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Morais R, Figueiredo M, Masgnaux LJ, Pioche M. Endoscopic Submucosal Dissection of a Large Gastric Lesion Using a Novel Adjustable Traction Device: A-TRACT 4. GE Port J Gastroenterol 2024; 31:67-69. [PMID: 38314033 PMCID: PMC10836855 DOI: 10.1159/000530828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/27/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Mariana Figueiredo
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Erasme Hospital, Anderlecht, Belgium
| | - Louis-Jean Masgnaux
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Ferreira MF, Marques M, Morais R, Lemmers A, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers. GE Port J Gastroenterol 2024; 31:41-47. [PMID: 38476304 PMCID: PMC10928857 DOI: 10.1159/000528107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/06/2022] [Indexed: 03/14/2024]
Abstract
Introduction Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions. Methods We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021. Results A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (p = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to en bloc resection rate (100% vs. 96%, p = 0.204), R0 resection rate (76% vs. 75%, p = 0.531), curative resection rate (70% vs. 70%, p = 0.920), procedures' median duration (120 min vs. 90 min, p = 0.072), ESD velocity (14 vs. 12 mm2/min, p = 0.415), histopathology result (p = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, p = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, p = 0.709), perforation (0% vs. 5%, p = 0.075), or the need for readmission (2% vs. 2%, p = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, p = 0.003) and anorectal pain (9% vs. 1%, p = 0.002) were significantly more frequent in ARJ lesions. Conclusion ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.
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Affiliation(s)
- Mariana Figueiredo Ferreira
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
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Morais R, Libanio D, Santos-Antunes J. eCura and W-eCura: different scores, different populations, same goal. Gut 2024:gutjnl-2024-331924. [PMID: 38286588 DOI: 10.1136/gutjnl-2024-331924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Rui Morais
- Gastroenterology, Centro Hospitalar de Sao Joao, EPE, Porto, Portugal
| | | | - João Santos-Antunes
- Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal
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Ribeiro T, Morais R, Monteiro C, Carvalho A, Barros S, Fernando A, Pioche M, de Santiago ER, Macedo G. Estimating the environmental impact of endoscopic activity at a tertiary center: a pilot study. Eur J Gastroenterol Hepatol 2024; 36:39-44. [PMID: 37942729 DOI: 10.1097/meg.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The growing number of endoscopic procedures, frequently requiring single-use disposable instruments, is responsible for the production of a large amount of waste. To this date, the reality of waste production at large European Gastroenterology centers is unknown. This study aimed to estimate the amount of waste due to endoscopic practice at a tertiary center in Portugal. METHODS We performed a prospective study to calculate the mass (in kg) of residues generated during a period of 5 working days of endoscopic practice. We included residues produced at endoscopy suites, pre and postprocedure areas and during endoscope reprocessing. Residues were categorized as non-dangerous (groups I/II), of biologic risk (group III) and specific hazardous hospital residues (group IV). The production of residues separated for recycling/valorization (paper/card and plastic) was also quantified. The volume of water used for reprocessing an endoscope was also assessed. RESULTS During the analyzed period, 241 endoscopic procedures were performed. A total of 443.2 kg of waste (22.6 kg from groups I/II, 266.9 kg from group III and 3.9 kg from group IV) were produced, most from group III (75%). For each endoscopic procedure, 1.8 kg of waste was generated. Of the total waste mass, 17.8% was separated for recycling/valorization. A volume of 55L of water was required for reprocessing one endoscope. CONCLUSION Each endoscopic procedure generated a significant amount of waste and water consumption during reprocessing. These real-life analyses are a pivotal step before implementing effective measures to improve resource utilization and more sustainable practices.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - Rui Morais
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
- Faculty of Medicine of the University of Porto
| | - Cristiana Monteiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - Ana Carvalho
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - Sónia Barros
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
| | - André Fernando
- Department of Facilities Operations, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João
- WGO Gastroenterology and Hepatology Training Center
- Faculty of Medicine of the University of Porto
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Morais R, Libanio D, Dinis Ribeiro M, Ferreira A, Barreiro P, Bourke MJ, Gupta S, Amaro P, Küttner Magalhães R, Cecinato P, Boal Carvalho P, Pinho R, Rodríguez de Santiago E, Sferrazza S, Lemmers A, Figueiredo M, Pioche M, Gallego F, Albéniz E, Ramos Zabala F, Uchima H, Berr F, Wagner A, Marques M, Pimentel-Nunes P, Gonçalves M, Mascarenhas A, Soares EG, Xavier S, Faria-Ramos I, Sousa-Pinto B, Gullo I, Carneiro F, Macedo G, Santos-Antunes J. Predicting residual neoplasia after a non-curative gastric ESD: validation and modification of the eCura system in the Western setting: the W-eCura score. Gut 2023; 73:105-117. [PMID: 37666656 DOI: 10.1136/gutjnl-2023-330804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To evaluate the risk factors for lymph node metastasis (LNM) after a non-curative (NC) gastric endoscopic submucosal dissection (ESD) and to validate and eventually refine the eCura scoring system in the Western setting. Also, to assess the rate and risk factors for parietal residual disease. DESIGN Retrospective multicentre multinational study of prospectively collected registries from 19 Western centres. Patients who had been submitted to surgery or had at least one follow-up endoscopy were included. The eCura system was applied to assess its accuracy in the Western setting, and a modified version was created according to the results (W-eCura score). The discriminative capacities of the eCura and W-eCura scores to predict LNM were assessed and compared. RESULTS A total of 314 NC gastric ESDs were analysed (72% high-risk resection (HRR); 28% local-risk resection). Among HRR patients submitted to surgery, 25% had parietal disease and 15% had LNM in the surgical specimen. The risk of LNM was significantly different across the eCura groups (areas under the receiver operating characteristic curve (AUC-ROC) of 0.900 (95% CI 0.852 to 0.949)). The AUC-ROC of the W-eCura for LNM (0.916, 95% CI 0.870 to 0.961; p=0.012) was significantly higher compared with the original eCura. Positive vertical margin, lymphatic invasion and younger age were associated with a higher risk of parietal residual lesion in the surgical specimen. CONCLUSION The eCura scoring system may be applied in Western countries to stratify the risk of LNM after a gastric HRR. A new score is proposed that may further decrease the number of unnecessary surgeries.
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Affiliation(s)
- Rui Morais
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libanio
- Department of Gastroenterology, IPO Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, University of Porto, Porto, Portugal
| | - Mario Dinis Ribeiro
- Department of Gastroenterology, IPO Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, University of Porto, Porto, Portugal
| | - Aníbal Ferreira
- Department of Gastroenterology, Hospital Braga, Braga, Portugal
| | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Pedro Amaro
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | | | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pedro Boal Carvalho
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Rolando Pinho
- Department of Gastrenterology, Centro Hospitalar de Vila Nova de Gaia, Gaia, Portugal
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
| | - Sandro Sferrazza
- Department of Gastroenterology and Endoscopy, ARNAS Civico Hospital, Palermo, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo
- Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marhieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | | | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, IdiSNA, Navarra, Spain
| | - Felipe Ramos Zabala
- Departamento de Gastroenterología, Departamento de Ciencias Médicas Clínicas, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Hugo Uchima
- Servicio de Endoscopia Digestiva Centro Médico Teknon, Barcelona, Spain
- Servicio de Gastroenterología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Frieder Berr
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Margarida Marques
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, IPO Porto, Porto, Portugal
| | | | - André Mascarenhas
- Gastroenterology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Elisa Gravito Soares
- Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Sofia Xavier
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Isabel Faria-Ramos
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Irene Gullo
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Fatima Carneiro
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Santos-Antunes
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
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Baptista D, Fernandes M, Garrido M, Sousa F, Morais R, Garcia-Pelaez J, Silva R, Leitão D, Baptista M, Barbosa J, Carneiro F, Gullo I. Gastric polyps in Familial Adenomatous Polyposis Portuguese patients: the first Western cohort with Asian features. Pathobiology 2023:000534571. [PMID: 37852192 DOI: 10.1159/000534571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Chronic atrophic gastritis may contribute to gastric polyps (GP) phenotype in familial adenomatous polyposis (FAP). Considering the high prevalence of Helicobacter-pylori (HP) infection in Portugal, we aim to characterise GP in a series of Portuguese patients. METHODS In a retrospectively-selected series of 53 FAP patients, clinical data and histopathological features of GP and background gastric mucosa were studied. SPSS (27.0) was used for statistical analysis. RESULTS Thirteen patients (24.5%) developed fundic gland polyps (FGP), seven (13.2%) gastric adenomas (GA) and ten (18.9%) both FGP and GA. Out of 100 GP, four were hyperplastic polyps, 58 FGP (24 with dysplasia), 35 intestinal-type GA (intGA) and three foveolar-type GA (fovGA). IntGA were larger (60% >7mm, p=0.03), occurred predominantly in the distal stomach (66.7%, p=0.024), in patients harbouring gastric intestinal metaplasia (IM) (86.7%, p<0.001) and duodenal adenomas (86.7%, p<0.001) Conclusion: This is the first Western series showing high prevalence of intGA in FAP patients, comparable to Asian cohorts. HP infection and chronic atrophic gastritis/intestinal metaplasia are likely responsible for this difference, with risk of neoplastic transformation and management implications. Biopsy/excision of GP >7mm, in the distal stomach, and in patients harbouring gastric intestinal metaplasia/duodenal adenomas should be considered.
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Medas R, Morais R, Marques M, Soares C, Macedo G. Small bowel entrapment after OTSC deployment for endoscopic closure of a colonic iatrogenic perforation. Clin Res Hepatol Gastroenterol 2023; 47:102184. [PMID: 37495203 DOI: 10.1016/j.clinre.2023.102184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Carlos Soares
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
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Santos-Antunes J, Berr F, Pioche M, Ramos-Zabala F, Cecinato P, Gallego F, Barreiro P, Félix C, Sferrazza S, Wagner A, Lemmers A, Figueiredo Ferreira M, Albéniz E, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Rios E, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Deep submucosal invasion as a risk factor for recurrence after endoscopic submucosal dissection for T1 colorectal cancer. Endoscopy 2023; 55:881-882. [PMID: 37643603 DOI: 10.1055/a-2073-3986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Felipe Ramos-Zabala
- Departamento de Gastroenterología, Departamento de Ciencias Médicas Clínicas, Hospital Universitario HM Montepríncipe, HM Hospitales, Universidad San Pablo-CEU, CEU Universities Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, Lisbon, Portugal
| | - Catarina Félix
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, IdiSNA, Pamplona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Rios
- Pathology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
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Santos-Antunes J, Pioche M, Ramos-Zabala F, Cecinato P, Gallego F, Barreiro P, Mascarenhas A, Sferrazza S, Berr F, Wagner A, Lemmers A, Ferreira MF, Albéniz E, Uchima H, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Risk of Residual Neoplasia after a Local-Risk Resection of Colorectal Lesions by Endoscopic Submucosal Dissection: A Multinational Study. J Clin Med 2023; 12:5356. [PMID: 37629398 PMCID: PMC10455482 DOI: 10.3390/jcm12165356] [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: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) in colorectal lesions is demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a piecemeal ESD resection, or after an en bloc resection but with positive horizontal margins (local-risk resection-LocRR), for colorectal benign neoplasia. A retrospective multicenter analysis of consecutive colorectal ESDs was performed. Patients with LocRR ESDs for the treatment of benign colorectal lesions with at least one follow-up endoscopy were included. A cohort of en bloc resected lesions, with negative margins, was used as the control. A total of 2255 colorectal ESDs were reviewed; 352 of the ESDs were "non-curative". Among them, 209 were LocRR: 133 high-grade dysplasia and 76 low-grade dysplasia. Ten cases were excluded due to missing data. A total of 146 consecutive curative resections were retrieved for comparison. Compared to the "curative group", LocRRs were observed in lengthier procedures, with larger lesions, and in non-granular LSTs. Recurrence was higher in the LocRR group (16/199, 8% vs. 1/146, 0.7%; p = 0.002). However, statistical significance was lost when considering only en bloc resections with positive horizontal margins (p = 0.068). In conclusion, a higher rate of residual lesion was found after a piecemeal ESD resection, but not after an en bloc resection with positive horizontal margins.
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Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), 4200-135 Porto, Portugal
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, 69003 Lyon, France
| | - Felipe Ramos-Zabala
- Servicio de Gastroenterología, Departamento de Ciencias Médicas Clínicas, Hospital Universitario HM Montepríncipe, HM Hospitales, 28660 Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francisco Gallego
- Gastroenterology Department, Hospital de Poniente, 04700 Almería, Spain
| | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, 1169-050 Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, 2724-002 Lisbon, Portugal
| | - André Mascarenhas
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, 1169-050 Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, 38123 Trento, Italy
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Research Institute, Public University of Navarra, IdiSNA, 31006 Pamplona, Spain
| | - Hugo Uchima
- Servicio de Endoscopia Digestiva Centro Médico Teknon, 08022 Barcelona, Spain
- Servicio de Gastroenterología Hospital Universitario Germans Trias i Pujol, 08916 Barcelona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4400-129 Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney 2145, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4169-007 Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), 4200-135 Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
| | - Michael J. Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney 2145, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal
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Estevinho MM, Cabeda J, Santiago M, Machado E, Silva R, Duro M, Pita I, Morais R, Macedo G, Bull TJ, Magro F, Sarmento A. Viable Mycobacterium avium subsp. paratuberculosis Colonizes Peripheral Blood of Inflammatory Bowel Disease Patients. Microorganisms 2023; 11:1520. [PMID: 37375022 DOI: 10.3390/microorganisms11061520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Pathobionts, particularly Mycobacterium avium subsp. paratuberculosis (MAP) and Escherichia coli isolates with adherence/invasive ability (AIEC) have been associated with inflammatory bowel disease (IBD), particularly Crohn's disease (CD). This study aimed to evaluate the frequency of viable MAP and AIEC in a cohort of IBD patients. As such, MAP and E. coli cultures were established from faecal and blood samples (with a total n = 62 for each) of patients with CD (n = 18), ulcerative colitis (UC, n = 15), or liver cirrhosis (n = 7), as well as from healthy controls (HC, n = 22). Presumptive positive cultures were tested by polymerase chain reaction (PCR), for a positive confirmation of MAP or E. coli identity. E. coli-confirmed isolates were then tested for AIEC identity using adherence and invasion assays in the epithelial cell line of Caco-2 and survival and replication assays in the macrophage cell line of J774. MAP sub-culture and genome sequencing were also performed. MAP was more frequently cultured from the blood and faecal samples of patients with CD and cirrhosis. E. coli presumptive colonies were isolated from the faecal samples of most individuals, in contrast to what was registered for the blood samples. Additionally, from the confirmed E. coli isolates, only three had an AIEC-like phenotype (i.e., one CD patient and two UC patients). This study confirmed the association between MAP and CD; however, it did not find a strong association between the presence of AIEC and CD. It may be hypothesized that the presence of viable MAP in the bloodstream of CD patients contributes to disease reactivation.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia/Espinho Hospital Center, 4434-502 Vila Nova de Gaia, Portugal
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - José Cabeda
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR, CIMAR), 4450-208 Matosinhos, Portugal
| | - Mafalda Santiago
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - Elisabete Machado
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
| | - Ricardo Silva
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
| | - Mary Duro
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
- LAQV@REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Inês Pita
- Department of Gastroenterology, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Rui Morais
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Tim J Bull
- Institute of Infection and Immunity, St George's University of London, London SW17 ORE, UK
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Amélia Sarmento
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-150 Porto, Portugal
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11
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Santos-Antunes J, Pioche M, Ramos-Zabala F, Cecinato P, Gallego Rojo FJ, Barreiro P, Félix C, Sferrazza S, Berr F, Wagner A, Lemmers A, Figueiredo Ferreira M, Albéniz E, Uchima H, Küttner-Magalhães R, Fernandes C, Morais R, Gupta S, Martinho-Dias D, Rios E, Faria-Ramos I, Marques M, Bourke MJ, Macedo G. Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study. Endoscopy 2023; 55:235-244. [PMID: 35863354 DOI: 10.1055/a-1906-8000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND : Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting. METHODS : Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. RESULTS : From 2255 colorectal ESDs, 381 (17 %) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18 %). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0 % if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score). CONCLUSIONS : Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs.
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Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Mathieu Pioche
- Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Felipe Ramos-Zabala
- Department of Gastroenterology, Department of Clinical Medical Sciences, Hospital Universitario HM Montepríncipe, HM Hospitales, Universidad San Pablo-CEU, CEU Universities Madrid, Madrid, Spain
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pedro Barreiro
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
- Lisbon Advanced Endoscopic Center, Hospital Lusíadas, Lisbon, Portugal
| | - Catarina Félix
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental EPE, Lisbon, Portugal
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eduardo Albéniz
- Navarrabiomed Research Institute, Complejo Hospitalario de Navarra, Public University of Navarra, IdiSNA, Pamplona, Spain
| | - Hugo Uchima
- Digestive Endoscopy Service, Centro Médico Teknon, Barcelona, Spain
- Gastroenterology Service, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Rios
- Pathology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Isabel Faria-Ramos
- Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Universitário S. João, Porto, Portugal
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Silva S, Costa EM, Machado M, Morais R, Calhau C, Pintado M. Antiadhesive and Antibiofilm Effect of Malvidin-3-Glucoside and Malvidin-3-Glucoside/Neochlorogenic Acid Mixtures upon Staphylococcus. Metabolites 2022; 12:metabo12111062. [PMID: 36355145 PMCID: PMC9694786 DOI: 10.3390/metabo12111062] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Several reports on the biological activity of anthocyanin-rich extracts have been made. However, despite the association of said activity with their anthocyanin content, to the best of our knowledge, there are no previous works regarding the antimicrobial, antibiofilm and/or antiadhesive properties of anthocyanins alone. Therefore, the present work aimed to determine the effects of malvidin-3-glucoside, a major component of a previously reported extract, and the impact of its association with neochlorogenic acid (the only non-anthocyanin phenolic present in said extract), upon several Staphylococcus strains with varying resistance profiles. Results show that, while malvidin-3-glucoside and malvidin-3-glucoside/neochlorogenic acid mixtures were unable to considerably inhibit bacterial growth after 24 h, they still possessed an interesting antibiofilm activity (with reductions of biofilm entrapped cells up to 2.5 log cycles, metabolic inhibition rates up to 81% and up to 51% of biomass inhibition). When considering the bacteria’s capacity to adhere to plain polystyrene surfaces, the inhibition ranges were considerably lower (21% maximum value). However, when considering polystyrene surfaces coated with plasmatic proteins this value was considerably higher (45% for adhesion in the presence of extract and 39% for adhesion after the surface was exposed to extract). Overall, the studied anthocyanins showed potential as future alternatives to traditional antimicrobials in adhesion and biofilm formation prevention.
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Affiliation(s)
- Sara Silva
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
- Correspondence: (S.S.); (M.P.); Tel.: +351-22-558-00-00 (S.S. & M.P.)
| | - Eduardo M. Costa
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Manuela Machado
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Rui Morais
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Conceição Calhau
- Nutrição e Metabolismo, NOVA Medical School, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal
- CINTESIS, Centro de Investigação em Tecnologias e Serviços de Saúde, Universidade do Porto, 4200-450 Porto, Portugal
| | - Manuela Pintado
- CBQF—Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
- Correspondence: (S.S.); (M.P.); Tel.: +351-22-558-00-00 (S.S. & M.P.)
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13
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Ferreira-Silva J, Morais R, Medas R, Marques M, Macedo G. Intrastone tunneling endoscopic lithotripsy technique for the treatment of Bouveret syndrome. Endoscopy 2022; 55:E118-E119. [PMID: 36241176 PMCID: PMC9829760 DOI: 10.1055/a-1934-9808] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Renato Medas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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14
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Bartolomeo C, Lemes R, Morais R, Pereria G, Nunes T, Costa A, Ivanov G, Maciel R, Braconi C, Maricatto J, Janini L, Okuda L, Lee K, Prado C, Uresh R. SARS-COV-2 INFECTION AND REPLICATION KINETICS IN DIFFERENT HUMAN CELL TYPES: THE ROLE OF AUTOPHAGY, CELLULAR METABOLISM AND ACE2 EXPRESSION. Cytotherapy 2022; 24. [PMCID: PMC9595395 DOI: 10.1016/s1465-3249(22)00919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Moutinho-Ribeiro P, Batista IA, Quintas ST, Adem B, Silva M, Morais R, Peixoto A, Coelho R, Costa-Moreira P, Medas R, Lopes S, Vilas-Boas F, Baptista M, Dias-Silva D, Esteves AL, Martins F, Lopes J, Barroca H, Carneiro F, Macedo G, Melo SA. Exosomal glypican-1 is elevated in pancreatic cancer precursors and can signal genetic predisposition in the absence of endoscopic ultrasound abnormalities. World J Gastroenterol 2022; 28:4310-4327. [PMID: 36159010 PMCID: PMC9453765 DOI: 10.3748/wjg.v28.i31.4310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/30/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Individuals within specific risk groups for pancreatic ductal adenocarcinoma (PDAC) [mucinous cystic lesions (MCLs), hereditary risk (HR), and new-late onset diabetes mellitus (NLOD)] represent an opportunity for early cancer detection. Endoscopic ultrasound (EUS) is a premium image modality for PDAC screening and precursor lesion characterization. While no specific biomarker is currently clinically available for this purpose, glypican-1 (GPC1) is overexpressed in the circulating exosomes (crExos) of patients with PDAC compared with healthy subjects or those harboring benign pancreatic diseases.
AIM To evaluate the capacity of GPC1+ crExos to identify individuals at higher risk within these specific groups, all characterized by EUS.
METHODS This cross-sectional study with a prospective unicentric cohort included 88 subjects: 40 patients with MCL, 20 individuals with HR, and 20 patients with NLOD. A control group (CG) was submitted to EUS for other reasons than pancreatic pathology, with normal pancreas and absence of hereditary risk factors (n = 8). The inclusion period was between October 2016 and January 2019, and the study was approved by the Ethics Committee of Centro Hospitalar Universitário de São João, Porto, Portugal. All patients provided written informed consent. EUS and blood tests for quantification of GPC1+ crExos by flow cytometry and carbohydrate antigen 19-9 (CA 19-9) levels by ELISA were performed in all subjects. EUS-guided tissue acquisition was done whenever necessary. For statistical analysis, SPSS® 27.0 (IBM Corp., Armonk, NY, United States) version was used. All graphs were created using GraphPad Prism 7.00 (GraphPad Software, San Diego, CA, United States).
RESULTS Half of MCLs harbored worrisome features (WF) or high-risk stigmata (HRS). Pancreatic abnormalities were detected by EUS in 10.0% and 35.0% in HR and NLOD individuals, respectively, all considered non-malignant and “harmless.” Median levels of GPC1+ crExos were statistically different: MCL [99.4%, interquartile range (IQR): 94.9%-99.8%], HR (82.0%, IQR: 28.9%-98.2%), NLOD (12.6%, IQR: 5.2%-63.4%), and CG (16.2%, IQR: 6.6%-20.1%) (P < 0.0001). Median levels of CA 19-9 were within the normal range in all groups (standard clinical cut-off of 37 U/mL). Within HR, individuals with a positive history of cancer had higher median levels of GPC1+ crExos (97.9%; IQR: 61.7%-99.5%), compared to those without (59.7%; IQR: 26.3%-96.4%), despite no statistical significance (P = 0.21). Pancreatic cysts with WF/HRS were statistically associated with higher median levels of GPC1+ crExos (99.6%; IQR: 97.6%-99.8%) compared to those without (96.5%; IQR: 81.3%-99.5%) (P = 0.011), presenting an area under the receiver operating characteristic curve value of 0.723 (sensitivity 75.0% and specificity 67.7%, using a cut-off of 98.5%; P = 0.012).
CONCLUSION GPC1+ crExos may act as biomarker to support the diagnosis and stratification of PDAC precursor lesions, and in signaling individuals with genetic predisposition in the absence of EUS abnormalities.
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Affiliation(s)
- Pedro Moutinho-Ribeiro
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Ines A Batista
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto 4200, Portugal
- IPATIMUP–Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto 4050, Portugal
| | - Sofia T Quintas
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto 4200, Portugal
- IPATIMUP–Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200, Portugal
| | - Bárbara Adem
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto 4200, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto 4050, Portugal
| | - Marco Silva
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Rui Morais
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Armando Peixoto
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Rosa Coelho
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Pedro Costa-Moreira
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Renato Medas
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Susana Lopes
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Filipe Vilas-Boas
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Manuela Baptista
- Serviço de Cirurgia Geral, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
| | - Diogo Dias-Silva
- Unidade de Saúde Familiar Serpa Pinto, ACeS Porto Ocidental, Porto 4250, Portugal
| | - Ana L Esteves
- Unidade de Saúde Familiar Serpa Pinto, ACeS Porto Ocidental, Porto 4250, Portugal
| | - Filipa Martins
- Unidade de Saúde Familiar Serpa Pinto, ACeS Porto Ocidental, Porto 4250, Portugal
| | - Joanne Lopes
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
| | - Helena Barroca
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
| | - Fátima Carneiro
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto 4200, Portugal
- IPATIMUP–Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200, Portugal
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
| | - Guilherme Macedo
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto 4200, Portugal
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
| | - Sonia A Melo
- Faculty of Medicine, University of Porto, Porto 4200, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto 4200, Portugal
- IPATIMUP–Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200, Portugal
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Conway Morris A, Kohler K, De Corte T, Ercole A, De Grooth HJ, Elbers PWG, Povoa P, Morais R, Koulenti D, Jog S, Nielsen N, Jubb A, Cecconi M, De Waele J. Correction: Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set. Crit Care 2022; 26:249. [PMID: 35978317 PMCID: PMC9383662 DOI: 10.1186/s13054-022-04124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK.
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK.
- JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK.
| | - Katharina Kohler
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
| | - Thomas De Corte
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ari Ercole
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Harm-Jan De Grooth
- Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pedro Povoa
- Nova Medical School, New University, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Rui Morais
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Despoina Koulenti
- 2Nd Critical Care Department, Attikon University Hospital, University of Athens, Athens, Greece
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sameer Jog
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Nathan Nielsen
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Transfusion Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Alasdair Jubb
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | - Jan De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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17
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Conway Morris A, Kohler K, De Corte T, Ercole A, De Grooth HJ, Elbers PWG, Povoa P, Morais R, Koulenti D, Jog S, Nielsen N, Jubb A, Cecconi M, De Waele J. Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set. Crit Care 2022; 26:236. [PMID: 35922860 PMCID: PMC9347163 DOI: 10.1186/s13054-022-04108-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
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Affiliation(s)
- Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK.
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK.
- JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK.
| | - Katharina Kohler
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
| | - Thomas De Corte
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ari Ercole
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Harm-Jan De Grooth
- Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pedro Povoa
- Nova Medical School, New University, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Rui Morais
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Despoina Koulenti
- 2Nd Critical Care Department, Attikon University Hospital, University of Athens, Athens, Greece
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sameer Jog
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Nathan Nielsen
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Transfusion Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Alasdair Jubb
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | - Jan De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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18
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Cidade JP, Coelho LM, Costa V, Morais R, Moniz P, Morais L, Fidalgo P, Tralhão A, Paulino C, Nora D, Valério B, Mendes V, Tapadinhas C, Povoa P. Septic shock 3.0 criteria application in severe COVID-19 patients: An unattended sepsis population with high mortality risk. World J Crit Care Med 2022; 11:246-254. [PMID: 36051940 PMCID: PMC9305684 DOI: 10.5492/wjccm.v11.i4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/17/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can be associated with life-threatening organ dysfunction due to septic shock, frequently requiring intensive care unit (ICU) admission, respiratory and vasopressor support. Therefore, clear clinical criteria are pivotal for early recognition of patients more likely to need prompt organ support. Although most patients with severe COVID-19 meet the Sepsis-3.0 criteria for septic shock, it has been increasingly recognized that hyperlactatemia is frequently absent, possibly leading to an underestimation of illness severity and mortality risk.
AIM To identify the proportion of severe COVID-19 patients with vasopressor support requirements, with and without hyperlactatemia, and describe their clinical outcomes and mortality.
METHODS We performed a single-center prospective cohort study. All adult patients admitted to the ICU with COVID-19 were included in the analysis and were further divided into three groups: Sepsis group, without both criteria; Vasoplegic Shock group, with persistent hypotension and vasopressor support without hyperlactatemia; and Septic Shock 3.0 group, with both criteria. COVID-19 was diagnosed using clinical and radiologic criteria with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive RT-PCR test.
RESULTS 118 patients (mean age 63 years, 87% males) were included in the analysis (n = 51 Sepsis group, n = 26 Vasoplegic Shock group, and n = 41 Septic Shock 3.0 group). SOFA score at ICU admission and ICU length of stay were different between the groups (P < 0.001). Mortality was significantly higher in the Vasoplegic Shock and Septic Shock 3.0 groups when compared with the Sepsis group (P < 0.001) without a significant difference between the former two groups (P = 0.713). The log rank tests of Kaplan-Meier survival curves were also different (P = 0.007). Ventilator-free days and vasopressor-free days were different between the Sepsis vs Vasoplegic Shock and Septic Shock 3.0 groups (both P < 0.001), and similar in the last two groups (P = 0.128 and P = 0.133, respectively). Logistic regression identified the maximum dose of vasopressor therapy used (AOR 1.046; 95%CI: 1.012-1.082, P = 0.008) and serum lactate level (AOR 1.542; 95%CI: 1.055-2.255, P = 0.02) as the major explanatory variables of mortality rates (R2 0.79).
CONCLUSION In severe COVID-19 patients, the Sepsis 3.0 criteria of septic shock may exclude approximately one third of patients with a similarly high risk of a poor outcome and mortality rate, which should be equally addressed.
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Affiliation(s)
- José Pedro Cidade
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa 1449-005, Portugal
| | - LM Coelho
- Polyvalent Intensive Care Unit, Hospital Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Vasco Costa
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Rui Morais
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Patrícia Moniz
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Luís Morais
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Pedro Fidalgo
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - António Tralhão
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Carolina Paulino
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - David Nora
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Bernardino Valério
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Vítor Mendes
- Polyvalent Intesive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Camila Tapadinhas
- Polyvalent Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Pedro Povoa
- Polyvalent Intens Care Unit; NOVA Medical School, Hospital Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
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Moutinho-Ribeiro P, Adem B, Batista I, Silva M, Silva S, Ruivo CF, Morais R, Peixoto A, Coelho R, Costa-Moreira P, Lopes S, Vilas-Boas F, Durães C, Lopes J, Barroca H, Carneiro F, Melo SA, Macedo G. Exosomal glypican-1 discriminates pancreatic ductal adenocarcinoma from chronic pancreatitis. Dig Liver Dis 2022; 54:871-877. [PMID: 34840127 DOI: 10.1016/j.dld.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker. METHODS This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed. RESULTS The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). CONCLUSION Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.
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Affiliation(s)
- P Moutinho-Ribeiro
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - B Adem
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - I Batista
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - M Silva
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - S Silva
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; iBiMED - Institute of Biomedicine, University of Aveiro
| | - C F Ruivo
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - R Morais
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - A Peixoto
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - R Coelho
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - P Costa-Moreira
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - S Lopes
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - F Vilas-Boas
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal
| | - C Durães
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - J Lopes
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - H Barroca
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - F Carneiro
- Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal; Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S A Melo
- Medical Faculty of the University of Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - G Macedo
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Medical Faculty of the University of Porto, Porto, Portugal.
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20
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Affiliation(s)
- Philip Fortuna
- Centro Hospitalar Universitário de Lisboa Central EPE, Lisbon, Portugal.
| | - Simão Rodeia
- Centro Hospitalar Universitário de Lisboa Central EPE, Lisbon, Portugal
| | - Rui Morais
- Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
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21
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Cidade JP, Coelho L, Costa V, Morais R, Moniz P, Morais L, Fidalgo P, Tralhão A, Paulino C, Nora D, Valerio B, Mendes V, Tapadinhas C, Póvoa P. Predictive value of D-dimer in the clinical outcome of severe COVID19 patients: Are we giving it too much credit? Clin Appl Thromb Hemost 2022; 28:10760296221079612. [PMID: 35139655 PMCID: PMC8841899 DOI: 10.1177/10760296221079612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COVID-19 is a new form of acute respiratory failure leading to multiorgan failure and ICU admission. Gathered evidence suggests that a 3-fold rise in D-dimer concentrations may be linked to poor prognosis and higher mortality. PURPOSE To describe D-dimer admission profile in severe ICU COVID19 patients and its predictive role in outcomes and mortality. METHODS Single-center retrospective cohort study. All adult patients admitted to ICU with COVID19 were divided into 3 groups: (1) Lower-values group (D-dimer levels < 3-fold normal range value [NRV] [500ng/mL]), Intermediate-values group (D-dimer ≥3-fold and <10-fold NRV) and Higher-value group (≥10-fold NRV). RESULTS 118 patients (mean age 63 years, 73% males) were included (N = 73 Lower-values group, N = 31 Intermediate-values group; N = 11 Higher-values group). Mortality was not different between groups (p = 0.51). Kaplan-Meier survival curves revealed no differences (p = 0.52) between groups, nor it was verified even when gender, age, ICU length of stay, and SOFA score were considered as covariables. CONCLUSIONS In severe COVID19 patients, the D-dimer profile does not retain a predictive value regarding patients' survivability and should not be used as a surrogate of disease severity.
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Affiliation(s)
- José P Cidade
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Luís Coelho
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon.,Nova Medical School, Clinical Medicine, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Vasco Costa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Rui Morais
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Patrícia Moniz
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Luís Morais
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Pedro Fidalgo
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - António Tralhão
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Carolina Paulino
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - David Nora
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Bernardino Valerio
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Vítor Mendes
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Camila Tapadinhas
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon
| | - Pedro Póvoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon.,Nova Medical School, Clinical Medicine, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
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22
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Santos AL, Santos-Antunes J, Morais R, Lima da Costa E, Pereira P, Macedo G. New Endoscopic Solutions in Managing Phlegmonous Esophagitis. Dig Dis 2022; 40:835-838. [PMID: 35081538 DOI: 10.1159/000521485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/08/2021] [Indexed: 02/02/2023]
Abstract
A 48-year-old woman was admitted in the emergency department due to epigastric pain, nausea, vomiting, and cough. She presented with fever and increased inflammatory parameters. A thoracoabdominal computed tomography (CT) was performed and revealed thickening of the gastric fundus and esophagus, with an apparent laceration in esophageal mucosa and associated dissection of esophageal wall. In upper endoscopy (UE), a bulging of esophageal and gastric walls was observed, with an ulceration in proximal esophagus, suggestive of a perforation. After multidisciplinary discussion, a minimally invasive endoscopic approach was decided. Internal esophageal drainage (IED) was assured with performance of some incisions with Dual-knife® (Olympus, Tokyo) along the mucosal and submucosal layers in the esophagus. During the incision, extravasation of pus was evident. One week later, due to clinical worsening and evidence of esophageal perforation in CT scan, UE was repeated. We confirmed esophageal perforation with visualization of two millimetric defects in the proximal esophagus. Significant bulging of the gastric fundus and body was also observed. IED was repeated with mucosal incision of the gastric bulging using Needle-Cut 3V® (Olympus, Tokyo), with extravasation of a significant quantity of pus. We decided to proceed to endoscopic vacuum therapy that was performed with sponge placement in the esophageal lumen (Endosponge®, B. Braun, Melsungen, Germany). UE was repeated 1 week later with sponge removal and confirmation of resolution of esophageal perforation. An improvement of the thickening of gastric fundus and body was also seen. One month later after admission, the patient was discharged home, eating normally, and remains well in the follow-up.
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Affiliation(s)
- Ana L Santos
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,WGO Porto Training Center, Porto, Portugal
| | - João Santos-Antunes
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,WGO Porto Training Center, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,WGO Porto Training Center, Porto, Portugal
| | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,WGO Porto Training Center, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,WGO Porto Training Center, Porto, Portugal
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23
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Santos-Antunes J, Marques M, Morais R, Baldaque-Silva F, Vilas-Boas F, Moutinho-Ribeiro P, Lopes S, Carneiro F, Macedo G. Retrospective analysis of the outcomes of endoscopic submucosal dissection for the diagnosis and treatment of subepithelial lesions in a center with high expertise. Ann Gastroenterol 2022; 35:68-73. [PMID: 34987291 PMCID: PMC8713347 DOI: 10.20524/aog.2021.0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background Use of endoscopic submucosal dissection (ESD) for the diagnosis and treatment of subepithelial lesions (SELs) is limited in the West, and the best approach for these lesions is still debated. In this study we describe our experience regarding the usefulness, safety and outcomes of ESD for SELs. Method We performed a retrospective analysis of ESD in the diagnosis and treatment of SELs between November 2010 and February 2021. Results A total of 634 ESDs were reviewed. Fifty-five (9%) were performed in SELs, 6 in the esophagus, 34 in the stomach, and 15 in the rectum. ESD was technically successful in 53 lesions (96%). Most of them (82%) had previous endoscopic ultrasound evaluation, but only 20% had a histological diagnosis previous to the ESD. Neuroendocrine tumors, gastrointestinal stromal tumors, and granular cell tumors accounted for 38% of the procedures, with a 100% rate of en bloc resection and 65% of R0 resection; the main criterion for non-curative resection was a deep positive margin, and none of the patients treated with complementary surgery had lesions on the gastrointestinal wall. Most of the procedures (62%) were performed in lesions with very low malignant potential, providing the definitive diagnosis of SELs where the previous diagnostic workup was inconclusive. We had a total of 2 delayed bleedings and 1 perforation, all treated endoscopically. Conclusion Our real-life experience showed that ESD can be an effective and safe diagnostic tool for undetermined SELs, as well as an effective treatment for neoplastic SELs with malignant potential.
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Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo).,Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal (João Santos-Antunes)
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo)
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo)
| | - Francisco Baldaque-Silva
- Division of Medicine, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden (Francisco Baldaque-Silva)
| | - Filipe Vilas-Boas
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo)
| | - Pedro Moutinho-Ribeiro
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo)
| | - Susana Lopes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo)
| | - Fátima Carneiro
- Pathology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (Fátima Carneiro)
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal (João Santos-Antunes, Margarida Marques, Rui Morais, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Guilherme Macedo)
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Garrido I, Morais R, Macedo G. Rectal Tear: A Rare Cause of Gastrointestinal Bleeding. GE Port J Gastroenterol 2021; 28:431-433. [PMID: 34901452 DOI: 10.1159/000510762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Rui Morais
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal
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Santos AL, Coelho R, Silva M, Morais R, Cardoso H, Macedo G. A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis. GE Port J Gastroenterol 2021; 29:393-400. [PMID: 36545188 PMCID: PMC9761355 DOI: 10.1159/000519934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/10/2021] [Indexed: 12/24/2022]
Abstract
Background Recent studies suggest that follow-up paracentesis (FuP) in cases of spontaneous bacterial peritonitis (SBP) should only be performed if there is a clinical and/or analytic worsening. We aimed to evaluate which patients with SBP would benefit from the FuP. Métodos This retrospective study included consecutive patients diagnosed with SBP between January 2011 and June 2018 in our tertiary center. Clinical and analytical data were obtained at baseline and on the third day of antibiotic therapy. An adequate response on the third day of treatment was defined by a decrease of ≥25% in the neutrophil count of the ascitic fluid (AF). Results Ninety-six episodes of PBE in 75 patients (79% male sex, mean age 61 ± 11 years old) were included. At admission, a higher serum neutrophil count (p = 0.043), a lower level of serum total proteins (p = 0.040), a positive culture in AF (p < 0.001) and a previous diagnosis of diabetes mellitus (p = 0.035) were related to inadequate response (IR). At day 3, acute kidney injury (p = 0.023), C-reactive protein >100 mg/L (p < 0.001), the presence of fever (p = 0.047) and abdominal pain (p < 0.001) were also associated with IR. In multivariate analysis, the presence of respiratory insufficiency (OR = 16.403; 95% CI: 2.315-116.222; p = 0.005) and abdominal pain (OR = 10.381; 95% CI: 1.807-59.626; p = 0.009) at admission, serum white blood cell count >9 × 109 (OR = 5.832; 95% CI: 1.275-26.669; p = 0.023), and CRP >100 mg/L (OR = 5.043; 95% CI: 1.267-20.076; p = 0.022) at day 3 of antibiotic therapy were predictors of IR. The predictive model presented good accuracy [AUROC of 0.893 (p < 0.001)] - a cutoff of 0.090 had a sensitivity, specificity, positive predictive value, and negative predictive value for IR of 97, 46, 83, and 77%, respectively. Conclusions The performance of FuP on day 3 after the beginning of empiric therapy should be individualized, according to clinical and analytic variables of this predictive model.
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Affiliation(s)
- Ana Luísa Santos
- Gastroenterology Department, Centro Hospitalar Universitário de São João, São João, Portugal,Porto Medical School, Porto, Portugal,WGO Porto Training Center, Porto, Portugal,*Ana Luísa Santos,
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar Universitário de São João, São João, Portugal,Porto Medical School, Porto, Portugal,WGO Porto Training Center, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar Universitário de São João, São João, Portugal,Porto Medical School, Porto, Portugal,WGO Porto Training Center, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário de São João, São João, Portugal,Porto Medical School, Porto, Portugal,WGO Porto Training Center, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, São João, Portugal,Porto Medical School, Porto, Portugal,WGO Porto Training Center, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, São João, Portugal,Porto Medical School, Porto, Portugal,WGO Porto Training Center, Porto, Portugal
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Santos-Antunes J, Marques M, Morais R, Carneiro F, Macedo G. Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile. GE Port J Gastroenterol 2021; 28:319-327. [PMID: 34604463 DOI: 10.1159/000514797] [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: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022]
Abstract
Introduction Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. Methods We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. Results Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (n = 24) and rectum (n = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). Conclusion Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.
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Affiliation(s)
- João Santos-Antunes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal.,Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Rui Morais
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Fátima Carneiro
- Department of Pathology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal.,Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
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Santos-Antunes J, Morais R, Marques M, Macedo G. Underwater Duodenal ESD of a Large Adenoma Using the Pocket-Creation Method. GE Port J Gastroenterol 2021; 28:367-369. [PMID: 34604470 DOI: 10.1159/000512360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
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Abstract
An 83 years-old female with history of silicosis was referred for upper endoscopy for duodenal wall thickness detected in thoracic computer tomography (CT). Upper endoscopy revealed multiple small (1 to 5mm) whitish polypoid lesions, involving a discrete portion of the descending part of the duodenum with 3cm of extension.
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Affiliation(s)
| | - Rui Morais
- Gastrenterology, Centro Hospitalar Universitário de São João, Portugal
| | - Elsa Fonseca
- Gastroenterology, Hospital de São João, Portugal
| | - Guilherme Macedo
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Magalhães L, Silveira H, Prestes S, Costa Magalhães LK, Santana RA, Ramasawmy R, Oliveira J, Roque CCR, Silva Junior RCA, Fé N, Duarte R, Maciel M, Ortiz J, Morais R, Monteiro WM, Guerra JA, Barbosa Guerra MGV. Bioecological aspects of triatomines and marsupials as wild Trypanosoma cruzi reservoirs in urban, peri-urban and rural areas in the Western Brazilian Amazon. Med Vet Entomol 2021; 35:389-399. [PMID: 33394514 DOI: 10.1111/mve.12507] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
In the Amazon region, Trypanosoma cruzi transmission cycles involve a great diversity of Triatominae vectors and mammal reservoirs. Some Rhodnius spp. mainly inhabit palm trees that act as microhabitats for hosts and vectors. The current study aimed to describe aspects of the bio-ecology of the vectors and reservoirs of T. cruzi in relation to human populations resident near areas with large quantities of palm trees, in rural, peri-urban and urban collection environments, located in the Western Brazilian Amazon. Rhodnius pictipes and Didelphis marsupialis were respectively the most predominant vector and reservoir, with rates of 71% for R. pictipes and 96.5% for D. marsupialis. The vast majority of T. cruzi isolates clustered with TcI. The most prevalent haplotype was TcI COII1 (69.7%). Mauritia flexuosa and Attalea phalerata were the main ecological indicators of infestation by triatomines. Birds were the most common food source (27,71%). T. cruzi isolated from R. robustus has the haplotype HUM-13, previously detected in a chronic Chagas patient living in the same area. Our results demonstrate the relevance of this study, with the occurrence of elevated infection rates in animals, and suggest the importance of the Amazon zones where there is a risk of infection in humans.
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Affiliation(s)
- L Magalhães
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - H Silveira
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - S Prestes
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - L K Costa Magalhães
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - R A Santana
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - R Ramasawmy
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - J Oliveira
- Fundação de Medicina Tropical - Heitor Vieira Dourado, Amazonas, Brasil
| | - C C R Roque
- Fundação de Medicina Tropical - Heitor Vieira Dourado, Amazonas, Brasil
| | | | - N Fé
- Fundação de Medicina Tropical - Heitor Vieira Dourado, Amazonas, Brasil
| | - R Duarte
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública (ENSP), Rio de Janeiro, Brasil
| | - M Maciel
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - J Ortiz
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - R Morais
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
| | - W M Monteiro
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
- Fundação de Medicina Tropical - Heitor Vieira Dourado, Amazonas, Brasil
| | - J A Guerra
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
- Fundação de Medicina Tropical - Heitor Vieira Dourado, Amazonas, Brasil
| | - M G V Barbosa Guerra
- Programa de Pós-graduação em Medicina Tropical, Unversidade do Estado do Amazonas, Amazonas, Brasil
- Fundação de Medicina Tropical - Heitor Vieira Dourado, Amazonas, Brasil
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Abstract
Cavernous hemangiomas of the colon are rare, benign vascular lesions, and the site most commonly affected is the rectosigmoid junction. Surgical treatment is recommended for large diffuse lesions but in the presence of pedunculated lesions, endoscopic resection should be preferred if possible. We report a case of a 65-year-old man referred for colonoscopy after positive fecal occult blood, that revealed at the level of the sigmoid colon, a wide base pedunculated polyp (35 mm) occupying more than half of the lumen, with the covering mucosa with a vinous appearance. In order to remove the lesion, a detachable snare was placed and polypectomy was performed. During the procedure, the detachable snare was cut with active bleeding, controlled after clip placement and diluted adrenaline injection. Afterwards, histology revealed a polypoid lesion with a hyperplastic mucosa and submucosal plane expanded by numerous thick-walled vessels in the context of a cavernous colonic hemangioma.
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Affiliation(s)
- Miguel Mascarenhas
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Rui Morais
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Regina Teixeira
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
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Dantas J, Vaz R, Morais R, Verdasca I. [A Narrative Review on Shock in the Emergency Room]. ACTA MEDICA PORT 2021; 34:451-459. [PMID: 33861193 DOI: 10.20344/amp.11704] [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: 12/17/2018] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
The patient in shock represents a common clinical challenge in the emergency room, and potentially represents an immediate lifethreatening situation that requires the intervention of different medical specialties in order for hemodynamic stabilization to be achieved. This paper reports a non-systematic review of the initial approach to the patient in shock, highlighting the adaptation of the instituted measures to the particularities of the emergency room environment. This review is structured according to a proposed protocol of action based on the early diagnosis of shock, the identification of the type of shock and the most likely cause, and the institution of supportive therapy. The initial stabilization of the patient should be guided by the identification of failing physiological mechanisms, having in mind that strategies with little meaning in other contexts may be of interest in the emergency room - as they are practical and can be rapidly implemented - as is the case with the administration of vasoactive drugs in bolus or by peripheral access.
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Affiliation(s)
- Jorge Dantas
- Unidade de Cuidados Intensivos Polivalente. Hospital Curry Cabral. Centro Hospitalar de Lisboa Central. Lisboa. Portugal
| | - Rita Vaz
- Zoorgsaam. Hulst. Países Baixos. Netherlands
| | - Rui Morais
- Unidade de Cuidados Intensivos Polivalente. Hospital São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Irene Verdasca
- Serviço de Medicina Interna. Hospital São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
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Pereira P, Santos AL, Morais R, Vilas-Boas F, Rodrigues-Pinto E, Santos-Antunes J, Macedo G. Endoscopic radiofrequency ablation for palliative treatment of hilar cholangiocarcinoma. VideoGIE 2021; 6:195-198. [PMID: 33898902 PMCID: PMC8058389 DOI: 10.1016/j.vgie.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS Recent data support a role for endoscopic radiofrequency ablation (RFA) in unresectable cholangiocarcinoma by improving stent patency and overall survival. METHODS We describe 3 patients with inoperable cholangiocarcinoma with jaundice and cholestasis who were recommended palliative chemotherapy. They underwent endoscopic retrograde cholangiopancreatography with single-operator cholangioscope and intraductal RFA. RESULTS The procedures were performed without adverse events in all patients, with clinical and analytical improvement 1 month later. CONCLUSIONS RFA is a promising and safe palliative treatment in patients with unresectable cholangiocarcinoma.
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Affiliation(s)
- Pedro Pereira
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Ana L Santos
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | | | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Rodrigues-Pinto E, Morais R, Sousa-Pinto B, Ferreira da Silva J, Costa-Moreira P, Santos AL, Silva M, Coelho R, Gaspar R, Peixoto A, Dias E, Baron TH, Vilas-Boas F, Moutinho-Ribeiro P, Pereira P, Macedo G. Development of an Online App to Predict Post-Endoscopic Retrograde Cholangiopancreatography Adverse Events Using a Single-Center Retrospective Cohort. Dig Dis 2021; 39:283-293. [PMID: 33429393 DOI: 10.1159/000514279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure with a high risk for adverse events (AEs). AIM evaluate patient- and procedure-related risk factors for ERCP-related AEs and develop an online app to estimate risk of AEs. METHODS retrospective study of 1,491 consecutive patients who underwent 1,991 ERCPs between 2012 and 2017 was conducted. AEs definition and severity were classified according to most recent ESGE guidelines. Each variable was tested for association with occurrence of overall AEs, post-ERCP pancreatitis (PEP) and cholangitis. For each outcome, 2 regression models were built, from which an online Shiny-based app was created. RESULTS Overall AE rate was 15.3%; in 19 procedures, >1 AE occurred. Main post-ERCP AE was PEP (7.5%), followed by cholangitis (4.9%), bleeding (1.3%), perforation (1%), cardiopulmonary events (0.9%), and cholecystitis (0.3%). Seventy-eight percent of AEs were mild/moderate; of severe (n = 55) and fatal (n = 20) AEs, more than half were related to infection, cardiac/pulmonary AEs, and perforation. AE-related mortality rate was 1%. When testing precannulation, procedural covariates, and ERCP findings, AE occurrence was associated with age (odds ratio [OR] 0.991), previous PEP (OR 2.198), ERCP complexity grade III/IV (OR 1.924), standard bile duct cannulation (OR 0.501), sphincterotomy (OR 1.441), metal biliary stent placement (OR 2.014), periprocedural bleeding (OR 3.024), and biliary duct lithiasis (OR 0.673). CONCLUSION Our app may allow an optimization of the patients' care, by helping in the process of decision-making, not only regarding patient or endoscopist's selection but also definition of an adequate and tailored surveillance plan after the procedure.
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Affiliation(s)
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | | | | | - Ana L Santos
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Emanuel Dias
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Ferreira-Silva J, Morais R, Macedo G. An Unusual Cause of Regurgitation and Heartburn In a Patient With Fundoplication. Gastroenterology 2020; 159:847-848. [PMID: 32142776 DOI: 10.1053/j.gastro.2020.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/02/2022]
Affiliation(s)
| | - Rui Morais
- Gastroenterology Department, Hospital de São João; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Hospital de São João; Faculty of Medicine of the University of Porto, Porto, Portugal
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Morais R, Vilas-Boas F, Santos-Antunes J, Pereira P, Macedo G. Single-Operator Pancreatoscopy for Diagnosis, Evaluation, and Staging of Mixed-Type Intraductal Papillary Mucinous Neoplasm. GE Port J Gastroenterol 2020; 27:368-371. [PMID: 32999911 PMCID: PMC7506227 DOI: 10.1159/000505273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/06/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Rui Morais
- *Rui Morais, MD, Gastroenterology Department, Centro Hospitalar São João, Al. Prof. Hernâni Monteiro, PT–4200-319 Porto (Portugal),
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Abstract
Sepsis is a medical emergency and life-threatening condition due to a dysregulated host response to infection, with unacceptably high morbidity and mortality. Similar to acute myocardial infarction or cerebral vascular accident, sepsis is a severe and continuous time-dependent condition. Thus, in the case of sepsis, early and adequate administration of antimicrobials must be a priority, ideally within the first hour of diagnosis, simultaneously with organ support.As a consequence of the emergence of multidrug-resistant pathogens, the choice of antimicrobials should be performed according to the local pathogen patterns of resistance. Individual antimicrobial optimization is essential to achieve adequate concentrations of antimicrobials, to reduce adverse effects, and to ensure successful outcomes, as well as preventing the emergence of multidrug-resistant pathogens. The loading dose is the administration of an initial higher dose of antimicrobials, regardless of the presence of organ dysfunction. Further doses should be implemented according to pharmacokinetics/pharmacodynamics of antimicrobials and should be adjusted according to the presence of renal or liver dysfunction. Extended or continuous infusion of beta-lactams and therapeutic drug monitoring can help to achieve therapeutic levels of antimicrobials. Duration and adequacy of treatment must be reviewed at regular intervals to allow effective de-escalation and administration of short courses of antimicrobials for most patients. Antimicrobial stewardship frameworks, leadership, focus on the optimal duration of treatments, de-escalation, and novel diagnostic stewardship approaches will help us to improve patients the process of care and overall quality of care.
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Affiliation(s)
- Erika P Plata-Menchaca
- Shock, Organ Dysfunction, and Resuscitation Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Intensive Care, Vall d'Hebron Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Juan Carlos Ruiz Rodríguez
- Shock, Organ Dysfunction, and Resuscitation Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Intensive Care, Vall d'Hebron Hospital, Barcelona, Spain
| | - Rui Morais
- Centro Hospitalar de Lisboa Ocidental - Polyvalent Intensive Care Unit, Hospital de S.Francisco Xavier, Lisboa, Portugal
| | - Pedro Póvoa
- Centro Hospitalar de Lisboa Ocidental - Polyvalent Intensive Care Unit, Hospital de S.Francisco Xavier, Lisboa, Portugal.,NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
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Liberal R, Morais R, Marques M, Santos Antunes J, Macedo G. Screening endoscopy in patients with cirrhosis: screening of varices and gastrointestinal neoplasia. Endoscopy 2020; 52:623. [PMID: 32580231 DOI: 10.1055/a-1167-8190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Rodrigo Liberal
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal
| | - Rui Morais
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal
| | - Margarida Marques
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal
| | - Joao Santos Antunes
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal
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Peixoto A, Morais R, Macedo G. Provocative Tests in High-Resolution Manometry Prior To Surgical Fundoplication: A Must Do. Clin Gastroenterol Hepatol 2020; 18:1645-1646. [PMID: 31712083 DOI: 10.1016/j.cgh.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Armando Peixoto
- Gastroenterology Department, Centro Hospitalar e Universitário de São João and, Porto World Gastroenterology Organization Training Center and, Porto Medical School, University of Porto, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar e Universitário de São João and, Porto World Gastroenterology Organization Training Center and, Porto Medical School, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar e Universitário de São João and, Porto World Gastroenterology Organization Training Center and, Porto Medical School, University of Porto, Porto, Portugal
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Cunha GJL, Rocha BML, Gomes RV, Ferraz M, Fernandes L, Morais R, Campos L, Araújo I, Fonseca C. Levosimendan with other inotropes or vasopressors: Should you combine them? Am J Emerg Med 2020; 38:2723-2726. [PMID: 32278570 DOI: 10.1016/j.ajem.2020.03.059] [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] [Received: 02/02/2020] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Gonçalo J L Cunha
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
| | - Bruno M L Rocha
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rita V Gomes
- Serviço de Cardiologia, Hospital Vila Franca de Xira, Lisbon, Portugal
| | - Mário Ferraz
- Serviço de Medicina, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Lúcia Fernandes
- Clínica de Insuficiência Cardíaca, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rui Morais
- Clínica de Insuficiência Cardíaca, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Luís Campos
- Clínica de Insuficiência Cardíaca, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cândida Fonseca
- Clínica de Insuficiência Cardíaca, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
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Morais R, Vilas-Boas F, Silva M, Pereira P, Macedo G. Endoscopic Vacuum Therapy for Esophageal Perforation Treatment after Foreign Body Ingestion: Resolution after a Single Session. GE Port J Gastroenterol 2020; 27:207-209. [PMID: 32509928 PMCID: PMC7250350 DOI: 10.1159/000503011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Rui Morais
- *Rui Morais, Gastroenterology Department, Hospital de São João, Alameda Professor Hernâni Monteiro, PT–4200-319 Porto (Portugal), E-Mail
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Morais R, Vilas-Boas F, Pereira P, Lopes P, Simões C, Dantas E, Cunha I, Roseira J, Cortez-Pinto J, Silva J, Lage J, Caine M, Rocha M, Flor de Lima M, Costa Santos MP, Garrido M, Sousa P, Marcos P, Azevedo R, Castro R, Cúrdia Gonçalves T, Leal T, Magno-Pereira V, Ramalho R, Rodrigues-Pinto E, Macedo G. Prevalence, risk factors and global impact of musculoskeletal injuries among endoscopists: a nationwide European study. Endosc Int Open 2020; 8:E470-E480. [PMID: 32258368 PMCID: PMC7089795 DOI: 10.1055/a-1038-4343] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Previous studies have suggested a high prevalence of musculoskeletal injuries (MI) in endoscopists. Little evidence has come from European countries. Our main aim was to evaluate the prevalence, type, and impact of MI among Portuguese endoscopists. We also sought to identify risk factors for the development, severity and number of endoscopy-related MI. Material and methods A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG - CEREGA. Results The survey was completed by 171 endoscopists (response rate of 24.3 %), 55.0 % female with a median age of 36 years (range 26-78). The prevalence of at least one MI related to endoscopy was 69.6 % (n = 119), the most frequent being neck pain (30.4 %) and thumb pain (29.2 %). The median time for MI development was 6 years (range 2 months-30 years). Severe pain was reported by 19.3 %. Change in endoscopic technique was undertaken by 61.3 % and reduction in endoscopic caseload was undertaken by 22.7 %. Missing work was reported by 10.1 %, with the median time off from work being 30 days (range 1-90). Female gender and ≥ 15 years in practice were independently associated with MI and severe pain. Years in practice, weekly-time performing endoscopy, and gender were significant predictors of the number of MI. Conclusions Prevalence of MI was significant among Portuguese endoscopists and had a relevant impact on regular and professional activities.
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Affiliation(s)
- Rui Morais
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal,Corresponding author Rui Morais, MD Gastroenterology DepartmentCentro Hospitalar São JoãoPorto. Al. Prof. Hernâni Monteiro4200 - 319 PortoPortugal+351 22 551 3601
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Lopes
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carolina Simões
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Eduardo Dantas
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Inês Cunha
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra Coimbra, Portugal
| | - Joana Roseira
- Gastroenterology Department, Centro Hospitalar Universitário Algarve, Faro, Portugal
| | | | - João Silva
- Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Jorge Lage
- Gastroenterology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Mafalda Caine
- Gastroenterology Department, IPO Coimbra, Coimbra, Portugal
| | - Manuel Rocha
- Gastroenterology Department, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Margarida Flor de Lima
- Gastroenterology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | | | - Mónica Garrido
- Gastroenterology Department, Centro Hospitalar Porto, Porto, Portugal
| | - Paula Sousa
- Gastroenterology Department, Centro Hospitalar Tondela-Viseu, Tondedla-Visue, Portugal
| | - Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Richard Azevedo
- Gastroenterology Department, Centro Hospitalar de Castelo-Branco, Castelo-Branco, Portugal
| | - Rui Castro
- Gastroenterology Department, IPO Porto, Porto, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães Braga, Portugal,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Braga, Portugal,ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Braga, Portugal
| | - Tiago Leal
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | | | - Rosa Ramalho
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Pereira P, Santos S, Morais R, Gaspar R, Rodrigues-Pinto E, Vilas-Boas F, Macedo G. Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors. Dig Dis 2020; 38:431-440. [PMID: 31940612 DOI: 10.1159/000504910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Peroral cholangioscopy (POC) has shown to be a useful diagnostic procedure in the evaluation of biliary strictures; however, data regarding its role on preoperative staging are scarce. The aim of this study was to evaluate POC role in the diagnosis and preoperative intraductal staging of perihilar cholangiocarcinoma (CCA). METHODS Retrospective study that included all patients who underwent POC with SpyGlassTM Direct Visualization System for the diagnosis of biliary strictures or for preoperative evaluation of extrahepatic biliary tumors, between 2015 and 2019, in a single tertiary center. RESULTS Forty-three patients were included, 63% male with a median age of 62 years. Thirty-eight (88.3%) underwent POC due to indeterminate biliary strictures, 3 (7%) due to bile duct filling defect, and 2 (4.7%) for intraductal staging of perihilar CCA. In the follow-up, a final diagnosis of malignancy was established in 56% of the patients. Visual impression accuracy with SpyGlass was 95.1% (with 100% sensitivity and 89.5% specificity). SpyBite biopsies accuracy was 80.5% (63.6% sensitivity and 100% specificity). In the 19 patients with a final perihilar CCA diagnosis, intraductal evaluation with SpyGlass altered anatomic classification (Bismuth-Corlette) defined by previous imagiologic findings in 8 (42.1%) patients. Alteration in anatomic classification changed therapeutic approach in 4 (21%). CONCLUSIONS POC use for evaluating intraductal spread in potentially resectable perihilar CCA can detect more extensive and change surgical management. In the future, preoperative staging of perihilar CCA with POC combined with imagiologic evaluation of vascular extension of the lesions may optimize surgical results.
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Affiliation(s)
- Pedro Pereira
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal, .,Faculty of Medicine, University of Porto, Porto, Portugal,
| | - Sancha Santos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Morais
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipe Vilas-Boas
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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Morais R, Marques M, Coelho R, Cardoso H, Macedo G. Duodenal Vascular Spider's Web: Radiofrequency Ablation to the Rescue! J Gastrointestin Liver Dis 2019; 28:381. [PMID: 31826061 DOI: 10.15403/jgld-449] [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] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/30/2019] [Indexed: 11/01/2022]
Affiliation(s)
- Rui Morais
- Gastroenterology Department, Hospital de São João, Porto, Portugal.
| | | | - Rosa Coelho
- Gastroenterology Department, Hospital de São João, Porto, Portugal.
| | - Hélder Cardoso
- Gastroenterology Department, Hospital de São João, Porto, Portugal.
| | - Guilherme Macedo
- Gastroenterology Department, Hospital de São João, Porto, Portugal.
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Rocha BML, Gomes RV, Cunha GJL, Silva BMV, Pocinho R, Morais R, Araújo I, Fonseca C. Diagnostic and therapeutic approach to cardioinhibitory reflex syncope: A complex and controversial issue. Rev Port Cardiol 2019; 38:661-673. [PMID: 31813672 DOI: 10.1016/j.repc.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/10/2018] [Accepted: 11/14/2018] [Indexed: 01/02/2023] Open
Abstract
Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion and is one of the leading causes of emergency department admission. The initial approach should focus on excluding non-syncopal causes for loss of consciousness and risk stratification for cardiac cause, in order to ensure an appropriate etiological investigation and therapeutic approach. Vasovagal syncope (VVS), the most common type of syncope, should be assumed once other causes are excluded. Pathophysiologically, the vasovagal reflex is the result of a paradoxical autonomic response, leading to hypotension and/or bradycardia. VVS has not been shown to affect mortality, but morbidity may be considerable in those with recurrent syncopal episodes. The management of VVS includes both non-pharmacological and pharmacological measures that act on various levels of the reflex arc that triggers the syncopal episode. However, most are of uncertain benefit given the scarcity of high-quality supporting evidence. Pacemaker therapy may be considered in recurrent refractory cardioinhibitory reflex syncope, for which it is currently considered a robust intervention, as noted in the European guidelines. Non-randomized and unblinded studies have shown a potential benefit of pacing in recurrent VVS, but double-blinded randomized controlled trials have not consistently demonstrated positive results. We performed a comprehensive review of the current literature and recent advances in cardiac pacing and pacing algorithms in VVS, and discuss the diagnostic and therapeutic approach to the complex patient with recurrent VVS and reduced quality of life.
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Affiliation(s)
- Bruno M L Rocha
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
| | - Rita V Gomes
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal; Serviço de Cardiologia, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Gonçalo J L Cunha
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Beatriz M V Silva
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Rita Pocinho
- Serviço de Medicina Interna 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui Morais
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Inês Araújo
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Cândida Fonseca
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Gaspar R, Rodrigues S, Silva M, Costa-Moreira P, Morais R, Andrade P, Cardoso H, Albuquerque A, Liberal R, Macedo G. Predictive models of mortality and hospital readmission of patients with decompensated liver cirrhosis. Dig Liver Dis 2019; 51:1423-1429. [PMID: 31113738 DOI: 10.1016/j.dld.2019.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/06/2019] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Complications of cirrhosis are one the major causes of hospital admission associated with high morbimortality rates and social and economic charges. The aims of this study were to evaluate hospital readmission and mortality rates and predictive factors for hospital readmission and mortality. METHODS Patients with decompensated cirrhosis admitted to our institution between 2008-2014 were retrospectively analyzed. RESULTS Included 427 admissions from 177 patients with cirrhosis with mean age of 59.0 ± 12.3 years. The major cause was alcoholic-related liver disease and the median duration of admission was 9.0 days (IQR 6.0-14.0). During the follow-up period,there were 250 readmissions from 95 patients, with a median of 58 (IQR27-134) days for readmission, representing 58.5% of the total number of admissions.The 180-day mortality rate was 35.0%. In the multivariate analysis, ascites, smoking and MELD Na were associated with 180-day mortality. Creatinine, albumin, esophageal variceal bleeding, previous variceal banding, lactulose, rifaximin and proton pump inhibitors use were independently associated with need of readmission. Based on regression analysis, two models were calculated to predict 180-day mortality (AUROC 0.74 (0.682-0.794)) and need for readmission(AUROC 0.821 (0.781-0.861)), p < 0.001. CONCLUSION The readmission rate and mortality of cirrhotic patients are still very high and it is a priority to determine preventable risk factors to improve patient outcome. Two models were created to predict 180-day mortality(AUROC 0.74) and need for readmission(AUROC 0.821), that could guide the management of the patients at the time of admission.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Susana Rodrigues
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Costa-Moreira
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patricia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Helder Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Andreia Albuquerque
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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Rocha ML, Cunha GC, Gomes RM, Morais R, Campos L, Araujo I, Fonseca MC. P5008Empagliflozin in a real-world chronic heart failure population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Heart Failure (HF) is a burdensome syndrome with significant mortality, morbidity and costs. Its prognosis is further aggravated by diabetes mellitus (DM). The EMPA-REG OUTCOME trial suggested that empagliflozin significantly reduced HF hospitalizations compared to placebo in patients with DM.
Purpose
We aimed to investigate which patients with chronic HF and DM in the outpatient setting could have been enrolled in the main empagliflozin trial.
Methods
This analysis is based on a retrospective cohort enrolling chronic HF patients who consecutively attended the HF appointment between January and July 2018. Of these, those with concomitant DM were selected and further analysed. The key EMPA-REG OUTCOME trial inclusion criteria [(i.e., hemoglobin A1c 7–10%, high cardiovascular (CV) risk and glomerular filtration rate [GFR] ≥30mL/min/1,73m2) were considered. Further, the European Medicine Agency (EMA) restriction (GFR>60mL/min/1,73m2) was also considered in an additional analysis.
Results
Of 316 patients with HF, 114 (36%) concomitantly had DM. Mean age was 74±10 years, 63% were male and most (54%) had preserved left ventricular ejection fraction. Ischemic (51%) and hypertensive (27%) HF were the most often observed etiologies. According to the inclusion criteria, 21 (18.4%) (or 5.3% when further considering the EMA restriction) HF patients could have been potentially enrolled in the main trial and derive a HF hospitalization reduction benefit from starting empagliflozin. The remainder would be excluded due to GFR<30mL/min/1.73m2 (2.6%), absence of “high CV risk” as per trial's definition (7%), HbA1c off target (18,4%) or a combination of the above criteria (53.6%). In light of the new Standards of Medical Care in Diabetes 2019, controlled patients with HbA1c off target (i.e., <7% or >10%) could be switched to a SGLT2 inhibitors, hence possibly expanding the indication to start empagliflozin to 36.8% of our HF cohort.
Figure 1
Conclusions
Roughly 1 in every 5 patients with HF and DM could have been enrolled in the main empagliflozin trial, as per key inclusion criteria, and potentially derive CV benefit from it. Thus, only a minority of our cohort shared the features for EMPA-REG OUTCOME trial inclusion, limiting the extrapolation of the trial's observed CV benefits to our HF cohort. Indeed, whether these benefits also expand to overall HF cohort is eagerly awaited by ongoing trials.
Acknowledgement/Funding
None
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Affiliation(s)
- M L Rocha
- Hospital de Santa Cruz, Lisbon, Portugal
| | - G C Cunha
- Hospital de Santa Cruz, Lisbon, Portugal
| | - R M Gomes
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - R Morais
- Hospital de Sao Francisco Xavier, Internal Medicine, Lisbon, Portugal
| | - L Campos
- Hospital de Sao Francisco Xavier, Internal Medicine, Lisbon, Portugal
| | - I Araujo
- Hospital de Sao Francisco Xavier, Heart Failure Clinic, Lisbon, Portugal
| | - M C Fonseca
- Hospital de Sao Francisco Xavier, Heart Failure Clinic, Lisbon, Portugal
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Morais R, Liberal R, Santos A, Pita I, Coelho R, Gaspar R, Andrade A, Cardoso H, Rodrigues S, Macedo G. Another clinical unmet need in liver patients: Multidrug resistant bacteria in decompensated cirrhosis. J Hepatol 2019; 71:844-845. [PMID: 31362835 DOI: 10.1016/j.jhep.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Ana Santos
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Inês Pita
- Gastroenterology Department, IPO Porto, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Ana Andrade
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Susana Rodrigues
- Swiss Liver Center, UVCM, Inselspital, Bern University Hospital, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Pereira P, Morais R, Vilas-Boas F, Rodrigues-Pinto E, Lopes J, Carneiro F, Macedo G. Brush Cytology Performance for the Assessment of Biliopancreatic Strictures. Acta Cytol 2019; 64:344-351. [PMID: 31550713 DOI: 10.1159/000502791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/11/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Brush cytology is commonly used during endoscopic retrograde cholangiopancreatography for the diagnostic evaluation of biliopancreatic strictures. However, since the overall sensitivity of brush cytology is poor, the exclusion of malignancy is difficult. Recognition of factors related to the patient, technique or lesion may help improve the diagnostic yield of brush cytology. The objective of this study was to evaluate the diagnostic yield of brush cytology in the assessment of biliopancreatic strictures and identify predictive factors associated with a positive diagnosis of malignancy. METHODS Retrospective study that evaluated all consecutive patients that underwent brush cytology for the investigation of biliopancreatic strictures in a tertiary center, between January 2012 and January 2018. RESULTS One hundred and sixty-five patients that underwent 182 procedures were included. A diagnosis of malignancy was confirmed in 110 patients (66.7%), of whom 62 had positive brush cytology (sensitivity 53.7%, specificity 98.5%, accuracy 69.8%). On the multivariate analysis, age ≥68 years (OR 4.83, 95% CI 1.04-22.37) and lesions suspicious of metastasis on cross-sectional imaging (OR 8.58, 95% CI 1.70-43.38) were independently associated with a positive result. Subanalysis of the patients presenting with these two factors (n = 26) revealed an increase in the diagnostic yield (sensitivity 80.8%). CONCLUSION Age ≥68 years and lesions suspicious of metastasis on cross-sectional imaging are independent factors associated with a positive result. Patient selection taking these factors into account may increase the diagnostic yield of brush cytology.
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Affiliation(s)
- Pedro Pereira
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal,
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Joanne Lopes
- Pathology Department, Centro Hospitalar São João, Porto, Portugal
| | - Fátima Carneiro
- Pathology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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da Cunha GJL, Rocha BML, Gomes RV, Silva BV, Mendes G, Morais R, Araújo IF, Fonseca C. A systematic review on recurrent cardioinhibitory vasovagal syncope: Does pacing therapy break the fall? Pacing Clin Electrophysiol 2019; 42:1400-1407. [DOI: 10.1111/pace.13790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/04/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Gonçalo José Lopes da Cunha
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Bruno Miguel Lopes Rocha
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Rita Ventura Gomes
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
- Cardiology DepartmentHospital de Vila Franca de Xira Lisbon Portugal
| | - Beatriz Valente Silva
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Gonçalo Mendes
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
- Internal Medicine Department, Hospital de São BernardoCentro Hospitalar de Setúbal Setúbal Portugal
| | - Rui Morais
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Inês Fornelos Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
| | - Cândida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco XavierCentro Hospitalar Lisboa Ocidental Lisbon Portugal
- NOVA Medical School, Faculdade de Ciências MédicasUniversidade Nova de Lisboa Lisbon Portugal
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50
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Affiliation(s)
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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