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Marques N, Jana S, Mendes MJ, Águas H, Martins R, Panigrahi S. Surface modification of halide perovskite using EDTA-complexed SnO 2 as electron transport layer in high performance solar cells. RSC Adv 2024; 14:12397-12406. [PMID: 38633492 PMCID: PMC11022184 DOI: 10.1039/d3ra08900b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
The long-term performance of metal halide perovskite solar cells (PSCs) can be significantly improved by tuning the surface characteristics of the perovskite layers. Herein, low-temperature-processed ethylenediaminetetraacetic acid (EDTA)-complexed SnO2 (E-SnO2) is successfully employed as an electron transport layer (ETL) in PSCs, enhancing the efficiency and stability of the devices. The effects of EDTA treatment on SnO2 are investigated for different concentrations: comparing the solar cells' response with 15%-2.5% SnO2 and E-SnO2 based ETLs, and it was found that 7.5% E-SnO2 provided the best results. The improved surface properties of the perovskite layer on E-SnO2 are attributed to the presence of small amount of PbI2 which contributes to passivate the defects at the grain boundaries and films' surface. However, for the excess PbI2 based devices, photocurrent dropped, which could be attributed to the generation of shallow traps due to excess PbI2. The better alignment between the Fermi level of E-SnO2 and the conduction band of perovskite is another favorable aspect that enables increased open-circuit potential (VOC), from 0.82 V to 1.015 V, yielding a stabilized power conversion efficiency of 15.51%. This complex ETL strategy presented here demonstrates the enormous potential of E-SnO2 as selective contact to enhance the perovskite layer properties and thereby allow stable and high-efficiency PSCs.
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Affiliation(s)
- Nuno Marques
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon and CEMOP/UNINOVA Campus de Caparica, Caparica 2829-516 Portugal
| | - Santanu Jana
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon and CEMOP/UNINOVA Campus de Caparica, Caparica 2829-516 Portugal
| | - Manuel J Mendes
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon and CEMOP/UNINOVA Campus de Caparica, Caparica 2829-516 Portugal
| | - Hugo Águas
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon and CEMOP/UNINOVA Campus de Caparica, Caparica 2829-516 Portugal
| | - Rodrigo Martins
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon and CEMOP/UNINOVA Campus de Caparica, Caparica 2829-516 Portugal
| | - Shrabani Panigrahi
- CENIMAT|i3N, Department of Materials Science, School of Science and Technology, NOVA University Lisbon and CEMOP/UNINOVA Campus de Caparica, Caparica 2829-516 Portugal
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Fortes Ferreira A, Alves H, da Silva HP, Marques N, Fred A. Exploring the electrical robustness of conductive textile fasteners for wearable devices in different human motion conditions. Sci Rep 2024; 14:7872. [PMID: 38570536 PMCID: PMC10991394 DOI: 10.1038/s41598-024-56733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Conventional snap fasteners used in clothing are often used as electrical connectors in e-textile and wearable applications for signal transmission due to their wide availability and ease of use. Nonetheless, limited research exists on the validation of these fasteners, regarding the impact of contact-induced high-amplitude artefacts, especially under motion conditions. In this work, three types of fasteners were used as electromechanical connectors, establishing the interface between a regular sock and an acquisition device. The tested fasteners have different shapes and sizes, as well as have different mechanisms of attachment between the plug and receptacle counterparts. Experimental evaluation was performed under static conditions, slow walking, and rope jumping at a high cadence. The tests were also performed with a test mass of 140 g. Magnetic fasteners presented excellent electromechanical robustness under highly dynamic human movement with and without the additional mass. On the other hand, it was demonstrated that the Spring snap buttons (with a spring-based engaging mechanism) presented a sub-optimal performance under high motion and load conditions, followed by the Prong snap fasteners (without spring), which revealed a high susceptibility to artefacts. Overall, this work provides further evidence on the importance and reliability of clothing fasteners as electrical connectors in wearable systems.
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Affiliation(s)
- Afonso Fortes Ferreira
- Instituto de Engenharia de Sistemas e Computadores-Microsistemas e Nanotecnologias (INESC-MN), Lisbon, Portugal.
- Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal.
| | - Helena Alves
- Instituto de Engenharia de Sistemas e Computadores-Microsistemas e Nanotecnologias (INESC-MN), Lisbon, Portugal.
| | - Hugo Plácido da Silva
- Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal.
- Instituto de Telecomunicações (IT), Lisbon, Portugal.
| | | | - Ana Fred
- Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
- Instituto de Telecomunicações (IT), Lisbon, Portugal
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Abrantes R, Pimentel V, Miranda MNS, Silva AR, Diniz A, Ascenção B, Piñeiro C, Koch C, Rodrigues C, Caldas C, Morais C, Faria D, Gomes da Silva E, Teófilo E, Monteiro F, Roxo F, Maltez F, Rodrigues F, Gaião G, Ramos H, Costa I, Germano I, Simões J, Oliveira J, Ferreira J, Poças J, Saraiva da Cunha J, Soares J, Fernandes S, Mansinho K, Pedro L, Aleixo MJ, Gonçalves MJ, Manata MJ, Mouro M, Serrado M, Caixeiro M, Marques N, Costa O, Pacheco P, Proença P, Rodrigues P, Pinho R, Tavares R, Correia de Abreu R, Côrte-Real R, Serrão R, Sarmento e Castro R, Nunes S, Faria T, Baptista T, Simões D, Mendão L, Martins MRO, Gomes P, Pingarilho M, Abecasis AB. Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind? Front Public Health 2024; 12:1336845. [PMID: 38500732 PMCID: PMC10947991 DOI: 10.3389/fpubh.2024.1336845] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/26/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019. Methods We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP). Results The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP. Conclusion Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.
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Affiliation(s)
- Ricardo Abrantes
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Ana Rita Silva
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Diniz
- U. Imunodeficiência, Hospital Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Bianca Ascenção
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Carmela Piñeiro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmo Koch
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Rodrigues
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Caldas
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Célia Morais
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Domitília Faria
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | - Eugénio Teófilo
- Serviço de Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Fátima Monteiro
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fausto Roxo
- Hospital de Dia de Doenças Infeciosas, Hospital Distrital de Santarém, Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar de Lisboa, Lisbon, Portugal
| | - Fernando Rodrigues
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilhermina Gaião
- Serviço de Patologia Clínica, Hospital de Sta Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Helena Ramos
- Serviço de Patologia Clínica, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Costa
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Simões
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Infeciologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina 2, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - José Saraiva da Cunha
- Serviço de Infeciologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jorge Soares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Fernandes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Pedro
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | | | - Maria José Manata
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar de Lisboa, Lisbon, Portugal
| | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Serrado
- U. Imunodeficiência, Hospital Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Micaela Caixeiro
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, Amadora, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, Almada, Portugal
| | - Olga Costa
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Rodrigues
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Pinho
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Infeciologia, Unidade de Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Rita Côrte-Real
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Sofia Nunes
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Telo Faria
- Unidade Local de Saúde do Baixo Alentejo, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Teresa Baptista
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Luis Mendão
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
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Vera J, Gomes A, Póvoas D, Seixas D, Maltez F, Pedroto I, Maia L, Mota M, Vieira MJ, Manata MJ, Ferreira P, Lino S, Pereira Guedes T, Barradas V, Marques N. Real-World Effectiveness and Safety of Glecaprevir/Pibrentasvir for the Treatment of Chronic Hepatitis C: A Prospective Cohort Study in Portugal. ACTA MEDICA PORT 2024. [PMID: 38325411 DOI: 10.20344/amp.19178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/02/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Information about pan-genotypic treatments for hepatitis in Portugal is scarce. We aimed to evaluate the effectiveness and safety of glecaprevir plus pibrentasvir (GLE/PIB) treatment for hepatitis C virus (HCV) infection in real-world clinical practice. METHODS An observational prospective study was implemented in six hospitals with 121 adult HCV patients who initiated treatment with GLE/PIB between October 2018 and April 2019, according to clinical practice. Eligible patients had confirmed HCV infection genotype (GT) 1 to 6 and were either treatment-naïve or had experience with interferon-, ribavirin- or sofosbuvir-based regimens, with or without compensated cirrhosis. Baseline sociodemographic and safety data are described for the total population (N = 115). Effectiveness [sustained virologic response 12 weeks after treatment (SVR12)] and patient-reported outcomes are presented for the core population with sufficient follow-up data (n = 97). RESULTS Most patients were male (83.5%), aged < 65 years (94.8%), with current or former alcohol consumption (77.3%), illicit drug use (72.6%), and HCV acquisition through intravenous drug use (62.0%). HIV co-infection occurred in 22.6% of patients. The prevalence of each GT was: GT1 51.3%, GT2 1.7%, GT3 30.4%, GT4 16.5%, and GT5.6 0%. Most patients were non-cirrhotic (80.9%) and treatment-naïve (93.8%). The SVR12 rates were 97.9% (95% CI: 92.8 - 99.4), and > 95% across cirrhosis status, GT, illicit drug use, alcohol consumption, and HCV treatment experience. The adverse event rate was 2.6%, and no patient discontinued treatment due to adverse events related to GLE/PIB. CONCLUSION Consistent with other real-world studies and clinical trials, treatment with GLE/PIB showed high effectiveness and tolerability overall and in difficult-to-treat subgroups (ClinicalTrials.gov: NCT03303599).
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Affiliation(s)
- José Vera
- Centro Hospitalar Barreiro-Montijo. Barreiro. Portugal
| | | | - Diana Póvoas
- Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Diana Seixas
- Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | | | | | - Luís Maia
- Centro Hospitalar Universitário Porto. Porto. Portugal
| | - Margarida Mota
- Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | | | | | | | - Sara Lino
- Centro Hospitalar Lisboa Central. Lisboa. Portugal
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Pacheco P, Marques N, Rodrigues P, Mansinho K, Maltez F, Janeiro N, Franco C, Trigo D, Batista J, Duque L, Lopes MJ, Aleixo MJ, Silva AR, Tavares R, Alves J, Peres S, Póvoas D, Lino S, Gomes P, Araújo V, Lopes C. Safety and Efficacy of Triple Therapy With Dolutegravir Plus 2 Nucleoside Reverse Transcriptase Inhibitors in Treatment-Naive Human Immunodeficiency Virus Type 2 Patients: Results From a 48-Week Phase 2 Study. Clin Infect Dis 2023; 77:740-748. [PMID: 37288954 DOI: 10.1093/cid/ciad339] [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: 01/11/2023] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitor-based regimens are recommended for first-line therapy in human immunodeficiency virus type 2 (HIV-2). Nonetheless, dolutegravir (DTG) clinical trial data are lacking. METHODS We conducted a phase 2, single-arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen that included DTG in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naive adults receive DTG in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of patients who achieved a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+ T-cell count and in CD4/CD8 ratio at week 48. RESULTS A total of 30 patients were enrolled (22 women; median age, 55 years). At baseline, 17 (56.7%) individuals were viremic (median, pVL 190 copies/mL; interquartile range [IQR], 99-445). The median CD4 count was 438 cells/μL (IQR, 335-605), and the CD4/CD8 ratio was 0.8. Three patients discontinued the study. At week 48, all participants (27) had pVL <40 copies/mL. No virological failures were observed. Mean changes in CD4 count and CD4/CD8 ratio at week 48 were 95.59 cells/µL (95% confidence interval [CI], 28-163) and 0.32 (95% CI, .19 to .46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported. CONCLUSIONS DTG plus 2 NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed that suggest a high potency of DTG in HIV-2 as occurs in HIV-1. CLINICAL TRIALS REGISTRATION M NCT03224338.
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Affiliation(s)
- Patrícia Pacheco
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Nuno Marques
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Rodrigues
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Fernando Maltez
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Nuno Janeiro
- Infectious Diseases Department, Hospital Santa Maria, Lisboa, Portugal
| | - Cláudia Franco
- Infectious Diseases Department, Hospital Santa Maria, Lisboa, Portugal
| | - Diva Trigo
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Joana Batista
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Luís Duque
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Maria João Lopes
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Maria João Aleixo
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Silva
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Tavares
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Alves
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Diana Póvoas
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Sara Lino
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Perpétua Gomes
- Molecular Biology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
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Bragança J, Pinto R, Silva B, Marques N, Leitão HS, Fernandes MT. Charting the Path: Navigating Embryonic Development to Potentially Safeguard against Congenital Heart Defects. J Pers Med 2023; 13:1263. [PMID: 37623513 PMCID: PMC10455635 DOI: 10.3390/jpm13081263] [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: 07/06/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Congenital heart diseases (CHDs) are structural or functional defects present at birth due to improper heart development. Current therapeutic approaches to treating severe CHDs are primarily palliative surgical interventions during the peri- or prenatal stages, when the heart has fully developed from faulty embryogenesis. However, earlier interventions during embryonic development have the potential for better outcomes, as demonstrated by fetal cardiac interventions performed in utero, which have shown improved neonatal and prenatal survival rates, as well as reduced lifelong morbidity. Extensive research on heart development has identified key steps, cellular players, and the intricate network of signaling pathways and transcription factors governing cardiogenesis. Additionally, some reports have indicated that certain adverse genetic and environmental conditions leading to heart malformations and embryonic death may be amendable through the activation of alternative mechanisms. This review first highlights key molecular and cellular processes involved in heart development. Subsequently, it explores the potential for future therapeutic strategies, targeting early embryonic stages, to prevent CHDs, through the delivery of biomolecules or exosomes to compensate for faulty cardiogenic mechanisms. Implementing such non-surgical interventions during early gestation may offer a prophylactic approach toward reducing the occurrence and severity of CHDs.
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Affiliation(s)
- José Bragança
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, 1400-038 Lisbon, Portugal
| | - Rute Pinto
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
| | - Bárbara Silva
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- PhD Program in Biomedical Sciences, Faculty of Medicine and Biomedical Sciences, Universidade do Algarve, 8005-139 Faro, Portugal
| | - Nuno Marques
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
| | - Helena S. Leitão
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
| | - Mónica T. Fernandes
- Algarve Biomedical Center-Research Institute (ABC-RI), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- Algarve Biomedical Center (ABC), University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
- School of Health, University of Algarve Campus Gambelas, 8005-139 Faro, Portugal
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Silva N, Rajado AT, Esteves F, Brito D, Apolónio J, Roberto VP, Binnie A, Araújo I, Nóbrega C, Bragança J, Castelo-Branco P, Andrade RP, Calado S, Faleiro ML, Matos C, Marques N, Marreiros A, Nzwalo H, Pais S, Palmeirim I, Simão S, Joaquim N, Miranda R, Pêgas A, Sardo A. Measuring healthy ageing: current and future tools. Biogerontology 2023. [DOI: https:/doi.org/10.1007/s10522-023-10041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 09/01/2023]
Abstract
AbstractHuman ageing is a complex, multifactorial process characterised by physiological damage, increased risk of age-related diseases and inevitable functional deterioration. As the population of the world grows older, placing significant strain on social and healthcare resources, there is a growing need to identify reliable and easy-to-employ markers of healthy ageing for early detection of ageing trajectories and disease risk. Such markers would allow for the targeted implementation of strategies or treatments that can lessen suffering, disability, and dependence in old age. In this review, we summarise the healthy ageing scores reported in the literature, with a focus on the past 5 years, and compare and contrast the variables employed. The use of approaches to determine biological age, molecular biomarkers, ageing trajectories, and multi-omics ageing scores are reviewed. We conclude that the ideal healthy ageing score is multisystemic and able to encompass all of the potential alterations associated with ageing. It should also be longitudinal and able to accurately predict ageing complications at an early stage in order to maximize the chances of successful early intervention.
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8
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Ferreira AF, da Silva HP, Alves H, Marques N, Fred A. Feasibility of Electrodermal Activity and Photoplethysmography Data Acquisition at the Foot Using a Sock Form Factor. Sensors (Basel) 2023; 23:620. [PMID: 36679418 PMCID: PMC9865091 DOI: 10.3390/s23020620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Wearable devices have been shown to play an important role in disease prevention and health management, through the multimodal acquisition of peripheral biosignals. However, many of these wearables are exposed, limiting their long-term acceptability by some user groups. To overcome this, a wearable smart sock integrating a PPG sensor and an EDA sensor with textile electrodes was developed. Using the smart sock, EDA and PPG measurements at the foot/ankle were performed in test populations of 19 and 15 subjects, respectively. Both measurements were validated by simultaneously recording the same signals with a standard device at the hand. For the EDA measurements, Pearson correlations of up to 0.95 were obtained for the SCL component, and a mean consensus of 69% for peaks detected in the two locations was obtained. As for the PPG measurements, after fine-tuning the automatic detection of systolic peaks, the index finger and ankle, accuracies of 99.46% and 87.85% were obtained, respectively. Moreover, an HR estimation error of 17.40±14.80 Beats-Per-Minute (BPM) was obtained. Overall, the results support the feasibility of this wearable form factor for unobtrusive EDA and PPG monitoring.
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Affiliation(s)
- Afonso Fortes Ferreira
- Instituto Superior Técnico (IST), Av. Rovisco Pais n. 1, 1049-001 Lisboa, Portugal
- Instituto de Telecomunicações (IT), Av. Rovisco Pais n. 1, Torre Norte—Piso 10, 1049-001 Lisboa, Portugal
| | - Hugo Plácido da Silva
- Instituto Superior Técnico (IST), Av. Rovisco Pais n. 1, 1049-001 Lisboa, Portugal
- Instituto de Telecomunicações (IT), Av. Rovisco Pais n. 1, Torre Norte—Piso 10, 1049-001 Lisboa, Portugal
| | - Helena Alves
- Instituto Superior Técnico (IST), Av. Rovisco Pais n. 1, 1049-001 Lisboa, Portugal
- Instituto de Engenharia de Sistemas e Computadores-Microsistemas e Nanotecnologias (INESC-MN), Rua Alves Redol 9, 1000-019 Lisboa, Portugal
| | - Nuno Marques
- Meia Mania Lda, Zona Industrial dos Matinhos Pav. 4/5, 3200-100 Lousã, Portugal
| | - Ana Fred
- Instituto Superior Técnico (IST), Av. Rovisco Pais n. 1, 1049-001 Lisboa, Portugal
- Instituto de Telecomunicações (IT), Av. Rovisco Pais n. 1, Torre Norte—Piso 10, 1049-001 Lisboa, Portugal
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Fernandes RM, Bento D, Marques N, Azevedo O, Mota T, Costa H, Santo ME, Silva DC, Jesus I. Challenges in Fabry disease: the combination of two individually amenable GLA variants may be nonamenable to migalastat. Future Cardiol 2023; 19:39-43. [PMID: 36695159 DOI: 10.2217/fca-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Fabry disease is a rare lysosomal storage disorder caused by mutations in the GLA gene, resulting in reduced or absent α-Gal A activity. Migalastat is an oral chaperone therapy for Fabry patients with amenable GLA variants. We previously reported a case of a 60-year-old male patient with a classic phenotype of Fabry disease, presenting with two GLA variants: p.R356Q and p.G360R. Herein, we report that, although these two missense variants are individually classified as amenable to migalastat in the validated in vitro human embryonic kidney-293 cell-based assay, their combination precludes the patient to be treated with this oral chaperone. This case illustrates how therapeutic decisions may be challenging and how a good genotypic characterization of Fabry patients is critical for the selection of the correct therapeutic strategy.
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Affiliation(s)
- Raquel Menezes Fernandes
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
| | - Dina Bento
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
| | - Nuno Marques
- Algarve Biomedical Center, Faro, 8005-139, Portugal.,Faculdade de Medicina e Ciências Biomédicas, University of Algarve, Faro, 8005-139, Portugal
| | - Olga Azevedo
- Department of Cardiology, Reference Center of Lysosomal Storage Disorders, Hospital Senhora da Oliveira-Guimarães, Guimarães, 4835-044, Portugal.,Life & Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal.,ICVS/3Bs PT Government Associate Laboratory, Guimarães, 4806-909, Portugal
| | - Teresa Mota
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
| | - Hugo Costa
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
| | - Miguel Espírito Santo
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
| | - Daniela Carvalho Silva
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
| | - Ilídio Jesus
- Department of Cardiology, Centro Hospitalar Universitário do Algarve-Hospital de Faro, Faro, 8000-386, Portugal.,Algarve Biomedical Center, Faro, 8005-139, Portugal
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10
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Freire CRC, Marques N, Sobiati VP, Lourenço AG, Kruzich CADA. SÍNDROME DE TROMBOSE COM TROMBOCITOPENIA INDUZIDA POR VACINA PARA COVID-19: RELATO DE DIAGNÓSTICO E MANEJO PRECOCE. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.1172] [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: 11/11/2022] Open
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11
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Menezes Fernandes R, Mota T, Costa H, Bispo J, Azevedo P, Bento D, Guedes J, Carvalho D, Marques N, Santos W, Mimoso J, de Jesus I. Premature acute coronary syndrome: understanding the early onset. Coron Artery Dis 2022; 33:456-464. [PMID: 35190516 DOI: 10.1097/mca.0000000000001141] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acute coronary syndrome (ACS) is less frequent in young adults, but it has become a significant health problem, associated with the increasing prevalence of modifiable risk factors. OBJECTIVES To characterize patients admitted with premature ACS, comparing with those with nonpremature ACS. METHODS We performed a retrospective study encompassing patients of the Portuguese Registry (ProACS), comparing two groups: one composed of men less than 55 and women less than 65 years old; and other with men ≥55 and women ≥65 years old at the ACS admission. The primary endpoint was the composite of in-hospital mortality, stroke and myocardial reinfarction (re-MI). RESULTS A total of 29 870 patients were enrolled and 25% had premature ACS, with a mean age of 50 ± 7 years old. They had a larger prevalence of smoking habits, obesity and dyslipidemia. ST-segment elevation MI (STEMI) was the main admission diagnosis in young patients and coronary angiogram mainly revealed one vessel disease in this subgroup. They had a lower Killip-Kimball (KK) class and mostly preserved left ventricular ejection fraction (LVEF). Composite endpoint was more frequent in nonpremature ACS patients. Nonpremature age, presentation with syncope or cardiac arrest, KK class >1, multivessel disease and LVEF <40% were independent predictors of the primary endpoint ( P < 0.001). Younger patients had lower rates of in-hospital all-cause mortality, re-MI and stroke. One-year all-cause mortality and 1-year cardiovascular and non-cardiovascular readmissions were also lower. CONCLUSIONS Premature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, prevention measures are essential to correct modifiable cardiovascular risk factors and reduce coronary events.
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Affiliation(s)
| | - Teresa Mota
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Hugo Costa
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - João Bispo
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Pedro Azevedo
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Dina Bento
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
- Medical and Biomedical Department, University of Algarve, Portugal
| | - João Guedes
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Daniela Carvalho
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Nuno Marques
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
- Medical and Biomedical Department, University of Algarve, Portugal
| | - Walter Santos
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Jorge Mimoso
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
| | - Ilídio de Jesus
- Cardiology Deparment, Centro Hospitalar Universitário do Algarve
- Algarve Biomedical Center, Faro
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12
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Pingarilho M, Pimentel V, Miranda MNS, Silva AR, Diniz A, Ascenção BB, Piñeiro C, Koch C, Rodrigues C, Caldas C, Morais C, Faria D, da Silva EG, Teófilo E, Monteiro F, Roxo F, Maltez F, Rodrigues F, Gaião G, Ramos H, Costa I, Germano I, Simões J, Oliveira J, Ferreira J, Poças J, da Cunha JS, Soares J, Henriques J, Mansinho K, Pedro L, Aleixo MJ, Gonçalves MJ, Manata MJ, Mouro M, Serrado M, Caixeiro M, Marques N, Costa O, Pacheco P, Proença P, Rodrigues P, Pinho R, Tavares R, de Abreu RC, Côrte-Real R, Serrão R, Castro RSE, Nunes S, Faria T, Baptista T, Martins MRO, Gomes P, Mendão L, Simões D, Abecasis A. HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019. Front Microbiol 2022; 13:823208. [PMID: 35558119 PMCID: PMC9090520 DOI: 10.3389/fmicb.2022.823208] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
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Affiliation(s)
- Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Mafalda N S Miranda
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Ana Rita Silva
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Diniz
- Unidade de Imunodeficiência, Centro Hospitalar Universitário Lisboa Norte - HPV, Lisbon, Portugal
| | | | - Carmela Piñeiro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmo Koch
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Rodrigues
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Caldas
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Célia Morais
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Domitília Faria
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | - Eugénio Teófilo
- Serviço de Medicina, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fátima Monteiro
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fausto Roxo
- Hospital de Dia de Doenças Infeciosas, Hospital Distrital de Santarém, Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fernando Rodrigues
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilhermina Gaião
- Serviço de Patologia Clínica, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Helena Ramos
- Serviço de Patologia Clínica, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Costa
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Simões
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Doenças, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | | | - Jorge Soares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Júlia Henriques
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Pedro
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | | | - Maria José Manata
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Serrado
- Unidade de Imunodeficiência, Centro Hospitalar Universitário Lisboa Norte - HPV, Lisbon, Portugal
| | - Micaela Caixeiro
- Serviço de Infeciologia, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, Almada, Portugal
| | - Olga Costa
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Rodrigues
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Pinho
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Infeciologia, Unidade de Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Rita Côrte-Real
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Sofia Nunes
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Telo Faria
- Unidade Local de Saúde do Baixo Alentejo, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Teresa Baptista
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Maria Rosário O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Costa da Caparica, Portugal
| | - Luís Mendão
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
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Morais B, Botelho T, Marques N, Ferrão A, Nóbrega J, Teixeira F, Grenho A. Is bilateral hallux valgus chevron osteotomy a safe procedure for ambulatory surgery? Foot (Edinb) 2022; 51:101891. [PMID: 35255406 DOI: 10.1016/j.foot.2021.101891] [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: 03/23/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Several osteotomies of the first metatarsal have been described for treatment of hallux valgus but chevron osteotomy is one of the most common and well-established procedure for treating this deformity. Although there is a trend towards considering bilateral surgery there is lack of publications addressing bilateral treatment in ambulatory units. The aim of this study is to analyze results of bilateral and unilateral distal chevron osteotomies associated with lateral soft tissue release as ambulatory procedures. MATERIALS AND METHODS A retrospective review was made about the patients treated at our ambulatory unit over a period of five years. Initially, general information as patient's satisfaction's rate and return to normal activity's time and evaluation of standardized follow-up charts and records made by the surgeon were recorded. Secondly, the hallux metatarsophalangeal interphalangeal scale developed by the American Orthopedic Foot & Ankle Society was used. RESULTS A total of 194 patients with 230 feet operated were included in this study. We found 29 patients that didn't meet the inclusion criteria and were excluded. The unilateral group was composed by 139 feet and the bilateral group by 52 feet. The improvement between preoperative and discharge clinical and radiographic results was significant independently in both groups. A total of 14% of complications were found in our study, 19% in the unilateral group and 12% at the bilateral group. None of them required revision surgery. CONCLUSION Bilateral distal chevron osteotomies, associated with lateral soft tissue release, are safe and effective ambulatory procedures. It was found a satisfactory deformity correction in moderate HV. Both patients that underwent unilateral and bilateral procedures had similar clinical and radiological outcomes with no increase in complications or return to normal activity time. With this study it was demonstrated that bilateral chevron osteotomies can be performed as ambulatory procedures.
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Affiliation(s)
- Bruno Morais
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal.
| | - Tiago Botelho
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Nuno Marques
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Ana Ferrão
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - João Nóbrega
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Frederico Teixeira
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - André Grenho
- Department of Orthopedics, Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
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14
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Fernandes S, Marques N, Goga L. The complexity of neuropsychiatric manifestations of COVID-19 in South Africa. S Afr Med J 2022; 112:313-316. [PMID: 35587242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023] Open
Abstract
SARS-CoV-2 was first identified in Wuhan City, China, in 2019. Initially it was associated with the development of pulmonary disease, but research over the past 2 years has identified effects on multiple systems. Neuropsychiatric manifestations of COVID-19 have been reported in countries around the world, including new-onset psychosis in patients with no personal or family psychiatric history. We present the first case series describing neuropsychiatric manifestations of patients in Johannesburg, South Africa (SA). All four patients presented with their index-episode psychosis, and evidence of COVID-19 infection. The patients had varied psychiatric presentations, from delirium and psychosis to mania, and all responded well to low doses of antipsychotics. One patient had newly diagnosed HIV in addition to COVID-19. Further research is needed to determine the prevalence of neuropsychiatric manifestations in acute SARS-CoV-2 infections in SA.
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Affiliation(s)
- S Fernandes
- Division of Neuropsychiatry, Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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15
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Serrão R, Mansinho K, Maltez F, Marques N, Carvalho A, Pazos R, Zagalo A, Mendez J, Neves I, Oliveira J, Pacheco P, Correia de Abreu R, Miranda AC, Camacho P, Paixão L, Almeida J. Real-World Characterization of the Portuguese Population Living with HIV who Initiated Raltegravir Based-Regimens: The REALITY Study. ACTA MEDICA PORT 2022; 35:558-565. [PMID: 35333155 DOI: 10.20344/amp.16785] [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: 06/29/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although raltegravir has been available since 2007, data are lacking on the Portuguese population living with HIV who initiated this antiretroviral therapy. Hence, this study aimed to characterize the patients who initiated raltegravir-based regimens between January 2015 and December 2017, on sociodemographics, clinical features, and treatment satisfaction. MATERIAL AND METHODS Observational, retrospective, multicentre study conducted at 11 reference sites. Sociodemographic and clinical data were collected retrospectively from hospital medical records. For participants continuing raltegravir at study inclusion, the HIV Treatment Satisfaction Questionnaire was administered to assess satisfaction with raltegravir-based therapy. Descriptive statistics were performed. Treatment-naïve and treatment-experienced subgroups were compared for demographic and clinical variables. RESULTS A total of 302 patients were included; mostly men (69.5%) with a mean age of 49 years old. Approximately half of the patients had at least one non-AIDS-related comorbidity at baseline (53.3%), such as hypercholesterolemia, arterial hypertension, diabetes mellitus, and depression. Moreover, 52.3% were treatment-experienced patients with up to two treatments prior to raltegravir. Across the study time points, there was a reduction in the viral load and improvement in CD4 counts in both the treatment-naïve and treatment-experienced subgroups. Continuing users of raltegravir reported high treatment satisfaction (55.4 ± 7.2 points). CONCLUSION Raltegravir-based regimens seem like a valid therapeutic option in heterogeneous populations of HIV-infected patients, in patients with previous ART experience and as part of first-line therapeutic options alongside with the latest generation of drugs from its class.
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Affiliation(s)
- Rosário Serrão
- Departamento de Doenças Infeciosas. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Kamal Mansinho
- Departamento de Doenças Infeciosas. Hospital Egas Moniz. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas. Hospital de Curry Cabral. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Nuno Marques
- Serviço de Doenças Infeciosas. Hospital Garcia de Orta. Almada. Portugal
| | - Alexandre Carvalho
- Departamento de Medicina Interna. Hospital de Braga. Braga. Instituto de Investigação em Ciências da Vida e da Saúde. Universidade do Minho. Braga. Portugal
| | - Rosário Pazos
- Departamento de Medicina Interna. Centro Hospitalar Universitário do Algarve. Portimão. Portugal
| | - Alexandra Zagalo
- Departamento de Doenças Infeciosas. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Josefina Mendez
- Departamento de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Isabel Neves
- Departamento de Infeciologia. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Joaquim Oliveira
- Serviço de Doenças Infeciosas. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia. Hospital Prof. Dr. Fernando da Fonseca. Amadora. Portugal
| | - Ricardo Correia de Abreu
- Departamento de Doenças Infeciosas. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Ana Cláudia Miranda
- Departamento de Doenças Infeciosas. Hospital Egas Moniz. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | | | - Laura Paixão
- Merck Sharp & Dohme Lda. Paço de Arcos. Portugal
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Nascimento MF, Marques N, Correia J, Faria NT, Mira NP, Ferreira FC. Integrated perspective on microbe-based production of itaconic acid: from metabolic and strain engineering to upstream and downstream strategies. Process Biochem 2022. [DOI: 10.1016/j.procbio.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Marques N. Left ventricular non-compaction: Challenges in the etiopathogenesis and risk stratification of sudden cardiac death in clinical practice. Rev Port Cardiol 2022; 41:261-262. [DOI: 10.1016/j.repc.2021.12.010] [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: 10/19/2022] Open
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18
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Montoto-Martínez T, De la Fuente J, Puig-Lozano R, Marques N, Arbelo M, Hernández-Brito JJ, Fernández A, Gelado-Caballero MD. Microplastics, bisphenols, phthalates and pesticides in odontocete species in the Macaronesian Region (Eastern North Atlantic). Mar Pollut Bull 2021; 173:113105. [PMID: 34763181 DOI: 10.1016/j.marpolbul.2021.113105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
The gastrointestinal contents of twelve individuals from six odontocete species that stranded between 2018 and 2019 in the Macaronesian Region (Eastern North Atlantic) were examined for the presence of marine debris. In addition, concentrations of eleven organic persistent contaminants (nonylphenols, bisphenols, phthalates and pesticides) were analysed in muscle samples by liquid chromatography. No particles larger than 5 mm were found, except for two plastic labels that were found on the same dolphin. On the contrary, all animals contained microplastics of diverse sizes, most of them being fibres (98.06%, n = 708). The predominant detected pollutants were bisphenols (4-984 ng/g) and DEHP (102-1533 ng/g). Also, except for two individuals, all animals had pesticide levels in their tissues. This work has allowed the establishment of a protocol for the study of microplastic ingestion in cetaceans, and tests the potential of microRaman to improve the understanding of microplastic alteration processes.
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Affiliation(s)
- Tania Montoto-Martínez
- Grupo de Investigación en Tecnologías, Gestión y Biogeoquímica Ambiental (TGBA), Departamento de Química, Universidad de Las Palmas de Gran Canaria (ULPGC), Edificio de Ciencias Básicas, Campus Universitario de Tafira, 35017, Las Palmas, Spain.
| | - Jesús De la Fuente
- Veterinary Histology and Pathology, Institute of Animal Health and Food Safety (IUSA), Centro Atlántico de Investigación de Cetáceos, Universidad de Las Palmas de Gran Canaria (ULPGC), Campus Universitario de Montaña de Cardones, 35415, Las Palmas, Spain.
| | - Raquel Puig-Lozano
- Veterinary Histology and Pathology, Institute of Animal Health and Food Safety (IUSA), Centro Atlántico de Investigación de Cetáceos, Universidad de Las Palmas de Gran Canaria (ULPGC), Campus Universitario de Montaña de Cardones, 35415, Las Palmas, Spain.
| | - Nuno Marques
- Museu da Baleia da Madeira, Canical, Madeira, Portugal.
| | - Manuel Arbelo
- Veterinary Histology and Pathology, Institute of Animal Health and Food Safety (IUSA), Centro Atlántico de Investigación de Cetáceos, Universidad de Las Palmas de Gran Canaria (ULPGC), Campus Universitario de Montaña de Cardones, 35415, Las Palmas, Spain.
| | - José Joaquín Hernández-Brito
- Grupo de Investigación en Tecnologías, Gestión y Biogeoquímica Ambiental (TGBA), Departamento de Química, Universidad de Las Palmas de Gran Canaria (ULPGC), Edificio de Ciencias Básicas, Campus Universitario de Tafira, 35017, Las Palmas, Spain; Plataforma Oceánica de Canarias (PLOCAN), Carretera de Taliarte s/n, 35200, Telde, Gran Canaria, Spain.
| | - Antonio Fernández
- Veterinary Histology and Pathology, Institute of Animal Health and Food Safety (IUSA), Centro Atlántico de Investigación de Cetáceos, Universidad de Las Palmas de Gran Canaria (ULPGC), Campus Universitario de Montaña de Cardones, 35415, Las Palmas, Spain.
| | - María Dolores Gelado-Caballero
- Grupo de Investigación en Tecnologías, Gestión y Biogeoquímica Ambiental (TGBA), Departamento de Química, Universidad de Las Palmas de Gran Canaria (ULPGC), Edificio de Ciencias Básicas, Campus Universitario de Tafira, 35017, Las Palmas, Spain.
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Aghemo A, Horsmans Y, Bourgeois S, Bondin M, Gschwantler M, Hofer H, Semmo N, Negro F, Zhang Z, Marcinak J, Veitsman E, Hazzan R, Mimidis K, Goulis I, Marques N, Flisiak R, Mazur W, Roncero C, Marra F, Pageaux GP, Asselah T, Lampertico P. Correction to: Real-World Outcomes in Historically Underserved Patients with Chronic Hepatitis C Infection Treated with Glecaprevir/Pibrentasvir. Infect Dis Ther 2021; 10:2223-2225. [PMID: 34529256 PMCID: PMC8572889 DOI: 10.1007/s40121-021-00529-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy. .,Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Yves Horsmans
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | | | | | - Michael Gschwantler
- Department of Internal Medicine IV, Wilhelminenspital, and Sigmund Freud University, Vienna, Austria
| | - Harald Hofer
- Department of Internal Medicine, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Nasser Semmo
- Department of BioMedical Research, Hepatology, Inselspital, University of Bern, 3010, Bern, Switzerland
| | - Francesco Negro
- Division of Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland.,Division of Clinical Pathology, University Hospital, Geneva, Switzerland
| | | | | | - Ella Veitsman
- Liver Unit, Rambam Health Care Campus, Haifa, Israel
| | | | - Konstantinos Mimidis
- First Department of Internal Medicine, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Ioannis Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nuno Marques
- Infectious Diseases Service, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Wlodzimierz Mazur
- Clinical Department of Infectious Diseases, Medical University of Silesia, Katowice, Poland
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine and School of Medicine, University of Salamanca, Salamanca, Spain
| | - Fiona Marra
- Hepatology Drug Interactions Group, University of Liverpool, Liverpool, UK
| | - Georges Philippe Pageaux
- Département Hépato-Gastro-Entérologie, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier Cedex 5, France
| | - Tarik Asselah
- Department of Hepatology, Hopital Beaujon, AP-HP, Paris University and INSERM UMR 1149, Clichy, France
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico-Division of Gastroenterology and Hepatology-CRC 'AM and A Migliavacca' Centre for Liver Disease, Milan, Italy.,University of Milan, Milan, Italy
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20
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Hipólito-Fernandes D, Elisa Luís M, Maleita D, Gil P, Maduro V, Costa L, Marques N, Branco J, Alves N. Intraocular lens power calculation formulas accuracy in combined phacovitrectomy: an 8-formulas comparison study. Int J Retina Vitreous 2021; 7:47. [PMID: 34407889 PMCID: PMC8371894 DOI: 10.1186/s40942-021-00315-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 07/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Our study aimed to assess and compare the accuracy of 8 intraocular lens (IOL) power calculation formulas (Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane and PEARL-DGS) in patients submitted to combined phacovitrectomy for vitreomacular (VM) interface disorders. Methods Retrospective chart review study including axial-length matched patients submitted to phacoemulsification alone (Group 1) and combined phacovitrectomy (Group 2). Using optimized constants in both groups, refraction prediction error of each formula was calculated for each eye. The optimised constants from Group 1 were also applied to patients of Group 2 – Group 3. Outcome measures included the mean prediction error (ME) and its standard deviation (SD), mean (MAE) and median (MedAE) absolute errors, in diopters (D), and the percentage of eyes within ± 0.25D, ± 0.50D and ± 1.00D. Results A total of 220 eyes were included (Group 1: 100; Group 2: 120). In Group 1, the difference in formulas absolute error was significative (p = 0.005). The Kane Formula had the lowest MAE (0.306) and MedAE (0.264). In Group 2, Kane had the overall best performance, followed by PEARL-DGS, EVO 2.0 and Barrett Universal II. The ME of all formulas in both Groups 1 and 2 were 0.000 (p = 0.934; p = 0.971, respectively). In Group 3, a statistically significant myopic shift was observed for each formula (p < 0.001). Conclusion Surgeons must be careful regarding IOL power selection in phacovitrectomy considering the systematic myopic shift evidenced—constant optimization may help eliminating such error. Moreover, newly introduced formulas and calculation methods may help us achieving increasingly better refractive outcomes both in cataract surgery alone and phacovitrectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-021-00315-7.
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Affiliation(s)
- Diogo Hipólito-Fernandes
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal.
| | - Maria Elisa Luís
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Diogo Maleita
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Pedro Gil
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Vitor Maduro
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Lívio Costa
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Nuno Marques
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - João Branco
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Nuno Alves
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal
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Brito Fernandes Ó, Lobo Julião P, Klazinga N, Kringos D, Marques N. COVID-19 Preparedness and Perceived Safety in Nursing Homes in Southern Portugal: A Cross-Sectional Survey-Based Study in the Initial Phases of the Pandemic. Int J Environ Res Public Health 2021; 18:ijerph18157983. [PMID: 34360296 PMCID: PMC8345424 DOI: 10.3390/ijerph18157983] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022]
Abstract
(1) Background: Nursing homes’ preparedness in managing a public health emergency has been poor, with effects on safety culture. The objective of this study was to assess nursing homes’ COVID-19 preparedness in southern Portugal, including staff’s work experiences during the pandemic. (2) Methods: We used a COVID-19 preparedness checklist to be completed by management teams, followed by follow-up calls to nursing homes. Thereafter, a survey of staff was applied. Data analysis included descriptive statistics, exploratory factor analysis, and thematic analysis of open-end questions. (3) Results: In total, 71% (138/195) of eligible nursing homes returned the preparedness checklist. We conducted 83 follow-up calls and received 720 replies to the staff survey. On average, 25% of nursing homes did not have an adequate decision-making structure to respond to the pandemic. Outbreak capacity and training were areas for improvement among nursing homes’ contingency plans. We identified teamwork as an area of strength for safety culture, whereas compliance with procedures and nonpunitive response to mistakes need improvement. (4) Conclusions: To strengthen how nursing homes cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, nursing homes’ preparedness and safety culture should be fostered and closely monitored.
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Affiliation(s)
- Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093 Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Correspondence:
| | - Pedro Lobo Julião
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Faculty of Medicine and Biomedical Sciences, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (N.K.); (D.K.)
| | - Nuno Marques
- Algarve Biomedical Center, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal; (P.L.J.); (N.M.)
- Faculty of Medicine and Biomedical Sciences, Campus Gambelas, University of Algarve, 8005-139 Faro, Portugal
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22
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Calado SM, Bento D, Marques N, Bragança J. Generation and cardiac differentiation of a human induced pluripotent stem cell line UALGi002-A from a female patient with Left-Ventricular Noncompaction Cardiomyopathy. Stem Cell Res 2021; 55:102462. [PMID: 34280889 DOI: 10.1016/j.scr.2021.102462] [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] [Received: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Left Ventricular Noncompaction Cardiomyopathy (LVNC) is characterized by abnormal number and prominence of trabeculations of the left ventricle of the heart. Although LVNC has been associated with mutations in several genes encoding for transcriptional regulators, ion channels, sarcomeric and mitochondrial proteins, approximately 60% of LVNC patients do not present these genetic alterations. Here, we describe an induced pluripotent stem cell (hiPSC) line (UALGi002-A) originated from a LVNC female patient (LVNC-hiPSC) who does not present any previously known mutations associated to LVNC. The LVNC-hiPSC exhibited full pluripotency and differentiation potential and retained a normal karyotype after reprogramming. Moreover, the LVNC-hiPSC differentiated into contracting cardiomyocytes. This cellular model will be useful to study the molecular, genetic and functional aspects of LVNC in vitro.
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Affiliation(s)
- Sofia M Calado
- CBMR, Centre for Biomedical Research, Universidade do Algarve, 8005-139 Faro, Portugal; Faculdade de Medicina e Ciências Biomédicas (FMCB), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; ABC-RI, Algarve Biomedical Center Research Institute, 8005-139 Faro, Portugal
| | - Dina Bento
- Centro Hospitalar e Universitário do Algarve, Department of Cardiology, Faro, Portugal
| | - Nuno Marques
- Faculdade de Medicina e Ciências Biomédicas (FMCB), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; ABC-RI, Algarve Biomedical Center Research Institute, 8005-139 Faro, Portugal; Centro Hospitalar e Universitário do Algarve, Department of Cardiology, Faro, Portugal
| | - José Bragança
- CBMR, Centre for Biomedical Research, Universidade do Algarve, 8005-139 Faro, Portugal; Faculdade de Medicina e Ciências Biomédicas (FMCB), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; ABC-RI, Algarve Biomedical Center Research Institute, 8005-139 Faro, Portugal; Champalimaud Research Program, Champalimaud Center for the Unknown, 1400-038 Lisbon, Portugal.
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 34187632 DOI: 10.1016/j.repce.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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Morais B, Branquinho A, Barreira M, Correia J, Machado M, Marques N, Ferrão A, Nóbrega J, Teixeira F, Diogo N. Validation of the Ottawa ankle rules: Strategies for increasing specificity. Injury 2021; 52:1017-1022. [PMID: 33551264 DOI: 10.1016/j.injury.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The majority of patients with ankle injuries undergo radiological examinations of the foot, ankle or both. The objective of this study was in the first place to validate the Ottawa Ankle Rules (OARs) for the population of our centre. Secondly, an attempt was made to identify parameters that contribute to improve the specificity of the method, with a view to reduce the need for patients to be exposed to radiation as well as optimizing the expenses of the Emergency Ward (EW). MATERIALS AND METHODS This was a prospective study conducted during a 9-month period. The study population included 148 patients, in 54 (36%) of the patients a fracture was present on the exams performed. Patients were submitted to a sequential protocol in the EW with a form completion, evaluation of OARs, application of the Visual Analog Pain Scale (VAS) and radiographic exams. RESULTS We found a sensitivity of OARs in ankle injuries of 100%, specificity of 26% and in midfoot injuries of 100% and 62% respectively. All patients with fractures had a VAS of 5 or more points in any of the tested sites. With the VAS criterium, we found a significant increase of global specificity (38% vs 15%), as well as when applied only to the ankle (26% to 47%) or to midfoot trauma (62% to 67%). In both, there would have been a 100% reduction of CT scans. Patients with a fracture or with fractures who required surgical treatment had a mean VAS significantly higher than patients with no fracture or fractures submitted to conservative treatment respectively. Although there was a lower percentage of fractures in the group of injuries in Work Accidents (31% vs 37% Sports Activity and 38% Leisure Activity), there was a statistically significant increase in the sum of average VAS in Accidents at Work vs Leisure Activities and vs Sports Activities. CONCLUSION We seek to confirm the usefulness of OARs for our population and we investigated strategies to further reduce the need for unnecessary radiographs. The introduction of parameters for grading pain and adapting to the context of the accident seem promising.
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Affiliation(s)
- Bruno Morais
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal.
| | - André Branquinho
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Mariana Barreira
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Joana Correia
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Marino Machado
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Nuno Marques
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Ana Ferrão
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - João Nóbrega
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Frederico Teixeira
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
| | - Nuno Diogo
- Department of Orthopedics Central Lisbon University Center, 8 Beneficiência Street, 1069-166 Lisbon, Portugal
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 33812706 DOI: 10.1016/j.repc.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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Marques N, Gerlier L, Ramos M, Pereira H, Rocha S, Fonseca AC, André A, Melo R, Sidelnikov E. Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Portugal. Revista Portuguesa de Cardiologia (English Edition) 2021. [DOI: 10.1016/j.repce.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Barreira M, Marques N, Campos V, Marques G, Gonçalves S, Stefanova Alves S. A giant hand lipoma as a rare cause of secondary carpal tunnel syndrome - A case report. Int J Surg Case Rep 2020; 77:538-542. [PMID: 33395841 PMCID: PMC7701893 DOI: 10.1016/j.ijscr.2020.11.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/14/2020] [Accepted: 11/14/2020] [Indexed: 11/09/2022] Open
Abstract
Space-occupying lesions like lipoma are a rare cause of secondary compression neuropathies of the upper extremity. Atypical symptomatology should raise suspicion of local causes and regular work-up should be extended. Images studies leads to successful diagnosis and guidance of the best surgical treatment. Monobloc resection is still the best treatment to reduce the risk of iatrogenic lesions and disease recurrence.
Introduction Lipomas are a rare cause of compressive neuropathy and they lead to atypical clinical presentation that can mimic carpal tunnel syndrome. Case Presentation The authors describe a rare presentation of a carpal tunnel syndrome recurrence after a hand giant lipoma, presenting with rapidly compression neuropathy of the median nerve, 6 months after de primary surgery. Discussion Lipomas are common benign soft tumours. Their occurrence in the hand remains rare and they rarely cause secondary entrapment neuropathies. Carpal tunnel syndrome is mostly idiopathic and bilateral. Local factors should be suspected when these neuropathies present with atypical symptomatology or even when they recur after primary conventional surgical release. Investigation should consider images studies as this correct preoperative assessment leads to successful diagnosis and treatment.
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Affiliation(s)
- Mariana Barreira
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal.
| | - Nuno Marques
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Vicente Campos
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Guilherme Marques
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Sérgio Gonçalves
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
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Ferrão AM, Morais B, Marques N, Nóbrega J, Monteiro J, Jorge JT, Teixeira F. Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence? J Hand Microsurg 2020; 15:23-30. [PMID: 36761051 PMCID: PMC9904981 DOI: 10.1055/s-0040-1721169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up. Materials and Methods Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented. Results The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant. Conclusion Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.
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Affiliation(s)
- Ana Moreira Ferrão
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal,Address for correspondence Ana Moreira Ferrão, MD Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa CentralRua da Beneficência n. 8, 1069-166 LisboaPortugal
| | - Bruno Morais
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Nuno Marques
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Nóbrega
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - José Monteiro
- Department of Orthopedic Surgery and Traumatology, Centro Hospitalar do Oeste, Hospital de Torres Vedras, Torres Vedras, Portugal
| | - João Torrinha Jorge
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Frederico Teixeira
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of in-hospital management in ST Segment Elevation Myocardial Infarction in Portuguese hospitals over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1619] [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
Objectives
To assess the evolution of in-hospital management of ST Segment Elevation Myocardial Infarction (STEMI) over the years in Portuguese hospitals and its impact on in-hospital complications and mortality
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of acute coronary syndrome since 2002 until 2019 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical data, revascularization strategy, medication during hospitalization. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess tendencies in categorical variables, and Kruskal-Wallis tests were used to assess tendencies in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 24425 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive increase in patients treated with aspirin, P2Y12 inhibitors (from 22.2% to 97.6% – p<0.001), beta blockers 62.% to 72.4% – p<0.001), ACE inhibitors (68.9% to 78.2% – p<0.001) and statins (72.1% to 88.4% – p<0.001), a progressive decrease in GP 2a3b inhibitors (20.9 to 14.6% – p<0.001), enoxaparin (55.2% to 29.9% – p<0.001), nitrates (82.7% to 16.1% – p<0.001), calcium channel blockers (5.0% to 3.1% – p<0.001) and inotropes (12.0% to 5.6% – p<0.001).
There was an increase of the use primary coronary angioplasty (36.4% to 73.2% – p<0.001), and of drug eluting stents (0% to 70.1% – p<0.001) a decrease in the use of fibrinolysis (75.7% to 1.6% – p<0.001), bare metal stents (88.1% to 0.3% – p<0.001) and intra-aortic balloon pump (1.8% to 0% – p=0.009), but not in invasive mechanical ventilation (2.5% to 1.9% – p=0.142).
Less patients had moderate to severely impaired left ventricle ejection fraction (28.8% to 14.9% – p<0.001), and there was a significant reduction in almost all in-hospital complications: re-infarction (2.0% to 1.0% – p<0.001); heart failure (36.2% to 9.9% – p<0.001); cardiogenic shock (10.8% to 3.9% – p<0.001); AV block (5.8% to 2.5% – p<0.001); mechanical complications (2.8% to 0.4% – p<0.001); stroke (1.3% to 0.4% – p<0.001); in-hospital mortality (9.9% to 3.8% – p<0.001); as well as length of stay ([4–10] days to [3–6] days – p<0.001). Exceptions were and increase in major bleeding (0.9% to 1.8% – p<0.001) and resuscitated cardiac arrest (3.9% to 4.5%, p=0.001).
Conclusion
In 17 years, we report a progressive evolution of the in-hospital treatment of STEMI patients in Portuguese hospitals, with a higher prescription of guideline recommended medications, use of invasive reperfusion techniques and last generation stents, resulting in a lower rate of in-hospital complications and mortality.
In-hospital outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Registo Nacional de Síndromes Coronárias Agudas - Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Dominguez F, Lopez-Sainz A, Rocha-Lopes L, Barriales-Villa R, Climent V, Tiron C, Marques N, Rasmussen T, Espinosa M, Quarta G, Arad M, Asselbergs F, Olivotto I, Elliott P, Garcia-Pavia P. Clinical characteristics and natural history of PRKAG2 syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
Purpose
Mutations in the PRKAG2 gene cause a syndrome characterized by hypertrophic cardiomyopathy, conduction disease and ventricular preexcitation. Only a small number of cases have been reported, and the natural history of the disease is poorly understood. The aim of this study is to describe phenotype and natural history of PRKAG2 mutation in a large multicenter international cohort.
Methods
We retrospectively studied clinical, electrocardiographic and echocardiographic data from 90 individuals with PRKAG2 mutations (53% males, 33±21 years) from 27 centers.
Results
At baseline evaluation, 93% of patients were in NYHA functional class I-II. Maximum left ventricular (LV) wall thickness was 18±8 mm and LV hypertrophy (LVH) was present in 60 (67%) subjects at baseline. LV ejection fraction was 61±12%. Seventeen pactients (19%) had a pacemaker (mean age at implantation 37±15and 16 (18%) had atrial fibrillation (AF) (mean age 41±23 years) and 33% had ventricular preexcitation or had undergone an accessory pathway ablation. After a median follow-up of 6 years (IQR:2.3–13.9), 71% of individuals had LVH, 29% had AF, 21% a de novo pacemaker (mean age at implantation 38±18 years), 14% required admission for heart failure (HF), 8% experienced sudden cardiac death or equivalent, 4% required a heart transplant and 13% died.
Conclusions
PRKAG2 syndrome is a severe, progressive cardiomyopathy characterized by high rates of AF, conduction disease, advanced HF and life-threatening arrhythmias. Outcome is not clearly related to the classical features of preexcitation and severe LVH, which are not always present.
Natural history of PRKAG2 syndrome
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III (ISCIII)
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Affiliation(s)
- F Dominguez
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
| | - A Lopez-Sainz
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | | | - V Climent
- General University Hospital of Alicante, Alicante, Spain
| | - C Tiron
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - N Marques
- Algarve University Hospital Center, Faro, Portugal
| | | | - M.A Espinosa
- University Hospital Gregorio Maranon, Madrid, Spain
| | - G Quarta
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Arad
- Leviev Heart Center, Sheba Medical Center and The Sackler Faculty of Medicine, Tel Aviv, Israel
| | - F Asselbergs
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - I Olivotto
- Careggi University Hospital, Florence, Italy
| | - P Elliott
- St Bartholomew's Hospital, London, United Kingdom
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain
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Menezes Fernandes R, Mota T, Bispo J, Azevedo P, Bento D, Guedes J, Carvalho D, Marques N, Santos W, Mimoso J, Jesus I. Premature acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1623] [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
The prevalence of acute coronary syndrome (ACS) at an early age is rising, resulting in higher morbidity and mortality rates.
Purpose
To characterize patients admitted with premature ACS, comparing with those with non-premature ACS.
Methods
A retrospective study encompassing patients of a National Registry of ACS was performed. We compared two groups: one composed of men <55 and women <65 years-old; and other with men ≥55 and women ≥65 years-old at the ACS admission. Clinical characteristics, in-hospital evolution and 1-year clinical outcomes were analysed. Primary endpoint was the composite of in-hospital mortality, stroke and re-myocardial infarction (MI). Secondary endpoints were re-MI, stroke, in-hospital and 1-year mortality, 1-year cardiovascular (CV) and non-CV readmissions.
Results
A total of 26523 patients were enrolled and 6637 (25%) had premature ACS, with a mean age of 49±7 years-old. It was found a larger prevalence of smoking habits, obesity and dyslipidemia, but not diabetes. ST-segment elevation MI (STEMI) was the main admission diagnosis (51,2% vs 40,3%), with more frequent activations of the STEMI network (17,1% vs 12,8%) and a consequently shorter time from symptom onset to admission (483 vs 584 min). Coronary angiogram was largely performed in younger patients (91,4% vs 82,1%), mainly revealing one-vessel disease (49,3% vs 34,3%). They had lower Killip-Kimbal (KK) class (6% vs 18,1% with KK class >1) and mostly preserved left ventricular ejection fraction (LVEF) (67,3% vs 58,6%). Major bleeding (0,9% vs 1,7%), sustained ventricular tachycardia (1,1% vs 1,5%) and mechanical complications (0,2% vs 0,7%) were uncommon. Composite endpoint was more frequent in non-premature ACS patients (6,2% vs 1,9%). Non-premature age, KK class >1, multivessel disease and depressed LVEF were independent predictors of primary endpoint (each with p<0,001). Younger patients had inferior rates of in-hospital mortality (1% vs 4,7%), re-MI (0,5% vs 1%) and stroke (0,4% vs 0,7%). One-year mortality (1,7% vs 9,1%), and 1-year CV (9,7% vs 15,5%) and non-CV readmissions (3,7% vs 8,2%) were also lower. All comparative data presented have a statistically significant p-value (p<0,012).
Conclusions
Premature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, primary prevention is essential to correct modifiable CV risk factors and reduce coronary events in these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - T Mota
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J.S Bispo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - P.M Azevedo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - D Bento
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J Guedes
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - D Carvalho
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - N Marques
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - W Santos
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J Mimoso
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - I Jesus
- Algarve University Hospital Center, Cardiology, Faro, Portugal
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De Sousa Bispo J, Azevedo P, Freitas P, Marques N, Reis C, Horta E, Trabulo M, Abecasis J, Canada M, Ribeiras R, Andrade M. Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation.
Objectives
To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI
Methods
Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint.
Results
377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF <40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102)
Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint.
We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001.
Conclusion
PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge.
Kaplan-Meier Survival Curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - C Reis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - E Horta
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Trabulo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Canada
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M.J Andrade
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1343] [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
Objectives
To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal.
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001).
At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001).
Conclusion
Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality.
6 Month Outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Menezes Fernandes R, Mota T, Bispo J, Costa H, Azevedo P, Bento D, Marques N, Jesus I. Recurrent syncope, which patient should we follow more closely. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The importance of education is well recognized in patients presenting with syncope, in order to reduce the recurrence rate.
Purpose
To determine a predictive score of recurrent syncopal episodes after the first medical assessment.
Methods
We conducted a retrospective study enrolling patients followed in our Syncope Consultation from January 2015 to November 2019. Clinical and episodes characteristics, as well as diagnostic studies were analysed. Correlation between variables was performed by the Chi-square and T-Student tests, with a significance level of 95%. Independent predictors of recurrent syncope were identified through a binary logistic regression analysis, considering p=0.05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analysed groups. SPSS 24.0 was used for statistical analysis.
Results
A total of 694 patients were included, and 420 (60.5%) had recurrent syncope at the first evaluation. After educational approach, 97 (14%) maintained recurrent episodes. In this subgroup, the mean age was 63.7±22.8 years-old and 88.7% already had previous recurrent syncope (vs 56.1%; p<0.001). The prodrome of malaise was common (40.2% vs 26.8%; p=0.008), but 32% of these patients had syncope without prodromes (vs 21.8%; p=0.032). They also had frequently first-degree atrioventricular (AV) block (22.5% vs 6.8%; p<0.001) and 51.7% had a final diagnosis of reflex syncope. No previous medication with calcium channel blockers (CCB) (p<0.001), malaise (p=0.011), not having Q-waves in the electrocardiogram (p=0.022) and the presence of first-degree AV block (p<0.001) were independent predictors of recurrent syncope. A predictive score of recurrence was determined using the formula: 0.108 − 1.556 x (medication with CCB) + 0.989 x (malaise) − 1.031 x (Q-waves) + 2.406 x (first degree AV block). Variables should be replaced by 1 or 0, depending on whether the condition is present or not. A cut-off of 0.283 was obtained with a specificity of 96.1% and a discriminative power of 81.2%.
Conclusion
In our patients presenting with syncope, recurrence rate reduced from 60,5% to 14% just with educational measures. To help identify patients who maintain recurrence, we determined a predictive score using clinical data from the first visit, with a good discriminative power and excellent specificity. It could be used to strengthen education, to direct diagnostic studies and to shorten follow-up visits, but it still needs validation to be used in clinical practice.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - T.F Mota
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J.S Bispo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - H Costa
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - P Azevedo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - D Bento
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - N Marques
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - I Jesus
- Algarve University Hospital Center, Cardiology, Faro, Portugal
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Marques N, Azevedo O, Almeida AR, Bento D, Cruz I, Correia E, Lourenço C, Lopes LR. Specific Therapy for Transthyretin Cardiac Amyloidosis: A Systematic Literature Review and Evidence-Based Recommendations. J Am Heart Assoc 2020; 9:e016614. [PMID: 32969287 PMCID: PMC7792401 DOI: 10.1161/jaha.120.016614] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The emergence of specific therapies for transthyretin cardiac amyloidosis (CA) warrants the need for a systematic review of the literature. Methods and Results A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A systematic search was performed on MEDLINE, PubMed, and Embase databases on November 29, 2019. Studies were selected based on the following predefined eligibility criteria: English‐language randomized controlled trials (RCTs), non‐RCTs, or observational studies, which included adult patients with variant/wild‐type transthyretin‐CA, assessed specific therapies for transthyretin‐CA, and reported cardiovascular outcomes. Relevant data were extracted to a predefined template. Quality assessment was based on National Institute for Health and Care Excellence recommendations (RCTs) or a checklist by Downs and Black (non‐RCTs). From 1203 records, 24 publications were selected, describing 4 RCTs (6 publications) and 16 non‐RCTs (18 publications). Tafamidis was shown to significantly improve all‐cause mortality and cardiovascular hospitalizations and reduce worsening in 6‐minute walk test, Kansas City Cardiomyopathy Questionnaire—Overall Summary score, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) in variant/wild‐type transthyretin‐CA. Patisiran showed promising results in a subgroup analysis of patients with variant transthyretin‐CA, which have to be confirmed in RCTs. Inotersen showed conflicting results on cardiac imaging parameters. The one study on AG10 had only a 1‐month duration and cardiovascular end points were exploratory and limited to cardiac biomarkers. Limited evidence from noncomparative single‐arm small non‐RCTs existed for diflunisal, epigallocatechin‐3‐gallate (green tea extract), and doxycycline+tauroursodeoxycholic acid/ursodeoxycholic acid. Conclusions This systematic review of the literature supports the use of tafamidis in wild‐type and variant transthyretin‐CA. Novel therapeutic targets including transthyretin gene silencers are currently under investigation.
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Affiliation(s)
- Nuno Marques
- Algarve Biomedical Center Algarve Portugal.,Biomedical and Medical Department Algarve University Algarve Portugal.,Cardiology Department Centro Hospitalar Universitário do Algarve Algarve Portugal
| | - Olga Azevedo
- Cardiology Department Hospital Senhora da Oliveira Guimarães Portugal.,Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Braga Portugal.,ICVS/3Bs PT Government Associate Laboratory Braga/Guimarães Portugal
| | | | - Dina Bento
- Algarve Biomedical Center Algarve Portugal.,Biomedical and Medical Department Algarve University Algarve Portugal.,Cardiology Department Centro Hospitalar Universitário do Algarve Algarve Portugal
| | - Inês Cruz
- Cardiology Department Hospital Garcia de Orta Almada Portugal
| | - Emanuel Correia
- Cardiology Department Centro Hospitalar Tondela Viseu Viseu Portugal
| | - Carolina Lourenço
- Cardiology Department Centro Hospitalar Universitário de Coimbra Coimbra Portugal
| | - Luís Rocha Lopes
- St. Bartholomew's Hospital-Barts Heart Centre Barts Health NHS Trust London United Kingdom.,Centre for Heart Muscle Disease Institute of Cardiovascular Science University College of London United Kingdom.,Centro Cardiovacular Universidade Lisboa Lisboa Portugal
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Moura Guedes JP, Marques N, Azevedo P, Mota T, Bispo J, Fernandes R, Costa H, Vinhas H, Mimoso J, de Jesus I. P2Y 12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy? Rev Port Cardiol 2020; 39:553-561. [PMID: 33023777 DOI: 10.1016/j.repc.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2Y12 inhibitor is the subject of debate and disagreement. The main aim of this study was characterize current practice in Portugal and to assess the prognostic impact of P2Y12 inhibitor LD administration strategy, before versus during or after primary percutaneous coronary intervention (PCI). METHODS This multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH). RESULTS A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2Y12 inhibitor was a predictor of the composite bleeding endpoint (major bleeding, need for transfusion or hemoglobin [Hb] drop >2g/dl), Hb drop >2g/dl and reinfarction. There were no differences between groups in major adverse events (MAE) (in-hospital mortality, reinfarction and stroke) or in-hospital mortality. CONCLUSIONS Prehospital use of a P2Y12 inhibitor was associated with an increased risk of bleeding, predicting the composite bleeding outcome and Hb drop >2g/dl, with no differences in mortality or MAE, calling into question the benefit of this strategy.
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Affiliation(s)
- João Pedro Moura Guedes
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal.
| | - Nuno Marques
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Departamento de Ciências Biomédicas e de Medicina da Universidade do Algarve, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Pedro Azevedo
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Teresa Mota
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - João Bispo
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Raquel Fernandes
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Hugo Costa
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Hugo Vinhas
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Jorge Mimoso
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Departamento de Ciências Biomédicas e de Medicina da Universidade do Algarve, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Ilídio de Jesus
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
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Fernandes RM, Mota T, Azevedo P, Cunha S, Bento D, Marques N, Bettencourt N, Pereira S, Nobre Â, de Jesus I. Giant Left Ventricular (Pseudo?) Aneurysm Complicating Anterior Myocardial Infarction. JACC Case Rep 2020; 3:334-338. [PMID: 34317530 PMCID: PMC8310941 DOI: 10.1016/j.jaccas.2020.05.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
The differential diagnosis of true aneurysms and pseudoaneurysms is challenging, and multimodality cardiac imaging is often necessary. We report a case in which the limitations of these techniques are exposed, showing that post-operative evaluation of tissue layers remains the gold standard in establishing this diagnosis. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| | - Teresa Mota
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| | - Pedro Azevedo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| | - Sandra Cunha
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| | - Dina Bento
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal.,Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal.,Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal
| | | | - Salomé Pereira
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Ilídio de Jesus
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
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Azevedo O, Marques N, Reis L, Cruz I, Craveiro N, Antunes H, Lourenço C, Gomes R, Guerreiro RA, Faria R, Sá F, Lima R, Gaspar P, Faria R, Miltenberger-Miltenyi G, Sousa N, Cunha D. Predictors of Fabry disease in patients with hypertrophic cardiomyopathy: How to guide the diagnostic strategy? Am Heart J 2020; 226:114-126. [PMID: 32531501 DOI: 10.1016/j.ahj.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Fabry disease (FD) is a treatable cause of hypertrophic cardiomyopathy (HCM). We aimed to determine the independent predictors of FD and to define a clinically useful strategy to discriminate FD among HCM. METHODS Multicenter study including 780 patients with the ESC definition of HCM. FD screening was performed by enzymatic assay in males and genetic testing in females. Multivariate regression analysis identified independent predictors of FD in HCM. A discriminant function analysis defined a score based on the weighted combination of these predictors. RESULTS FD was found in 37 of 780 patients with HCM (4.7%): 31 with p.F113L mutation due to a founder effect; and 6 with other variants (p.C94S; p.M96V; p.G183V; p.E203X; p.M290I; p.R356Q/p.G360R). FD prevalence in HCM adjusted for the founder effect was 0.9%. Symmetric HCM (OR 3.464, CI95% 1.151-10.430), basal inferolateral late gadolinium enhancement (LGE) (OR 10.677, CI95% 3.633-31.380), bifascicular block (OR 10.909, CI95% 2.377-50.059) and ST-segment depression (OR 4.401, CI95% 1.431-13.533) were independent predictors of FD in HCM. The score ID FABRY-HCM [-0.729 + (2.781xBifascicular block) + (0.590xST depression) + (0.831xSymmetric HCM) + (2.130xbasal inferolateral LGE)] had a negative predictive value of 95.8% for FD, with a cut-off of 1.0, meaning that, in the absence of both bifascicular block and basal inferolateral LGE, FD is a less probable cause of HCM, being more appropriate to perform HCM gene panel than targeted FD screening. CONCLUSION FD prevalence in HCM was 0.9%. Bifascicular block and basal inferolateral LGE were the most powerful predictors of FD in HCM. In their absence, HCM gene panel is the most appropriate step in etiological study of HCM.
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Robalo Nunes T, Calderón A, Barroso C, Marques N. Disseminated infection by Mycobacterium genavense in an HIV-1 infected patient. IDCases 2020; 21:e00926. [PMID: 32775210 PMCID: PMC7399251 DOI: 10.1016/j.idcr.2020.e00926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022] Open
Abstract
Mycobacterium genavenseinfection, a non-tuberculous mycobacteria, should be considered in immunosuppressed patients. Disseminated infection by Mycobacterium genavense is a clinical and microbiological diagnostic challenge. There are no standardized treatment guidelines for Mycobacterium genavense, but schemes with clarithromycin are favoured.
Opportunistic infections are an important cause of death and morbidity among HIV infected patients. Disseminated infections by nontuberculous mycobacteria are a diagnostic to consider among these patients with a high level of immunosuppression. A 64 year old Caucasian man, born in Angola, living in Portugal since 1975, presented in the emergency room with generalized malaise, weight loss, vesperal temperatures of around 37.5 °C with night sweats for two months, and epigastric abdominal pain with liquid stools in the 2 previous weeks. Laboratory study revealed a previously undiagnosed HIV-1 infection with 42 Lymphocytes CD4+/uL and viremia of 61,249 copies/mL. The abdominal-pelvic CT scan showed multiple necrotic ganglia in the mesenterium and mesenteric vases, which were biopsied revealing positive PCR for a nontuberculous mycobacteria; duodenal biopsies showed similar results. The bone marrow blood culture yeald the growth of Mycobacterium genavense. Antimicobacterial treatment was started and after six months he showed imagiological deterioration and the antibiogram revealed resistance to all antimycobacterial agents. The therapeutic scheme was empirically changed and the patient kept under vigilance with chronic therapy. This rare clinical case is both a diagnostic and therapeutic challenge.
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Affiliation(s)
- Tomás Robalo Nunes
- Infectious Diseases Resident, Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Calderón
- Pathology Resident, Histopathology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Clara Barroso
- Consultant in Pneumology, Centro de Diagnóstico Pneumológico, Almada, Portugal
| | - Nuno Marques
- Head of Department of Infectious Diseases, Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
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Pintassilgo I, Cesari M, Santos HN, Milic J, Franconi I, Mussini C, Marques N, Guaraldi G. The Lisbon patient: exceptional longevity with HIV suggests healthy aging as an ultimate goal for HIV care. BMC Infect Dis 2020; 20:290. [PMID: 32306918 PMCID: PMC7168988 DOI: 10.1186/s12879-020-05020-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
In the context of global aging, HIV infection has become a new chronic disease and requires innovative models of care. Treating isolated comorbidities represents a useless and potentially harmful practice at advanced age. Therefore, a patient-centered approach, in which the interventions are focused on the biology and function of the individual, with understanding of the importance of securing social and home environment that provides psychosocial support, better suits unmet health needs. We present a paradigmatic case of healthy aging: the first reported HIV-infected patient who achieved 100th of life - the Lisbon patient. The construct of healthy aging, recently introduced by the World Health Organization, is the best example of this comprehensive model and could represent the fourth target of UNAIDS agenda of the end of AIDS.
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Affiliation(s)
- Ines Pintassilgo
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | - Matteo Cesari
- Department of Clinical and Community Sciences, Università di Milano, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Henrique N Santos
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Azienda Policlinico-Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Iacopo Franconi
- Modena HIV Metabolic Clinic, Azienda Policlinico-Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Azienda Policlinico-Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Nuno Marques
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Azienda Policlinico-Universitaria di Modena, Modena, Italy.
- Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
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Pedro B, Alves L, Magano R, Nunes T, Marques N. Scrofula Caused by Multidrug-Resistant Tuberculosis. Eur J Case Rep Intern Med 2020; 7:001390. [PMID: 32015974 PMCID: PMC6993908 DOI: 10.12890/2020_001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 11/12/2022] Open
Abstract
Tuberculosis (TB) is one of the top 10 causes of death worldwide. Multidrug-resistant tuberculosis (MDR-TB) occurs when at the minimum there is resistance to isoniazid and rifampin. Prevention of new infections of Mycobacterium tuberculosis and progression to TB disease is critical to reduce the burden and mortality of this disease. We present the case of a 73-year-old human immunodeficiency virus (HIV)-negative female who presented with cervical lymphadenopathy and who was diagnosed with MDR-TB.
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Affiliation(s)
- Bárbara Pedro
- Serviço de Medicina II, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Liliana Alves
- Serviço de Infecciologia, Hospital Garcia de Orta, Almada, Portugal
| | - Rita Magano
- Serviço de Infecciologia, Hospital Garcia de Orta, Almada, Portugal
| | - Tomás Nunes
- Serviço de Infecciologia, Hospital Garcia de Orta, Almada, Portugal
| | - Nuno Marques
- Serviço de Infecciologia, Hospital Garcia de Orta, Almada, Portugal
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Azevedo O, Marques N, Craveiro N, Pereira AR, Antunes H, Reis L, Guerreiro RA, Pontes Dos Santos R, Miltenberger-Miltenyi G, Sousa N, Cunha D. Screening for Fabry disease in patients with left ventricular noncompaction. Rev Port Cardiol 2020; 38:709-716. [PMID: 31901299 DOI: 10.1016/j.repc.2019.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/03/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND AIM It is unclear whether left ventricular noncompaction (LVNC) is a distinct cardiomyopathy or a morphologic manifestation of different cardiomyopathies. We previously reported a case of LVNC in a Fabry disease (FD) patient, but it remains to be clarified whether LVNC is a cardiac manifestation of FD, a coincidental finding or an overdiagnosis, which has major therapeutic implications. This study aims to determine the prevalence of FD among patients with LVNC. METHODS We performed a retrospective study including all patients diagnosed with LVNC in eight hospital centers. Diagnosis of LVNC was based on at least one echocardiographic or cardiac magnetic resonance criterion. FD screening was performed by combined enzyme and genetic testing. RESULTS The study included 78 patients diagnosed with LVNC based on the Jenni (84.6%), Stöllberger (46.2%), Chin (21.8%), Petersen (83.8%) and Jacquier (16.2%) criteria. Left ventricular systolic dysfunction was present in 48.7%. Heart failure was found in 60.3%, ventricular dysrhythmias in 21.6% and embolic events in 11.5%. FD screening found no additional cases among patients with LVNC, besides the previously described case. CONCLUSION No additional FD cases were found among patients with LVNC, which argues against the hypothesis that LVNC is a cardiac manifestation of FD.
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Affiliation(s)
- Olga Azevedo
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Biomedical Science and Medicine Department, Algarve University, Faro, Portugal
| | - Nuno Craveiro
- Cardiology Department, Hospital de Santarém, Santarém, Portugal
| | - Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Hugo Antunes
- Cardiology Department, Centro Hospitalar de Tondela e Viseu, Viseu, Portugal
| | - Liliana Reis
- Cardiology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | | | - Gabriel Miltenberger-Miltenyi
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal; Genetics Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Damião Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Menezes Fernandes R, Mota T, Azevedo P, Bispo J, Guedes J, Costa H, Cunha S, Bento D, Cordeiro P, Bettencourt N, Marques N, Pereira S, Nobre A, Jesus I. P871 Giant left ventricular (pseudo?)aneurysm complicating anterior myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Clinical approach of cardiac aneurysms and pseudoaneurysms is significantly distinct. Therefore, it is crucial to accurately differentiate these two entities, which could be a real challenge.
Case report
We describe a case of a 55-year-old woman, with hypertension and previous smoking habits. She was admitted in our Cardiology Department with the diagnosis of anterior acute myocardial infarction, and was submitted to emergent coronariography, unveiling an occlusion of the middle segment of the anterior descending artery. She underwent successful primary percutaneous coronary intervention (PCI) 1h45 after the chest pain onset. Transthoracic echocardiogram (TTE) revealed depressed left ventricle ejection fraction (LVEF 30%), with akinesia of anterior and septal walls and all apical segments. She evolved in Killip-Kimbal class 2 and was discharged clinically stable. One week later, the patient performed a control TTE that showed an apical thrombus, with a small pericardial effusion, and she initiated warfarin. Three weeks later, a reevaluation TTE demonstrated a severe increase of the left ventricle dimensions, with LVEF 32%, and a small pericardial effusion. In apical 4-chambers incidence, it was visualized a linear structure (42 mm x 5 mm) attached to the endocardial border of the anterolateral apical segment and to the apical segment of the interventricular septum, of undefined nature. The apical segments were dyskinetic and had a very thin wall, which could correspond to aneurysm versus pseudoaneurysm. To clarify these findings, the patient performed a cardiac magnetic resonance revealing a large anterior myocardial infarction complicated with extensive myocardial necrosis, severe depression of LV systolic function (LVEF 25%) and septum rupture distal to the right ventricle apex (without connecting with it), compatible with a large apical pseudoaneurysm. The clinical case was discussed in the Heart Team and it was decided to perform cardiac surgery. However, surgical findings showed integrity of septal and free walls, and she underwent an aneurysmectomy, without further complications. Histological examination confirmed the presence of a thin myocardial wall with marked fibrosis and, consequently, the diagnosis of ventricular aneurysm. She was discharged clinically stable and maintains follow-up in Cardiology consultation of our Hospital.
Conclusion
In this patient, initially admitted with an anterior myocardial infarction submitted to primary PCI, follow-up with advanced imaging modalities pointed to the diagnosis of pseudoaneurysm. Despite the preoperative diagnosis, surgical findings were compatible with a giant left ventricular aneurysm. Even with high spatial resolution exams, postoperative evaluation of tissue layers remains the gold standard for this differential diagnosis.
Abstract P871 Figure. Apical pseudoaneurysm vs aneurysm
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - H Costa
- Faro Hospital, Cardiology, Faro, Portugal
| | - S Cunha
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Cordeiro
- Hospital Particular do Algarve, Cardiology, Faro, Portugal
| | - N Bettencourt
- Hospital Particular do Algarve, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - S Pereira
- Faro Hospital, Cardiology, Faro, Portugal
| | - A Nobre
- Hospital de Santa Maria, Cardiothoracic Surgery, Lisbon, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Carvalho Silva D, Marques N, Azevedo O, Miltenberger-Miltenyi G, Bento D, Guedes J, Azevedo P, Bispo J, Mota T, Fernandes R, Nzwalo H, Cabrita A, Ramos A, de Jesus I. p.G360R Is a Pathogenic GLA Gene Mutation Responsible for a Classic Phenotype of Fabry Disease. Cardiology 2019; 144:125-130. [DOI: 10.1159/000502437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/28/2019] [Indexed: 11/19/2022]
Abstract
The authors report the case of a classic phenotype of Fabry disease in a 60-year-old male patient presenting with left ventricular hypertrophy and stroke. Genetic analysis revealed 2 GLA-gene variants, i.e., p.R356Q and p.G360R. This clinical case highlights that the finding of 2 or more GLA gene variants in a Fabry patient should lead to a careful evaluation in order to determine their exact role in the condition. This case also provides the first clinical evidence that the p.G360R mutation is pathogenic and responsible for a classic phenotype of Fabry disease. The clinical improvement following the initiation of enzyme replacement therapy reinforces the importance of Fabry disease awareness and diagnosis in patients exhibiting red flags, such as left ventricular hypertrophy and stroke.
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Azevedo PM, Mota T, Bispo J, Guedes J, Carvalho D, Marques N, Santos W, Mimoso J, Jesus I. P879Discharge medication and 1-year outcomes in patients with myocardial infarction and nonobstructive coronary artery disease: a nationwide registry-based study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 5% to 10% of all patients with myocardial infarction. Although these patients are often treated as if they had obstructive coronary artery disease (OCAD), optimal medical therapy for secondary prevention in MINOCA patients have not been prospectively studied. We hypothesize that the same treatment strategy as for OCAD is unlikely to be beneficial in MINOCA patients due to their heterogeneous nature.
Purpose
Characterize and assess the impact of discharge medication on 1-year mortality or hospitalization in patients with MINOCA.
Methods
Retrospective cohort study of consecutive patients with acute myocardial infarction (AMI) recorded in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 1017. All patients who underwent coronary angiography and had no obstructive lesions (defined as <50% diameter stenosis) were included for analysis (n=829, 4.8% of a total of 17213). Patient demographics, clinical characteristics and medication at discharge were analyzed. The association between treatment and outcome was estimated by comparing treated and untreated groups using Cox proportional hazard models. The exposures considered were treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers (BB), aspirin (ASA) or dual antiplatelet therapy (DAPT). The outcomes evaluated were 1-year all-cause mortality and 1-year hospitalization due to cardiovascular disease (CVD)
Results
829 patients (54% male, mean age 65±13 years) were included. 67% had hypertension, 20% diabetes mellitus, 45% hyperlipidemia, 66% were overweight, 23% were current smokers, 5.5% had history of heart failure, 4.3% valvular heart disease, 8% cerebrovascular disease and 4.7% chronic kidney disease. The admission diagnosis was most frequently non-ST elevation MI (79.3%) and mean left ventricular ejection fraction (%) was 56±12. 4 patients died during hospitalization (0.5%). At discharge, aspirin was prescribed in 85.7% patients, clopidogrel in 54.8%, ticagrelor in 7.5%, DAPT in 57.7%, ACEi/ARB in 79.2%, beta-blocker in 69% and statins in 90.2%. 1-year mortality and 1-year CVD hospitalization was 3.8% and 9%, respectively. After adjusting for covariates in Cox regression analysis, we found no association between any medication at discharge and 1-year outcomes.
Conclusion
A high proportion of patients are prescribed antiplatelet therapy, including DAPT. We found no significant 1-year beneficial effect of treatment with statins, ACEi/ARBs, BB, aspirin or DAPT in MINOCA. This may be partially explained by the highly heterogenous population and relative short-term follow-up. In MINOCA patients, treatment should be individualized after an exhaustive diagnostic workup to identify the underlying cause (e.g. CAD with spontaneous autolysis of an intracoronary thrombus, myocarditis or takotsubo syndrome).
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Menezes Fernandes R, Mota T, Bispo J, Azevedo P, Guedes J, Silva D, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P1721Determination of a predictive score of cardiogenic shock in acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0476] [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
Cardiogenic shock is one of the leading causes of death in patients with acute coronary syndrome (ACS), reaching in-hospital mortality rates of 50%.
Purpose
To identify a predictive score of cardiogenic shock in patients with ACS.
Methods
We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of cardiogenic shock were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. Statistical analysis was conducted with SPSS 24.0.
Results
During this period, 4458 patients were admitted with ACS and 74 (1,7%) developed cardiogenic shock. In this subgroup, 59,5% were over 65 years of age, 63,5% were male and 93,2% presented with acute myocardial infarction with ST segment elevation. Also, 83,8% were in sinus rhythm at admission, 22,7% had creatinine>1,5 mg/dL and 17,9% had left ventricular ejection fraction (LVEF) <30%. The in-hospital mortality rate was 51,4%. LVEF <30% (p=0,018), creatinine>1,5 mg/dL (p=0,044) and absence of sinus rhythm at admission (p=0,041) were independent predictors of cardiogenic shock. A predictive score of this complication in patients with ACS was determined using the formula: 1,723 + 1,505 x (creatinine>1,5) + 4,483 x (LVEF <30%) – 2,094 x (sinus rhythm at admission). A cutoff of 0,58 was obtained with 44,4% sensitivity, 85,2% specificity and 85% discriminative power.
Conclusion
Cardiogenic shock occurred in 1,7% of patients admitted with ACS and was associated with a high mortality rate. We determined a predictive score of this complication with a good discriminative power, which included LVEF <30%, creatinine >1,5 mg/dL and the rhythm on admission's electrocardiogram. By taking into account clinical variables, this score can be used at a very early stage of admission, allowing risk stratification of developing cardiogenic shock in each patient. However, it needs validation to be applied in clinical practice.
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Silva
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Faria Da Mota T, Sousa Bispo J, Azevedo P, Fernandes R, Guedes JP, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P844NAS2H score, a novel predictive score of 1-year all cause mortality in Acute Coronary Syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients admitted for Acute Coronary Syndromes (ACS), mortality is influenced by several clinical and therapeutical factors, and management of these patients should be guided by an estimate of individual risk.
Objective
To develop a simple predictive model of 1-year mortality in patients admitted for ACS.
Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for ACS in a Cardiology department between the 1st of October 2010 and the 1st of October 2017. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Patients with 1y mortality (1yM) events were studied regarding baseline demographic and clinical characteristics, risk factors and hospitalization data, and a correlational analysis with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%) was performed. Independent predictors of 1yM were identified through binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.
Results
A total of 3251 patients were included, 826 (25,4%) of which were female, with a mean age of 65,5±13,4 years. In the studied sample, 268 patients (8,2%) died in the year following hospital discharge; this group had a mean age of 65,6±13,2 years, and 80 (29,9%) were female patients. There was a significant association between 1yM and multiple clinical, therapeutical and laboratorial variables, but after multivariate analysis only age greater than 65 years old (yo) [p=0,001], previous stroke [p=0,005], haemoglobin (Hb) <10mg/dL [p<0,001], brain natriuretic peptide (BNP) >100pg/mL [p=0,001], and left ventricular ejection fraction (LVEF) <50% [p <0,001] proved to be independent predictors of the studied outcome. Using these variables, the authors developed a scoring model to predict 1yM in patients admitted for ACS with the following formula = 0,002 + (0,736 x Age >65yo) + (0,91 x previous stroke) + (2,562 x Hb <10) + (0,63 x BNP >100) - (1,207 x FEVE >50%). In this function, variables should be substituted by 1 or 0, depending on wheter they are present or not. The discrimination cutoff was 0,57, with a 70,6% sensibility and 75,9% specificity, and a discriminant power of 75,4%.
Conclusion
Defining the mortality risk of ACS patients after discharge represents a real challenge and demands a careful evaluation of multiple factors in an attempt to achieve an accurate estimation of risk. The authors developed a predicting model for 1yM in ACS patients, with a good discriminant power, based on simple variables. The present score will require validation in a larger cohort of ACS patients before it can be applied in a clinical context.
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Affiliation(s)
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J P Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Azevedo PM, Fernandes R, Mota T, Bispo J, Guedes J, Carvalho D, Santos W, Marques N, Pereira S, Mimoso J, Jesus I. P1698Age shock index is a simple bedside clinical risk stratification tool in patients with non-ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0453] [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
Shock index (SI), (heart rate (HR)/systolic blood pressure (SBP)), has been reported to predict worse outcomes in different acute settings. Two derivatives, named modified SI (MSI), defined as HR/mean BP; and Age SI, defined as SI multiplied by age, were later developed, but only the former was tested for short-term outcomes in patients with myocardial infarction (MI). We hypothesize that Age SI may demonstrate higher prognostic accuracy than SI and MSI due to the added prognostic value of age in this population.
Purpose
Compare the prognostic performance of admission age SI, MSI and SI for predicting in-hospital mortality in patients with NSTEMI.
Methods
Retrospective cohort study of consecutive patients admitted to the Cardiology department of a tertiary care hospital with the diagnosis of NSTEMI between October 2010 and September 2018. Very high-risk patients in need of emergent treatment were excluded. Of the initial cohort of 2476 patients, we excluded 5 who presented cardiac arrest before or at hospital admission, 4 with cardiogenic shock, 95 with acute pulmonary oedema, 10 with SBP <80 mmHg, 1 with HR <40bpm and 1 with HR >160bpm. The primary outcome was all-cause in-hospital mortality. The discriminatory capacity of Age SI, MSI, SI for the primary outcome was assed using the ROC-AUC and compared with the DeLong method, and the value with highest Youden-index was considered the optimal cut-off point. Calibration was assessed using the Hosmer-Lemeshow (HL) test and adjustment for confounding variables was performed using logistic regression analysis.
Results
2359 patients were included [mean age 66±13 years; 1732 (73.4%) men], of whom 40 (1.7%) died during hospitalization. Discrimination by ROC-AUC was highest for Age SI (0.78 [95% CI 0.71–0.86)], compared to MSI (0.69 [95% CI 0.61–0.78]) and SI (0.69 [95% CI 0.61–0.78)], p<0.01 for comparison. All indexes demonstrated adequate calibration (HL: Age SI 7.4; MSI 4.5; SI 6.4; p>0.5). The optimal cut-off for Age SI was 40, which was present in 684 patients (29%) and had 75% sensitivity, 72% specificity, 4.5% positive and 99.5% negative predictive value (NPV) for in-hospital mortality (4.4% vs 0.6%, p<0.001). After adjusting for covariates, an Age SI higher than 40 was associated with increased in-hospital mortality (adjusted OR 3.2, 95% IC 1.06–9.55), p=0.039).
Mortality and Age Shock Index
Conclusion
Age SI demonstrated better discriminatory capacity and equal calibration, compared to SI and MSI for in-hospital mortality. An age SI higher than 40 was associated with a 3-fold increased risk of in-hospital death. This cut-off demonstrated excellent negative predictive value (99.5%) and may allow very early risk assessment in patients with non-ST-segment elevation MI (NSTEMI), before laboratorial values are available for GRACE calculation. This may guide initial therapy and help select the most appropriate initial site of care.
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Affiliation(s)
| | | | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - S Pereira
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Faria Da Mota T, Azevedo P, Fernandes R, S J, Guedes J, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P4579Prediction of CABG indication in patients admitted for NSTEMI with the new CABG DAPE2S score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0967] [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
A significant number of patients admitted for Non-ST Elevation Myocardial Infarction (NSTEMI) have multivessel complex coronary artery disease (CAD) and benefit from Coronary Artery Bypass Graft surgery (CABG). These patients frequently present high-risk surgical profiles, constituting a challenging group when it comes to balancing ischemic and haemorrhagic risk.
Objective
To develop a simple predictive risk model of referral to CABG in patients admitted for NSTEMI.
Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for NSTEMI in a Cardiology department between the 1st of October 2010 and the 1st of October 2018. Demographic profile, clinical characteristics, risk factors and hospitalization data of NSTEMI patients referred to CABG were studied, and a correlational analysis was performed with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%). Independent predictors of CABG in patients with NSTEMI were identified through Binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was subsequently applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.
Results
A total of 2476 patients were included, 668 (27%) of which were female, with a mean age of 68,5±13,4 years. In the studied sample, 273 patients (11%) were proposed to CABG. The authors found a significant association between CABG and multiple clinical, laboratorial and therapeutical variables, but after multivariate analysis only male sex, previous Diabetes Mellitus, previous angina, previous Percutaneous coronary intervention, absence of a normal EKG, ST segment depression at admission, sinus rythm and brain natriuretic peptide (BNP) >100pg/mL proved to be independent predictors of referral. Using these variables, the authors developed a risk model to predict CABG referral in NSTEMI patients: −0,614 − (0,756 x female sex) + (0,305 x diabetes) + (0,631 x angina) − (1,513 x previous PCI) + (1,216 x sinus rythm) + (0,672 x ST depression) − (0,806 x normal EKG) + (0,562 x BNP>100). In this function, variables should be substituted by 1 or 0, depending on wheter the condition they specify is present or absent. The optimal discrimination cutoff was 0,23, with a 64% sensibility and 59% specificity, and a discriminant power of 60%.
Conclusion
Being able to predict referral to surgical revascularization in NSTEMI may help physicians to optimize a specific approach in each patient, in particular with regard to anti-thrombotic strategies. The authors developed a risk predicting model for CABG in NSTEMI patients based on simple clinical and laboratory variables, which will require validation in a larger cohort, before it can be applied in a clinical context.
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Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J S
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Azevedo PM, Mota T, Bispo J, Guedes J, Carvalho D, Marques N, Santos W, Mimoso J, Jesus I. 3036Identifying low-risk patients eligible for early discharge after ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0004] [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
Early discharge after ST-segment elevation myocardial infarction (STEMI) should be considered in low-risk patients after successful percutaneous coronary intervention (PCI) to reduce healthcare costs and improve resource utilization. The Zwolle criteria is recommended by current guidelines for the identification of low-risk patients but a new score, the FASTEST score, has recently demonstrated to add prognostic value over Zwolle score in small and unicentric studies.
Purpose
Assess if FASTEST score could better identify low-risk patients compared to Zwolle in a contemporary nationwide cohort of patients with STEMI who underwent primary PCI and complete revascularization.
Methods
Multicentric observational study of consecutive patients with ACS recorded in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between October 2010 and January 2019. Patients who underwent primary PCI and received complete revascularization were included, and those with missing data for score calculation were excluded. The FASTEST score awards 1 point for each: femoral access, age>65, LVEF<50, TIMI<3; creatinine >1.5 mg/dl; stenosis of the left main coronary artery; and Killip≥2. The Zwolle score was calculated for comparison. The rate of hospital mortality and a composite of serious adverse events (heart failure, cardiogenic shock, re-infarction, mechanical complication, ventricular arrhythmia and major hemorrhage) was compared between low-risk patients as classified by FASTEST (score=0) or Zwolle (score≤3). One-year mortality and cardiovascular rehospitalization was compared between the two groups.
Results
We included 3322 patients (77.4% male, mean age 62±13 years, 49.5% with anterior STEMI). The FASTEST score identified 855 (25.8%) and Zwolle 2353 (70.7%) low-risk patients. Discrimination by AUC for hospital mortality was 0.92 (95% CI 0.91–0.93) for FASTEST score, significantly higher than Zwolle (0.83 (95% CI 0.82–0.84), p<0.001 for comparison) (Fig.1). Overall hospital mortality was 2.8%. 1 patient died in low-risk FASTEST compared to 24 (1%) in low-risk Zwolle (p=0.01). Low-risk Zwolle patients were more likely to suffer serious hospital adverse events compared with FASTEST score low-risk (19.5% vs 8.5%, p<0.001).
At one-year, 1384 patients had follow-up data. Mortality was significantly lower in low-risk FASTEST than Zwolle (1.5% vs 4.6%, p<0.001) and a tendency for less cardiovascular rehospitalization was also noted (5.4% vs 7.5%, p=0.08).
Figure 1. ROC-AUC for hospital mortality
Conclusion
Approximately one in every four patients were classified as low-risk according to FASTEST score, in contrast with 70% for Zwolle score. Low-risk FASTEST score patients exhibited significantly less hospital mortality (1 patient), hospital serious adverse events and 1-year mortality compared with low-risk Zwolle patients. FASTEST score demonstrated better discriminatory capacity for hospital mortality than Zwolle score and its use for risk stratification should be preferred.
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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