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Cevik J, Read D, Putland M, Fazio T, Gumm K, Varma A, Santos R, Ramakrishnan A. The impact of electric scooters in Melbourne: data from a major trauma service. ANZ J Surg 2024; 94:572-579. [PMID: 38087881 DOI: 10.1111/ans.18814] [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: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia. METHODS A retrospective cohort study was conducted using hospital and registry data from January 2022 to January 2023. Data collected included demographic details, alcohol and helmet use, injury type and severity, operative treatment provided, and direct medical costs. The economic impact (in AUD) of the patient's emergency presentation and hospital admission was calculated. RESULTS During the study period, 256 electric scooter related injuries were recorded, comprising 247 riders and nine pedestrians. The majority of patients were males (69%) with a median age of 29.5 (15-78). Alcohol use was reported by 34% and helmet use by 33%. Injuries most commonly affected the upper limb (53%) and head (50%), with abrasions (75%) and fractures (48%) being the most common type of injury sustained. The total hospital cost was $1 911 062, and the median cost was $1321.66 per patient (IQR: $479.37-$5096.65). CONCLUSION Electric scooter usage, as observed through patient presentations to the Royal Melbourne Hospital, is associated with a considerable number of injuries, primarily among young males, and an ensuing substantial economic burden. The findings underscore the urgent need for improved safety measures to minimize electric scooter-related injuries and their clinical and economic repercussions.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Putland
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amrita Varma
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Roselyn Santos
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Pedersen MRV, Kraus B, Santos R, Harrison G. Sonographers' perspectives on research - A worldwide online questionnaire study. Radiography (Lond) 2024; 30:483-491. [PMID: 38219390 DOI: 10.1016/j.radi.2023.12.010] [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: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Research has been performed by sonographers (also known as ultrasound reporting radiographers) for many years for improving diagnosis of disease, developing new imaging approaches, and enhancing patient outcomes. Despite this, sonographers' perspectives on research have not been well studied. To understand the views of sonographers is essential, as they have an important role in the successful implementation of research outcomes during their daily work. The study aimed to explore sonographers' perspectives on research. METHODS This cross-sectional online questionnaire was developed, and pilot tested, before distribution on social media platforms by the research group to sonographers or reporting radiographers in ultrasound worldwide. The questionnaire included 21-items. The link was open for 8 weeks in the spring of 2023. A mix of closed, open and scale questions were used. Informed consent was mandatory, and information about the study and anonymity was presented. RESULTS A total of 165 sonographers participated in the questionnaire of which 66.1 % were from Europe (n = 109), 6.1 % from North America (n = 10), 0.6 % from South America (n = 1), 2.4 % from Asia (n = 4), 13.3 % from Africa (n = 22) and 11.5 % from Oceania (n = 19). A total of 32 % of the participants had performed research. Also, 68.5 % would like to become more involved in research. CONCLUSION Most sonographers work in large hospitals, and half of them have obtained academic level 7 education. A limited number of sonographers have published peer reviewed papers. Many sonographers expressed an interest in research. This suggests a potential for future development of the sonographers' role in research. IMPLICATIONS FOR PRACTICE The findings for this study provide insight that could be used to improve research practice for sonographers.
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Affiliation(s)
- M R V Pedersen
- Department of Radiology, Vejle Hospital - Part of Lillebaelt Hospital, Vejle, Denmark; Department of Radiology, Kolding Hospital- Part of Lillebaelt Hospital, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; European Federation of Radiographer Societies (EFRS), Rue Marechal Teixeira Rebelo 425, 5030-058 Cumiera, Portugal.
| | - B Kraus
- Department of Health Sciences, Radiological Technology, University of Applied Sciences FH Campus Wien, Favoritenstrasse 226, A-1100 Vienna, Austria; European Federation of Radiographer Societies (EFRS), Rue Marechal Teixeira Rebelo 425, 5030-058 Cumiera, Portugal
| | - R Santos
- Medical Imaging Radiotherapy Department, Coimbra Health School, Polytechnic University of Coimbra, Rue 5 de Outubro, 3046-854, Portugal; Laboratory for Applied Health Research ((LabinSaúde), Coimbra 3046-854, Portugal; European Federation of Radiographer Societies (EFRS), Rue Marechal Teixeira Rebelo 425, 5030-058 Cumiera, Portugal
| | - G Harrison
- Society and College of Radiographers, 207 Providence Square Mill Street, London SE1 2EW, UK; European Federation of Radiographer Societies (EFRS), Rue Marechal Teixeira Rebelo 425, 5030-058 Cumiera, Portugal
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Kraus B, Harrison G, Santos R, Vils Pedersen MR. Ultrasound education across European Federation of Radiographers Societies (EFRS) countries: Similarities and differences. Radiography (Lond) 2024; 30:715-722. [PMID: 38428195 DOI: 10.1016/j.radi.2024.01.024] [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: 10/13/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Ultrasound education varies greatly across European healthcare systems. This paper focuses on ultrasound academic education as a part of wider suite of surveys on radiographers working in ultrasound. The aim was to investigate sonography educational levels, methods of training, course duration and other factors in European Federation of Radiographers Societies (EFRS) member countries. METHOD In 2019 an online survey was sent to the 38 EFRS member societies to distribute to higher education institutions within their own country. The survey was in English and contained different types of questions such as closed questions, free text options, and scale responses, to investigate sonography education including academic course types and duration, curriculum content, learning and teaching methods. RESULTS A total of 45 responses were received, showing wide variation in the duration of training between the respective countries. Academic level 7 (part-time) ultrasound education was most frequently reported (n = 13), followed by direct entry ultrasound courses (n = 9) and bachelor's degree programmes at EQF level 6 (n = 7). The duration of part-time courses ranged from nine months up to four years. CONCLUSION Sonography training and education varies among EFRS member countries ranging from short focused courses to postgraduate awards. Few countries offer sonography education leading to an award. The majority of clinical teaching and learning takes place in the learner's workplace. IMPLICATIONS FOR PRACTICE High quality academic and clinical education for radiographers extending their role into ultrasound is important to ensure safe, effective sonography practice and good patient care.
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Affiliation(s)
- B Kraus
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV Utrecht, the Netherlands; Department of Health Sciences, Radiological Technology, University of Applied Sciences FH Campus Wien, Favoritenstrasse 226, A-1100 Vienna, Austria.
| | - G Harrison
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV Utrecht, the Netherlands; Society and College of Radiographers, 207 Providence Square Mill Street, London SE1 2EW, UK; School of Health and Psychological Sciences. City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - R Santos
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV Utrecht, the Netherlands; Medical Imaging Radiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, Rue 5 de Outubro, 3046-854, Portugal
| | - M R Vils Pedersen
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV Utrecht, the Netherlands; University Hospital Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark
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Robalo A, Brandão J, Shibata T, Solo-Gabriele H, Santos R, Monteiro S. Detection of enteric viruses and SARS-CoV-2 in beach sand. Sci Total Environ 2023; 901:165836. [PMID: 37517729 DOI: 10.1016/j.scitotenv.2023.165836] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
Beach sand harbors a diverse group of microbial organisms that may be of public health concern. Nonetheless, little is known about the presence and distribution of viruses in beach sand. In this study, the first objective was to evaluate the presence of seven viruses (Aichi virus, enterovirus, hepatitis A virus, human adenovirus, norovirus, rotavirus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) in sands collected at public beaches. The second objective was to assess the spatial distribution of enteric viruses in beach sand. To that end, 27 beach sand samples from different beaches in Portugal were collected between November 2018 and August 2020 and analyzed for the presence of viruses. At seven beaches, samples were collected in the supratidal and intertidal zones. Results show that viruses were detected in 89 % (24/27) of the sand samples. Aichi virus was the most prevalent (74 %). Noroviruses were present in 19 % of the samples (norovirus GI - 15 %, norovirus GII - 4 %). Human adenovirus and enterovirus were detected in 48 % and 22 % of the samples, respectively. Hepatitis A virus and rotavirus were not detected. Similarly, SARS-CoV-2 in beach sand collected during the initial stages of the pandemic was also not detected. The detection of three or more viruses occurred in 15 % of the samples. Concentrations of viruses were as high as 7.2 log copies (cp)/g of sand. Enteric viruses were found in higher prevalence in sand collected from the supratidal zone compared to the intertidal zone. Human adenovirus was detected in 43 % of the supratidal and 14 % in the intertidal samples and Aichi virus in 57 % and 86 % of the intertidal and supratidal areas, respectively. Our findings suggest that beach sand can be a reservoir of enteric viruses, suggesting that it might be a vehicle for disease transmission, particularly for children, the elderly, and immunocompromised users.
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Affiliation(s)
- A Robalo
- Laboratorio Analises, Técnico Lisboa, Universidade Lisboa, Portugal
| | - J Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
| | - T Shibata
- Institute for the Study of the Environment, Sustainability, and Energy, Northern Illinois University, DeKalb, IL, USA; Center for Southeast Asian Studies, Northern Illinois University, DeKalb, IL, USA
| | - H Solo-Gabriele
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL, USA
| | - R Santos
- Laboratorio Analises, Técnico Lisboa, Universidade Lisboa, Portugal; Departamento de Engenharia e Ciências Nucleares, Técnico Lisboa, Universidade de Lisboa, Portugal
| | - S Monteiro
- Laboratorio Analises, Técnico Lisboa, Universidade Lisboa, Portugal; Departamento de Engenharia e Ciências Nucleares, Técnico Lisboa, Universidade de Lisboa, Portugal.
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Jenkins V, Matthews L, Solis-Trapala I, Gage H, May S, Williams P, Bloomfield D, Zammit C, Elwell-Sutton D, Betal D, Finlay J, Nicholson K, Kothari M, Santos R, Stewart E, Bell S, McKinna F, Teoh M. Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results. Support Care Cancer 2023; 31:570. [PMID: 37698629 PMCID: PMC10497681 DOI: 10.1007/s00520-023-08002-z] [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: 02/27/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway. METHODS Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary). RESULTS 99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician. CONCLUSION The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.
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Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK.
| | - L Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - I Solis-Trapala
- School of Medicine, Keele University, University Road, Staffordshire, England, UK
| | - H Gage
- Surrey Health Economics Centre/Department of Clinical and Experimental Medicine, Leggett Building, University of Surrey, Guildford, Surrey, England, UK
| | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - P Williams
- Department of Mathematics, University of Surrey, Guildford, Surrey, England, UK
| | - D Bloomfield
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - C Zammit
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - D Elwell-Sutton
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - D Betal
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - J Finlay
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - K Nicholson
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - M Kothari
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - R Santos
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - E Stewart
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - S Bell
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - F McKinna
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - M Teoh
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
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Bony S, Labeille M, Lefrancois E, Noury P, Olivier JM, Santos R, Teichert N, Besnard A, Devaux A. The goby fish Sicydium spp. as valuable sentinel species towards the chemical stress in freshwater bodies of West Indies. Aquat Toxicol 2023; 261:106623. [PMID: 37429095 DOI: 10.1016/j.aquatox.2023.106623] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Implementation of the European Water Framework Directive in tropical areas such as the French West Indies (FWI) requires to select relevant aquatic sentinel species for investigating the ecological status of surface waters. The present work aimed to study the biological response of the widespread fish Sicydium spp. towards river chemical quality in Guadeloupe island through a set of proper biomarkers. During a 2-year survey, the hepatic EROD activity, the micronucleus formation and the level of primary DNA strand breaks in erythrocytes were measured respectively as an enzymatic biomarker of exposure and genotoxicity endpoints in fish living upstream and downstream of two chemically-contrasted rivers. Hepatic EROD activity was shown to be variable along the time but always significantly higher in fish from the most contaminated river (Rivière aux Herbes) compared to the low contaminated one (Grande Rivière de Vieux-Habitants). Fish size did not influence EROD activity. Female fish exhibited a lower EROD activity compared to males depending on the catching period. We observed significant temporal variation in micronucleus frequency and primary DNA damage level measured in fish erythrocytes that did not depend on the fish size. Micronucleus frequency and to a lesser extent DNA damage were significantly higher in fish from the Rivière aux Herbes compared to the Grande Rivière de Vieux-Habitants. Our results argue for the interest of using Sicydium spp. as sentinel species to assess river quality and chemical pressures in FWI.
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Affiliation(s)
- S Bony
- Univ Lyon, Université Claude Bernard Lyon 1, ENTPE, CNRS, INRAE, USC 1369, UMR 5023 LEHNA, F-69518 Vaulx-en-Velin, France
| | - M Labeille
- Sentinelle Lab, F-97125 Bouillante, France
| | | | - P Noury
- INRAE, UR RiverLy, Laboratoire d'écotoxicologie, F-69616 Villeurbanne, France
| | - J M Olivier
- Univ Lyon, Université Claude Bernard Lyon 1, CNRS, ENTPE, UMR 5023 LEHNA, F-69622 Villeurbanne, France
| | - R Santos
- INRAE, UR RiverLy, Laboratoire d'écotoxicologie, F-69616 Villeurbanne, France
| | - N Teichert
- UMR 7208 BOREA, MNHN, CNRS, IRD, SU, UCN, UA, Laboratoire de Biologie des Organismes et Ecosystèmes Aquatiques, Paris, France
| | - A Besnard
- CEFE, Université Montpellier, CNRS, EPHE-PSL University, IRD, Montpellier, France
| | - A Devaux
- Univ Lyon, Université Claude Bernard Lyon 1, ENTPE, CNRS, INRAE, USC 1369, UMR 5023 LEHNA, F-69518 Vaulx-en-Velin, France.
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Micallef C, Enoch DA, Kamranpour P, Santos R, Tyler N, Scott S. The role of hospital antimicrobial and infectious diseases pharmacists in the UK: a theoretically underpinned exploration. JAC Antimicrob Resist 2023; 5:dlac136. [PMID: 36644412 PMCID: PMC9833282 DOI: 10.1093/jacamr/dlac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives We sought to characterise the role of hospital infection pharmacists in the UK and to understand the core challenges being faced, future role development desires and the required support to address these. Methods We developed a questionnaire underpinned by the theoretical domains framework exploring the barriers and enablers to pharmacists fulfilling their perceived roles and responsibilities. Any pharmacist whose role included 'specialist antimicrobial' or 'infectious diseases' was invited to complete a questionnaire sent via national infection and pharmacy groups/networks. Descriptive statistics were used to report responses to each item, and a content analysis was undertaken to summarize the key messages from an extended response option. Results Of the 102 respondents, 91 (89.2%) were from English hospitals. Fifty-three (52%) were from district general hospitals and 45 (45.1%) from teaching hospitals. Most (97, 95%) respondents were of a senior grade. The need for a comprehensive educational programme, recognition of research as core to the role and integration with infection/microbiology departments were key requirements along with protected time to engage with the activities. Highlights of the role were opportunities to teach, making a significant contribution to patient care and scope to contribute to strategy and vision. The COVID-19 pandemic negatively impacted on respondents' capacity to undertake their perceived roles and responsibilities. Conclusions Our study delineates the need for UK infection and pharmacy policy makers to review hospital infection pharmacist developmental pathways and roles. Joint learning, and closer working, with infection/microbiology departments may be an efficient strategy to address the issues raised.
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Affiliation(s)
- C Micallef
- Pharmacy Department, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D A Enoch
- Clinical Microbiology & Public Health Laboratory, UK Health Security Agency, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Kamranpour
- Pharmacy Department, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - R Santos
- Pharmacy Department, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Tyler
- Pharmacy Department, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Pharmacy Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - S Scott
- Corresponding author. E-mail: @DrChristianneM, @PKamranpour, @SantosReem, @NettaTyler, @sionscott
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Oliveira M, Reis Silva R, Fonseca J, Santos R, Demetrio D. 11 The impact of multiple ovum pickups on reproductive and productive performance of Holstein heifers. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab11] [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: 12/11/2022] Open
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Demetrio D, Oliveira M, Reis Silva R, Amorim D, Demetrio C, Santos R. 12 Relationship between Angus oocyte quality and embryo production. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab12] [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: 12/12/2022] Open
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Reis Silva R, Demetrio D, Walhof C, Oliveira M, Spricigo J, Santos R. 13 Is pregnancy failure still a major concern for bovine. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab13] [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: 12/12/2022] Open
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Sousa-Sá E, Agostinis-Sobrinho C, Lopes L, Moreira C, Abreu S, Pereira JR, Zhang Z, Rodrigues B, Santos R. Prevalence, patterns and socio-demographic correlates of sleep duration in adolescents: results from the LABMED study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pinto L, Joaquim A, Dinis R, Amarelo A, Amorim A, Dias Â, Brandão D, Godinho J, Ribeiro L, Travado L, Brito M, Luis M, Brice M, Almeida S, Hussong Milagre T, Dionísio M, Domingues M, Rosa P, Santos R, Vieira C. Advanced breast cancer journey: a consensus guidance from a multidisciplinary panel for improving clinical practice in Portugal. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Enoch DA, Murphy ME, Gouliouris T, Santos R, Micallef C. Temocillin use as a carbapenem-sparing option in a UK teaching hospital for treating serious Gram-negative bacterial infections. JAC Antimicrob Resist 2022; 4:dlac111. [PMID: 36324332 PMCID: PMC9619245 DOI: 10.1093/jacamr/dlac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- D A Enoch
- Corresponding author. E-mail: @DrChristianneM
| | - M E Murphy
- Department of Microbiology, UKNHS GGC Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow G31 2ER, UK
| | - T Gouliouris
- Clinical Microbiology & Public Health Laboratory, UK Health Security Agency, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 OQW, UK
| | - R Santos
- Department of Pharmacy, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 OQQ, UK
| | - C Micallef
- Department of Pharmacy, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 OQQ, UK
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Paiva M, Rato J, Santos R, Cunha G, Gomes D, Cordeiro S, Madeira S, Guerreiro S, Moreno L, Durazzo A, Mendes M. Cardiopulmonary exercise testing in Fontan patients: unmasking the secret of Super-Fontans. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Exercise capacity is usually reduced in Fontan patients, however there is a subset of patients who have normal exercise capacity and better outcomes, the “Super-Fontans”. The aim of this study was to characterize a cohort of Fontan patients undergoing cardiopulmonary exercise testing (CPET) and identify predictors of better functional capacity.
Methods
Single center retrospective analysis of consecutive Fontan patients aged >10 years old who underwent CPET, between March 2018 and May 2021.
Peak respiratory exchange ratio1.05 defined maximal CPET. Peak VO2 (pVO2) as a percentage of its predicted value was used as reference value to stratify patients in tertiles.
Patients in 3rd tertile, with a percentage predicted pVO2 superior to 75%, were considered good-performers.
Blood tests and transthoracic echocardiogram (TTE) were performed on the same day. Additional data were collected from electronic charts.
Results
In total, 49 patients were included (mean age 19±7 years old, 67% male) with intra or extracardiac conduit implanted in mean 12±7 years prior to the CPET.
The most common primary diagnoses were tricuspid/pulmonary atresia (43%), followed by unbalanced complete AV septal defect (14%) and double inlet left ventricle (14%). 12 patients had a systemic right ventricle. All, except 5 patients, had preserved systolic ventricular function and 37% had moderate to severe AV regurgitation.
The majority had normal hemoglobin levels (median 15.6 g/dL), hepatic enzymes (median total bilirubin 0.8 mg/dL), renal function (median creatinine 0.8 mg/dL) and low NT-proBNP (median 122 pg/mL).
All patients had maximal CPET, median %VO2 at VT1 was 57% of peak and mean pVO2 was 66±14% of the predicted. Most patients (69%) showed exercise limitation due to cardiovascular cause, followed by O2 desaturation, present in 22% of CPETs. The age of Fontan completion was not associated with functional capacity (p=0.6).
The good-performer group comprised 13 patients (27%), all in sinus rhythm, of which 10 were physically active. Compared with the remainder, this group had higher VO2 at VT1 (18.7 vs. 14.6, p=0.01) and VO2 at VT2 (25.9 vs. 22.1, p=0.02), both in mL/kg/min. Also, peak heart rate (% predicted) (90 vs. 81, p=0.03) was higher in this subgroup – fig.1. Conversely, differences on TTE parameters (GLS and AV valve regurgitation) and blood biomarkers were not statistically significant. On multivariable analysis, no single variable predicted better functional capacity.
Conclusion
In our Fontan cohort, most patients had reduced exercise capacity, largely due to cardiovascular dysfunction. However, “Super-Fontans” stood out as they had a higher anaerobic threshold illustrating their better physical condition. These findings highlight the role of regular physical activity in Fontan patients as a cornerstone for better functional capacity.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Paiva
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - J Rato
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - R Santos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - G Cunha
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - D Gomes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - S Cordeiro
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - S Madeira
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - S Guerreiro
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - L Moreno
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - A Durazzo
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - M Mendes
- Centro Hospitalar de Lisboa Ocidental, Centro Hospitalar Lisboa Ocidental , Lisbon , Portugal
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15
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Paiva M, Gomes D, Freitas P, Santos R, Presume J, Lopes P, Matos D, Guerreiro S, Santos A, Saraiva S, Mendes M, Ferreira A. Potential impact of replacing SCORE with SCORE-2 on risk classification and statin eligibility – a coronary calcium score correlation study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently, the European Society of Cardiology issued new algorithms to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD), along with new age-specific thresholds to classify individuals as low-to-moderate, high, or very-high risk.
The aim of this study was to compare the latest SCORE-2 model with the older SCORE (Systematic COronary Risk Evaluation) in their ability to identify individuals with high coronary artery calcium score (CACS), and assess the relationship between potential eligibility for statin therapy and CACS.
Methods
Individuals 40–69 years old without diabetes or known ASCVD were identified in a single center registry of patients undergoing CACS and coronary CT angiography for suspected coronary artery disease. SCORE and SCORE-2 were calculated and used with each patient's untreated LDL-C values to assess eligibility for statin therapy. High CACS was defined as an Agatston score ≥100.
Results
A total of 389 pts (46% men, mean age 58±8 years) were included, of which 15% (n=60) were active smokers. The mean systolic blood pressure and untreated LDL-C values were 136±17 mmHg and 155±65 mg/dL, respectively.
The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 93%, 6% and 1% using the SCORE algorithm, and 42%, 44%, and 14% using SCORE-2, respectively. Overall, 218 patients (56%) would have their risk category revised upwards, while no patients would be downgraded.
The median CACS was 5 (IQR 0–71 AU), with 166 patients (43%) having CACS = 0, and 81 (21%) presenting CACS values ≥100.
SCORE and SCORE-2 showed similar discriminative power to identify patients with CACS ≥100 (C-statistic 0.77, 95% CI 0.71–0.82, vs. 0.75, 95% CI 0.69–0.80, P=0.109 for comparison]. The up-reclassification of risk conveyed by SCORE-2 affected patients across all categories of CACS (Fig. 1).
The proportion of patients in whom statin therapy would generally be indicated was higher with the SCORE-2 criteria vs. the SCORE algorithm (61% vs. 29%, respectively, p<0.001). The broadening of potential indication for statin therapy spanned all categories of CACS, including patients with CACS = 0 (Fig. 2).
Conclusion
Even though the discriminative power of SCORE-2 is similar to the older SCORE, the introduction of age-specific thresholds results in the up-reclassification of risk in roughly half of the patients. The application of SCORE-2 will broaden statin eligibility overall, not only in patients with high atherosclerotic burden, but also in those with CACS = 0. These findings support the use of risk modifiers in selected patients to improve the effectiveness of statin therapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Paiva
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - D Gomes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - P Freitas
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - R Santos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - J Presume
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - P Lopes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - D Matos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - S Guerreiro
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - A Santos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - S Saraiva
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - M Mendes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - A Ferreira
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
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16
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Paiva M, Gomes D, Freitas P, Presume P, Santos R, Lopes P, Matos D, Guerreiro S, Abecasis J, Santos A, Saraiva C, Mendes M, Ferreira A. Use of coronary calcium score to refine the cardiovascular risk classification of the new SCORE2 and SCORE2-OP algorithms in patients undergoing coronary CT angiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.194] [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
Recently, the European Society of Cardiology issued new algorithms (SCORE-2 and SCORE2-OP) to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). CACS has been shown to reclassify a significant proportion of patients when applied on top of several scores, but data on its use with these new algorithms are lacking.
The aim of this study was to assess the risk reassignment that can be attained by using CACS as a risk modifier of the SCORE-2 / SCORE2-OP classification, in patients referred for coronary CT angiography (CCTA).
Methods
Individuals without diabetes or known ASCVD were included in a single center registry of patients undergoing CCTA for suspected coronary artery disease (CAD). The 10-year risk of cardiovascular disease was calculated for each patient using SCORE-2 (ages 40–69) or SCORE2-OP (ages 70–89), and categorised as low-to-moderate, high, or very-high risk, according to guideline-recommended age-specific thresholds. CACS was considered to reclassify risk one level downward if = 0 in high or very-high risk patients, and reclassify risk upward if >100 (or >75th percentile) in those with low-to-moderate risk, or >1000 in those with high-risk.
Results
A total of 529 patients (43% men, mean age 63±10 years) were included, of which 13% (n=69) were active smokers. The mean systolic blood pressure and non-HDL-C values were 137±18 mmHg and 140±37 mg/dL, respectively.
A total of 47 patients (9%) had obstructive CAD on CCTA, classifying them as very-high risk. In the remainder 482 patients without obstructive CAD, the median CACS was 8 (IQR 0–80 AU), with 194 patients (40%) having CACS = 0, and 111 (23%) presenting CACS values ≥100.
The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 36%, 46% and 19% using the SCORE-2 / SCORE2-OP algorithm.
Using CACS would reclassify 150 patients (31%): 107 patients (22%) downward, and 43 patients (9%) upward. The extent of risk reclassification conveyed by CACS was 33% in patients assessed with SCORE-2, and 25% with SCORE-2 OP (p=0.082). Overall, most of the risk reassignment (42%, n=93) would occur in patients originally classified as high-risk – Fig. 1.
At the time of testing, 32% (n=61) of patients with CACS = 0 were being treated with statins, whereas 52% (n=58) of those with CACS ≥100 were not.
Conclusion
Even when the most recent SCORE-2 / SCORE-2 OP algorithms are used, risk refinement with CACS leads to the reclassification of nearly one third of the patients undergoing CCTA, mostly from downgrading risk. This opportunistic use of CACS may be employed to improve the allocation of primary prevention therapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Paiva
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - D Gomes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - P Freitas
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - P Presume
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - R Santos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - P Lopes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - D Matos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - S Guerreiro
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - J Abecasis
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - A Santos
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - C Saraiva
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - M Mendes
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
| | - A Ferreira
- Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal
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17
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Avila R, Krishnan K, Wynes M, Connolly C, McWilliams A, Logan J, Henschke C, Yankelevitz D, Pastorino U, Santos R, Hochhegger B, Ashizawa K, Kobayashi T, Rzyman W, Jelitto-Gorska M, Field J, Mulshine J, Lam S. EP01.04-005 Quantitative Characteristics in Global CT Lung Cancer Screening Populations Using the ELIC Distributed Database and Computation Environment. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.300] [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: 10/14/2022]
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18
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Avila R, Krishnan K, Wynes M, Connolly C, McWilliams A, Logan J, Henschke C, Yankelevitz D, Pastorino U, Santos R, Hochhegger B, Ashizawa K, Kobayashi T, Rzyman W, Jelitto-Gorska M, Field J, Mulshine J, Lam S. MA11.07 The ELIC Distributed Database and Computation Environment for Analyses of Lung Cancer Screening LDCTs Across the World. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Matthews L, Teoh M, May S, Zammit C, Bloomfield D, Kothari M, Betal D, Santos R, Stewart E, Finlay J, Nicholson K, Elwell-Sutton D, McKinna F, Gage H, Bell S, Jenkins V. CN61 Patients’ experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): Interview results. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.384] [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: 11/25/2022] Open
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20
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Dharmayat K, Vallejo-Vaz A, Stevens C, Lyons A, Catapano A, Freiberger T, Hovingh G, Mata P, Santos R, Soran H, Watts G, Raal F, Ray K. Global perspective of paediatric Familial Hypercholesterolaemia: Analysis from the EAS FHSC registry on over 11,200 children and adolescents with heterozygous Familial Hypercholesterolaemia from 44 countries. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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21
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Vallejo-Vaz A, Stevens C, Dharmayat K, Lyons A, Brandts J, Freiberger T, Hovingh G, Kastelein J, Mata P, Raal F, Santos R, Soran H, Watts G, Catapano A, Ray K. Identification, characteristics and management of adults with heterozygous Familial Hypercholesterolaemia in high and non-high income countries participating in the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Paiva M, Santos R, Freitas P, Gomes D, Presume J, Lopes P, Matos D, Guerreiro S, Santos A, Saraiva C, Mendes M, Ferreira A. 461 Use Of Coronary Calcium Score To Refine The Cardiovascular Risk Classification Of The New Score-2 And Score-2 Op Algorithms In Patients Undergoing Coronary Ct Angiography. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Paiva M, Gomes D, Freitas P, Presume J, Santos R, Lopes P, Matos D, Guerreiro S, Abecasis J, Santos A, Saraiva C, Mendes M, Ferreira A. 468 Potential Impact Of Replacing Score With Score-2 On Risk Classification And Statin Eligibility - A Coronary Calcium Score Correlation Study. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Santos R, Silva R, Gomes A, Cardoso H. Subarachnoid and subdural haematoma after attempted spinal anaesthesia for caesarean section. Anaesth Rep 2022; 10:e12181. [PMID: 35924029 PMCID: PMC9338784 DOI: 10.1002/anr3.12181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/09/2022] Open
Abstract
We report a case of a previously healthy patient who developed a vertebral canal haematoma in the subarachnoid and subdural spaces after a spinal puncture for elective caesarean section. Vertebral canal haematomas are rare. There are different mechanisms for haematoma formation, but coagulation disturbances and trauma, most often due to needle punctures, are the most important. Vertebral canal haematoma may warrant emergent surgical decompression. In this case report we discuss vertebral canal haematomas, including possible mechanisms, clinical diagnosis, imaging modalities, methods for management and advice for patients. We consider the possible association between a vertebral canal haematoma and non-steroidal anti-inflammatory drugs, and draw attention to an existing black box warning for ketorolac. In this case, we explain why a conservative approach was chosen with a good outcome. We also report the effect of this complication on the patient experience.
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Affiliation(s)
- R. Santos
- Department of Anaesthesiology Penafiel Hospital Centre Porto Portugal
| | - R. Silva
- Department of Anaesthesiology Penafiel Hospital Centre Porto Portugal
| | - A. Gomes
- Department of Anaesthesiology Penafiel Hospital Centre Porto Portugal
| | - H. Cardoso
- Department of Anaesthesiology Penafiel Hospital Centre Porto Portugal
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25
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Carvalho M, Cabral M, Ferreira JB, Santos R, Fonseca-Pinto R, Januario F, Antunes A, Morais J. Phase III impact of telerehabilitation in patients with coronary heart disease. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.237] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac rehabilitation (CR) in coronary heart disease (CAD) has been shown to improve physical capability and health-related quality of life, reducing morbimortality. However, CR accessibility is still low and patient adherence remains poor. It has been hypothesized that using mobile applications to telemonitor exercise-based CR would increase patient adherence to CR, improving results. Hybrid cardiac telerehabilitation (HCTR) is a new concept that includes center and home interventions.
Objectives
Investigate the effects of HCTR program on improving physical activity, quality of life and reducing cardiovascular risk factors among patients with CAD 1 year after CR phase II.
Materials and methods
Longitudinal retrospective study with patients who attended phase 2 CR program (CRP) at a hospital center between august 2018-november 2020. They were divided in 2 groups: group 1 completed conventional CRP (CCRP), 12 weeks of monitored hospital physical exercise and educational sessions; group 2 participated on HCTR program (CCRP associated to a tele-monitorization platform consisting of a mobile application, MOVIDA.eros, with medical prescription of physical exercise and remote interaction). Group 2 maintained use of MOVIDA.eros on phase 3. Evaluations were performed on T0 – phase 2 onset, T1 – end of phase 2, T2 – 1 year after T1, with registration of age, gender, occupation, body mass index (BMI), exercise stress testing, echocardiogram (evaluation of left ventricular ejection fraction [LVEF]), LDL, HDL cholesterol, triglycerides, NTproBNP levels, and application of EuroQol-5D questionnaire (EQ5D), International Physical Activity Questionnaire – Short Form (IPAQ).
Statistical analysis was completed through software SPSS v28. p-values <0.05 were considered statistically significant.
Results
We analyzed 68 patients, 46 on group 1 and 22 on group 2. Variable analysis revealed similar group characteristics, except for age (p=0.011) and LVEF (p=0.005). There was an association between HCTR adherence and occupation (p=0.002; greater proportion of intellectual professionals on group 2). We observed a significant IPAQ (p=0.018) and EQ-5D index (p=0.034) improvement between T0 to T1 in both groups, but only in group 2 persisted till T2. In exercise stress testing, both groups revealed an increase in METs at T1 and decrease at T2, without significant differences between them. Regarding lipid profile, HbA1c, NTproBNP and BMI, both groups improved from T0 to T1 maintaining it till T2 with no differences between them, however in group 2 HDL cholesterol levels were greater and HbA1c levels were lower than group 1. In both groups, LVEF increased from T0 to T1 and from T1 to T2 in both groups, with faster and higher improvement in group 2.
Conclusions
HCTR outperformed CCRP improving physical activity, patient quality of life, HDL cholesterol and faster improvement of LVEF. These findings encourage the use of a mobile platform in CR.
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Affiliation(s)
- M Carvalho
- Leiria Hospital Centre, Leiria, Portugal
| | - M Cabral
- Leiria Hospital Centre, Leiria, Portugal
| | | | - R Santos
- Leiria Hospital Centre, Leiria, Portugal
| | | | - F Januario
- Leiria Hospital Centre, Leiria, Portugal
| | - A Antunes
- Leiria Hospital Centre, Leiria, Portugal
| | - J Morais
- Leiria Hospital Centre, Leiria, Portugal
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26
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Leite M, Tercya H, Nascimento BG, Rodrigues J, Santos R, Costa BPD, Nascimento WL, Luis ZG, Lima-Maximino M, Maximino C, Siqueira-Silva DH. Anesthesia or seizure-like behavior? The effects of two Amazonian plants, Acmella oleracea and Piper alatabaccum in zebrafish (Danio rerio). BRAZ J BIOL 2022; 82:e266010. [DOI: 10.1590/1519-6984.266010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract Currently, available fish anesthetics can produce important side effects, including respiratory arrest and distress. Easy-to-implement alternatives with low toxicity are needed to ensure fish health as well as to help artisanal fisheries and fish sellers in handling and transporting fishes, and native plants seems to be the best alternative. We aimed to implement an anesthetic protocol using crude ethanolic extracts from flowers and leaves of two Amazonian plants, the Acmella oleracea and Piper alatabaccum. We first tested the extracts for anesthesia, using the zebrafish as model. Even though in some treatments the animals apparently entered deep anesthesia, many of them presented aberrant behaviors and even died. Thus, we performed new experiments testing the extracts effects on seizure-like behaviors of the fish. Only the leaf extract of A. oleracea has potential effects for fish anesthesia. Both the flower extract from this plant and the leaf extract from P. alatabaccum induced seizure-like behavior in the animals. In conclusion, besides bringing a possible new anesthetic protocol for fish, our work draws attention for the neurotoxic effects the anesthetic solutions may cause, since several studies defend other Piper species as anesthetic for fish and A. oleracea flowers’ extract was already pointed as fish anesthetic.
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Affiliation(s)
- M. Leite
- Universidade Federal do Sul e Sudeste do Pará, Brasil
| | - H. Tercya
- Universidade Federal do Sul e Sudeste do Pará, Brasil
| | | | - J. Rodrigues
- Universidade Federal do Sul e Sudeste do Pará, Brasil
| | - R. Santos
- Universidade Federal do Sul e Sudeste do Pará, Brasil
| | | | | | - Z. G. Luis
- Universidade Federal do Sul e Sudeste do Pará, Brasil
| | | | - C. Maximino
- Universidade Federal do Sul e Sudeste do Pará, Brasil
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27
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Demetrio D, Oliveira M, Baumgartner T, Demetrio C, Santos R. 8 Jersey in vitro embryo production data. Reprod Fertil Dev 2021; 34:237-238. [PMID: 35231208 DOI: 10.1071/rdv34n2ab8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - C Demetrio
- Universidade de São Paulo, Piracicaba, SP, Brazil
| | - R Santos
- Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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28
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Oliveira M, Demetrio C, Baumgartner T, Santos R, Demetrio D. 12 Factors affecting Jersey in vitro embryo pregnancy rates. Reprod Fertil Dev 2021; 34:240. [PMID: 35231257 DOI: 10.1071/rdv34n2ab12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - C Demetrio
- Universidade de São Paulo, Piracicaba, SP, Brazil
| | | | - R Santos
- Universidade de Uberlândia, Uberlândia, MG, Brazil
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29
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Cabral M, Santos R, Januario F, Antunes A, Pinto RF, Morais J. Hybrid cardiac telerehabilitation program as a potential strengthening factor in the quality of life in patients with coronary heart disease: a retrospective single-centre analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2676] [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
Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality in patients with coronary artery disease (CAD). However, underuse of CR and not sustained improvements have been noted. It has been proposed that telemonitored exercise-based CR, by the use of mobile applications, can improve patient adherence to CR programs providing better outcomes.
The aim of this study was to investigate the effects of telemonitored cardiac rehabilitation on physical capacity, health-related quality of life and control of cardiovascular risk factors among patients with CAD on phase 2 of the Cardiac Rehabilitation Program (CRP).
A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. Outcomes were Body Mass Index, Hospital Anxiety and Depression Scale (HADS), EuroQol-5D score (EQ-5D), International Physical Activity Questionnaire (IPAQ), estimated functional capacity in cardiac stress test, lipid panel and glycated hemoglobin. Patients were divided into two groups: group 1 followed the conventional strategy and group 2 followed a hybrid telemonitored CRP, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of the phase 2, around 3 months after. Group comparisons tests and multivariate logistic regression were performed. A p-value less than 0.05 is statistically significant. Statistical analysis was performed using SPSS software v25.0.
We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 44 patients in group 1 and 25 patients in group 2. Two groups have similar baseline characteristics, except for age (p=0.02). It appears that participation in the PRC led to an improvement in physical capacity, mental well-being, and in lipid panel, regardless of the strategy. The improvement in quality of life, quantified by EQ-5D, was significant only in group 2 (p=0.03). There is also no correlation between age and the differences recorded in EQ-5D (p=0.86).
We hypothesise that, when compared to conventional CRP, cardiac telemonitored exercise using modern communication methods and on-demand coaching will result in an improved behavioural change, which translates to higher quality of life. Further studies including more patients and the phase 3 of CRP are needed to confirm these results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Cabral
- Leiria Hospital Centre, Leiria, Portugal
| | - R Santos
- Leiria Hospital Centre, Leiria, Portugal
| | - F Januario
- Leiria Hospital Centre, Leiria, Portugal
| | - A Antunes
- Leiria Hospital Centre, Leiria, Portugal
| | - R F Pinto
- Polytechnic Institute of Leiria, ciTechCare, Leiria, Portugal
| | - J Morais
- Leiria Hospital Centre, Leiria, Portugal
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Candjondjo A, Ferreira J, Esteves A, Farinha J, Fonseca M, Coelho R, Gama L, Sa C, Lopes A, Fernandes A, Perdigao A, Seixo F, Fonseca N, Santos R, Caria R. Predictors of patient and system delay for primary percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1278] [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
Background
The delay times of the patient and the system for primary percutaneous coronary intervention (p-PCI) have a determining impact on the prognosis of patients with acute myocardial infarction with ST segment elevation (STEMI).
Purpose
To identify the predictors of patient and system delay for p-PCI in the period of 2020 at a reference hospital for p-PCI.
Methods
Patients submitted to p-PCI in the period from March to September 2020 were included and compared with the same period in 2019. We analyzed the differences between the two groups regarding the patient's delay times, time from the onset of symptoms to the first medical contact (FCM) and the system (time from the first contact with the health system to p-ICP). Data collection of the patient's previous history, coronary intervention performed and post-PCI follow-up was performed using the electronic patient record. Univariate analysis and logistic regression models from multivariate analysis were used to determine the predictors of “patient delay” and “system delay” and adjusted for confounding factors. The analysis was performed with a significance level of 5%.
Results
We included in the study 255 patients who underwent p-PCI, of which 122 in the period from 2020 and 133 in the period from 2019. Regarding the characteristics of the population, there were no significant differences between the two periods. Regarding the patient's delay time, there were no statistically significant differences. The variable first medical contact with a non p-PCI center was the only variable associated with system delay>90 minutes in the multivariate analysis, OR (6.18: 95% CI, 1.91–20), p=0.002. There was a statistically significant association between the period of 2020 (pandemic period) and total ischemia time, but with a negative effect, dependent variable adjusted for confounding factors [adjusted OR: −0.10; 95% CI: −107.61 to −5.57; p=0.03].
Conclusion
In this study, the patient's admission to a non p-PCI centers was identified as the only predictor of longer delay until p-PCI (system delay). However, these results should serve as a contribution to decision making in order to mitigate risks, regardless of any associated catastrophe and eventually alert the population not to neglect the symptoms suspected of acute myocardial infarction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - A Esteves
- Hospital Center of Setubal, Setubal, Portugal
| | - J Farinha
- Hospital Center of Setubal, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
| | - L Gama
- Unidade local de Saúde do Litoral Alentejano, EPE, Alentejo, Portugal
| | - C Sa
- Centro Hospitalar Barreiro/Montijo, EPE / Hospital Nossa Senhora do Rosário, Setúbal, Portugal
| | - A Lopes
- Hospital Center of Setubal, Setubal, Portugal
| | - A Fernandes
- Hospital Center of Setubal, Setubal, Portugal
| | - A Perdigao
- Hospital Center of Setubal, Setubal, Portugal
| | - F Seixo
- Hospital Center of Setubal, Setubal, Portugal
| | - N Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Santos
- Hospital Center of Setubal, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Setubal, Portugal
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Uday S, Shaw NJ, Mughal MZ, Randell T, Högler W, Santos R, Padidela R. Monitoring response to conventional treatment in children with XLH: Value of ALP and Rickets Severity Score (RSS) in a real world setting. Bone 2021; 151:116025. [PMID: 34052463 DOI: 10.1016/j.bone.2021.116025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION X-linked hypophosphataemia (XLH) is conventionally managed with oral phosphate and active vitamin D analogues. OBJECTIVES To evaluate long term treatment response by assessing biochemical disease activity [serum alkaline phosphatase (ALP)], radiological rickets severity score (RSS), growth and morbidity in patients with XLH on conventional therapy and assess the correlation between serum ALP and RSS. METHODS XLH patients from 3 UK tertiary centres with ≥3 radiographs one year apart were included. Data was collected retrospectively. The RSS was assessed from routine hand and knee radiographs and ALP z scores were calculated using age-specific reference data. RESULTS Thirty-eight (male = 12) patients met the inclusion criteria. The mean ± SD knee, wrist and total RSS at baseline (median age 1.2 years) were 2.0 ± 1.2, 1.9 ± 1.2 and 3.6 ± 1.3 respectively; and at the most recent clinic visit (median age 9.0 years, range 3.3-18.9) were 1.6 ± 1.0, 1.0 ± 1.0 and 2.5 ± 1.5 respectively. The mean ± SD serum ALP z scores at baseline and the most recent visit were 4.2 ± 2.3 and 4.0 ± 3.3. Median height SDS at baseline and most recent visit were -1.2 and -2.1 (p = 0.05). Dental abscess, craniosynostosis, limb deformity requiring orthopaedic intervention and nephrocalcinosis were present in 31.5%, 7.9%, 31.6% and 42.1% of the cohort respectively. There was no statistically significant (p > 0.05) correlation between ALP z scores and knee (r = 0.07) or total (r = 0.12) RSS. CONCLUSIONS Conventional therapy was not effective in significantly improving biochemical and radiological features of disease. The lack of association between serum ALP and rickets severity on radiographs limits the value of ALP as the sole indicator of rickets activity in patients receiving conventional therapy.
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Affiliation(s)
- S Uday
- IMSR, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's Hospital, Birmingham, UK.
| | - N J Shaw
- IMSR, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's Hospital, Birmingham, UK
| | - M Z Mughal
- Royal Manchester Children's Hospital, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - T Randell
- Nottingham Children's Hospital, Nottingham, UK
| | - W Högler
- IMSR, University of Birmingham, Birmingham, UK; Johannes Kepler University, Linz, Austria
| | - R Santos
- Evelina London Children's Hospital, London, UK
| | - R Padidela
- Royal Manchester Children's Hospital, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Santos R, Franceschini J. PL03.02 Lung Cancer Screening in Latin America: Current Status and Challenges. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.736] [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: 10/20/2022]
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Monteiro S, Ebdon J, Santos R, Taylor H. Elucidation of fecal inputs into the River Tagus catchment (Portugal) using source-specific mitochondrial DNA, HAdV, and phage markers. Sci Total Environ 2021; 783:147086. [PMID: 34088114 DOI: 10.1016/j.scitotenv.2021.147086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
Determining the source of fecal contamination in a water body is important for the application of appropriate remediation measures. However, it has been suggested in the extant literature that this can best be achieved using a 'toolbox' of molecular- and culture-based methods. In response, this study deployed three indicators (Escherichia coli (EC), intestinal enterococci (IE) and somatic coliphages (SC)), one culture-dependent human marker (Bacteroides (GB-124) bacteriophage) and five culture-independent markers (human adenovirus (HAdV), human (HMMit), cattle (CWMit), pig (PGMit) and poultry (PLMit) mitochondrial DNA markers (mtDNA)) within the River Tagus catchment (n = 105). Water samples were collected monthly over a 13-month sampling campaign at four sites (impacted by significant specific human and non-human inputs and influenced by differing degrees of marine and freshwater mixing) to determine the dominant fecal inputs and assess geographical, temporal, and meteorological (precipitation, UV, temperature) fluctuations. Our results revealed that all sampling sites were not only highly impacted by fecal contamination but that this contamination originated from human and from a range of agricultural animal sources. HMMit was present in a higher percentage (83%) and concentration (4.20 log GC/100 mL) than HAdV (32%, 2.23 log GC/100 mL) and GB-124 bacteriophage with the latter being detected once. Animal mtDNA markers were detected, with CWMit found in 73% of samples with mean concentration of 3.74 log GC/100 mL. Correlation was found between concentrations of fecal indicators (EC, IE and SC), CWMit and season. Levels of CWMit were found to be related to physico-chemical parameters, such as temperature and UV radiation, possibly as a result of the increasing presence of livestock outside in warmer months. This study provides the first evaluation of such a source-associated 'toolbox' for monitoring surface water in Portugal, and the conclusions may inform future implementation of surveillance and remediation strategies for improving water quality.
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Affiliation(s)
- S Monteiro
- School of Environment and Technology, University of Brighton, Brighton, UK; Laboratorio Analises, Instituto Superior Tecnico, Lisbon, Portugal.
| | - J Ebdon
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - R Santos
- Laboratorio Analises, Instituto Superior Tecnico, Lisbon, Portugal
| | - H Taylor
- School of Environment and Technology, University of Brighton, Brighton, UK
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Pedersen MRV, Kraus B, Santos R, Harrison G. Radiographers' individual perspectives on sonography - A survey of European Federation of Radiographer Societies (EFRS). Radiography (Lond) 2021; 28:31-38. [PMID: 34391653 DOI: 10.1016/j.radi.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Radiographers can elect to work within many different modalities, one being ultrasound. Within Europe there are differing opinions about how much of a role radiographers should take in relation to the ultrasound examination, particularly report writing. This paper provides findings exploring the radiographer's views on working within sonography. METHODS In 2019 an electronic survey was disseminated to radiographer members by European Federation of Radiographer Societies (EFRS) national radiographer societies, following a pilot study. A mix of closed questions, free text, and scale responses aimed to investigate radiographers' practice, legal responsibilities, report writing, educational level and experiences of support and mentoring. RESULTS Of 561 radiographers participating, most (92%) reported performing ultrasound scans. Challenges with legislation, medical protectionism and lack of high-quality education restricted other radiographers. On average, the respondents have practiced ultrasound for 13.5 years. A total of 60% had postgraduate education and carried out a wide range of examinations. A full interpretative report, including advice on further investigations is performed by 52%, whilst 22% provide a checklist or descriptive report. Over 55% of radiographers took legal responsibility for the examination and the majority had clear protocols, good mentoring and support in the workplace. Peer review of their work was less common. CONCLUSION The result shows that in 21 (n = 25) countries radiographers perform ultrasound, however not without challenges. Educational levels range from no formal education or short courses to an MSc in ultrasound. Report writing practice differs across the EFRS countries responding to the survey, as does peer review to enhance skills and clinical practice. IMPLICATIONS FOR PRACTICE National Radiographer societies could review findings to support campaigning for a change in legislation and improvements to educational offerings in ultrasound.
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Affiliation(s)
- M R V Pedersen
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; University Hospital Southern Denmark, Department of Radiology, Vejle, Beriderbakken 4, 7100, Vejle, Denmark; University of Southern Denmark, Department of Regional Health, Campusvej 55, Odense, Denmark.
| | - B Kraus
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; Department of Health Sciences, Radiological Technology, University of Applied Sciences FH Campus Wien, Favoritenstrasse 226, A-1100, Vienna, Austria
| | - R Santos
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; Polytechnic Institute of Coimbra, Coimbra Health School, Department of Clinical Physiology, Rua 5 de Outubro - SM Bispo, Apartado 7006, 3046-854, Coimbra, Portugal; Laboratory for Applied Health Research (LabinSaúde), Rua 5 de Outubro - SM Bispo, Apartado 7006, 3046-854, Coimbra, Portugal
| | - G Harrison
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; Society and College of Radiographers, 207 Providence Square Mill Street, London, SE1 2EW, UK
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Gaudet D, Ruzza A, Bridges I, Maruff P, Schembri A, Hamer A, Kurtz C, Mach F, Bergeron J, Gaudet I, St-Pierre J, Kastelein J, Hovingh G, Wiegman A, Raal F, Santos R. Effect of evolocumab on cognition in pediatric patients with familial hypercholesterolemia: Results from the HAUSER-RCT study. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Monteiro M, Lavrador AS, Santos R, Rangel F, Iglesias P, Tárraga M, Couto A, Serra CR, Tafalla C, Da Costa E, Domingues MR, Oliva-Teles A, Carvalho AP, Enes P, Díaz-Rosales P. Evaluation of the Potential of Marine Algae Extracts as a Source of Functional Ingredients Using Zebrafish as Animal Model for Aquaculture. Mar Biotechnol (NY) 2021; 23:529-545. [PMID: 34189658 DOI: 10.1007/s10126-021-10044-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
Research on immunotherapeutic agents has become a focus for the treatment of fish diseases. The ability of algae to produce secondary metabolites of potential interest as immunotherapeutics has been documented. The present research intended to assess antiviral and antibacterial activities of macro- and microalgae extracts against viral and bacterial pathogens and explore their immunomodulatory potential using zebrafish (Danio rerio) larvae as a model organism. The cytotoxicity and antiviral activity of eight methanolic and ethanolic extracts from two macroalgae (Fucus vesiculosus, Ulva rigida) and two microalgae (Nannochloropsis gaditana, Chlorella sp.) were analyzed in established fish cell lines. Six extracts were selected to evaluate antibacterial activity by disk diffusion and growth inhibition assays. The three most promising extracts were characterized in terms of fatty acid composition, incorporated at 1% into a plant-based diet, and evaluated their effect on zebrafish immune response and intestinal morphology in a short-term feeding trial. All extracts exhibited in vitro antiviral activity against viral hemorrhagic septicemia and/or infectious pancreatic necrosis viruses. Methanolic extracts from F. vesiculosus and U. rigida were richer in saturated fatty acids and exhibited in vitro antibacterial action against several bacteria. Most promising results were obtained in vivo with F. vesiculosus methanol extract, which exerted an anti-inflammatory action when incorporated alone into diets and induced pro-inflammatory cytokine expression, when combined with the other extracts. Moreover, dietary inclusion of the extracts improved intestinal morphology. In summary, the results obtained in this study support the potential of algae as natural sources of bioactive compounds for the aquaculture industry.
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Affiliation(s)
- M Monteiro
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal.
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal.
| | - A S Lavrador
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
| | - R Santos
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal
| | - F Rangel
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal
| | - P Iglesias
- , Parque Industrial Base 2000, Lorquí, Murcia, Spain
| | - M Tárraga
- , Parque Industrial Base 2000, Lorquí, Murcia, Spain
| | - A Couto
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal
| | - C R Serra
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
| | - C Tafalla
- Inmunología Y Patología de Peces, Centro de Investigación en Sanidad Animal (CISA, INIA), Carretera de Algete a El Casar s/n, 28130, Madrid, Spain
| | - E Da Costa
- Centro de Espetrometria de Massa, LAQV-REQUIMTE, Departamento de Química, QOPNA, Universidade de Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
- CESAM - Centro de Estudos do Ambiente e do Mar, Departamento de Química, Universidade de Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - M R Domingues
- Centro de Espetrometria de Massa, LAQV-REQUIMTE, Departamento de Química, QOPNA, Universidade de Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
- CESAM - Centro de Estudos do Ambiente e do Mar, Departamento de Química, Universidade de Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - A Oliva-Teles
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal
| | - A P Carvalho
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal
| | - P Enes
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade Do Porto, Rua Do Campo Alegre, Edifício FC4, 4169-007, Porto, Portugal
| | - P Díaz-Rosales
- Centro Interdisciplinar de Investigação Marinha E Ambiental (CIIMAR), Terminal de Cruzeiros Do Porto de Leixões, Universidade Do Porto, Av. General Norton de Matos S/N, 4450-208, Matosinhos, Portugal
- Inmunología Y Patología de Peces, Centro de Investigación en Sanidad Animal (CISA, INIA), Carretera de Algete a El Casar s/n, 28130, Madrid, Spain
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Esteves AF, Parreira L, Fonseca M, Farinha JM, Pinheiro A, Ferreira J, Coelho R, Mesquita D, Amador P, Fonseca N, Santos R, Seixo F, Costa C, Caria R. Rapid atrial fibrillation increases cardiac biomarkers: decision to perform coronary angiography based on novel high-sensitivity Troponin I peak. Europace 2021. [DOI: 10.1093/europace/euab116.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Since January 2018 the availability of high sensitivity Troponin I (hsTnI) has improved ischemia diagnosis. In patients with rapid atrial fibrillation (AF), the decision to undergo coronary angiography is usually due to elevated cardiac biomarkers. However, evidence to support the rentability of this approach is sparse.
Purpose
Evaluate if hsTnI in patients with rapid AF and elevated cardiac biomarkers has a good discriminative power to predict a positive coronary angiography.
Methods
We retrospectively studied consecutive patients admitted to the emergency department (ED) between January 2018 and December 2019 with rapid AF that underwent coronary angiography and had multiple hsTnI values obtained. We analysed risk factors, initial and peak hsTnI, time from ED admission to peak hsTnI and ST-T segment abnormalities (ST depression and/or T wave inversion). We evaluated the presence of significant coronary artery stenosis with the need of revascularization at coronary angiography. Univariable and multivariable analysis was performed to obtain the Odds Ratio (OR, 95% CI, p-value) for significant coronary artery disease (CAD).
Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of peak hsTnI as predictor of a positive coronary angiography. Optimal cut-point value was obtained (Youden index) and patients were divided according to this value.
Results
From 1407 patients admitted to the ED with rapid AF, 30 patients, 60% male, median age 74 (IQR 61.25-80.75) years, were submitted to coronary angiography. Significant coronary artery stenosis was present in 17 (57%) patients.
Age, ST-T segment abnormalities and peak hsTnI were predictors of significant CAD, respectively 1.203, 1.064-1.361, 0.003; 25.00, 3.522-177.477, 0.001; and 1.000, 1.000-1.001, 0.015.
Optimal cut-point value for predicting the presence of significant coronary artery stenosis at coronary angiography was a peak hsTnI of 359 pg/mL (AUC 0.869, p-value 0.001, 95% CI 0.742-0.995). The two groups with hsTnI < 359 and hsTnI >359 differed in age and ST-T segment abnormalities (see Table).
After adjustment, peak hsTnI >359 pg/mL was the only independent predictor of significant CAD (23.894, 1.310-435.669, 0.032).
Conclusion
In this group of patients with rapid AF, peak hsTnI >359 pg/mL was the only independent predictor of significant coronary artery disease. Therefore, those patients should undergo coronary angiography. Abstract Figure.
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Affiliation(s)
- AF Esteves
- Hospital Center of Setubal, Setubal, Portugal
| | - L Parreira
- Hospital Center of Setubal, Setubal, Portugal
| | - M Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - JM Farinha
- Hospital Center of Setubal, Setubal, Portugal
| | - A Pinheiro
- Hospital Center of Setubal, Setubal, Portugal
| | - J Ferreira
- Hospital Center of Setubal, Setubal, Portugal
| | - R Coelho
- Hospital Center of Setubal, Setubal, Portugal
| | - D Mesquita
- Hospital Center of Setubal, Setubal, Portugal
| | - P Amador
- Hospital Center of Setubal, Setubal, Portugal
| | - N Fonseca
- Hospital Center of Setubal, Setubal, Portugal
| | - R Santos
- Hospital Center of Setubal, Setubal, Portugal
| | - F Seixo
- Hospital Center of Setubal, Setubal, Portugal
| | - C Costa
- Hospital Center of Setubal, Setubal, Portugal
| | - R Caria
- Hospital Center of Setubal, Setubal, Portugal
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Silverio Antonio P, Alves Da Silva P, Valente Silva J, Brito J, Rodrigues T, Couto Pereira S, Cunha N, Santos R, Rigueira J, Aguiar-Ricardo I, David D, J Pinto J, G Almeida A. Should we redifine Hypertensive response in stress test to better predict cardiovascular risk? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.145] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Systolic blood pressure (SBP) rise during exercise is normal, but some patients present with hypertensive response to exercise (HRE). The clinical implication of such phenomenon is not fully elucidated, and treatment strategies are still uncertain.
Purpose
To evaluate the relationship between HRE and the development of major cardiovascular events (MACE) - death, acute coronary syndrome (ACS) and stroke.
Methods
Single-center retrospective study of consecutive patients submitted to exercise test (ET) from 2012 to 2015. Patient’s demographics, baseline clinical characteristics, vital signs during ET and MACE occurrence during follow-up were analysed. HRE was defined as a peak systolic blood pressure (PSBP) >210 mmHg in men and >190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure >90 mmHg or a rise of 10 mmHg.
Results
We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%) and dyslipidaemia (61%). During a mean follow-up of 60 ± 2 months, the incidence of MACE was 9.2% with ACS being the most frequent (4.2%), followed by mortality (3.8%) and stroke (2.1%). Patients with inconclusive ET had a fourfold higher risk of acute coronary events (OR 4.1, CI 95% 1.55-11.14, p = 0.005). Baseline SBP and PSBP were predictors of MACE occurrence (OR 1.022, CI 95% 1.004-1.04, p = 0.016, OR 1.031 CI 95% 1.012-1.051, p = 0.001, respectively) and were both associated with cardiovascular hospitalization (p = 0.006; p < 0.001, respectively). PSBP had moderate ability to predict hospitalization of cardiovascular (CV) cause (AUC 0.71, p < 0.001) with a cut-off of 193 mmHg (sensibility 91%, specify 40%) and had moderate ability to predict MACE (AUC 0.67, p < 0.001) with a cut-off of 198 mmHg (sensibility 78.6%, specify 46.1%). Regarding mortality, antihypertensive therapy prior to ET was protective (p = 0.042), with no difference between different classes of drugs.
Conclusion
Our data reveal a high rate of MACE occurrence between patients with HRE. The finding of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs. An increased risk of ACS between patients with an inconclusive ET should lead to consider then for further investigation. HRE should be considered as part of CV risk assessment and adjusted lower HRE cut-off values should be considered in order to better predict MACE occurrence, particularly in high risk patients.
Abstract Figure.
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Affiliation(s)
- P Silverio Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Valente Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - D David
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A G Almeida
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Cabral M, Santos R, Januario F, Antunes A, Fonseca-Pinto R. Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR.
The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR.
A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant.
We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p < 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04).
We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.
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Affiliation(s)
- M Cabral
- Leiria Hospital Centre, Leiria, Portugal
| | - R Santos
- Leiria Hospital Centre, Leiria, Portugal
| | - F Januario
- Leiria Hospital Centre, Leiria, Portugal
| | - A Antunes
- Leiria Hospital Centre, Leiria, Portugal
| | - R Fonseca-Pinto
- Polytechnic Institute of Leiria, ciTechCare, Leiria, Portugal
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Brito J, Rigueira J, Rodrigues T, Aguiar-Ricardo I, Santos R, Nunes-Ferreira A, Cunha N, Pereira S, Antonio PS, Morais P, Alves Silva P, Valente Silva B, Pinto FJ, Almeida AG. Mitral valve prolapse: American versus European guidelines - which one is better. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
According to the most recent recommendations of AHA, mitral valve prolapse (MVP) is defined as systolic displacement of the mitral leaflet into the left atrium (LA) of at least 2 mm from the mitral annular plane. The ESC recommendations define MVP, flail and billowing, according to the location of the leaflet tips in relation to the coaptation plan. Differences in outcomes considering these classifications are not established.
Purpose
To evaluate the differences in clinical presentation and outcomes of MVP considering AHA and ESC classifications.
Methods
Single-center retrospective study of consecutive patients with MVP (defined according to the AHA classification) documented in transthoracic echocardiogram between January 2014 and October 2019. Demographic, clinical, echocardiographic and electrocardiographic data were collected. The results were obtained using Chi-square and ANOVA tests.
Results
We included 247 patients (mean age 62.9 ± 18 years, 61% males) according to AHA classification; considering the ESC classification: 147 (59%) had prolapse, 30 (12%) flail and 67 (39%) billowing.
In comparison to patients with flail and billowing, patients with MVP had less cordae rupture (p = 0.02). Prolapse was associated with better survival (p = 0.037) and was an independent predictor of survival (OR = 0.372, CI95% [0.148-0.935], p = 0.035) Patients with flail were older in comparison to the ones with prolapse and billowing (71 ± 14 vs 63 ± 17 vs 60 ± 21 years, respectively, p = 0.022). Patients with flail were mostly men (80%, p = 0.028), with more significant mitral regurgitation (p = 0.003) and higher NYHA class (p = 0.018). They also had higher systolic pulmonary artery pressure (SPAP) (48 ± 23 vs 38 ± 18 vs 36 ± 12mmHg, p = 0.015) and higher values of LV mass and posterior wall thickness (144 ±32 vs 125 ± 44 vs 114 ± 37g/m2, p = 0.005 and 11 ± 1,5 vs 10 ± 1,7 vs 9 ± 1.9 mm, p = 0.009, respectively). Women had more billowing (p = 0.04) than prolapse and flail.
Conclusion
The ESC classification adds information to the AHA classification in what concerns to clinical presentation and prognosis of mitral valve prolapse, so both classifications should be used in daily practice.
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Affiliation(s)
- J Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Rigueira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - T Rodrigues
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - R Santos
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - A Nunes-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - S Pereira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - PS Antonio
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Morais
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Alves Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - B Valente Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - FJ Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - AG Almeida
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Silva BV, Rigueira J, Aguiar Ricardo I, Mendonca C, Alves Da Silva P, Brito J, Rodrigues T, Santos R, Cunha N, Placido R, Jorge C, Pinto FJ. Best approach in d-dimer algorithm to exclude pulmonary thromboembolism: a comparative study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ruling out pulmonary embolism (PE) through a combination of clinical assessment and Ddimer is crucial to avoid excessive computed tomography pulmonary angiography (CTPA), and different algorithms should be considered as an alternative to the fixed cutoff to achieve that goal.
Purpose
To compare sensitivity, specificity, and reduction in CTPA requests of 4 algorithms to rule out PE: fixed Ddimer cutoff, age-adjusted, YEARS and PEGeD.
Methods
Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied.
In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if Ddimer ≥500µg/L or age x10 µg/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimers >500µg/L or low probability and Ddimer >1000 µg/L are selected for CTPA.
Results
We enrolled 409 patients and PE was confirmed by CTPA in 125 patients. Compared with a fixed Ddimer cutoff, age-adjusted was associated with a significant increased of specificity (p < 0.001), correctly avoiding 29 CTPAs, without losing sensitivity. YEARS resulted in a marked increase in specificity, compared to the fixed cutoff, but with an impairment of sensitivity(p = 0.002). PEGeD had the worst sensitivity, associated with 11 more false negatives (FN) than the fixed cutoff. Despite the lack of difference between PEGed and YEARS strategies regarding sensitivity, YEARS had a significantly higher specificity (p < 0.001) and allowed to correctly avoid a higher number of CTPA(55 vs 63), compared to the fixed cutoff. Results are summarized in table 1.
Conclusion
Compared to fixed d-dimer cutoff, all algorithms were associated with an increased specificity. Age-adjusted cutoff was the only that is not associated with a significant decrease in sensitivity when compared to fixed cutoff, allowing to safely reduce the need to perform CTPA.
Sens(%) Spec(%) Correctly avoid CTPAs(n) FN(n) Fixed cutoff 95 29 85 6 Age-adjusted 93 40 114 9 YEARS 87 52 148 16 PEGeD 86 49 140 17
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Affiliation(s)
- BV Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar Ricardo
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - C Mendonca
- Hospital de Santa Maria Faculty of Medicine, Radiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Santos
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Placido
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - C Jorge
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
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Silverio Antonio P, Rodrigues T, Santos R, Nunes-Ferreira A, Cunha N, Couto Pereira S, S Morais P, Alves Da Silva P, Valente Silva B, Brito J, Placido R, David C, J Pinto F, G Almeida A. Mitral valve prolapse - it"s possible to stratify prognosis in these patients? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Mitral valve prolapse (MVP) is one of the most frequent causes of mitral valve disease in developed countries, traditionally with a benign prognosis, however some patients develop arrythmias and significant mitral regurgitation (MR) with need of intervention. Herein our purpose was to establish clinical, electrocardiographic and echocardiographic predictors of arrythmias, mitral valve intervention (MVI) and hospitalization in MVP patients to better characterize the prognosis in these patients.
Methods
Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined as systolic displacement of the mitral leaflet into the left atrium ≥ 2 mm from the mitral annular plane. Demographic, clinical, echocardiographic, electrocardiographic data were collected as well as adverse events at follow-up. The results were obtained using Chi-square and Student-t tests; predictors were found with logistic regression.
Results
247 patients were included (mean age 62.9 ± 18 years, 61% males), most with MVP involving the posterior leaflet (48.6%). 40% were symptomatic, 47.4% had more than moderate MR, and 25% had interventricular conduction delay in the ECG. During a mean follow-up of 30 ± 19 months, 38% had arrythmias, 27.1% needed mitral valve intervention (95% surgery and 5% percutaneous), 27.1% had atrial fibrillation (AF), 3.4% had ventricular arrythmias, 19.2% had ventricular premature beats, 13.3% had hospital admission for cardiovascular cause and 8.5% (n = 21) died. 9.3% of the patients had mitral annulus disjunction (MAD).
Palpitations (p = 0.018), AF (p < 0.001), significant MR (p < 0.001), higher NYHA class (p = 0.016), systolic pulmonary artery pressure (SPAP) (p < 0.001), LV mass (p < 0.001), QTc (p = 0.01) and MAD maximum distance (p = 0.02) associated with MVI.
MAD maximum distance value presented an excellent capacity to predict the MVI (AUC 0.85 p = 0.019); the best cut-off was 11,5 mm (Sens = 80%; Spec = 83%).
AF was a predictor of hospitalization in univariate analysis (OR = 2.57, CI95% 1.15-5.75, p = 0.022).
Regarding arrhythmic events, we found association with aortic root dilatation (p = 0.032), NYHA III-IV (p = 0.013), age and LV mass (both with p < 0.001).
In multivariate analysis, LV mass (OR = 1.02, CI95% 1.005-1.027, p = 0.005) and age (OR = 1.038, CI95% 1.004-1.053, p = 0.021) were independent predictors of arrythmias.
In this sample, MAD was not associated with arrythmias.
Conclusion
Opposing to previous studies in our population, MAD was not associated with arrythmias but had an excellent capacity to predict MVI. Age and LV hypertrophy were independent predictors of arrythmias in our patients. Larger studies are needed to better stratify patients with MVP, as its association with arrhythmias, hospitalization and the need for intervention is not negligible.
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Affiliation(s)
- P Silverio Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P S Morais
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Placido
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - C David
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A G Almeida
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon Schoolof Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Cunha NPD, Rigueira J, Santos R, Nunes-Ferreira A, Rodrigues T, Antonio P, Pereira S, Morais P, Silva P, Brito J, Silva B, Placido R, David C, Pinto FJ, Almeida AG. Mitral annulus disjunction: is it a marker of ominous prognosis? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Mitral annulus disjunction (MAD) has been proposed as a contributing factor for arrythmias and mitral regurgitation in patients with mitral valve prolapse (MVP), however its clinical relevance is still under investigation.
Objective
To evaluate the frequency of MAD in MVP patients, to characterize clinically patients with MAD and assess potential markers for events.
Methods
Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined according to the 2017 AHA recommendations; MAD was defined as a separation between mitral valve annulus and the left ventricle free wall. Demographic, clinical, echocardiographic, electrocardiographic data were collected. The results were obtained using Chi-square and Mann-Whitney tests; logistic regression was used to find predictors of events.
Results
247 patients were included (mean age 62.9 ± 18 years, 61% males), of these 23 (9.3%) had MAD (mean age 56 ± 20 years, 56.5% males). The maximum diameter of MAD was 10 ± 3mm (range 5-18). 21 patients (92.3%) had mitral regurgitation, and it was at least of moderate severity in 65.2% of patients. Most of the patients (91.3, n = 21) were in sinus rhythm (SR).
During follow-up (FUP) of 29 ± 19 months, 39% (n = 9) of the patients developed symptoms, 22% (n = 5) had atrial fibrillation (AF), 4.3% (n = 1) had acute aortic syndrome (AAS), 4.3% (n = 1) needed ICD, 22% (n = 5) were submitted to mitral valve intervention, 8.7% (n = 2) were admitted to hospital and 8.7% (n = 2) died. None of the patients presented sustained ventricular arrhythmias (SVA) as assessed in regular Holter monitoring.
These patients had more AAS and needed more ICD in FUP compared to patients without MAD (p = 0.007 and p = 0.006, respectively)
Mitral cord rupture (p = 0.04), age (p = 0.044), maximum velocity of tricuspid regurgitation (p = 0.04) and IVS thickness (p = 0.017) were associated with AF in MAD patients. in univariate analysis, interventricular septum thickness was a predictor of AF in this subgroup (OR 4.0, 95%CI 1.1-14.3, p = 0-032) The presence of SR was associated with survival (p = 0.03). There were no predictors of hospital admission or mitral intervention.
Conclusion
Patients with MAD had a relatively benign prognosis with few events during follow-up, although with more AAS and ICD in FUP. In our sample, AF was more common than SVA. Left ventricle hypertrophy was a predictor of AF and sinus rhythm was associated with survival. Larger studies with more patients and other methods of imaging are needed to confirm our results.
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Affiliation(s)
- NPD Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Morais
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Placido
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - C David
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - AG Almeida
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Yanavich C, Pacheco AG, Cardoso SW, Nunes EP, Chaves U, Freitas G, Santos R, Morata M, Veloso VG, Grinsztejn B, Perazzo H. Diagnostic value of serological biomarkers for detection of non-alcoholic fatty liver disease (NAFLD) and/or advanced liver fibrosis in people living with HIV. HIV Med 2021; 22:445-456. [PMID: 33529485 DOI: 10.1111/hiv.13060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We aimed to evaluate the accuracy of serological biomarkers for non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR-F3F4) in HIV mono-infected individuals. METHODS In all, 674 participants from the PROSPEC-HIV study (NCT02542020), who had blood sample tests and transient elastography (TE) performed on the same day, were eligible. Exclusion criteria were viral hepatitis co-infection (n = 90), abusive alcohol intake (n = 61), missing data (n = 47) or unreliable TE (n = 39). NAFLD was defined by controlled attenuation parameter ≥ 248 dB/m and advanced fibrosis by liver stiffness measurement ≥ 8.7 kPa with M probe or ≥ 7.2 kPa with XL probe. Biomarkers for NAFLD [Steato-ELSA, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), NAFLD-Liver Fat Score (NAFLD-LFS)] and fibrosis [Fibrosis-4 score (FIB-4), Aspartate-to-Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS)] were calculated. RESULTS A total of 437 patients [57% female, age = 44 (interquartile range: 35-52) years, body mass index (BMI) = 26.1 (23.4-29.3) kg/m2 , CD4 = 660 (427-901) cells/μL] were included. The prevalence [95% confidence interval (CI)] of NAFLD and advanced fibrosis were 38.2% (33.8-42.9) and 10.5% (8.0-13.8), respectively. The areas (95% CI) under the receiver operator curve (AUROCs) for diagnosis of NAFLD were 0.854 (0.818-0.889), 0.840 (0.804-0.877), 0.805 (0.762-0.847) and 0.793 (0.750-0.836) for Steato-ELSA, FLI, HSI and NAFLD-LFS (P < 0.001), respectively. All tests yielded satisfactory sensitivities, specificities and negative predictive values (NPVs). The AUROCs (95% CI) for diagnosis of advanced fibrosis were 0.736 (0.659-0.814), 0.700 (0.614-0.7851) and 0.795 (0.726-0.864) for FIB-4, APRI and NFS (P = 0.077), respectively. These tests yielded high specificities and negative predictive values (NPVs) > 90%. CONCLUSION Biomarkers for NAFLD had a good accuracy and those for fibrosis had high specificities and NPVs. These tests should be integrated to HIV care to detect NAFLD and to exclude advanced liver fibrosis.
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Affiliation(s)
- C Yanavich
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - A G Pacheco
- Scientific Computation Program (PROCC), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - S W Cardoso
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - E P Nunes
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Usb Chaves
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - G Freitas
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - R Santos
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - M Morata
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - V G Veloso
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - B Grinsztejn
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - H Perazzo
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Mishra AK, Cabaço S, de Los Santos CB, Apostolaki ET, Vizzini S, Santos R. Long-term effects of elevated CO 2 on the population dynamics of the seagrass Cymodocea nodosa: Evidence from volcanic seeps. Mar Pollut Bull 2021; 162:111824. [PMID: 33162054 DOI: 10.1016/j.marpolbul.2020.111824] [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] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/25/2020] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
Population reconstruction techniques was used to assess for the first time the population dynamics of a seagrass, Cymodocea nodosa, exposed to long-term elevated CO2 near three volcanic seeps and compared them with reference sites away from the seeps. Under high CO2, the density of shoots and of individuals (apical shoots), and the vertical and horizontal elongation and production rates, were higher than at the reference sites. Nitrogen limitation effects on rhizome elongation and production rates and on biomass were more evident than CO2 as these were highest at the location where the limitation of nitrogen was highest. At the seep where the availability of CO2 was highest and nitrogen lowest, density of shoots and individuals were highest, probably due to CO2 effects on shoot differentiation and induced reproductive output, respectively. At the three seeps, there was higher short- and long-term shoot recruitment than at the reference sites, and growth rates was around zero, indicating that elevated CO2 increases the turnover of C. nodosa shoots.
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Affiliation(s)
- A K Mishra
- Marine Plant Ecology Research Group (ALGAE), Centre of Marine Sciences (CCMAR), University of Algarve, Faro 8005-139, Portugal; School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Portland Square, Drake Circus, Plymouth PL48LA, UK.
| | - S Cabaço
- Marine Plant Ecology Research Group (ALGAE), Centre of Marine Sciences (CCMAR), University of Algarve, Faro 8005-139, Portugal
| | - C B de Los Santos
- Marine Plant Ecology Research Group (ALGAE), Centre of Marine Sciences (CCMAR), University of Algarve, Faro 8005-139, Portugal
| | - E T Apostolaki
- Institute of Oceanography, Hellenic Center for Marine Research (HCMR), PO Box 2214, 71003 Heraklion-Crete, Greece
| | - S Vizzini
- Department of Earth and Marine Sciences, University of Palermo, via Archirafi 18, 90123 Palermo, Italy; CoNISMa, Piazzale Flaminio 9, 00196 Roma, Italy
| | - R Santos
- Marine Plant Ecology Research Group (ALGAE), Centre of Marine Sciences (CCMAR), University of Algarve, Faro 8005-139, Portugal
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Nakazawa C, Batista P, Santos R, Liao A, Jacobina K, Hirose F, Bousso A, Nobrega D, Sakashita A, Paula T. FLUXO DE ATENDIMENTO A GESTANTE COM RISCO DE SANGRAMENTO E REDUÇÃO DE TRANSFUSÃO DE CONCENTRADO DE HEMÁCIAS O RHD NEGATIVO EM UM HOSPITAL TERCIÁRIO DE SÃO PAULO. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.653] [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: 11/26/2022] Open
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Brito J, Agostinho J, Duarte C, Silva B, Pereira S, Morais P, Cunha N, Rodrigues T, Antonio P, Santos R, Nunes-Ferreira A, Rigueira J, Aguiar-Ricardo I, Pinto F, Brito D. Are we aiming for different metabolic targets in heart failure patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1044] [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
Metabolic control plays an important role on major cardiovascular events (MACE) prevention. The 2019 ESC guidelines on dyslipidaemia management recommend tighter LDL-cholesterol (LDL-C) control in order to prevent cardiovascular events. However, it is not yet proven that thigh control of dyslipidaemia, glycaemic levels and body mass index (BMI) in Heart Failure (HF) patients (pts) have an impact on prognosis.
Objective
To evaluate the impact of LDL-C, HbA1c and BMI values on HF pts mortality and MACE rates.
Methods
Single centre study that included consecutive pts hospitalized for acute / decompensated chronic HF in a tertiary Hospital between January 2016 to December 2018 and followed for 12 months. The impact of LDL-C, HbA1c and BMI on mortality and MACE was assessed using Cox regression and Kaplan-Meier curve, after adjustment for age, sex, functional class and ejection fraction. A safety cut-off was established when any of these variables was deemed protective using ROC curve analysis.
Results
Two hundred twenty-four patients (71.68±13.45 years, 63.8% males) were included. Eighty-four (37.5%) pts had type 2 diabetes, 39.7% had ischemic heart disease and the median left ventricular ejection fraction was 34% (IQR 25–49.5; 60.3% HFrEF; 13.8% HFmrEF; 22.3% HFpEF). The median BMI was 25.4 kg/m2 (IQR 23.1–30.5), HbA1c, 6.4% (IQR 5.6–6.8) and LDL-C, 89.5 mg/dL (IQR 64–106); 145 (64.7%) pts were medicated with statins. The overall mortality and MACE rates during follow-up were 16.1% and 21.0%, respectively. According to the CV risk classification 39.7% pts were at very high risk and 19.6% pts at high risk. On multivariate analysis HbA1c (HR 1.5 IQR 1.1–1.9; p=0.007) and female sex (HR 9.453 IQR 2.4–37.2; p=0.001) were independent predictors of mortality, whereas LDL-C (OR 1.05 IQR 1.022–1.075; p<0.001) and BMI (OR 1.23 IQR 1.075–1.404; p=0.002) were independent protective factors. LDL-C and BMI had no effect on MACE rates, although HbA1c was an independent predictor of MACE (HR 1.27 IQR 1.03–1.57; p=0.026). For high and very high-risk pts there was still a protective trend on mortality, although non-significant, for higher levels of LDL-C (OR 1.04 IQR 0.99–1.075; P=NS). Protective LDL-C cut-off were estimated for the whole population (LDL-C 88mg/dL; AUC 0.819; sn 56.6%, sp 100%) and for the high and very-high CV risk pts (LDL-C 84mg/dL; AUC 0.815; sn 59.3%; sp 100%). A BMI safety cut-off for mortality of 25.75 kg/m2 was found (AUC 0.627; sn 61.2%; sp 58.3%).
Conclusion
This study supports the theory of the obesity and LDL-C paradox in HF. Lower LDL-C and BMI increased mortality and there is no trade-off effect on MACE rates, supporting the idea that LDL-C and BMI should not be aggressively addressed in HF pts. In our cohort a cut-off level of LDL-C below 88mg/dL is associated with higher mortality. On the other hand, diabetes should be actively treated as HbA1c predicts death and MACE in HF pts.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J.R Agostinho
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - C Duarte
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - B Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - S Pereira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Morais
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - T Rodrigues
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P.S Antonio
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - R Santos
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - A Nunes-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Rigueira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - F.J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - D Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Santos R, Nobre-Menezes M, Carrilho-Ferreira P, Jorge C, Francisco A, Infante-Oliveira E, Duarte J, Cardoso P, Torres D, Aguiar-Ricardo I, Rigueira J, Rodrigues T, Nunes-Ferreira A, Pinto F, Silva P. One stent versus two stents for distal LM PCI: insights from the experience of a high volume center. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1475] [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
Distal left main (LM) PCIremains a challenge. One of the most debated issues is whether to use a single vs 2 stent provisional strategy. While most studies and guidelines favour a single stent strategy, the recent DK-CRUSH V trial has shown better results with a 2 stent strategy.
Objective
To evaluate the performance of a single vs dual stent strategy for LM PCI in a real-world population setting.
Methods
Single-center procedural prospective registry of patients (pts) submitted to LM PCI from 2015–2018, with retrospective event analysis. Demographic, clinical data and procedure characteristics were analysed. Results were obtained with χ2 test, T student test, Kaplan-Meier survival analysis, logistic and Cox regression.
Results
100 pts (73 men; 69±11 years) were included. Co-morbidities were very frequent (85 had hypertension, 54 had diabetes, 71 had dyslipidemia and 39 were past smokers). 32 had reduced LVEF (<40%) and 45 previous CABG. The decision to proceed to PCI vs surgery was undertaken individually by the local HeartTeam. Most of the procedures (57) were in an acute coronary syndrome setting (11 in STEMI, 7 with cardiogenic shock). The anatomical distribution of the lesions was: distal in 69 pts (61 involved the LAD and or Cx ostium), mid shaft in 7 pts, ostial in 18 pts and diffuse in 6 pts. Protected left main PCI encompassed 41% of the procedures.
The complication rate was 7%. During a mean follow-up of 866±400 days, there were 4 peri-procedural deaths, 1-year mortality rate of 10% and 22 pts died overall.
In pts submitted to distal LM PCI, a single stent was used in 49 pts (66%) versus a 2 stent approach in 23 pts (31%). The only significant difference between these groups were diabetes (66% in the single stent vs 32% in the 2 stent group, p=0.006) and protected LM (51% in the single stent vs 26.1% in the two stent group, p=0.046).
While a 2 stent strategy was associated with higher mortality by Kaplan Meyer analysis (LogRank = 11.07, p=0.001), it was not an independent predictor of mortality in Cox regression. Cox univariate analysis identified LVEF <40% (OR 2.2, CI 1.01–4.9, p=0.047) and complications (OR 3.1, CI 1.4 – 6.9, p=0.004) as the only predictors of death. In multivariate analysis, only the latter was an independent predictor of mortality (OR 2.6, IC 1.1–5.9, p=0.028). The use of a 2 stent strategy was significantly associated with complications (χ2=5.1 p=0.024)) and was the only independent predictor of it (OR 3.8, IC 1.1–12.8, p=0.03). This was true even in the subgroup of protected LM PCI.
Conclusion
In a real-world setting of challenging LM PCI cases, a single stent strategy for distal LM PCI performed better. The use of 2 stents was an independent predictor of complications, strongly associated with increased risk of death. While a LM PCI must be undertaken on an individual basis, a single stent provisional strategy, whenever feasible, seems to be the best option.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospita Santa Maria
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Affiliation(s)
- R Santos
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Nobre-Menezes
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Carrilho-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - C Jorge
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A.R Francisco
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - E Infante-Oliveira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Duarte
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Cardoso
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - D Torres
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - F.J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P.C Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Sousa R, Silva F, Silva R, Santos R, Mouta J, Cardoso T, Cardoso O. Analysis of hospitalization trends for ambulatory care sensitive conditions in Piauí/Brazil, 2009-18. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hospitalizations for ambulatory care sensitive conditions (ACSC) are hospitalizations that can be potentially preventable through care at the first level of contact for health care. In fact, the actions offered in a timely and effective manner can reduce the risk of unnecessary hospitalizations by preventing diseases, controlling acute episodes and managing chronic diseases.
Aim
Analyze the trends in hospitalizations for ACSC in Piauí, Brazil, from 2009 to 2018.
Methods
Ecological time-series study based on data from the Hospital Information System (SIH) of the public health system (SUS), which comprised all hospitalizations of residents of Piauí, Brazil, in the period from 2009 to 2018. The explanatory variables were the hospitalizations for ACSC groups. For temporal trend analysis, the Prais-Winsten linear regression model was used in the Stata version 14 program.
Results
567,577 were recorded as ACSC, representing 35.3% of the total hospitalizations (1,608,263). Most hospitalizations for ACSC were caused by infectious gastroenteritis (33.5%). The risk of hospitalization for ACSC decreased 36.8%, showing a significant reduction in the trend of the hospitalization rate (Annual Percent Change - APC: -4.6%; 95%CI: -6.4; -2.8). There was a greater decrease in the risk of hospitalization for asthma (70.3%), hypertension (66.4%) and infectious gastroenteritis (61.8%). However, a significant increase was identified for skin infection (6.1 times) and diseases related to prenatal care and childbirth (3.2 times).
Conclusions
The reduction in hospitalizations due to ACSC is a result of the strengthening of Primary Health Care as the Brazilian health system organizer and the implementation of the Mais Médicos Program, which enabled the presence of doctors in family health teams, especially in places that had not previously been attended. It is also necessary to develop new studies to expand the discussions and debates on these findings.
Key messages
Hospitalizations reflect the living conditions of individuals, with social changes being perceived by changes in hospitalization patterns over time. The strengthening of primary care policies in Brazil was able to reduce hospitalizations for ACSC and it is necessary to further strengthen these practices to improve people's health care.
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Affiliation(s)
- R Sousa
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
| | - F Silva
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
| | - R Silva
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
| | - R Santos
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
| | - J Mouta
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
| | - T Cardoso
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Ribeirão Preto College of Nursing, University of São Paulo, Ribairão Preto, Brazil
| | - O Cardoso
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
- Department of Biochemistry and Pharmacology, Federal University of Piauí, UFPI, Teresina, Brazil
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Santos R, Lima M, Santos L, Sousa R, Silva F, Silva R, Cardoso T, Cardoso O. Nurses' production of meaning about National Program for Access and Quality Improvement Primary Care. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The Brazil's Family Health Strategy (ESF) is one of the initiatives for the strengthening of primary health care (PHC) in Brazil. The ESF is composed of a team of professionals, with the nurse usually adding care and administrative functions. In regard to the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), the nurses have played a prominent role, especially in the external evaluation phase.
Aim
Analyze the meanings produced by nurses about the PMAQ-AB in a state in the northeastern of Brazil.
Methods
A qualitative research was carried out with twenty-five nurses from the health macro-regions of the State of Piauí. Data were collected from four focus groups, with one group in each macro-region, containing at least six and at most seven participants. The meetings were held from September to October 2018, in which semi-structured interview script was used. For the analysis of information, the maps of association of ideas proposed by Spink and Gimenes (1994) were used.
Conclusions
Despite the difficulties and conflicts felt by nurses with the implementation of PMAQ-AB, the program was understood as an agent for transforming in the work process of family health teams. In addition, the realization of this study allowed another space for reflection to the nurses about the program, qualification and financing of PHC, which can contribute to the institutionalization of the culture of monitoring and evaluation and also the consequent strengthening of these services.
Key messages
Based on the expected impacts, we seek collaborate with reflection on the experience and generate consistent and useful information to contribute to the decision-making processes of health policies. The PMAQ-AB was considered a program that was able to induce substantial changes in work processes because it was a way to finance the workforce.
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Affiliation(s)
- R Santos
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
| | - M Lima
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
| | - L Santos
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
| | - R Sousa
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
| | - F Silva
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
| | - R Silva
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
| | - T Cardoso
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - O Cardoso
- Public Health Studies Center, Federal University of Piauí, UFPI, Teresina, Brazil
- Postgraduate Program in Health and Community, Federal University of Piauí, UFPI, Teresina, Brazil
- Department of Biochemistry and Pharmacology, Federal University of Piauí, UFPI, Teresina, Brazil
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