Center, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - N D Friedman
- Department of Infectious Diseases, Barwon Health, Geelong, VIC, 3220, Australia
| |
Collapse
|
20
|
Almeida M, Pereira D, Muga NJ, Facão M, Pinto AN, Silva NA. Secret key rate of multi-ring M-APSK continuous variable quantum key distribution. Opt Express 2021; 29:38669-38682. [PMID: 34808915 DOI: 10.1364/oe.439992] [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] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
Discrete modulation continuous variable quantum key distribution (DM-CV-QKD) is highly considered in real implementations to avoid the complexity of Gaussian modulation (GM), which is optimum in terms of the key rate. DM-CV-QKD systems usually consider M-symbol phase shift keying (M-PSK) constellations. However, this type of constellation cannot reach transmission distances and key rates as high as GM, limiting the practical implementation of CV-QKD systems. Here, by considering M-symbol amplitude and phase shift keying (M-APSK) constellations, we can approximate GM. Indeed, considering finite-size effects, 4 ring 64-APSK can reach 52.0 km, only 7.2 km less than GM and 282% the maximum achievable transmission distance for 8-PSK.
Collapse
|
21
|
Bernabeu AM, Plaza-Morlote M, Rey D, Almeida M, Dias A, Mucha AP. Improving the preparedness against an oil spill: Evaluation of the influence of environmental parameters on the operability of unmanned vehicles. Mar Pollut Bull 2021; 172:112791. [PMID: 34523429 DOI: 10.1016/j.marpolbul.2021.112791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
When an oil spill occurs, a prompt response reduces significantly the impact. The preparedness and contingency plans are essential to identify the most appropriate technologies. Unmanned and autonomous vehicles (UAVs) is emerging as a powerful tool of strategic potential in the observation, oil tracking and damage assessment of an oil spill. The SpilLess project explored the suitability of these devices to be the first-line response to an oil spill. This work analyses the operational requirements related to environmental parameters following a two steps approach: 1) Environmental characterization from long wind and waves time series and modelling; 2) Definition of the optimal periods for operating each UAVs. We have defined the periods in which each of these facilities acts best, confirming that the operational limits of UAVs are not significantly more restrictive than the traditional operations. UAVs should be included in contingency plans as available tools to fight against oil spills.
Collapse
Affiliation(s)
- A M Bernabeu
- Centro de Investigación Mariña, Universidade de Vigo, GEOMA, 36310 Vigo, Spain.
| | - M Plaza-Morlote
- Centro de Investigación Mariña, Universidade de Vigo, GEOMA, 36310 Vigo, Spain
| | - D Rey
- Centro de Investigación Mariña, Universidade de Vigo, GEOMA, 36310 Vigo, Spain
| | - M Almeida
- CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal
| | - A Dias
- INESC Technology and Science, Porto, Portugal; ISEP - School of Engineering of Porto Polytechnic Institute, Porto, Portugal
| | - A P Mucha
- CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; FCUP - Faculty of Sciences, University of Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal
| |
Collapse
|
22
|
Rocha B, Nolasco T, Teles R, Madeira S, Vale N, Madeira M, Brito J, Raposo L, Goncalves P, Gabriel HM, Sousa-Uva M, Abecasis M, Almeida M, Neves JP, Mendes M. TAVI via alternative access routes: patient selection and 10-year center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Femoral access is considered the gold standard for transcatheter aortic valve implantation (TAVI). However, this route might be precluded due to the presence of tortuosity, small vessel diameter and/or peripheral artery disease. We aimed to investigate TAVI through an alternative access (AA), focusing on the selection criteria and clinical outcomes compared to the femoral route (TF).
Methods
We conducted an all-comers longitudinal single-centre prospective registry in whom a TAVI was performed. The feasibility, safety and efficacy of TAVI by means of an access route other than standard TF was assessed, according to the VARC-2 criteria. The prospective surgical criteria used at our institution to accept an AA route were: a) TF deemed inappropriate; b) acceptable haemorrhagic risk; c) acceptable general anaesthesia risk; and d) adequate anatomy and diameter within acceptable range (subclavian, axillar, transaortic) or e) age <85 years and non-frail patient (transapical). The primary endpoint was all-cause death at 1-year.
Results
From 2008 to 2018, there were 548 patients submitted to TAVI [median age 84 (79–87) years, males 45.4%]. An AA route was used in 100 patients (79 trans-apical, 9 trans-aortic, and 12 trans-subclavian), with a decreasing rate over follow-up (−11% per year). Compared to TF, these patients were younger [80 (77–84) vs. 85 (80–87) years; p<0.001) with a similar baseline surgical risk as per EuroSCORE II [5.1 (3.3–9.0) vs. 4.7 (3.3–7.0); p=0.410). AA patients presented a higher burden of atherosclerotic disease, namely coronary (54.0 vs. 41.3%; p<0.001) and peripheral artery disease (35.0 vs. 16.5%, p<0.001) despite a lower number of other comorbidities (e.g. glomerular filtration rate <50mL/min: 53.1 vs. 64.8%; p=0.030). Left ventricular ejection fraction (56±13 vs 55±12%; p=0.203) and aortic stenosis severity (e.g. valve area: 0.70±0.19 vs. 0.67±0.18cm2; p=0.302) were similar between groups. Haemorrhagic events (minor or major) following TAVI were less often documented in the AA group (11.0 vs 21.7%; p=0.015), contrasting with de novo atrial fibrillation (18.5 vs 7.6%; p=0.048). Overall, 67 patients met the primary endpoint (18.8 vs 16.2%; p=0.584). After adjusted multivariate analysis, the independent predictors of one-year mortality did not include the TAVI access route.
Conclusion
In the first 10 years of experience, 1 in every 6 patients was treated with a TAVI by means of an AA, most often trans-apically initially and, nowadays, via a trans-subclavian approach. The use of meticulous prospective selection criteria seems to explain the one-year similar results, regardless of the access route.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- B Rocha
- Hospital de Santa Cruz, Lisbon, Portugal
| | - T Nolasco
- Hospital de Santa Cruz, Lisbon, Portugal
| | - R Teles
- Hospital de Santa Cruz, Lisbon, Portugal
| | - S Madeira
- Hospital de Santa Cruz, Lisbon, Portugal
| | - N Vale
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Madeira
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Brito
- Hospital de Santa Cruz, Lisbon, Portugal
| | - L Raposo
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | | | | | - M Abecasis
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J P Neves
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| |
Collapse
|
23
|
Presume J, Gomes D, Albuquerque F, Strong C, Trabulo M, De Araujo Goncalves P, Campante Teles R, Almeida M, Mendes M, Ferreira J. Incremental prognostic value of worsening renal function parameters in addition to the GRACE score in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Baseline renal function, one of the parameters included in the GRACE score, has prognostic relevance in patients admitted for acute coronary syndrome (ACS).
Purpose
The aim of this study was to compare different worsening renal function (WRF) parameters during hospitalization for ACS and their impact on all-cause mortality. Furthermore, we aimed to assess if these parameters had any incremental prognostic value in addition to the GRACE score.
Methods
We conducted a single-center retrospective study enrolling consecutive patients admitted for ACS from January 2016 to December 2018. Estimation of glomerular filtration rate (eGFR) for each patient was calculated based on the CKD-EPI formula. WRF during hospitalization was assessed by means of: serum creatinine (sCr) elevation ≥0,3mg/dL, duplication of the sCr value or maximum sCr value ≥2,0mg/dL.
Results
A total of 555 patients were included (65±13 years old, 72% male). Overall, 402 (72%) had hypertension, 167 (30%) were diabetic, 88 (16%) had left ventricular ejection fraction <40%. Mean GRACE score was 102.7±29.1 and median sCr at baseline was 0.83 mg/dL [0.70; 0.97]. Median length of hospitalization was 4 days [2; 10] and the mean follow-up of 963 days.
Baseline eGFR showed significant correlation with mortality during follow-up (HR 0.742 [95% CI 0.691–0.797] per 10 mL/min/1.73m2 increase in eGRF). Moreover, all WRF parameters showed significant association with all-cause mortality during follow-up on a univariate analysis - p<0,001 (Table 1). Elevation of sCr ≥0,3 mg/dL during hospitalization was the most frequent WRF parameter (210 patients - 38%) and the most sensitive parameter to predict our endpoint, occurring in 56 patients who died during follow-up (sensitivity 66.7%). Both duplication of sCr and absolute sCr ≥2,0mg/dL during hospitalization showed a lower prevalence; however, the majority of patients with one of these findings died during follow-up (51,4% and 68,5%, respectively).
On a multivariate Cox regression analysis, adjusted for the GRACE score, all individual WRF parameters remained independently associated with all-cause mortality during follow up (Table 2).
Conclusion
Worsening renal function has significant prognostic impact in patients admitted for ACS. Identification of these parameters during hospitalization adds significant value to the prognostic stratification of the GRACE score.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- J Presume
- Hospital de Santa Cruz, Lisbon, Portugal
| | - D Gomes
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - C Strong
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Trabulo
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | | | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Ferreira
- Hospital de Santa Cruz, Lisbon, Portugal
| |
Collapse
|
24
|
Oliveira L, Campante Teles R, Machado C, Madeira S, Vale N, Almeida C, Brito J, Leal S, Raposo L, Araujo Goncalves P, Pacheco A, Mesquita Gabriel H, Almeida M, Martins D, Mendes M. Impact of COVID-19 pandemic on ST-elevation myocardial infarction: data from two Portuguese centers. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1316] [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
Recently during the COVID-19 pandemic there was a general belief in a reduction of hospital admissions due to non-infectious causes, namely cardiovascular diseases.
Objectives
To evaluate the impact of the pandemic in the admissions by ST elevation acute myocardial infarction (STEMI), during the first pandemic wave.
Methods
Multicentric and retrospective analysis of consecutive patients presenting in two Portuguese hospital centers with STEMI in two sequential periods – P1 (1st March to 30th April) and P2 (1st May to 30th June). A comparison of patient's clinical and hospital outcomes data was performed between the year 2020 and 2017 to 2019 for both periods.
Results
A total of 347 consecutive STEMI patients were included in this study. The patient's baseline characteristics and cardiovascular risk factors were similar across the considered periods. During P1 of 2020, in comparison with previous years, a reduction in the number of STEMI patients was observed (26.0±4.2 vs 16.5±4.9 cases per month; p=0.033), contrary to what was observed during P2 (19.5±0.7 vs 20.5±0.7 cases per month; p=0.500). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs 9.1%; p=0.033). A global trend in longer delays in time-key bundles of STEMI care was noted, namely pain to first medical contact, door to needle, door to wire crossing and symptoms to wire crossing times, however without statistical significance. Mortality rate was six-fold higher during P1 comparing to previous years (1.9% vs 12.1%; p=0.005), and also an increase in the number of mechanical complications (0.0% vs 3.0%; p=0.029) was observed.
Conclusions
During the first COVID-19 pandemic wave there were fewer patients presenting with STEMI at catheterization laboratory for coronary angioplasty. These patients presented more mechanical complications and higher mortality rates.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- L Oliveira
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | | | - C Machado
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - S Madeira
- Hospital Santa Cruz, Lisbon, Portugal
| | - N Vale
- Hospital Santa Cruz, Lisbon, Portugal
| | - C Almeida
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - J Brito
- Hospital Santa Cruz, Lisbon, Portugal
| | - S Leal
- Hospital Santa Cruz, Lisbon, Portugal
| | - L Raposo
- Hospital Santa Cruz, Lisbon, Portugal
| | | | - A Pacheco
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | | | - M Almeida
- Hospital Santa Cruz, Lisbon, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - M Mendes
- Hospital Santa Cruz, Lisbon, Portugal
| |
Collapse
|
25
|
Custodio P, Madeira S, Teles R, Almeida M, Mendes M. Prognostic impact of the presence and management of coronary artery disease in patients undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2125] [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
Approximately half of transcatheter aortic valve implantaton (TAVI) candidates have coronary artery disease (CAD). Controversial results have been reported regarding the effect of the presence/severity of CAD and its management on clinical outcomes post-TAVI.
Aim
To describe the presence, extension, severityand management of CAD pre-TAVIand to evaluate its impact on 2-yearmortality in areal world all comers population.
Methods and population
Single centre retrospective analysis from a prospectively collected institutional registry (VCROSS) including 517 patients that underwent TAVI for severe aortic stenosis between January 2009 and December 2018. Patients who underwent pre TAVI CA in the context of ACS or at other institution were excluded n=138. Ultimately 380 entered the analysis. Obstructive CAD was defined as stenosis >50% in in major epicardial vessels (>2.5 mm). The total number of major epicardial with obstructive CAD was reported as was assessed the number of those left untreated. Univariate analysis was performed to assess 1) differences between patients with or without CAD and between those with significant CAD who have or have not undergone PCI, 2) variables associated with 2-year mortality. Binary logistic regression was performed to identify independent predictors of 2-year mortality including the presence of significant CAD and the type of management.
Results
A total of 380 patients were included, 55.3% male with an average age of 83YO (±6.3), mean Euroscore II of 4.35. 76 had previous coronary artery bypassgrafting (CABG) and 136 had previous PCI (43 had both). 55 patients (14.4%) presented with normal coronary arteries, 120 (31.6%) with non-obstructive CAD and 205 (54%) with obstructive CAD. Out of the latter, 112 (29.5%) underwent PCI. Statistically significant differences were found between obstructive CAD vs non-obstructive patients in terms of age, previous history of ICP and CABG. In the subgroup population with obstructive CAD, no statistically significant differences was found in the PCI vs non PCI group, apart from previous history of ICP and CABG – Figure 1. Diabetes mellitus, previous history of percutaneous coronary intervention (PCI) and reduced ejection fraction (rEF – defined has <50% echocardiographically) had a negative prognosticimpact in the 2 year mortality of the 380 patients. 2-year mortality was 14,5% (55 patients).The presence and management of CAD pre TAVI had no impact in 2-year mortality, when accounting for the differences in previous ICP history, CABG, age, and rEF.
Conclusion
The presence and type of management of obstructive CAD in this real world all comers registry did not impact the prognosis at 2 years.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- P Custodio
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - S Madeira
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Teles
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| |
Collapse
|
26
|
Fontinha D, Sousa SA, Morais TS, Prudêncio M, Leitão JH, Le Gal Y, Lorcy D, Silva RAL, Velho MFG, Belo D, Almeida M, Guerreiro JF, Pinheiro T, Marques F. Gold(iii) bis(dithiolene) complexes: from molecular conductors to prospective anticancer, antimicrobial and antiplasmodial agents. Metallomics 2021; 12:974-987. [PMID: 32391537 DOI: 10.1039/d0mt00064g] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The anticancer, antimicrobial and antiplasmodial activities of six gold(iii) bis(dithiolene) complexes were studied. Complexes 1-6 showed relevant anticancer properties against A2780/A2780cisR ovarian cancer cells (IC50 values of 0.08-2 μM), also being able to overcome cisplatin resistance in A2780cisR cells. Complex 1 also exhibited significant antimicrobial activity against Staphylococcus aureus (minimum inhibitory concentration (MIC) values of 12.1 ± 3.9 μg mL-1) and both Candida glabrata and Candida albicans (MICs of 9.7 ± 2.7 and 19.9 ± 2.4 μg mL-1, respectively). In addition, all complexes displayed antiplasmodial activity against the Plasmodium berghei parasite liver stages, even exhibiting better results than the ones obtained using primaquine, an anti-malarial drug. Mechanistic studies support the idea that thioredoxin reductase, but not DNA, is a possible target of these complexes. Complex 1 is stable under biological conditions, which would be important if this compound is ever to be considered as a drug. Overall, the results obtained evidenced the promising biological activity of complex 1, which might have potential as a novel anticancer, antimicrobial and antiplasmodial agent to be used as an alternative to current therapeutics.
Collapse
Affiliation(s)
- Diana Fontinha
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sílvia A Sousa
- iBB-Institute for Bioengineering and Biosciences, Departmento de Bioengenharia, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Tânia S Morais
- Centro de Química Estrutural, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
| | - Miguel Prudêncio
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Jorge H Leitão
- iBB-Institute for Bioengineering and Biosciences, Departmento de Bioengenharia, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Yann Le Gal
- Univ Rennes, CNRS, ISCR (Institut des Sciences Chimiques de Rennes) - UMR 6226, F-35000 Rennes, France
| | - Dominique Lorcy
- Univ Rennes, CNRS, ISCR (Institut des Sciences Chimiques de Rennes) - UMR 6226, F-35000 Rennes, France
| | - Rafaela A L Silva
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal.
| | - Mariana F G Velho
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal. and Instituto de Telecomunicações, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisboa, Portugal
| | - Dulce Belo
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal.
| | - M Almeida
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal.
| | - Joana F Guerreiro
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal.
| | - Teresa Pinheiro
- iBB-Institute for Bioengineering and Biosciences, Departamento de Engenharia e Ciências Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Fernanda Marques
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal.
| |
Collapse
|
27
|
Alves M, Almeida M, Oliani AH, Breitenfeld L, Ramalhinho A. P–569 Woman with CYP19A1 TC/CC genotype have increased susceptibility to infertility development, independently of the cause. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.568] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Is TC/CC genotype of codon 39 at CYP19A1 gene associated with the development of female infertility?
Summary answer
Yes, CYP19A1 codon 39 TC/CC genotype is associated with increased susceptibility to infertility development in women, regardless of associated cause.
What is known already
Aromatase protein is responsible for the aromatization of androgens into estrogens. This protein that catalyzes the final step in biosynthesis of estrogens is encoded by the gene CYP19A1. The CYP19A1 gene is located on chromosome 15q21.1. It is a member of the cytochrome P450 superfamily which are monooxygenases that catalyze many reactions involved in steroidogenesis. TC/CC genotype of codon 39 at CYP19A1 gene results in an increase of aromatase activity and thus affect the hormone levels which can lead to the development of various diseases, including infertility.
Study design, size, duration
A case-control study was designed to investigate the association of CYP19A1 gene polymorphism with female infertility. Case subjects, 201 women with infertility established as women under 39 years of age, that failed to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse. 161 fertile female controls, with no previous history of infertility, no previous history of gynecological pathologies compatible with infertility, and no history of IVF treatments, were selected.
Participants/materials, setting, methods
Blood was collected by venous puncture and genomic DNA was extracted. CYP19A1 genotyping was performed by polymerase chain reaction-based methods with confronting two-pair primers. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by unconditional logistic regression.
Main results and the role of chance
Significant statistical association of the TC/CC genotype combined with endometriosis risk was found, with reference to TT genotype (OR 4.554; 95% CI 2.209–9.386; p < 0.001). We also found an increased risk of developing polycystic ovary syndrome (PCOS) associated with TC/CC genotype (OR 5.317; 95% CI 2.767–10.215; p < 0.001). We also observed an increased prevalence of premature ovarian failure associated with TC/CC genotype (OR 3.376; 95% CI 1.672–6.815; p = 0.001) and verified an increased prevalence of tubal pathology in carriers of TC/CC genotype (OR 3.231; 95% CI 1.653–6.314; p = 0.001). Finally, a strong association of TC/CC genotype with female infertility, regardless of the cause was found (OR 4.232; 95% CI 2.710–6.609; p < 0.001). In conclusion, TC/CC genotype is associated with increased susceptibility to infertility development in women.
Limitations, reasons for caution
The sample size may eventually be considered small, despite the strong significance found.
Wider implications of the findings: There are not many studies in this area and the few existing exhibit disparate results. The association of TC/CC genotype with endometriosis was observed in a few studies, but some disagree. This difference could be attributed to the notable heterogeneity across the different studies.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- M Alves
- Academic Hospital Center of Cova da Beira, Assisted Reproduction Unit, Covilhã, Portugal
- University of Beira Interior, CICS-UBI-Health Sciences Research Centre, Covilhã, Portugal
| | - M Almeida
- University of Beira Interior, CICS-UBI-Health Sciences Research Centre, Covilhã, Portugal
| | - A H Oliani
- Academic Hospital Center of Cova da Beira, Assisted Reproduction Unit, Covilhã, Portugal
| | - L Breitenfeld
- University of Beira Interior, CICS-UBI-Health Sciences Research Centre, Covilhã, Portugal
| | - A Ramalhinho
- Academic Hospital Center of Cova da Beira, Assisted Reproduction Unit, Covilhã, Portugal
- University of Beira Interior, CICS-UBI-Health Sciences Research Centre, Covilhã, Portugal
| |
Collapse
|
28
|
Goyal S, Tanigawa Y, Zhang W, Jin-Fang C, Almeida M, Sim X, Lerner M, Chainakul J, Ramiu J, Seraphin C, Apple B, Vaughan A, Muniu J, Peralta J, Lehman D, Ralhan S, Wander G, Singh J, Mehra N, Sidorov E, Peyton M, Blackett P, Curran J, Tai E, Van Dam R, Cheng CY, Duggirala R, Blangero J, Chambers J, Sabanayagam C, Kooner J, Rivas M, Sanghera D. Association of ApoCIII common variants with risk of coronary artery disease: A Mendelian randomization study. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.036] [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: 10/20/2022]
|
29
|
Silva C, Goncalves M, Lopes P, Ventosa A, Calqueiro J, Freitas PN, Guerreiro S, Brito J, Abecasis J, Raposo L, Saraiva C, Goncalves PA, Gabriel HM, Almeida M, Ferreira AM. Patients undergoing invasive coronary angiography after a positive single-photon emission computed tomography or a positive stress cardiac magnetic resonance - What to expect at the cath lab. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). However, there are few data on whether or not this remains true in routine clinical practice.
The aim of this study was to assess the clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after a positive stress CMR or positive SPECT, and to compare their positive predictive value with published results from the CE-MARC trial.
Methods
In this retrospective tertiary-center analysis, we included 429 patients (mean age 67 ± 10 years, 28% women, 42% diabetic) undergoing ICA between January 2016 and December 2020, after a positive stress CMR or positive SPECT. Regarding stress test, an adenosine protocol was performed in all stress CMR and in 76.4% (n = 272) of stress SPECT.
Stress test results, including ischemia location and severity, were classified as reported by their primary readers. Patients with missing data on key variables, and those in whom microvascular disease was considered likely in the original stress test report were excluded. Obstructive CAD was defined as any coronary artery stenosis ≥ 50% in a vessel compatible with the ischemic territory on stress testing.
Results
Out of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ regarding age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p = 0.046). Overall, 320 patients (75%) had obstructive CAD on ICA. The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p = 0.385). There were also no significant differences in the prevalence of left main or 3-vessel disease (9.0% vs. 9.6%, p = 0.871, and 19.7% vs. 23.3% p = 0.483, respectively). Revascularization was performed or planned in 59.3% of patients in the SPECT group, and 52.1% of those in the stress CMR group (p = 0.255). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial (Figure), and would increase to 88.1% and 89.4% for SPECT and stress CMR, respectively, if patients reported as having only mild ischemia were excluded.
Conclusion
In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial.
Collapse
Affiliation(s)
- C Silva
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - P Lopes
- Hospital de Santa Cruz, Lisbon, Portugal
| | - A Ventosa
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - PN Freitas
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - J Brito
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Lisbon, Portugal
| | - L Raposo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Saraiva
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - HM Gabriel
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | | |
Collapse
|
30
|
Chaves C, Cunha F, Martinho M, Garrido S, Silva-Vieira M, Estevinho C, Melo A, Figueiredo O, Morgado A, Almeida MC, Almeida M. Metformin combined with insulin in women with gestational diabetes mellitus: a propensity score-matched study. Acta Diabetol 2021; 58:615-621. [PMID: 33459895 DOI: 10.1007/s00592-020-01665-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/24/2020] [Indexed: 01/22/2023]
Abstract
AIM Metformin use in gestational diabetes (GDM) is a common practice. Although its use in combination with insulin might be advantageous, it was never formally tested. We studied whether combined treatment was associated with better obstetric or neonatal outcomes compared to insulin alone. METHODS This is a retrospective study, using the Portuguese National Registry of GDM (2012-2017), of women treated with insulin ± metformin. Primary endpoints were obstetric and neonatal complications. Secondary endpoints were gestational weight gain (GWG) and insulin dose. A propensity score-matched analysis was performed to balance the distribution of age, BMI, insulin treatment duration, HbA1c, first trimester diagnosis of GDM and previous GDM or macrosomia. Women treated with metformin plus insulin and insulin only were then compared. RESULTS A total of 4034 women were treated with insulin or insulin plus metformin (10.2%). After propensity score matching, we studied two groups of 386 patients. Obstetric and neonatal complications were similar. Women treated with metformin plus insulin had 201 (52.1%) obstetric complications versus 184 (47.7%) in insulin-only group, p = 0.22; and 112 (29.0%) neonatal complications versus 96 (24.9%), p = 0.19. Patients treated with metformin plus insulin had similar GWG, excessive weight gain and insulin dose compared to the insulin-only group. CONCLUSIONS Women with GDM treated with insulin plus metformin had similar obstetric and neonatal complications, weight gained and insulin dose compared to those only treated with insulin.
Collapse
Affiliation(s)
- Catarina Chaves
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal.
| | - Filipe Cunha
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Mariana Martinho
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Susana Garrido
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Margarida Silva-Vieira
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| | - Catarina Estevinho
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Anabela Melo
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Odete Figueiredo
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana Morgado
- Serviço de Ginecologia e Obstetrícia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Maria Céu Almeida
- Serviço de Obstetrícia, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Almeida
- Serviço de Endocrinologia do Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007, Guilhufe, Penafiel, Portugal
| |
Collapse
|
31
|
Leite RA, Almeida M, Costa A, Alcafache J, Mesquita A. First psychotic episode as first manifestation of lyme disease: Case report. Eur Psychiatry 2021. [PMCID: PMC9480174 DOI: 10.1192/j.eurpsy.2021.2148] [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 Lyme disease (LD) is caused by the spirochete Borrelia burgdorferi (Bb) and has been reported to be associated with various psychiatric presentations. Objectives To report a case with LD and to highlight the importance of differential diagnosis in a first psychotic episode. Methods Case report and non-systematic review of the literature. Results
A woman aged 31 was admitted to the psychiatric department, after a car accident with a mortal victim, due to a first psychotic episode with visual hallucinations, disorientation in time and space, persecutory and grandiosity delusions. She had a personal psychiatric history of obsessive-compulsive disorder and no previous admission to an inpatient Unit. On psychotropic drugs the condition failed to improve, and subsequently neurological symptoms developed. EEG abnormalities prompted a lumbar puncture. In the CSF a strong plasma cell reaction with atypical cells was observed. The enzyme immunoassay for Borrelia burgdorferi was positive and after treatment with penicillin the psychiatric and neurological signs and symptoms remitted. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, mental status exam, neurological exam and physical exam relevant to the patient’s complaints and findings with clinical judgment, pattern recognition and knowledgeable interpretation of laboratory findings facilitates diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression. Conclusions LD is relatively rare, but awareness of the association between LD and neuropsychiatric presentations can improve understanding of the causes of mental illness and result in more effective prevention, diagnosis and treatment. Disclosure No significant relationships.
Collapse
|
32
|
Borges J, Leite RA, Almeida M, Morais S, Madeira N. Attention deficit hyperactivity disorder in adulthood and the heritability of this condition. Eur Psychiatry 2021. [PMCID: PMC9479830 DOI: 10.1192/j.eurpsy.2021.1638] [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 Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and/or hyperactivity-impulsivity resulting from the interaction of genetic and environmental risk factors. Family studies shows that persistent ADHD is very familial. Objectives We aim to review the literature on this condition and its heritability and describe the implications that a possible misdiagnosis can have during life. Methods Bibliography review was performed using the databases PubMed and Cochrane, using the following keywords: “ADHD”; “Adults”; “Heretability”; “Family” and “Rater effect”. Results
Childhood ADHD persists into adolescence and adulthood substantially, identified in some studies, as going up to 78%. The prevalence of ADHD in children and adults is between 2.5% and 5% worldwide. Family studies have shown that children of adults with ADHD are at higher risk of having ADHD. Some large-scale twin studies of adult ADHD, used self-report assessments of ADHD symptoms and estimated the heritability of this condition to be between 30 to 40%, which differs from other studies that analyse parents and teachers responses and estimates heritability to be between 60 and 90%. Conclusions Since there is a direct influence of the evaluators in estimating the extent of ADHD heritability, future studies need to clarify and describe in detail all the related characteristics of the raters. Although ADHD is widely studied, there is still a lot to learn about its etiology. The diagnosis of ADHD is clinical and complex and must be considered both in childhood and adolescence and in adulthood, with special emphasis on the family antecedents. Disclosure No significant relationships.
Collapse
|
33
|
Leite RA, Almeida M, Borges J, Costa A. Lithium in severe affective disorders: Balancing safety with efficacy. Eur Psychiatry 2021. [PMCID: PMC9480386 DOI: 10.1192/j.eurpsy.2021.2060] [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
IntroductionLithium has been one of the oldest substances used in psychiatric treatments and remains the first-line treatment for prevention of manic and depressive episodes of bipolar disorder (BD), but it has also a wide spectrum of side-effects.ObjectivesThe goal is to review efficacy, and clinical use of lithium, such as its side effects, and its benefit-to-risk ratio.MethodsNon-systematic literature review based on scientific databases such as PubMed.ResultsThe first modern use of lithium was for the treatment of mania. Lithium has also proven useful in major depression, particularly for augmentation of antidepressants, for aggressive behavior and it has a specific antisuicide effect. Lithium’s prophylactic and antisuicidal effects are most unique. However, the use of lithium became problematic due to the serious toxicity since lithium also a narrow therapeutic index, with therapeutic levels between 0.6 and 1.5 mEq/L.ConclusionsAwareness of the benefits and risks of lithium is essential for the use of this lifesaving agent. Lithium levels must be carefully monitored and lithium dosage adjusted as necessary.DisclosureNo significant relationships.
Collapse
|
34
|
Sa Mendes G, Ferreira AM, Freitas P, Abecasis J, Campante Teles R, De Araujo Goncalves P, Ribeiras R, Santos AC, Trabulo M, Silva C, Lopes P, Andrade MJ, Saraiva C, Almeida M, Mendes M. Calcium score of the aortic valve as a predictor of aortic stenosis severity. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The calcium score of the aortic valve (CaScAoV) is now recommended as a supporting tool to assist in the grading of aortic stenosis (AS) severity when echocardiographic assessment is inconclusive. However, the proposed CaScAoV cut-offs for considering severe AS "unlikely", "likely", or "very likely" have never been validated in Portuguese cohorts.
Aim
The purpose of this study was to assess the performance of the proposed CaScAoV cut-offs in identifying patients with severe aortic stenosis.
Methods
A total of 513 consecutive patients (median age 83 years [IQR 79–87], 38% males) evaluated at a single-centre TAVI-programme between Jan/2016 and Nov/2019 were retrospectively identified. Only patients with an ECG-gated cardiac computed tomography (CT) and a transthoracic echocardiography performed within a 6-month time-frame were included. Main exclusion criteria were left ventricular ejection fraction < 50%, indexed stroke volume < 35 ml/m2, previous valve surgery and
bicuspid aortic disease. CaScAoV was measured according to the Agatston method (Agatston units – AU). As previously reported, the likelihood of aortic stenosis as assessed by CT was categorized as: "very likely" (>3000 AU for men, >1600 AU for women); "likely" (>2000 AU for men, >1200 AU for women) ; or unlikely (<1600 AU for men, <800 AU for women). Diagnostic tests performance measures were calculated for each category. Separate analyses were performed for each gender.
Results
Severe AS (mean gradient ≥ 40 mmHg) was present in 422 patients (overall 82.3%: 83.1% in females and 80.8% in males), with a median transvalvular gradient of 49 mmHg (IQR 42 – 60).
Overall, the discriminative ability of the CaScAoV to distinguish severe from non-severe AS was higher in men when compared with women (c-statistic 0.86 [95%CI 0.80 – 0.93] vs. 0.72 [95%CI 0.64 – 0.80], p for comparison < 0.001). In males, the "very likely" cut-off had a sensitivity of 71% (95%CI 63 – 78%), a specificity of 81% (95%CI 65 – 92%), a positive predictive value (PPV) of 94% (95%CI 89 – 97%) and a negative predictive value (NPV) of 40% (95%CI 33 – 46%) for the diagnosis of severe AS. Conversely, in women the sensitivity was 75% (95%CI 69 – 80%), specificity was 57% (95%CI 43 – 71%), PPV was 90% (95%CI 86 – 92%) and NPV was 32% (95%CI 25 – 39%).
On the other end of the spectrum, the "unlikely" cut-off showed poor performance in dismissing severe AS, particularly in females – NPV of 43% (95%CI 25-63%) in women vs. 83% (95%CI 63-93%) in men.
Conclusion
In our population, the discriminative power of CaScAoV for identifying patients with severe AS was lower than in previously published cohorts, particularly in females. While very high CaScAoV is strongly supportive of severe AS, caution should be employed when interpreting low CaScAoV values in women, since the recommended cut-off value does not allow the safe exclusion of severe aortic stenosis.
Abstract Figure. Waterfall chart of individuals CaScAoV
Collapse
Affiliation(s)
| | | | - P Freitas
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | | | - R Ribeiras
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - AC Santos
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Trabulo
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Silva
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - P Lopes
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - MJ Andrade
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Saraiva
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Carnaxide, Portugal
| |
Collapse
|
35
|
Albuquerque F, Brizido C, Madeira S, Teles R, Raposo L, Gabriel H, Leal S, Goncalves M, Brito J, Goncalves P, Almeida M, Mendes M. Patterns of revascularization in stable ischemic heart disease in the pre-ISCHEMIA era. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1468] [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
New evidence on the role of myocardial revascularization in stable ischemic heart disease (SIHD), recently presented, showed that revascularization guided by the presence of moderate-to severe ischemia relieves angina more effectively than optimal medical therapy (OMT), without a significant benefit in hard clinical endpoints.
Aim
To assess the representativeness of the ISCHEMIA trial in a real-world population and compare management strategies between patients who fulfill the eligibility criteria of the trial (Group 1, G1) and those who do not (Group 2, G2).
Methods and population
Single centre retrospective analysis including all consecutive patients referred to coronary angiography (CA) for SIHD from January 2018 to December 2019. Patients were stratified in two groups (G1 and G2) according to the ISCHEMIA trial inclusion and exclusion criteria. G1 was compared with G2 and with a subset of G2 with obstructive coronary artery disease (CAD), defined as ≥70% luminal stenosis in at least one coronary artery or >50% for the left main.
Results
A total of 1020 patients underwent CA, of whom only 124 (12.2%) would have been eligible for the ISCHEMIA trial (G1). Overall, there were no significant differences in baseline characteristics between the two groups. G1 patients had more extensive and severe disease, presenting more frequently with proximal left anterior descending (LAD) involvement (26.6% vs 10.4%; p<0.001), two vessel disease without proximal LAD stenosis (23.4% vs 10.3%; p<0.001) and three vessel disease (18.5% vs 5.9%; p<0.001). These patients had higher rates of revascularization, both CABG (25.8% vs 10.8%, p<0.001) and PCI (56.5% vs 39.5%, p<0.001). However, when comparing G1 with the subset of G2 patients with obstructive CAD, G1 patients had higher rates of CABG (26.8% vs 17.8%, p=0.034) but there were no differences on the rates of PCI (58.0% vs 56.9%, p=0.916).
Conclusions
Patients included in the ISCHEMIA trial are underrepresented in a real-world population of SIHD patients referred to coronary angiography. PCI rates were similar among patients with at least one significant coronary artery stenosis, regardless of previous evidence or severity of ischemia. Our findings underline the need for further refinement in criteria for revascularization in SIHD.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
| | - C Brizido
- Hospital Santa Cruz, Carnaxide, Portugal
| | - S Madeira
- Hospital Santa Cruz, Carnaxide, Portugal
| | - R Teles
- Hospital Santa Cruz, Carnaxide, Portugal
| | - L Raposo
- Hospital Santa Cruz, Carnaxide, Portugal
| | - H Gabriel
- Hospital Santa Cruz, Carnaxide, Portugal
| | - S Leal
- Hospital Santa Cruz, Carnaxide, Portugal
| | | | - J Brito
- Hospital Santa Cruz, Carnaxide, Portugal
| | | | - M Almeida
- Hospital Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital Santa Cruz, Carnaxide, Portugal
| |
Collapse
|
36
|
Silva C, Maltes S, Freitas P, Ferreira A, Teles R, Andrade M, Nolasco T, Guerreiro S, Abecasis J, Horta E, Oliveira A, Ribeiras R, Brito J, Almeida M, Mendes M. External validation of a new staging system for severe aortic stenosis in a Portuguese cohort. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Recently, a new staging system for severe aortic stenosis (AS) based upon the extent of extra-aortic-valve cardiac damage has been developed (Genereux et al. Eur Heart J 2017). The present study aimed to: 1) determine the prevalence of the different stages of extra-aortic valvular cardiac damage and its impact on prognosis in a real-world Portuguese cohort and; 2) evaluate the distribution of aortic valve calcium score (AV-CaSc) and its prognostic value.
Methods
Consecutive patients evaluated at a single-centre TAVI-programme between Nov/2015 and Nov/2018 were retrospective selected. The extent of extra-aortic valve cardiac damage was defined by echocardiography as stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (mitral valve or left atrial damage), stage 3 (tricuspid valve or pulmonary artery vasculature damage) or stage 4 (right ventricular damage). AV-CaSc was estimated routinely at CT-angiography as per TAVI-programme protocol. The primary endpoint was 1-year all-cause mortality after CT-angiography. Survival analysis (Cox-regression hazards model and Kaplan-Meier) was performed. To account for the effect of aortic valve replacement (AVR), this variable entered the Cox-regression model as a time-dependent covariate.
Results
A total of 443 patients (mean age 82±7 years, 44% men, median euroSCORE II 4% [IQR 2.4–5.8]) were identified. After Heart Team discussion, 79% (n=349) underwent AVR (TAVI=307; surgical valve repair=42); 9% (n=42) await intervention; 6% (n=25) remain under medical treatment; 4% (n=19) died during the period of evaluation; and 2% (n=8) underwent palliative aortic balloon valvuloplasty.
According to the proposed classification, the distribution of patients from stages 0 through 4 was: 0.2% (n=1), 7.5% (n=34), 67.8% (n=306), 14% (n=63), and 10.4% (n=47). Additionally, for each increasing stage of cardiac damage, the burden of AV-CaSc was higher (from stage 1 through 4: 1776 [IQR 1217–2448]; 2448 [1796–3442]; 2448 [1832–3622]; 2960 [1936–4878] units; p for trend = 0.002).
All-cause mortality at 1-year was 14% (n=63). Mortality increased alongside with increasing extent of cardiac damage (from stage 0 through 4: 0% [n=0], 6% [n=2], 12% [n=36], 20% [n=12], and 30% [n=13]) – Fig. Multivariable analysis revealed chronic renal disease (HR 1.37 per stage [1.15–1.64], p<0.001), AV-CaSc (HR 1.02 per 100 units [1.01–1.03], p=0.007), AVR (HR 0.46 [0.26–0.81], p=0.007) and stage of cardiac damage (HR 1.54 per stage [1.15–2.05], p=0.004) as independent predictors of 1-year mortality.
Conclusion
In a real-world Portuguese cohort of severe AS patients, the extent of cardiac damage was associated with 1-year mortality. AV- CaSc grants additional prognostic information to this classification. Incorporation of this staging system into patient evaluation may be useful in the risk assessment of severe AS.
Survival analysis
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- C Silva
- Hospital de Santa Cruz, Lisbon, Portugal
| | - S Maltes
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - R.C Teles
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - T Nolasco
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | | | - E Horta
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - R Ribeiras
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Brito
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| |
Collapse
|
37
|
Gama F, Teles R, Oliveira A, Brizido C, Goncalves P, Brito J, Ferreira A, Abecasis J, Almeida M, Mendes M. Predicting pacemaker implantation after TAVR with procedural CT. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve replacement (TAVR). Calcium distribution in the aortic-valvular complex (AVC) and, more recently, membranous septum (MS) length seem to be surrogate markers for conduction abnormalities after specific last generation balloon and self-expandable expandable valves. We sough to evaluate whether such pre-procedural association remains across the entire device spectrum.
Methods
Single-centre prospective study of 239 consecutive patients (140 women, median age of 84) with severe symptomatic aortic stenosis patients who underwent ECG-gated contrast-enhanced multi-detector computed tomography (MSCT) before TAVR since Jun/2017. Exclusion criteria were those with previous PPMI, previous bioprothesis, congenital bicuspid valve, and poor imaging quality. The J-score with an 850-Hounsfield unit threshold was used to detect areas of calcium in the region of interest. AVC was characterized by leaflet sector and region, using 3mensio Valves software 7.0 TM. An independent team retrospectively measured MS length blindly by determining the thinnest part of the interventricular septum in the coronal view in the better-defined systolic phase (usually at 40% of the R-R interval, Figure). Device selection (75.8% self-expandable devices, 20.1% balloon expandable, 3.1% other) and positioning were performed according to the operator criteria. Final implant depth was assessed based on the pre-release angiogram or final aortography.
Results
Mortality at 30-days was 1.3% and PPMI occurred in 43 patients (18%). Median MS length was 9.59mm (IQR: 3.11mm). After multivariable logistic regression analysis, MS length emerged as the single significant protective predictor for PPMI (OR: 0.14; 95% 95% CI: 0.05–0.42; p<0.001), independently of the device used (p<0.001). MS length showed strong discriminatory ability for PPMI (c-statistic 0.93; 95% CI 0.88–0.99). Sensitivity/specificity decision plots yielded an MS length of 6.9 mm as the optimal cut-off point for predicting the need for PPMI with a positive and negative predictive value of 91% and 93%, respectively (Figure). There wasn't any calcium accumulation within a specific region of AVC that independently predicted the outcome.
Conclusion
In our experience, a short membranous septum was strongly and independently associated with new permanent pacemaker implantation, regardless of the device type.
Our findings suggest that this simple measure should be routinely made to help device selection and implantation technique.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- F Gama
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - R.C Teles
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A Oliveira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Brizido
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - J Brito
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Carnaxide, Portugal
| |
Collapse
|
38
|
Gama F, Rocha B, Freitas P, Ferreira A, Abecasis J, Guerreiro S, Saraiva C, Santos A, Andrade M, Ventosa A, Almeida M, Pintao S, Mendes M. Downstream testing after an halted coronary CT angiography due to high coronary artery calcium score. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and aim
In many centers, coronary artery calcium score (CACS) is performed immediately before coronary CT angiography (CCTA) in order to exclude heavy calcification that could hamper test performance. When high CACS values are found, CCTA is usually aborted and other tests suggested. However, there are no recommendations on which test to pursue, and little data on their diagnostic yield in this setting. The aim of this study was to assess the type and results of downstream testing among patients whose CCTA study was halted due to high CACS.
Methods
Single-centre retrospective study of consecutive patients undergoing CCTA for suspected obstructive coronary artery disease (CAD). A CACS threshold of >400 was generally used to cancel CCTA. Downstream testing and its results were assessed using electronic medical records. A group of consecutive patients with CACS <400 who underwent CCTA was used for comparison.
Results
Of the 795 patients who performed CCTA for suspected CAD, 86 (10.8%), had their test halted due to high CACS (57 men, mean age 71±11 years). In this subgroup, the median pre-test probability for CAD was 27% (interquartile range 25) and the median CACS was 983 (interquartile range 930). Compared to patients who underwent CCTA, those who saw their tests cancelled were older, more frequently male, and had higher prevalence of cardiovascular risk factors and higher pre-test probability for CAD.
Patient's downstream testing is illustrated in Figure. From the 86 patients enrolled, 12 are currently waiting for downstream tests and were excluded from further analysis. Overall, 35 patients ended up performing invasive coronary angiography (ICA, 47.3%) of whom 19 (54.3%) had significant CAD. Among those who underwent non-invasive testing (N=19, 25.7%), 10 (52.6%) had significant ischemia and 4 (21%) underwent additional testing with ICA. In 24 patients (32.4%), no downstream testing was pursued. Finally, 17 (22.3%) patients underwent coronary revascularization, either percutaneous (N=10, 13.5%) or surgical (N=7, 10.8%).
Conclusion
Invasive coronary angiography is the most frequently used downstream test when CCTA is halted due to high CACS values, and shows significant CAD in roughly half of the cases. Considering the high prevalence of significant CAD, direct referral for ICA (with the possibility of invasive functional testing) seems a reasonable approach.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- F Gama
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - B Rocha
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - C Saraiva
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A.C Santos
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - A Ventosa
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - S Pintao
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Carnaxide, Portugal
| |
Collapse
|
39
|
Abstract
Purpose We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs. Methods A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension. Results Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only. Conclusion Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.
Collapse
Affiliation(s)
- José Moreira
- Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Margarida Almeida
- Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Nuno Lunet
- EPIUnit-Instituto de Saúde Pública, University of Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.,Serviço de Ortopedia e Traumatologia, Centro Hospitalar de S. João, Porto, Portugal
| |
Collapse
|
40
|
Nunes Carneiro D, Madanelo M, Silva F, Pestana N, Ribeiro C, Almeida M, Malheiro J, Cavadas V, Fraga A, Silva Ramos M. Remaining kidney volume is a strong predictor of estimated glomerular filtration rate at 1 year and mid-term renal function after living donor nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33666-1] [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] Open
|
41
|
Bueno F, Silva C, Oba A, Almeida M, Medeiros L, Pitarello A, Shinyashike A. Performance, carcass yield, and meat quality of broilers supplemented with organic or inorganic zinc. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-10316] [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: 11/22/2022] Open
Abstract
ABSTRACT A total of 640 one-day-old Cobb broiler chicks, half male and half female, were reared up to 49 days of age. A completely randomized 2 × 4 factorial design was used. Experimental treatments consisted of four levels of organic zinc supplementation and one control (inorganic zinc supplementation) and two levels of sex (female and male), with four replicates of 16 birds per experimental plot. Animal performance, carcass and cut yields, and meat quality were evaluated. Feed intake increased with zinc supplementation. Broilers that received the lowest level of organic zinc showed better feed conversion than those fed an equivalent level of inorganic zinc. Increased levels of organic zinc reduced the abdominal fat content in females but impaired the oxidative stability of meat. The results showed that male broilers have better performance, carcass yield, and meat quality than females and that organic zinc improves broiler feed conversion and reduces abdominal fat but increases lipid oxidation in meat.
Collapse
Affiliation(s)
- F.R. Bueno
- Universidade Estadual de Londrina, Brazil
| | - C.A. Silva
- Universidade Estadual de Londrina, Brazil
| | - A. Oba
- Universidade Estadual de Londrina, Brazil
| | - M. Almeida
- Universidade Estadual de Londrina, Brazil
| | | | | | | |
Collapse
|
42
|
Chichareon P, Modolo R, Kogame N, Tomaniak M, Teiger E, Quintella EF, Almeida M, Hamm C, Steg G, Juni P, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Serruys PW. 4181Prognosis of patients with mid-range left ventricular ejection fraction treated with PCI: insight from the global leaders study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure with mid-range ejection fraction (left ventricular ejection fraction between 40 to 49%) was introduced in the 2016 European Society of Cardiology guidelines for heart failure. The prognosis of the mid-range of left ventricular ejection fraction (LVEF) was less well assessed in patients treated with percutaneous coronary intervention (PCI).
Purpose
We aimed to assess the 2-year outcomes of patients with mid-range ejection fraction (LVEF between 40 to 49%) after PCI compared with reduced LVEF (<40%) and preserved LVEF (≥50) in the GLOBAL LEADERS study.
Methods
The GLOBAL LEADERS study was a multicenter, randomized trial comparing the efficacy and safety of two antiplatelet strategies in all-comers patients undergoing PCI with biolimus-A9 eluting stent.
Patients with available information of LVEF were eligible in the present analysis. Patients were classified according to their LVEF into three groups; preserved (LVEF ≥50), mid-range (LVEF 40–49%) and reduced (LVEF <40%) left ventricular ejection fraction. Clinical outcomes at 2 years after PCI were compared among three groups in the multivariable Cox regression analysis.
The primary outcome of present study was all-cause mortality at 2 years after PCI. The secondary outcomes were patient-oriented composite endpoint (POCE). Individual components of the composite endpoint, definite or probable stent thrombosis and bleeding academic research consortium (BARC) type 3 or 5 were also reported.
Results
Out of 15968 patients included in the GLOBAL LEADERS study, information of LVEF was available in 15008 patients (93.99%); 12,128 patients (80.81%) were in the group of preserved LVEF, 1,737 patients (11.57%) were in the mid-range LVEF group and 1,143 patients (7.62%) were in the reduced LVEF group.
The risk of all-cause mortality and POCE at 2 years were significantly different among the three groups. In an adjusted model, compared with the group of preserved LVEF, the hazard ratio for the all-cause mortality at 2 years rose from 1.89 (95% CI, 1.46–2.45) to 3.72 (95% CI, 2.95–4.70) in the group of mid-range and reduced LVEF respectively. Similar rises were observed for the POCE at 2 years from 1.27 (95% CI, 1.11–1.44) in the group of mid-range LVEF to 1.63 (95% CI, 1.42–1.87) in the group of reduced LVEF.
The risk of stroke, myocardial infarction, and definite or probable stent thrombosis in patients with mid-range LVEF was not different from patients with reduced LVEF (see figure). A similar risk of revascularization was observed among the three groups.
Outcomes among three LVEF categories
Conclusion
Patients with mid-range LVEF undergoing PCI had a different prognosis from patients with reduced LVEF and preserved LVEF in term of survival and composite ischemic endpoints at 2 years.
Collapse
Affiliation(s)
- P Chichareon
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - R Modolo
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - N Kogame
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - M Tomaniak
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - E Teiger
- University Hospital Henri Mondor, Creteil, France
| | - E F Quintella
- Instituto Estadual Cardiologia Aloisio De Castro, Rio de Janeiro, Brazil
| | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - G Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Juni
- St. Michael's Hospital, Toronto, Canada
| | - P Vranckx
- Virga Jesse Hospital, Hasselt, Belgium
| | - M Valgimigli
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S Windecker
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - P W Serruys
- Imperial College London, London, United Kingdom
| |
Collapse
|
43
|
Paiva J, Paula L, Almeida M, Silva A, Portilho V. Spinal dural fistula mimicking neuromyelitis optica spectrum disorders (NMODS). J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1359] [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: 11/30/2022]
|
44
|
Veiga Oliveira P, Madeira M, Ranchordas S, Brizido C, Nolasco T, Boshoff S, Marques M, Almeida M, Teles R, Calquinha J, Sousa-Uva M, Ventosa A, Abecassis M, Neves JP. P4737Complete surgical revascularization: the impact of the different definitions on mortality. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The concept of complete revascularization arises from the early stages on coronary artery bypass grafting (CABG). There are several different definitions applied across the literature, promoting a difficult comparison between studies. Despite the established importance of complete revascularization, there is no agreement which definition has the most impact on mortality.
Objectives
Evaluate the impact of the different definitions of complete surgical revascularization in late mortality.
Methods
Single center retrospective study of all consecutive patients submitted to isolated CABG with previous myocardial viability assessment (myocardial perfusion scintigraphy) from 2011 to 2016. Exclusion criteria: emergent procedures and previous cardiac surgery. The primary end-point was follow-up mortality (n=20). The population of study was162 patients with 22,2% female gender and a mean age of 66 years. The follow-up was complete in 98,8%, median time of 4,1 (IQR 3,0–5,5) years.
The completeness of revascularization was classified in all patients according to four different definitions (n=162 for each definition): Numerical (the number of stenotic vessels must equal the number of distal anastomoses applied); Functional (all ischemic myocardial territories are reperfused; areas of old infarction with no viable myocardium are not required to be reperfused); Anatomical Conditional (all stenotic main-branch vessels are revascularized) and Anatomical Unconditional (all stenotic vessels are revascularized, irrespective of size and territory supplied).
For each definition, statistical analysis was performed using the Kaplan-Meier method with log rank test and Cox proportional analysis (EuroSCORE II and revascularization definition).
Results
On univariate analysis, there was no significant statistical association between each definition of complete revascularization and follow-up mortality: numerical (p=0,694); anatomical unconditional (p=0,294); but a trend was found on functional (p=0,063) and anatomical conditional (p=0,084).
On multivariate analysis, incomplete functional revascularization increased the risk of follow-up mortality in 2,89 folds and anatomical conditional in 3,28 folds (Figure 1). The other definitions were not statistically associated with late mortality.
Conclusion
According to this study, complete functional and anatomical conditional revascularization definitions are determinants of follow-up mortality in a multivariate model including EuroScore II. The revascularization of all stenotic main-branch vessels (anatomical conditional) seems to have the highest impact, fact that we should be taken in consideration on daily work.
Collapse
Affiliation(s)
| | - M Madeira
- Santa Cruz Hospital, Lisbon, Portugal
| | | | - C Brizido
- Santa Cruz Hospital, Lisbon, Portugal
| | - T Nolasco
- Santa Cruz Hospital, Lisbon, Portugal
| | - S Boshoff
- Santa Cruz Hospital, Lisbon, Portugal
| | - M Marques
- Santa Cruz Hospital, Lisbon, Portugal
| | - M Almeida
- Santa Cruz Hospital, Lisbon, Portugal
| | - R Teles
- Santa Cruz Hospital, Lisbon, Portugal
| | | | | | - A Ventosa
- Santa Cruz Hospital, Lisbon, Portugal
| | | | - J P Neves
- Santa Cruz Hospital, Lisbon, Portugal
| |
Collapse
|
45
|
Carvalheira Dos Santos R, Raposo L, Madeira S, Brito J, Goncalves M, Brizido C, Vale N, Leal S, Sousa P, Araujo Goncalves P, Mesquita Gabriel H, Campante Teles R, Almeida M, Mendes M. P4575UA and NSTEMI in the era of high-sensitivity Troponin: impact on patient risk profile and management. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0965] [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
Aim
High-sensitivity troponin assays (HST) entered the clinical arena to facilitate exclusion of ACS in the emergency department (ER) in patients presenting with chest pain. Due to its higher sensitivity there is the potential for an overestimation of the diagnosis of NSTEMI, and possibly ACS overall. We assessed the impact of HST in the classification of ACS (NSTEMI vs UA) and its ability to predict obstructive coronary disease (CAD), in a population of pts referred to coronary angiography (ICA).
Methods
Retrospective analysis of 1844 pts with suspected NSTEMI or UA referred for ICA from a single ER between Feb 2013 and Nov 2018. Standard Troponin-I was used until Feb 2016 and HST thereafter. The characteristics of UA and NSTEMI pts before and after the introduction of HST were compared. Multivariate binary logistic regression models were used to access the association of different troponin assays with CAD (>50% for LM and >70% for the remaining). Sensitivity, specificity, NPV and PPV for angiographic CAD were also determined.
Results
The relative proportion of patients with UA and NSTEMI was similar between study periods: 31% vs 29% and 69% vs 71%, respectively (p=0.3). Clinical and angiographic characteristics did not differ in UA pts before and after the use of HST. NSTEMI patients in the HST era were less frequently women (39% vs 32%, p=0.026), had higher creatinine (0.93 IQR 0.75–1.3 vs 1.0 IQR 0.82–1.38), higher number of lesions (2 IQR 1–4 vs 3 IQR 1–4) and a lower rate of normal coronary arteries (10.5% vs 3.9%, p<0.001). The prevalence of significant CAD in this population, before and after HST, was 65% and 73%, respectively (p=0.001). However, when clinically relevant characteristics and judgement were accounted for, both standard troponin (OR 0.99, 95% CI 0.99–1.01) and HST (1.0, 95% CI 1.0–1.0) were poor predictors of significant CAD. Sensitivity was 69% vs 72%, specificity 30% vs 30%, PPV 65% vs 73% and NNP 34% vs 28%, respectively. Finally, rates of percutaneous intervention did not differ between the two periods (30% vs 33.5%, p=0.157), nor between ACS types within each period.
CAD/PCI in ACS within each period
Conclusion
The introduction of HST did not result in an increase of the diagnosis of NSTEM vs UA, suggesting that clinical judgment remains an important determinant of the diagnosis of ACS. Also there was no evidence of an increase in PCI rates, despite worse CAD severity in NSTEMI patients.
Collapse
Affiliation(s)
| | - L Raposo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - S Madeira
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Brito
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - C Brizido
- Hospital de Santa Cruz, Lisbon, Portugal
| | - N Vale
- Hospital de Santa Cruz, Lisbon, Portugal
| | - S Leal
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Sousa
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | | | | | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| |
Collapse
|
46
|
Dias Ferreira Reis JP, Strong C, Roque D, Morais L, Mendonca T, Modas PD, Farto E Abreu P, Almeida M, Cacela D, Morais C, Mendes M, Cruz Ferreira R, Bravo Baptista S, Raposo L, Ramos R. P3633Should we continue to routinely revascularize patients during valve surgery in optimal medical therapy era? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Optimal management of stable obstructive coronary artery disease (CAD) in patients (pts) undergoing heart valve surgery remains controversial. The aim of the present study is to evaluate the effective prognostic role of CABG in pts undergoing valve surgery who had concomitant CAD.
Methods
We conducted a retrospective multicenter survival analysis using multivariable Cox models and Kaplan-Meier curves of consecutive pts undergoing valve surgery with or without concomitant CABG between January 2015 and February 2017.
Results
From 1196 consecutive pts undergoing valvular surgery in 3 portuguese centers, 257 (21.5%) were found to have obstructive CAD (55.6% male, mean age 74±8 y.o., mean follow-up time 16±8 months, aortic valve disease 78.8%). No coronary revascularization (R) was attempted in 177 pts, complete R was achieved in 40 and R was anatomically incomplete in the remaining 40 pts. Age (75 vs 77.3 y.o.; p=0.202), multivessel disease (46.3% vs 53.8%, p=0.270), aortic valve disease (91.0% vs 92.5%, p=0.683), left ventricular ejection fraction <40% (11.8% vs 19.4%, p=0.272) were comparable between nonrevascularized and revascularized pts; SYNTAX score was low and also similar in both groups (7±12 vs 7±5, p=0.856). Left main disease (8.5% vs 17.5%, p=0.034) and EUROSCORE IIrisk score (2.3±2 vs 3.2±2, p=0.011) was higher for those with any revascularization. Non-revascularized pts had significantly lower all-cause mortality at follow up than those with any R (10.2% vs 21.2%, p=0.016). However, both in-hospital (4% vs 7.5%, p=0.230) and cardiovascular mortality (6.9% vs 7.1%, p=1.00) were similar. In a multivariate analysis, independent predictors for all-cause mortality were: any surgical R (HR 4.52, CI95% 2.09–9.78), baseline atrial fibrillation (HR 2.51, CI95% 1.07–5.90), left main disease (HR 3.153, CI95% 1.26–7.90) and peripheral artery disease (HR 2.95, CI95% 1.036–8.421). All-cause mortality for pts with obstructive CAD was higher than in pts with no CAD (13.6% vs 6.2, p<0.001). Interestingly, however, after multivariable adjustment, complete R was not found to be protective as compared to no R (HR 0.79, IC 0.31–2.06, p=0.633)
Kaplan-Meier Plots
Conclusion
Significant CAD is associated with worse outcomes in pts undergoing valve surgery. In this study, standard angiographically-guided R was not associated with improved results. Randomized controlled trials are needed to further assess risk stratification and the role of coronary R of stable CAD in this setting.
Collapse
Affiliation(s)
| | - C Strong
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - L Morais
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | - P D Modas
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Farto E Abreu
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | | | - S Bravo Baptista
- Hospital Prof Fernando da Fonseca EPE, Cardiology, Amadora, Portugal
| | - L Raposo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| |
Collapse
|
47
|
Carvalho Mendonca TJ, Strong C, Roque D, Morais L, Reis JP, Daniel PM, Abreu P, Almeida M, Cacela D, Morais C, Mendes M, Ferreira RC, Baptista SB, Raposo L, Ramos R. P3628Contemporary coronary artery disease prevalence in a valvular heart disease population undergoing surgery. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Older studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently.
Objectives
The goal of this study is to evaluate the baseline characteristics, prevalence of CAD and treatment strategies in a contemporary population with valvular heart disease (VHD) referred for valve surgery.
Methods
In a national multicentre registry, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine coronary angiogram were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70% (≥50% for left main artery). The prognostic impact of the different valve disease and CAD treatment strategies were assessed.
Results
1175 patients (mean age 72.5±10.1; male 49.2%) fulfilled the clinical or echocardiographic indication for valve surgery by European guidelines. Valvular disease prevalence was: aortic stenosis (66.7%), aortic regurgitation (6.6%), mitral stenosis (6%), mitral regurgitation (19.2%), tricuspid regurgitation (7.5%). Mean follow-up time was 29.06±18.46 months. Prevalence of comorbidities was: Diabetes Mellitus (DM) 26%, chronic obstructive pulmonary disease (COPD) 5.7% and chronic kidney disease (CKD) 23.4%. Mean Euroscore II was 2.6%. Obstructive CAD was present in 27.3% patients. Mean Syntax score was 10.2 (<22 in 88%, 23–32 in 10.2% and >33 in 1.8%). Left main artery and 3-vessel disease were found in 13.1% and 11.8% of patients with CAD, respectively. Valvular surgery was ultimately performed in 80.3%. In patients with CAD, 57.3% were revascularized. All-cause mortality rate during follow-up was 12.9%, with 7.8% from cardiovascular causes. In univariate analysis DM, COPD, CKD, NYHA class, obstructive CAD and no surgery (p<0.05) were associate with mortality on follow up. In multivariate analysis obstructive CAD (OR 2.36, 95% CI 1.53–3.65, p<0.01) and no surgery (OR 6.05, 95% CI 3.95–9.30, p<0.01) persisted as independent all-cause mortality predictors.
Conclusion
In a contemporary cohort of patients with VHD and surgical indication, CAD prevalence is lower (27.3%) than described in literature. Mortality rates were higher in patients with obstructive CAD, worse NYHA functional class and in those who never underwent surgery.
Collapse
Affiliation(s)
| | - C Strong
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - D Roque
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - L Morais
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - J P Reis
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - P M Daniel
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - P Abreu
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - C Morais
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - R C Ferreira
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| | - S B Baptista
- Hospital Prof Fernando da Fonseca EPE, Department of Cardiology, Amadora, Portugal
| | - L Raposo
- Hospital de Santa Cruz, Department of Cardiology, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Department of Cardiology, Lisbon, Portugal
| |
Collapse
|
48
|
Sa Mendes G, Teles R, Neves J, Trabulo M, Almeida M, Ribeira R, Abecasis J, Nolasco T, Strong C, Mendes M. P6508Percutaneous versus surgical paravalvular leak: a ten-year tertiary centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1098] [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
Aims
Paravalvular leak (PVL) presents an incidence ranging from 2–17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL.
Methods
Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously or by surgery, after heart team agreement, between 2007 and 2018. The primary goal was to assess mortality and rehospitalizations. The secondary goals were: a) the technical success, defined as reduction in regurgitation [≥1 degree] and b) clinic and laboratorial improvement.
Results
Forty-eight patients were included (mean age of 66±13 years, 56% male), 12 submitted to percutaneous closure and 36 to surgery (74 vs 65 years, p=0,026, respectively), with similar gender distribution. 56% had an aortic PVL, with the remainder having a mitral leak, with no difference between groups. The indications were heart failure in 91% and haemolytic anaemia in 42%. A combination of both indications and NYHA heart failure functional class ≥ III were higher in percutaneous group. The severity of leak was comparable in both groups.
Patients treated percutaneously had a significant higher rate of atrial fibrillation (92% vs 42%), COPD (33% vs 3%), peripheral artery disease (58% vs 22%) and higher EuroScore II (13,1% [7,1 - 19,0 CI 95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003).
There was no significant difference between groups with respect to all- cause mortality at 6 months, and to cardiovascular (CV) mortality and CV rehospitalization at 1-year follow-up. The technical success was lower in percutaneous group, but clinic and laboratorial results did not differ (table).
Primary and secondary [(a) tecnical success (b) clinical and laboratorial improvements] endpoints of percutaneous vs surgery paravalvular leak closure Percutaneous PVL closure Surgical PVL Closure p-value Mortality @ 6 M 17% 25% p=1.000 CV Mortality @ 12 M 25% 31% p=1.000 Rehospitalization @ 12 M 18% 21% p=0.694 Technical success (a) 75% 97% p=0.043 NYHA improvement (b) 70% 71% p=0.171 Hb improvement (b) mean Δ: 1.2±1.1 g/dl mean Δ: 1.3±2.5 g/dl p=0.737 LDH reduction (b) mean Δ: −682±828 U/L mean Δ: −473±1215 U/L p=0.577
Conclusions
In this high-risk population, clinical and laboratorial improvement was achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite a lower technical success in the reduction of the severity of the leak.
Collapse
Affiliation(s)
| | - R Teles
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Neves
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Trabulo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Almeida
- Hospital de Santa Cruz, Lisbon, Portugal
| | - R Ribeira
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Lisbon, Portugal
| | - T Nolasco
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Strong
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
| |
Collapse
|
49
|
Reis SL, Silva HB, Almeida M, Cunha RA, Simões AP, Canas PM. Adenosine A
1
and A
2A
receptors differently control synaptic plasticity in the mouse dorsal and ventral hippocampus. J Neurochem 2019; 151:227-237. [DOI: 10.1111/jnc.14816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Sara L. Reis
- CNC‐Center for Neuroscience and Cell Biology Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | | | | | - Rodrigo A. Cunha
- CNC‐Center for Neuroscience and Cell Biology Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Ana P. Simões
- CNC‐Center for Neuroscience and Cell Biology Coimbra Portugal
| | - Paula M. Canas
- CNC‐Center for Neuroscience and Cell Biology Coimbra Portugal
| |
Collapse
|
50
|
Martín-Millán M, Gónzalez-Martín MC, Ruíz P, Almeida M, Ros MA, González-Macías J. La vía Wnt/β-catenina disminuye la cantidad de osteoclastos en el hueso y favorece su apoptosis. Rev Osteoporos Metab Miner 2019. [DOI: 10.4321/s1889-836x2019000200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|