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Silva S, Bicker J, Fialho S, Cunha S, Falcão A, Fortuna A. Intranasal delivery of paroxetine: A preclinical study on pharmacokinetics, depressive-like behaviour, and neurochemical sex differences. Biochem Pharmacol 2024; 223:116184. [PMID: 38556027 DOI: 10.1016/j.bcp.2024.116184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/09/2024] [Accepted: 03/29/2024] [Indexed: 04/02/2024]
Abstract
Treatment of major depressive disorder remains a major unmet clinical need. Given the advantages of intranasal administration for targeted brain delivery, the present study aimed at investigating the pharmacokinetics of paroxetine, after its intranasal instillation and assessing its potential therapeutic effect on female and male mice subjected to unpredictable chronic mild stress (UCMS) protocol. IN administration revealed direct nose-to-brain paroxetine delivery but dose- and sex-dependent differences. Pharmacokinetics was nonlinear and paroxetine concentrations were consistently higher in plasma and brain of male mice. Additionally, UCMS decreased animal preference for sucrose in both male and female mice following acute (p < 0.01) and chronic stress (p < 0.05), suggesting anhedonia. Both male and female mice exhibited depressive-like behavior in the forced swimming test. UCMS females displayed a significantly longer immobility time and shorter climbing time than the control group (p < 0.05), while no differences were found between male mice. Two weeks of paroxetine intranasal administration reduced immobility time and lengthened climbing and swimming time, approaching values similar to those observed in the healthy control group. The therapeutic effect was stronger on female mice. Importantly, melatonin plasma levels were significantly decreased in female mice following UCMS (p < 0.05), while males exhibited heightened corticosterone levels. On the other hand, treatment with IN paroxetine significantly increased corticosterone and melatonin levels in both sexes compared to healthy mice (p < 0.05). Intranasal paroxetine delivery undoubtedly ameliorated the behavioral despair, characteristic of depressive-like animals. Despite its efficiency in male and female mice subjected to UCMS, females were more prone to this novel therapeutic strategy.
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Affiliation(s)
- Soraia Silva
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - S Fialho
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Susana Cunha
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.
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Arab JP, Arabloo J, Arafat M, Araki DT, Aravkin AY, Arkew M, Armocida B, Arndt MB, Arooj M, Artamonov AA, Aruleba RT, Arumugam A, Ashbaugh C, Ashemo MY, Ashraf M, Asika MO, Askari E, Astell-Burt T, Athari SS, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awotidebe AW, Awuviry-Newton K, Ayala Quintanilla BP, Ayuso-Mateos JL, Azadnajafabad S, Azevedo RMS, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bah S, Bai R, Baker JL, Bakkannavar SM, Bako AT, Balakrishnan S, Bam K, Banik PC, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Barqawi HJ, Barrow A, Barteit S, Barua L, Bashiri Aliabadi S, Basiru A, Basu S, Basu S, Bathini PP, Batra K, Baune BT, Bayileyegn NS, Behnam B, Behnoush AH, Beiranvand M, Bejarano Ramirez DF, Bell ML, Bello OO, Beloukas A, Bensenor IM, Berezvai Z, Bernabe E, Bernstein RS, Bettencourt PJG, Bhagavathula AS, Bhala N, Bhandari D, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, 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Yehualashet SS, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yismaw Y, Yon DK, Yonemoto N, Younis MZ, Yu C, Yu Y, Yusuf H, Zahid MH, Zakham F, Zaki L, Zaki N, Zaman BA, Zamora N, Zand R, Zandieh GGZ, Zar HJ, Zarrintan A, Zastrozhin MS, Zhang H, Zhang N, Zhang Y, Zhao H, Zhong C, Zhong P, Zhou J, Zhu Z, Ziafati M, Zielińska M, Zimsen SRM, Zoladl M, Zumla A, Zyoud SH, Vos T, Murray CJL. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Romadlon DS, Romero-Rodríguez E, Romoli M, Ronfani L, Roshandel G, Roth GA, Rout HS, Roy N, Roy P, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Rwegerera GM, Rynkiewicz A, S N C, Saad AMA, Saadatian Z, Saber K, Saber-Ayad MM, SaberiKamarposhti M, Sabour S, Sacco S, Sachdev PS, Sachdeva R, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi E, Sadeghian F, Saeb MR, Saeed U, Safaeinejad F, Safi SZ, Sagar R, Saghazadeh A, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahoo U, Sahu M, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salamati P, Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santomauro DF, Santos IS, Santric-Milicevic MM, Sao Jose BP, Sarasmita MA, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Satpathy M, Sayeed A, Sayeed MA, Saylan M, Sayyah M, Scarmeas N, Schaarschmidt BM, Schlaich MP, Schlee W, Schmidt MI, Schneider IJC, Schuermans A, Schumacher AE, Schutte AE, Schwarzinger M, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Senapati S, Senthilkumaran S, Sepanlou SG, Serban D, Sethi Y, Sha F, Shabany M, Shafaat A, Shafie M, Shah NS, Shah PA, Shah SM, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh A, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shetty A, Shetty BSK, Shetty PH, Shi P, Shibuya K, Shiferaw D, Shigematsu M, Shin MJ, Shin YH, Shiri R, Shirkoohi R, Shitaye NA, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shokraneh F, Shokri A, Shool S, Shorofi SA, Shrestha S, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh G, Singh J, Singh NP, Singh P, Singh S, Sinha DN, Sinto R, Siraj MS, Sirota SB, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Spearman S, Sreeramareddy CT, Srivastava VK, Stanaway JD, Stanikzai MH, Stark BA, Starnes JR, Starodubova AV, Stein C, Stein DJ, Steinbeis F, Steiner C, Steinmetz JD, Steiropoulos P, Stevanović A, Stockfelt L, Stokes MA, Stortecky S, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun HZ, Sun J, Sundström J, Sunkersing D, Sunnerhagen KS, Swain CK, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabish M, TADAKAMADLA JYOTHI, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taiba J, Takahashi K, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tang HK, Tarigan IU, Tariku MK, Tariqujjaman M, Tarkang EE, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tefera YM, Temsah MH, Temsah RMH, Teramoto M, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Tharwat S, Thayakaran R, Thomas N, Thomas NK, Thomson AM, Thrift AG, Thum CCC, Thygesen LC, Tian J, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Titova MV, Tonelli M, Topor-Madry R, Toriola AT, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran NM, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah I, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Valizadeh R, Van de Velde SM, Van den Eynde J, Varga O, Vart P, Varthya SB, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Villanueva GI, Vinayak M, Violante FS, Viskadourou M, Vladimirov SK, Vlassov V, Vo B, Vollset SE, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang N, Wang S, Wang S, Wang Y, Wang YP, Waqas M, Ward P, Wassie EG, Watson S, Watson SLW, Weerakoon KG, Wei MY, Weintraub RG, Weiss DJ, Westerman R, Whisnant JL, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wilson S, Wojewodzic MW, Woldegebreal DH, Wolf AW, Wolfe CDA, Wondimagegene YA, Wong YJ, Wongsin U, Wu AM, Wu C, Wu F, Wu X, Wu Z, Xia J, Xiao H, Xie Y, Xu S, Xu WD, Xu X, Xu YY, Yadollahpour A, Yamagishi K, Yang D, Yang L, Yano Y, Yao Y, Yaribeygi H, Ye P, Yehualashet SS, Yesiltepe M, Yesuf SA, Yezli S, Yi S, Yigezu A, Yiğit A, Yiğit V, Yip P, Yismaw MB, Yismaw Y, Yon DK, Yonemoto N, Yoon SJ, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuh FH, Zadey S, Zadnik V, Zafari N, Zakham F, Zaki N, Zaman SB, Zamora N, Zand R, Zangiabadian M, Zar HJ, Zare I, Zarrintan A, Zeariya MGM, Zeinali Z, Zhang H, Zhang J, Zhang J, Zhang L, Zhang Y, Zhang ZJ, Zhao H, Zhong C, Zhou J, Zhu B, Zhu L, Ziafati M, Zielińska M, Zitoun OA, Zoladl M, Zou Z, Zuhlke LJ, Zumla A, Zweck E, Zyoud SH, Wool EE, Murray CJL. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Yeung J, Liao A, Shaw M, Silva S, Vetharoy W, Rico DL, Kirby I, Zammarchi F, Havenith K, de Haan L, van Berkel PH, Sebire N, Ogunbiyi OK, Booth C, Gaspar HB, Thrasher AJ, Chester KA, Amrolia PJ. Anti-CD45 PBD-based antibody-drug conjugates are effective targeted conditioning agents for gene therapy and stem cell transplant. Mol Ther 2024:S1525-0016(24)00210-7. [PMID: 38549377 DOI: 10.1016/j.ymthe.2024.03.032] [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: 07/27/2023] [Revised: 12/21/2023] [Accepted: 03/26/2024] [Indexed: 04/15/2024] Open
Abstract
Stem cell gene therapy and hematopoietic stem cell transplantation (SCT) require conditioning to ablate the recipient's hematopoietic stem cells (HSCs) and create a niche for gene-corrected/donor HSCs. Conventional conditioning agents are non-specific, leading to off-target toxicities and resulting in significant morbidity and mortality. We developed tissue-specific anti-human CD45 antibody-drug conjugates (ADCs), using rat IgG2b anti-human CD45 antibody clones YTH24.5 and YTH54.12, conjugated to cytotoxic pyrrolobenzodiazepine (PBD) dimer payloads with cleavable (SG3249) or non-cleavable (SG3376) linkers. In vitro, these ADCs internalized to lysosomes for drug release, resulting in potent and specific killing of human CD45+ cells. In humanized NSG mice, the ADCs completely ablated human HSCs without toxicity to non-hematopoietic tissues, enabling successful engraftment of gene-modified autologous and allogeneic human HSCs. The ADCs also delayed leukemia onset and improved survival in CD45+ tumor models. These data provide proof of concept that conditioning with anti-human CD45-PBD ADCs allows engraftment of donor/gene-corrected HSCs with minimal toxicity to non-hematopoietic tissues. Our anti-CD45-PBDs or similar agents could potentially shift the paradigm in transplantation medicine that intensive chemo/radiotherapy is required for HSC engraftment after gene therapy and allogeneic SCT. Targeted conditioning both improve the safety and minimize late effects of these procedures, which would greatly increase their applicability.
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Affiliation(s)
- Jenny Yeung
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK; UCL Cancer Institute, 72 Huntley Street, London, UK
| | - Aiyin Liao
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | - Matthew Shaw
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | - Soraia Silva
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | - Winston Vetharoy
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | - Diego Leon Rico
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | - Ian Kirby
- ADC Therapeutics UK (Ltd), Imperial College White City Campus, 84 Wood Lane, London W12 0BZ, UK
| | - Francesca Zammarchi
- ADC Therapeutics UK (Ltd), Imperial College White City Campus, 84 Wood Lane, London W12 0BZ, UK
| | - Karin Havenith
- ADC Therapeutics UK (Ltd), Imperial College White City Campus, 84 Wood Lane, London W12 0BZ, UK
| | - Lolke de Haan
- ADC Therapeutics UK (Ltd), Imperial College White City Campus, 84 Wood Lane, London W12 0BZ, UK
| | - Patrick H van Berkel
- ADC Therapeutics UK (Ltd), Imperial College White City Campus, 84 Wood Lane, London W12 0BZ, UK
| | - Neil Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 1JH, UK
| | - Olumide K Ogunbiyi
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 1JH, UK
| | - Claire Booth
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 1JH, UK
| | - H Bobby Gaspar
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | - Adrian J Thrasher
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK
| | | | - Persis J Amrolia
- UCL Great Ormond Street Institute of Child Health, Zayed Centre of Research, 20 Guilford Street, London WC1N 1DZ, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 1JH, UK.
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Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdoun M, Abdullahi A, Abdurehman AM, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abhilash ES, Abiodun OO, Aboagye RG, Abolhassani H, Abouzid M, Abreu LG, Abrha WA, Abrigo MRM, Abtahi D, Abu Rumeileh S, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Acuna JM, Adair T, Addo IY, Adebayo OM, Adegboye OA, Adekanmbi V, Aden B, Adepoju AV, Adetunji CO, Adeyeoluwa TE, Adeyomoye OI, Adha R, Adibi A, Adikusuma W, Adnani QES, Adra S, Afework A, Afolabi AA, Afraz A, Afyouni S, Afzal S, Agasthi P, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmadzade M, Ahmed A, Ahmed H, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akalu GT, Akara EM, Akinosoglou K, Akkala S, Akyirem S, Al Hamad H, Al Hasan SM, Al Homsi A, Al Qadire M, Ala M, Aladelusi TO, 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Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samara KA, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanganyado E, Sanjeev RK, Sanmarchi F, Sanna F, Santri IN, Santric-Milicevic MM, Sarasmita MA, Saravanan A, Saravi B, Sarikhani Y, Sarkar C, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sattin D, Saulam J, Sawyer SM, Saxena S, Saya GK, Sayadi Y, Sayeed A, Sayeed MA, Saylan M, Scarmeas N, Schaarschmidt BM, Schlee W, Schmidt MI, Schuermans A, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Sertsu A, Sethi Y, SeyedAlinaghi S, Seyedi SA, Shafaat A, Shafaat O, Shafie M, Shafiee A, Shah NS, Shah PA, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shakil H, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Shariff M, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shenoy MM, Shetty BSK, Shetty RS, Shey RA, Shiani A, Shibuya K, Shiferaw D, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shrestha S, Shuja KH, Shuval K, Si Y, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Silva S, Simões JP, Simpson CR, Singal A, Singh A, Singh A, Singh A, Singh BB, Singh B, Singh M, Singh M, Singh NP, Singh P, Singh S, Siraj MS, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Slepak ELN, Sohrabi H, Soleimani H, Soliman SSM, Solmi M, Solomon Y, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Starnes JR, Starodubov VI, Starodubova AV, Stefan SC, Stein DJ, Steinbeis F, Steiropoulos P, Stockfelt L, Stokes MA, Stortecky S, Stranges S, Stroumpoulis K, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Susanty S, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taborda-Barata LM, Tabuchi T, Tadesse BT, Taheri A, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tamuzi JL, Tan KK, Tang H, Tang HK, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tebeje TM, Tefera YM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Tesfaye SH, Thangaraju P, Thankappan KR, Thapa R, Thapar R, Thomas N, Thrift AG, Thum CCC, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tohidast SA, Tonelli M, Touvier M, Tovani-Palone MR, Tram KH, Tran NM, Trico D, Trihandini I, Tromans SJ, Truong VT, Truyen TTTT, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Ubah CS, Udoakang AJ, Udoh A, Ulhaq I, Ullah S, Ullah S, Umair M, Umar TP, Umeokonkwo CD, Umesh A, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Vacante M, Vahdani AM, Vaithinathan AG, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Varma SA, Vart P, Varthya SB, Vasankari TJ, Veerman LJ, Venketasubramanian N, Venugopal D, Verghese NA, Verma M, Verma P, Veroux M, Verras GI, Vervoort D, Vieira RJ, Villafañe JH, Villani L, Villanueva GI, Villeneuve PJ, Violante FS, Visontay R, Vlassov V, Vo B, Vollset SE, Volovat SR, Volovici V, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wado YD, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang D, Wang F, Wang S, Wang S, Wang Y, Wang YP, Ward P, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Werdecker A, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Wijeratne T, Wilson S, Wojewodzic MW, Wool EE, Woolf AD, Wu D, Wulandari RD, Xiao H, Xu B, Xu X, Yadav L, Yaghoubi S, Yang L, Yano Y, Yao Y, Ye P, Yesera GE, Yesodharan R, Yesuf SA, Yiğit A, Yiğit V, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Zadey S, Zadnik V, Zafari N, Zahedi M, Zahid MN, Zahir M, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Silva S, Fonseca C, Bicker J, Falcão A, Fortuna A. Intranasal administration of sertraline ensures sustained brain delivery and antidepressant effect in a mouse model of depression. Eur J Pharm Biopharm 2024; 194:118-130. [PMID: 38092320 DOI: 10.1016/j.ejpb.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 12/31/2023]
Abstract
The pursuit of more potent and efficacious antidepressant therapies is of utmost significance. Herein, the intranasal (IN) route was investigated for sertraline brain delivery, encompassing a comparative pharmacokinetic study after a single-dose administration to mice by IN, intravenous (IV) (4.87 mg/kg) and oral (10 mg/kg) routes, and an efficacy/toxicity study to explore the therapeutic effect in mice subjected to the unpredictable chronic mild stress (UCMS) protocol. Neurotransmitters and melatonin were quantified in prefrontal cortex and plasma, respectively. A different drug biodistribution behavior was unveiled for a CNS-acting drug administered by means of the IN route. For the first time, IN administration of sertraline exhibited heightened systemic exposure (bioavailability = 166 %), and a sustained drug release into the brain, in opposition to IV and oral routes, avoiding drug fluctuation. The lower lung exposition (given by normalized area under the curve) observed after IN instillation envisions the reduction of sertraline pulmonary side effects and similarly other peripheral side effects. IN sertraline treatment displayed significant efficacy in ameliorating anhedonia after one week of administration while the 14-day IN treatment regimen translated into decreased immobility time and increased swimming time in the forced swimming test, suggesting an improvement of the depressive-like behavior displayed by the animal depressive-model. Remarkably, these effects were absent with oral sertraline, despite the higher used dose. Noteworthy neurotransmitter alterations were observed, with IN sertraline markedly reducing adrenaline in the prefrontal cortex, while serotonin and melatonin increased following both administration routes. With its sustained brain delivery and serotonin- and melatonin-enhancing potential, the innovative strategy of IN sertraline holds the potential not only to effectively address depressive symptoms but also to mitigate challenges inherent to classic treatments.
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Affiliation(s)
- Soraia Silva
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Carla Fonseca
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal; Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain; Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
| | - Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.
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Fernandes MGO, Vilariça AS, Fernandes B, Camacho C, Saraiva C, Estevinho F, Novais E Bastos H, Lopes JM, Fidalgo P, Garrido P, Alves S, Silva S, Sequeira T, Barata F. Improving non-small-cell lung cancer survival through molecular characterization: Perspective of a multidisciplinary expert panel. Pulmonology 2024; 30:4-7. [PMID: 37210340 DOI: 10.1016/j.pulmoe.2022.11.009] [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] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 05/22/2023] Open
Affiliation(s)
- M G O Fernandes
- Pulmonology Department, Centro Hospitalar e Universitário de São João, EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal; IBMC/i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal Pulmonology Department, Centro Hospitalar e Universitário de São João, EPE, Porto, Portugal.
| | - A S Vilariça
- Pulmonology Department, Centro Hospitalar e Universitário de Lisboa Norte, EPE - Hospital Pulido Valente, Lisboa, Portugal
| | - B Fernandes
- Pulmonology Department, Hospital de Braga, Braga, Portugal
| | - C Camacho
- Oncology Department, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - C Saraiva
- Pulmonology Department, Centro Hospitalar e Universitário do Algarve, EPE - Hospital de Portimão, Portugal
| | - F Estevinho
- Oncology Department, Unidade Local de Saúde de Matosinhos, EPE - Hospital Pedro Hispano, Matosinhos, Portugal
| | - H Novais E Bastos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal; IBMC/i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal Pulmonology Department, Centro Hospitalar e Universitário de São João, EPE, Porto, Portugal
| | - J M Lopes
- Pulmonology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - P Fidalgo
- Oncology Department, Centro Hospitalar e Universitário do Porto, EPE - Hospital de Santo António, Porto, Portugal
| | - P Garrido
- Pulmonology Department, Fundação Champalimaud, Lisboa, Portugal
| | - S Alves
- Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - S Silva
- Pulmonology Department, Centro Hospital de Leiria, EPE - Hospital de Santo André, Leiria, Portugal
| | - T Sequeira
- Oncology Department, Centro Hospitalar e Universitário de Lisboa Central, EPE - Hospital Santo António dos Capuchos, Lisboa, Portugal
| | - F Barata
- Pulmonology Department; Centro Hospitalar e Universitário de Coimbra, EPE - Hospitais da Universidade de Coimbra, Coimbra, Portugal
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Ramadasa U, Silva S, Udumulla U, Perera S, Lekamwasam S. Caregiver strain among patients of palliative care in Sri Lanka: validation of modified caregiver strain index - Sinhala version. BMC Palliat Care 2023; 22:172. [PMID: 37924086 PMCID: PMC10625189 DOI: 10.1186/s12904-023-01270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Care givers of Palliated patients are at risk of adverse physical, psychosocial and emotional sequelae in varied nature. Efficient and valid assessment tools facilitate early detection to take corrective measures. The Modified Caregiver Strain Index (MCSI), composed of domains associated with caregiver strain is a simple and brief tool that can be used in both clinical and field settings. This study aimed to adapt and validate this in order to cater effective palliative care services in Sri Lanka. METHODS After cross-cultural adaptation, 200 primary caregivers in 3 teaching hospitals were recruited. The internal consistency, item-total correlations, of the 13-item S-MCSI were performed. The criterion validity was assessed by Pearson correlation between the total scores of S-MCSI, the Karnofky Performance Scale and the Barthel index. Construct validity was determined by the principal component analysis keeping the Varimax with Keiser normalization as the rotation method. The Kaiser-Meyer-Olkin test (KMO) and Bartlett's test of sphericity statistics were also performed to determine the adequacy of the sample and correlations between items, respectively. The number of factors was determined by the Scree plot, percentage of variance explained by each component and number of Eigen values over 01 (Kaiser-Guttman rule). RESULTS The total MCSI score ranged 0 to 26. The overall Cronbach's alpha of the 13-item questionnaire was 0.80 while item-total corrections ranged 0.34 to 0.62, exception of one item (0.11). Inverse correlations were demonstrated in total scores of MCSI and Karnofky Performance Scale (r =- 0.32, p < 0.001) and Barthel index (r =-0.34, P < 0.001). A Kaiser-Meyer-Olkin value of 0.79 (p < 0.001) for Bartlett's test indicated adequate sampling and nonlinearity of factors. The Scree plot showed a three-factor structure explaining 57% of the variation. Items regarding personal wellbeing of caregiver loaded together while the effects on the family loaded separately. Adjustment of personal concerns and family issues along with time alteration grouped as the third factor. CONCLUSIONS The study showed that the Sinhala version of MCSI has adequate psychometric properties and reliability to be used as a validated tool to estimate the caregiver burden within a short time period for any health care workers.
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Affiliation(s)
- U Ramadasa
- Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
| | - S Silva
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - U Udumulla
- Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
| | - S Perera
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - S Lekamwasam
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Henriques P, Bicker J, Silva S, Doktorovová S, Fortuna A. Nasal-PAMPA: A novel non-cell-based high throughput screening assay for prediction of nasal drug permeability. Int J Pharm 2023; 643:123252. [PMID: 37479103 DOI: 10.1016/j.ijpharm.2023.123252] [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: 05/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
In nasal drug product development, screening studies are vital to select promising compounds or formulations. The Parallel Artificial Membrane Permeability Assay (PAMPA), a high throughput screening tool, has been applied to evaluate drug permeability across several barriers such as the skin or blood-brain barrier. Herein, a new nasal-PAMPA model was optimized to predict nasal permeability, using a biorelevant donor medium containing mucin. The apparent permeability (Papp) of 15 reference compounds was assessed in six different experimental conditions, and the most discriminating and predictive model was applied to a test drug (piroxicam) and mucoadhesive powder formulations loading the same drug. The model with 0.5% (w/v) mucin in the donor compartment and 2% (w/v) phosphatidylcholine in the lipid membrane accurately distinguished high and low permeable compounds. Additionally, it exhibited the highest correlation with permeation across human nasal epithelial cells, RPMI 2650 (R2 = 0.93). When applied to powder formulations, this model was sensitive to the presence of mucoadhesive excipients and the drug solid state. Overall, the nasal-PAMPA model was more rapid than cell-based assays, without requiring specialized training or equipment, showing to be a promising in vitro tool that can be applied in drug and formulation screening for nasal delivery.
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Affiliation(s)
- Patrícia Henriques
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; R&D, Drug Product Development, Hovione FarmaCiencia SA, Lisbon, Portugal
| | - Joana Bicker
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Soraia Silva
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | | | - Ana Fortuna
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal.
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Herrera ML, Silva S, Berrosteguieta I, Casanova G, Rosillo JC, Fernández AS. Rod precursors in the adult retina of the Austrolebias charrua annual fish. Tissue Cell 2023; 83:102150. [PMID: 37423033 DOI: 10.1016/j.tice.2023.102150] [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: 04/28/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
Rod photoreceptors in the adult teleost retina are produced by rod precursors located in the outer nuclear layer (ONL). Annual fishes of the genus Austrolebias exhibit extensive adult retinal cell proliferation and neurogenesis, as well as surprising adaptive strategies to their extreme and changing environment, including adult retinal plasticity. Thus, here we identify and characterize rod precursors in the ONL of the Austrolebias charrua retina. For this aim we used classical histological techniques, transmission electron microscopy, detection of cell proliferation, and immunohistochemistry. Through these complementary approaches, we describe a cell population clearly distinguishable from photoreceptors in the ONL of the adult retina of A. charrua, which we propose corresponds to the rod precursor population. These cells exhibited particular morphological and ultrastructural characteristics, uptake of cell proliferation markers (BrdU+) and expression of stem cell markers (Sox2+). Determining the existence of the population of rod precursors is crucial to understand the sequence of events related to retinal plasticity and regeneration.
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Affiliation(s)
- M L Herrera
- Departamento Neurociencias Integrativas y Computacionales, Lab. Neurobiología Comparada, Instituto de Investigaciones Biológicas Clemente Estable (IIBCE), Avenida. Italia 3318, 11600 Montevideo, Uruguay; Sección Fisiología y Nutrición, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400 Montevideo, Uruguay
| | - S Silva
- Departamento Neurociencias Integrativas y Computacionales, Lab. Neurobiología Comparada, Instituto de Investigaciones Biológicas Clemente Estable (IIBCE), Avenida. Italia 3318, 11600 Montevideo, Uruguay
| | - I Berrosteguieta
- Departamento Neurociencias Integrativas y Computacionales, Lab. Neurobiología Comparada, Instituto de Investigaciones Biológicas Clemente Estable (IIBCE), Avenida. Italia 3318, 11600 Montevideo, Uruguay
| | - G Casanova
- Unidad de Microscopía Electrónica, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400 Montevideo, Uruguay
| | - J C Rosillo
- Departamento Neurociencias Integrativas y Computacionales, Lab. Neurobiología Comparada, Instituto de Investigaciones Biológicas Clemente Estable (IIBCE), Avenida. Italia 3318, 11600 Montevideo, Uruguay; Departamento de Histología y Embriología, Facultad de Medicina, Universidad de la República, Avda. General Flores 2125, 11800 Montevideo, Uruguay.
| | - A S Fernández
- Departamento Neurociencias Integrativas y Computacionales, Lab. Neurobiología Comparada, Instituto de Investigaciones Biológicas Clemente Estable (IIBCE), Avenida. Italia 3318, 11600 Montevideo, Uruguay; Laboratorio de Neurociencias, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400 Montevideo, Uruguay.
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Araújo D, Castro J, Matos F, Oliveira R, Ramos C, Almeida C, Silva S. Exploring the prevalence and antibiotic resistance profile of Klebsiella pneumoniae and Klebsiella oxytoca isolated from clinically ill companion animals from North of Portugal. Res Vet Sci 2023; 159:183-188. [PMID: 37148737 DOI: 10.1016/j.rvsc.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
Klebsiella spp. is an important pathogen in humans and animals and due to the indiscriminate use of antibiotics, its prevalence and antibiotic resistance has increased in companion animals. The main goal of this study was to investigate the prevalence and antibiotic resistance of Klebsiella spp. isolated from clinically ill cats and dogs admitted in veterinary clinics in the North of Portugal. A total of 255 clinical specimens were collected and, after isolation, the identification of Klebsiella strains was performed using the BBL Crystal™ identification system and confirmed by PCR-based sequencing with specific primers. Antibiotic resistance profile was determined through the disc diffusion method. Beta-lactam resistance genes were screened through a multiplex PCR assay. Fifty Klebsiella strains were isolated and, 39 were identified as Klebsiella pneumoniae and 11 as Klebsiella oxytoca. Thirty-one were recovered from dogs and 19 from cats. The Klebsiella isolates were recovered mainly from skin wounds, respiratory tract, and from urine. Fifty percent of K. oxytoca and K. pneumoniae isolates revealed to be Multidrug Resistant (MDR) strains, with most of them positive for the presence of blaTEM-like and blaSHV genes. This data shows that MDR Klebsiella are highly disseminated in companion animals and that extended-spectrum beta-lactamases can be easily found among these isolates. This highlights the potential role of dogs and cats as a reservoir of resistant Klebsiella spp. that have the potential to be transmitted to humans.
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Affiliation(s)
- D Araújo
- INIAV, IP - National Institute for Agrarian and Veterinary Research, Rua dos Lagidos, Lugar da Madalena, 4485-655 Vairão, Portugal
| | - J Castro
- INIAV, IP - National Institute for Agrarian and Veterinary Research, Rua dos Lagidos, Lugar da Madalena, 4485-655 Vairão, Portugal; Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal
| | - F Matos
- INIAV, IP - National Institute for Agrarian and Veterinary Research, Rua dos Lagidos, Lugar da Madalena, 4485-655 Vairão, Portugal
| | - R Oliveira
- INIAV, IP - National Institute for Agrarian and Veterinary Research, Rua dos Lagidos, Lugar da Madalena, 4485-655 Vairão, Portugal; LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - C Ramos
- Clínica Veterinária das Glicínias - Vets On The Road, Rua Dr. Edgardo Sá Malheiro 175, 4705-267 Braga, Portugal
| | - C Almeida
- INIAV, IP - National Institute for Agrarian and Veterinary Research, Rua dos Lagidos, Lugar da Madalena, 4485-655 Vairão, Portugal; Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - S Silva
- INIAV, IP - National Institute for Agrarian and Veterinary Research, Rua dos Lagidos, Lugar da Madalena, 4485-655 Vairão, Portugal; Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal.
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12
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Araújo D, Gonçalves B, Vilas Boas D, Rodrigues ME, Henriques M, Silva S. Combined Application of Antisense Oligomers to Control Transcription Factors of Candida albicans Biofilm Formation. Mycopathologia 2023:10.1007/s11046-023-00734-0. [PMID: 37099227 DOI: 10.1007/s11046-023-00734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/29/2023] [Indexed: 04/27/2023]
Abstract
Antisense oligomers (ASOs) have been little exploited to control determinants of Candida albicans virulence. Biofilm formation is an important virulence factor of C. albicans, that is regulated by a complex network of transcription factors (such as EFG1, BRG1 and ROB1). Thus, the main goal of this work was to project ASOs, based on the 2'-OMethyl chemical modification, to target BRG1 and ROB1 mRNA and to validate its application either alone or in combination with the EFG1 mRNA target, to reduce C. albicans biofilm formation. The ability of ASOs to control gene expression was evaluate by qRT-PCR. The effect on biofilm formation was determined by the total biomass quantification, and simultaneously the carbohydrates and proteins reduction on extracellular matrix. It was verified that all the oligomers were able to reduce the levels of gene expression and the ability of C. albicans to form biofilms. Furthermore, the combined application of the cocktail of ASOs enhances the inhibition of C. albicans biofilm formation, minimizing biofilm thickness by reducing the quantity of matrix content (protein and carbohydrate). So, our work confirms that ASOs are useful tools for research and therapeutic development on the control of Candida species biofilm formation.
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Affiliation(s)
- D Araújo
- Centre of Biological Engineering, LMaS-Laboratório de Microbiologia Aplicada à Saúde, CEB-Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal.
- LABBELS, Associate Laboratory, Braga/Guimarães, Portugal.
| | - B Gonçalves
- Centre of Biological Engineering, LMaS-Laboratório de Microbiologia Aplicada à Saúde, CEB-Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal
- LABBELS, Associate Laboratory, Braga/Guimarães, Portugal
| | - D Vilas Boas
- Centre of Biological Engineering, LMaS-Laboratório de Microbiologia Aplicada à Saúde, CEB-Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal
- LABBELS, Associate Laboratory, Braga/Guimarães, Portugal
| | - M E Rodrigues
- Centre of Biological Engineering, LMaS-Laboratório de Microbiologia Aplicada à Saúde, CEB-Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal
- LABBELS, Associate Laboratory, Braga/Guimarães, Portugal
| | - M Henriques
- Centre of Biological Engineering, LMaS-Laboratório de Microbiologia Aplicada à Saúde, CEB-Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal
- LABBELS, Associate Laboratory, Braga/Guimarães, Portugal
| | - S Silva
- Centre of Biological Engineering, LMaS-Laboratório de Microbiologia Aplicada à Saúde, CEB-Centre of Biological Engineering, University of Minho, 4710-057, Braga, Portugal
- INIAV, IP-National Institute for Agrarian and Veterinary, Rua Dos Lagidos, Lugar da Madalena, Vairão, Vila Do Conde, Portugal
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13
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Silva S, Bicker J, Falcão A, Fortuna A. Air-liquid interface (ALI) impact on different respiratory cell cultures. Eur J Pharm Biopharm 2023; 184:62-82. [PMID: 36696943 DOI: 10.1016/j.ejpb.2023.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 03/23/2022] [Revised: 09/24/2022] [Accepted: 01/19/2023] [Indexed: 01/23/2023]
Abstract
The intranasal route has been receiving greater attention from the scientific community not only for systemic drug delivery but also for the treatment of pulmonary and neurological diseases. Along with it, drug transport and permeability studies across the nasal mucosa have exponentially increased. Nevertheless, the translation of data from in vitro cell lines to in vivo studies is not always reliable, due to the difficulty in generating an in vitro model that resembles respiratory human physiology. Among all currently available methodologies, the air-liquid interface (ALI) method is advantageous to promote cell differentiation and optimize the morphological and histological characteristics of airway epithelium cells. Cells grown under ALI conditions, in alternative to submerged conditions, appear to provide relevant input for inhalation and pulmonary toxicology and complement in vivo experiments. Different methodologies and a variety of materials have been used to induce ALI conditions in primary cells and numerous cell lines. Until this day, with only exploratory results, no consensus has been reached regarding the validation of the ALI method, hampering data comparison. The present review describes the most adequate cell models of airway epithelium and how these models are differently affected by ALI conditions. It includes the evaluation of cellular features before and after ALI, and the application of the method in primary cell cultures, commercial 3D primary cells, cell lines and stem-cell derived models. A variety of these models have been recently applied for pharmacological studies against severe acute respiratory syndrome-coronavirus(-2) SARS-CoV(-2), namely primary cultures with alveolar type II epithelium cells and organotypic 3D models. The herein compiled data suggest that ALI conditions must be optimized bearing in mind the type of cells (nasal, bronchial, alveolar), their origin and the objective of the study.
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Affiliation(s)
- Soraia Silva
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.
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14
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Cogliati M, Arikan-Akdagli S, Barac A, Bostanaru AC, Brito S, Çerikçioğlu N, Efstratiou MA, Ergin Ç, Esposto MC, Frenkel M, Gangneux JP, Gitto A, Gonçalves CI, Guegan H, Gunde-Cimerman N, Güran M, Jonikaitė E, Kataržytė M, Klingspor L, Mares M, Meijer WG, Melchers WJG, Meletiadis J, Nastasa V, Babič MN, Ogunc D, Ozhak B, Prigitano A, Ranque S, Romanò L, Rusu RO, Sabino R, Sampaio A, Silva S, Stephens JH, Tehupeiory-Kooreman M, Velegraki A, Veríssimo C, Segal E, Brandão J. Environmental and bioclimatic factors influencing yeasts and molds distribution along European shores. Sci Total Environ 2023; 859:160132. [PMID: 36400291 DOI: 10.1016/j.scitotenv.2022.160132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
The present study employed data collected during the Mycosands survey to investigate the environmental factors influencing yeasts and molds distribution along European shores applying a species distribution modelling approach. Occurrence data were compared to climatic datasets (temperature, precipitation, and solar radiation), soil datasets (chemical and physical properties), and water datasets (temperature, salinity, and chlorophyll-a concentration) downloaded from web databases. Analyses were performed by MaxEnt software. Results suggested a different probability of distribution of yeasts and molds along European shores. Yeasts seem to tolerate low temperatures better during winter than molds and this reflects a higher suitability for the Northern European coasts. This difference is more evident considering suitability in waters. Both distributions of molds and yeasts are influenced by basic soil pH, probably because acidic soils are more favorable to bacterial growth. Soils with high nitrogen concentrations are not suitable for fungal growth, which, in contrast, are optimal for plant growth, favored by this environment. Finally, molds show affinity with soil rich in nickel and yeasts with soils rich in cadmium resulting in a distribution mainly at the mouths of European rivers or lagoons, where these metals accumulate in river sediments.
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Affiliation(s)
- M Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
| | - S Arikan-Akdagli
- Mycology Laboratory at Department of Medical Microbiology of Hacettepe University Medical School, Ankara, Turkey
| | - A Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropical Diseases, Faculty of Medicine, University of Belgrade, Serbia
| | - A C Bostanaru
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - S Brito
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - N Çerikçioğlu
- Mycology Laboratory at Department of Medical Microbiology of Marmara University Medical School, Istanbul, Turkey
| | - M A Efstratiou
- Department of Marine Sciences, University of the Aegean, University Hill, Mytilene, Greece
| | - Ç Ergin
- Department of Medical Microbiology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - M C Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - M Frenkel
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J P Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - A Gitto
- UCD School of Biomolecular and Biomedical Science, UCD Earth Institute, and UCD Conway Institute, University College Dublin, Ireland
| | - C I Gonçalves
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - H Guegan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - N Gunde-Cimerman
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - M Güran
- Faculty of Medicine, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin, Turkey
| | - E Jonikaitė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - M Kataržytė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - L Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Mares
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - W G Meijer
- UCD School of Biomolecular and Biomedical Science, UCD Earth Institute, and UCD Conway Institute, University College Dublin, Ireland
| | - W J G Melchers
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - J Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - V Nastasa
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - M Novak Babič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - D Ogunc
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - B Ozhak
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - A Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - S Ranque
- Aix Marseille Univ, IHU-Méditerranée Infection, AP-HM, IRD, SSA, VITROME, Marseille, France
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - R O Rusu
- Ion Ionescu de la Brad University of Life Sciences, Iasi, Romania
| | - R Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - A Sampaio
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), UTAD, Vila Real, Portugal
| | - S Silva
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - J H Stephens
- UCD School of Biomolecular and Biomedical Science, UCD Earth Institute, and UCD Conway Institute, University College Dublin, Ireland
| | - M Tehupeiory-Kooreman
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - A Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Mycology Laboratory, BIOMEDICINE S.A., Athens, Greece
| | - C Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - E Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; Centre for Environmental and Marine Studies (CESAM) - Department of Animal Biology, University of Lisbon, Lisbon, Portugal
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Santos-Pereira M, Silva S, Santos-Leite L, Silva A, Terceiro A, Pinto C, Canedo T, Monteiro F, Summavielle T, Vicent K, Treede R, Nagel J, Merlos M, Cruz F, Charrua A. The insula, a key brain area for bladder pain control, is modulated by stress. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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16
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Tempaku P, D´;Almeida V, Silva S, Bittencourt L, Belangero S, Tufik S. Study of the Effect of Obstructive Sleep Apnea on Telomere Length and its Associated Mechanisms. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Ramos P, Mateus A, Vale L, Botelho F, Manso M, Silva S, Pacheco-Figueiredo L, Silva C. Prognostic impact of variant histology in bladder cancer: Would early and aggressive treatment shift the paradigm? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kislaya I, Rodrigues AP, Silva S, Santos AJ, Matias Dias C, Nunes B, Machado A. Impact of booster vaccination on COVID-19 outcomes in Portuguese population aged 80 or more years old. Eur J Public Health 2022. [PMCID: PMC9594436 DOI: 10.1093/eurpub/ckac129.666] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Vaccination is essential to control SARS-CoV-2 transmission and complications. The study aimed to estimate the number of SARS-CoV-2 infections, COVID-19 hospitalizations and deaths averted by booster vaccination in Portuguese population aged 80 or more years old. Methods We developed an ecological study for the period of the Omicron variant of concern predominance (week 2 to week 16, 2022). Data on vaccine coverage and effectiveness, and number of events of different severity reported to the national COVID-19 surveillance system were used to estimate the number of averted events, prevented fraction and number needed to vaccinate. Uncertainty intervals (UI) were obtained using Monte Carlo simulations. Results By week 2 2022, vaccination coverage in the target population reached 91.2%. Booster vaccine effectiveness was 4.1% (CI95%: -0.1 to 9.0), 87.5% (CI95%: 84.9 to 89.7) and 83.2 (CI95%: 80.3 to 85.7) against infection, hospitalization and death, respectively. During the study period, 70862 SARS-CoV-2 infections, 2697 COVID-19 hospitalizations and 2106 deaths were reported. Booster vaccination averted 2731 (UI95%: -298 to 5838) infections, 10629 (UI95%: 9173 to 12127) hospitalizations and 6608 (UI95%: 5725 to 7546) COVID-19 related deaths among individuals aged 80 years or more resident in Portugal. Prevented fractions were 3.7% (UI95%: 0 to 7.6%), 79.7% (UI95%: 77.3 to 81.7%) and 75.8% (UI95%: 73.2 to 78.1%), respectively. It would require to vaccinate 59 individuals (UI95%: 52 to 69) to prevent one hospitalization and 94 individuals (UI95%: 82 to 109) to prevent one death in the target population. Conclusions The booster vaccination strategy had considerable impact on preventing severe outcomes in the Portuguese population aged 80 and more years old. Key messages • High vaccine coverage combined with high vaccine effectiveness resulted in considerable reduction of severe COVID-19 outcomes. • Information on number of outcomes of different severity levels averted by COVID-19 booster vaccination allows to strength public health communication.
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Affiliation(s)
- I Kislaya
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - AP Rodrigues
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
| | - S Silva
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
| | - AJ Santos
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - C Matias Dias
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - B Nunes
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - A Machado
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
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Cruz EDA, Covo MZ, Pavese R, Grigoletti LS, Luz OO, Onofre S, Silva S. IMPACTO DA PANDEMIA DA COVID-19 NAS DOAÇÕES DE SANGUE TOTAL E AFÉRESE NO HEMOCENTRO COORDENADOR DO PARANÁ. Hematol Transfus Cell Ther 2022. [PMCID: PMC9574158 DOI: 10.1016/j.htct.2022.09.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
O doador de sangue é a figura central no processo de produção de hemocomponentes. O objetivo deste estudo consistiu na análise do impacto da pandemia da COVID - 19 no fornecimento dos produtos da doação. A fonte de dados documental desta pesquisa corresponde ao Sistema de Banco de Sangue - SBS.web que contém informações de doadores de sangue do Hemocentro Coordenador do Paraná, no período de janeiro de 2017 a dezembro de 2021, bem como os dados do Formsus. Entre 2017 e 2019 a média anual aproximada de doadores foi de 34.693 (n=35.065, 34.738 e 34.278, respectivamente), e entre 2020 e 2021 foi de 34.169 doadores (n=33.223 e 35.116). Considerando-se a declaração da pandemia no Brasil em março de 2020, observa-se o declínio do número de doadores nos anos seguintes, quando comparado ao triênio anterior. A possibilidade de contaminação, com limitação na circulação de pessoas potencialmente infectadas propiciou esse cenário. O impacto desse declínio foi minimizado frente à suspensão temporária de cirurgias eletivas no estado do Paraná, mediante aumento das internações hospitalares para o atendimento da COVID - 19. Reduzida a demanda ao paciente cirúrgico, os estoques de hemocomponentes foram destinados, mais frequentemente, aos serviços de urgência e emergência, os quais também tiveram redução de atendimentos e menor incidência de traumas em decorrência da limitação na circulação de pessoas. Conclui-se que, embora os estoques tenham sofrido prejuízos, inclusive pela restrição no atendimento de candidatos a doação com idade acima de 60 anos, a demanda no consumo também se modificou. Além da habitual necessidade de hemocomponentes por pacientes crônicos, houve a necessidade de intensificar a produção de plasma para tratamento da COVID - 19. Como estratégias encontradas pelo Hemepar Curitiba destaca-se o apelo às campanhas de reposição de estoques nos hospitais, a divulgação da necessidade de doadores nas mídias e o remanejamento de bolsas de sangue entre a hemorrede e os estados.
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Affiliation(s)
- EDA Cruz
- Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - MZ Covo
- Hemocentro Coordenador do Paraná, Curitiba, PR, Brasil
| | - R Pavese
- Hemocentro Coordenador do Paraná, Curitiba, PR, Brasil
| | - LS Grigoletti
- Hemocentro Coordenador do Paraná, Curitiba, PR, Brasil
| | - OO Luz
- Hemocentro Coordenador do Paraná, Curitiba, PR, Brasil
| | - S Onofre
- Hemocentro Coordenador do Paraná, Curitiba, PR, Brasil
| | - S Silva
- Hemocentro Coordenador do Paraná, Curitiba, PR, Brasil
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Estevinho F, Figueiredo A, Teixeira E, Oliveira J, Pego A, Barroso A, Faria A, Fernandes A, Chaves A, Araújo A, Meleiro A, Parente B, Matos C, Canário D, Camacho E, Barata F, Câmara G, Queiroga H, Lopes J, Mellidez J, Barradas L, Ferreira L, Ferreira L, Felizardo M, Figueiredo M, Soares M, Lopes M, Gil N, Fidalgo P, Gomes R, Vitorino R, Valente S, Silva S, Cardoso T, Brito U, Almodovar T. EP04.01-011 Diagnostic Approach and Treatment of Lung Cancer Patients in Portugal: Portuguese Lung Cancer Study Group Survey. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Alvito P, Silva M, Viegas S, Vasco E, Martins C, Assunção R, Silva S, Gilles L, Govarts E, Schoeters G, Namorado S. P22-27 Exposure assessment of total DON in urine of Portuguese adult population under the HBM4EU aligned studies. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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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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Ruivo CF, Bastos N, Adem B, Batista I, Duraes C, Melo CA, Castaldo SA, Campos‐Laborie F, Moutinho-Ribeiro P, Morão B, Costa-Pinto A, Silva S, Osorio H, Ciordia S, Costa JL, Goodrich D, Cavadas B, Pereira L, Kouzarides T, Macedo G, Maio R, Carneiro F, Cravo M, Kalluri R, Machado JC, Melo SA. Extracellular Vesicles from Pancreatic Cancer Stem Cells Lead an Intratumor Communication Network (EVNet) to fuel tumour progression. Gut 2022; 71:gutjnl-2021-324994. [PMID: 35012996 PMCID: PMC9271144 DOI: 10.1136/gutjnl-2021-324994] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Intratumor heterogeneity drives cancer progression and therapy resistance. However, it has yet to be determined whether and how subpopulations of cancer cells interact and how this interaction affects the tumour. DESIGN We have studied the spontaneous flow of extracellular vesicles (EVs) between subpopulations of cancer cells: cancer stem cells (CSC) and non-stem cancer cells (NSCC). To determine the biological significance of the most frequent communication route, we used pancreatic ductal adenocarcinoma (PDAC) orthotopic models, patient-derived xenografts (PDXs) and genetically engineered mouse models (GEMMs). RESULTS We demonstrate that PDAC tumours establish an organised communication network between subpopulations of cancer cells using EVs called the EVNet). The EVNet is plastic and reshapes in response to its environment. Communication within the EVNet occurs preferentially from CSC to NSCC. Inhibition of this communication route by impairing Rab27a function in orthotopic xenographs, GEMMs and PDXs is sufficient to hamper tumour growth and phenocopies the inhibition of communication in the whole tumour. Mechanistically, we provide evidence that CSC EVs use agrin protein to promote Yes1 associated transcriptional regulator (YAP) activation via LDL receptor related protein 4 (LRP-4). Ex vivo treatment of PDXs with antiagrin significantly impairs proliferation and decreases the levels of activated YAP.Patients with high levels of agrin and low inactive YAP show worse disease-free survival. In addition, patients with a higher number of circulating agrin+ EVs show a significant increased risk of disease progression. CONCLUSION PDAC tumours establish a cooperation network mediated by EVs that is led by CSC and agrin, which allows tumours to adapt and thrive. Targeting agrin could make targeted therapy possible for patients with PDAC and has a significant impact on CSC that feeds the tumour and is at the centre of therapy resistance.
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Affiliation(s)
- Carolina F Ruivo
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- ICBAS Instituto de Ciencias Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Nuno Bastos
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- ICBAS Instituto de Ciencias Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Barbara Adem
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- ICBAS Instituto de Ciencias Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Ines Batista
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- ICBAS Instituto de Ciencias Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Cecilia Duraes
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | | | - Stephanie A Castaldo
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- Department of Oncology, VIB-KU Leuven Center for Cancer Biology, Leuven, Belgium
| | | | - Pedro Moutinho-Ribeiro
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
- CHUSJ Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Ana Costa-Pinto
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Soraia Silva
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Hugo Osorio
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
| | - Sergio Ciordia
- Proteomics Facility, Spanish National Center for Biotechnology, Madrid, Spain
| | - Jose Luis Costa
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
| | | | - Bruno Cavadas
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Luisa Pereira
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | | | - Guilherme Macedo
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
- CHUSJ Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rui Maio
- Hospital Beatriz Ângelo, Loures, Portugal
- Hospital da Luz, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Fatima Carneiro
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
- CHUSJ Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marília Cravo
- Hospital da Luz, Lisbon, Portugal
- FMUL Faculty of Medicine University of Lisbon, Lisbon, Portugal
| | - Raghu Kalluri
- Cancer Biology, University Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Carlos Machado
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
| | - Sonia A Melo
- i3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- IPATIMUP Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- FMUP Faculty of Medicine University of Porto, Porto, Portugal
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Naccache L, Luauté J, Silva S, Sitt JD, Rohaut B. Toward a coherent structuration of disorders of consciousness expertise at a country scale: A proposal for France. Rev Neurol (Paris) 2021; 178:9-20. [PMID: 34980510 DOI: 10.1016/j.neurol.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022]
Abstract
Probing consciousness and cognitive abilities in non-communicating patients is one of the most challenging diagnostic issues. A fast growing medical and scientific literature explores the various facets of this challenge, often coined under the generic expression of 'Disorders of Consciousness' (DoC). Crucially, a set of independent converging results demonstrated both (1) the diagnostic and prognostic importance of this expertise, and (2) the need to combine behavioural measures with brain structure and activity data to improve diagnostic and prognostication accuracy as well as potential therapeutic intervention. Thus, probing consciousness in DoC patients appears as a crucial activity rich of human, medical, economic and ethical consequences, but this activity needs to be organized in order to offer this expertise to each concerned patient. More precisely, diagnosis of consciousness differs in difficulty across patients: while a minimal set of data can be sufficient to reach a confident result, some patients need a higher level of expertise that relies on additional behavioural and brain activity and brain structure measures. In order to enable this service on a systematic mode, we present two complementary proposals in the present article. First, we sketch a structuration of DoC expertise at a country-scale, namely France. More precisely, we suggest that a 2-tiers network composed of local (Tier-1) and regional (Tier-2) centers backed by distant electronic databases and algorithmic centers could optimally enable the systematic implementation of DoC expertise in France. Second, we propose to create a national common register of DoC patients in order to better monitor this activity, to improve its performance on the basis of nation-wide collected evidence, and to promote rational decision-making.
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Affiliation(s)
- L Naccache
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of clinical neurophysiology, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of neurology, Neuro ICU, Paris, France.
| | - J Luauté
- Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis Laval, France; Équipe « Trajectoires », centre de recherche en neurosciences de Lyon, Inserm UMR-S 1028, CNRS UMR 5292, université de Lyon, université Lyon 1, Bron, France
| | - S Silva
- Intensive Care Unit, Purpan University Hospital, 31000 Toulouse, France; Toulouse NeuroImaging Center (ToNIC lab) URM UPS/INSERM 1214, 31000 Toulouse, France
| | - J D Sitt
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France
| | - B Rohaut
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of neurology, Neuro ICU, Paris, France
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25
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Silva S, Bicker J, Fonseca C, Ferreira NR, Vitorino C, Alves G, Falcão A, Fortuna A. Encapsulated Escitalopram and Paroxetine Intranasal Co-Administration: In Vitro/In Vivo Evaluation. Front Pharmacol 2021; 12:751321. [PMID: 34925013 PMCID: PMC8675330 DOI: 10.3389/fphar.2021.751321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/05/2021] [Indexed: 01/16/2023] Open
Abstract
Depression is a common mental disorder. Its treatment with selective serotonin reuptake inhibitors (SSRIs) is effective only in a fraction of patients, and pharmacoresistance is increasing steadily. Intranasal (IN) drug delivery to the brain stands out as a promising strategy to improve current therapeutic approaches by operating as a shuttle to overcome the blood–brain barrier. This work aimed to simultaneously administer escitalopram and paroxetine by IN route to mice. For this purpose, three nanostructured lipid carriers (NLC1, NLC2, and BorNLC) and one nanoemulsion (NE) were tested for drug loading. After their characterization, investigation of their impact on nasal cell viability and SSRI permeability assays were performed, using a human nasal RPMI 2650 cell line in air–liquid interface. In vitro assays demonstrated that NLCs, including borneol (BorNLC), significantly increased escitalopram permeability (p < 0.01) and paroxetine recovery values (p < 0.05) in relation to the other formulations and non-encapsulated drugs. IN and intravenous (IV) pharmacokinetic studies performed in vivo with a single dose of 2.38 mg/kg demonstrated similar results for escitalopram brain-to-plasma ratios. IN administrations delayed escitalopram peak concentrations in the brain for 15–60 min and no direct nose-to-brain delivery was detected. However, encapsulation with BorNLC considerably decreased escitalopram exposure in the lungs (124 μg min/g) compared with free escitalopram by IN (168 μg min/g) and IV (321 μg min/g) routes. Surprisingly, BorNLC IN instillation increased concentration levels of paroxetine in the brain by five times and accelerated brain drug delivery. Once again, lung exposure was considerably lower with BorNLC (AUCt = 0.433 μg min/g) than that with IV administration (AUCt = 1.01 μg min/g) and non-encapsulated IN formulation (AUCt = 2.82 μg min/g). Direct nose-to-brain delivery was observed for paroxetine IN administration with a direct transport percentage (DTP) of 56.9%. If encapsulated, it increases to 74.2%. These results clearly emphasize that nose-to-brain delivery and lung exposure depend on the formulation and on the characteristics of the drug under investigation. NLCs seem to be an advantageous strategy for nose-to-brain delivery of lipophilic molecules, since they reduce systemic and lung exposure, thereby decreasing adverse effects. For hydrophilic compounds, NLCs are particularly important to decrease lung exposure after IN administration.
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Affiliation(s)
- Soraia Silva
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Carla Fonseca
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Nuno R Ferreira
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Carla Vitorino
- Laboratory of Technology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,Coimbra Chemistry Center, Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
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Silva S, Bicker J, Falcão A, Fortuna A. Antidepressants and Circadian Rhythm: Exploring Their Bidirectional Interaction for the Treatment of Depression. Pharmaceutics 2021; 13:1975. [PMID: 34834391 PMCID: PMC8624696 DOI: 10.3390/pharmaceutics13111975] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 01/07/2023] Open
Abstract
Scientific evidence that circadian rhythms affect pharmacokinetics and pharmacodynamics has highlighted the importance of drug dosing-time. Circadian oscillations alter drug absorption, distribution, metabolism, and excretion (ADME) as well as intracellular signaling systems, target molecules (e.g., receptors, transporters, and enzymes), and gene transcription. Although several antidepressant drugs are clinically available, less than 50% of depressed patients respond to first-line pharmacological treatments. Chronotherapeutic approaches to enhance the effectiveness of antidepressants are not completely known. Even so, experimental results found until this day suggest a positive influence of drug dosing-time on the efficacy of depression therapy. On the other hand, antidepressants have also demonstrated to modulate circadian rhythmicity and sleep-wake cycles. This review aims to evidence the potential of chronotherapy to improve the efficacy and/or safety of antidepressants. It includes pre-clinical and clinical studies that demonstrate the relevance of determining the most appropriate time of administration for antidepressant drugs. In parallel, their positive influence on the resynchronization of disrupted circadian rhythms is also herein discussed. It is expected that this review will promote the investigation of chronotherapy for the treatment of depression, contribute to a better understanding of the relationship between antidepressants and circadian rhythms, and consequently promote the development of new therapeutics.
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Affiliation(s)
- Soraia Silva
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; (S.S.); (A.F.); (A.F.)
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
| | - Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; (S.S.); (A.F.); (A.F.)
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; (S.S.); (A.F.); (A.F.)
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; (S.S.); (A.F.); (A.F.)
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal
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Alves E, Amorim M, Nogueira C, Silva S. Childbearing intentions after a very preterm delivery: a study among Portuguese mothers and fathers. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adjustments to intended family size are strongly affected by life-course events, but data on childbearing plans after a very preterm delivery are lacking. This study intends to assess the childbearing intentions of mothers and fathers of very preterm infants, regarding the desired and intended number of children, the factors associated with the intention to have more children and the main reasons for not wanting to have more children.
Methods
Between May and July 2017, mothers and fathers of very preterm infants were invited to participate in a structured online questionnaire through the Portuguese association of parents for support to the premature baby, and 231 mothers and 21 fathers were included. The discrepancy between the ideal and intended number of children was assessed by the McNemar-Bowker test. To assess the main factors associated with the plan to have more children in the future, unconditional logistic regression models were fitted to compute odds ratios (OR) and 95% confidence intervals (95%CI), adjusted for age, number of children and time after the very preterm delivery.
Results
Participants intend to have fewer children than they ideally desired (p < 0.001). Although 69.8% of parents would like to have more children, only 25% actually plan to conceive. After adjustment, participants aged above 34 years (OR = 0.27; 95%CI:0.08-0.86), with more than one offspring (OR = 0.34; 95%CI:0.14-0.69) and who experienced a very preterm delivery 5 or more years ago (OR = 0.28; 95%CI:0.09-0.90) were less likely to report the intention to have more children. The main reasons reported for not wanting to have more children were “having the desired number of children” (38.5%), “financial unavailability” (24.2%) and “being too old to have more children” (20.5%).
Conclusions
This study provides a comprehensive assessment of childbearing intentions after a very preterm delivery, advocating for reproductive counselling policies supportive of family planning.
Key messages
Discrepancy between the ideal and actual childbearing intentions support the enhancement of reproductive healthcare services for family planning. Socioeconomic and age-related constraints were the main motives presented by mothers and fathers of very preterm infants for not wanting to have more children.
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Affiliation(s)
- E Alves
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - M Amorim
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - C Nogueira
- Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences of the University of Porto, Porto, Portugal
| | - S Silva
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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De Freitas C, Silva S, Machado H, Baptista MJ, Leão Teles E, Maia T, Amorim M. Support for decision-making on sharing health data for research: are data counsellors relevant? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The implications of sharing one's health data are far-reaching. Potential applications of health data range from the delivery of treatments tailored to individuals' characteristics to improvements in public health, while also posing concerns about privacy, social justice and equity. Making informed decisions about health data sharing thus requires thorough consideration of the scientific, ethical and personal implications of donations. This study assessed participants' preferences regarding decision-making about health data sharing for research, including the need for support by data counsellors.
Methods
This observational cross-sectional study includes 159 patients and 479 carers followed at two reference centres for rare diseases in a Portuguese academic hospital, between June 2019 and March 2020. Participants were asked about preferred modes of decision-making: deciding on their own, deciding with support from another person, or delegating the decision to someone else. Those who responded the last two options also reported who they would choose for support or delegation: family or friends; a data counsellor; a professional with no specific training on data counselling; other. Data were analysed using descriptive and inferential statistics.
Results
The majority of respondents would prefer to decide with support (62%), 37% would prefer to decide on their own and 1% would opt to delegate the decision of sharing health data. Among those who expressed a preference for support, 60% would like to rely on a data counsellor. Carers, older and higher educated participants, and those with upper white-collar occupations and who were satisfied with their own health were significantly more likely to select data counsellors as their preferred source of support when engaging in decision-making about health data sharing for research (p < 0.05).
Conclusions
This study supports recommendations for the creation of a new professional specialty of health data counsellors.
Key messages
Most participants express the need for support in making decisions about health data sharing for research, with 60% preferring support from a data counsellor. As a new professional specialism, health data counselling can help to advance informed public participation in health research.
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Affiliation(s)
- C De Freitas
- EPIUnit, Institute of Public Health of University of Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educacion, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - S Silva
- EPIUnit, Institute of Public Health of University of Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educacion, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - H Machado
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Porto, Portugal
| | - MJ Baptista
- Centro de Referência de Cardiopatias Congénitas do Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento de Ginecologia, Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - E Leão Teles
- Centro de Referência de Doenças Hereditárias do Metabolismo do Centro Hospitalar Universitário São João, Porto, Portugal
| | - T Maia
- EPIUnit, Institute of Public Health of University of Porto, Porto, Portugal
| | - M Amorim
- EPIUnit, Institute of Public Health of University of Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
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Ponzio M, Borreli P, Monti MC, Amicizia D, Perotti P, Silva S, Ansaldi F, Mallucci G, Bergamaschi R, Montomoli C. Prevalence and economic burden of major comorbidities in multiple sclerosis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although comorbidity is important in Multiple Sclerosis (MS), few validated methods for its assessment exist. Our aim is to estimate the prevalence and economic burden of major comorbidities in people with MS (pwMS) in two Northern Italy study areas (Pavia, PV and Genoa, GE), using routinely collected healthcare data.
Methods
We estimated prevalence of comorbid conditions in pwMS in the period 2012-2017. Anxiety, depression, cancer, leukemia, lymphoma, hypertension, heart disease, cerebrovascular diseases, vascular diseases, ischemic stroke, hyperlipidaemia, bronchopathy, diabetes, gastropathy, gastric ulcer, autoimmune diseases, chronic renal failure, connective tissue diseases and HIV/AIDS were identified by a specific algorithm currently used for monitoring prevalence of chronic diseases by Italian Local Health Authorities (BDA system). Direct healthcare costs were defined by regional and governmental contracts; the aggregated healthcare expenditure was compared between pwMS with/without comorbidities.
Results
The MS cases identified were 2983, 2035 in GE and 948 in PV. 55.6% of pwMS had at least one comorbidity (50.6% GE and 66.5% PV, p < 0.001). The most prevalent comorbidities were: depression (32.9%), hypertension (18.0%), cancer (10.9%), heart disease (7.8%), cerebrovascular diseases (7.0%) and hyperlipidaemia (6.1%). Comorbidity ranking was similar in the two provinces, although we observed significant differences considering specific prevalence rates. The mean direct healthcare costs of MS were substantially higher for individuals with comorbidity (36,463 €vs 26,284 €, p < 0.001), showing 39% of additive costs.
Conclusions
Our study provides evidence of the burden of comorbidities in MS. Comorbidity is common in MS and produce additive costs.
Key messages
The use of administrative data for tracking the MS comorbidity could help knowledge gaps. When additivity situation is involved, preventive policies could lead to monetary savings.
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Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - P Borreli
- Department of Public Health, Experimental and Forensic Medic, University of Pavia, Pavia, Italy
- Department of Medical, Oral and Biotechnological Sciences, L, University, Pescara, Italy
| | - MC Monti
- Department of Public Health, Experimental and Forensic Medic, University of Pavia, Pavia, Italy
| | - D Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - P Perotti
- Pavia Health Protection Agency, Pavia, Italy
| | - S Silva
- Pavia Health Protection Agency, Pavia, Italy
| | - F Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - G Mallucci
- Multiple Sclerosis Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - R Bergamaschi
- Multiple Sclerosis Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - C Montomoli
- Department of Public Health, Experimental and Forensic Medic, University of Pavia, Pavia, Italy
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Martinho R, Correia G, Seixas R, Oliveira A, Silva S, Serrão P, Fernandes-Lopes C, Costa C, Moreira-Rodrigues M. Treatment With Nepicastat Decreases Contextual Traumatic Memories Persistence in Post-traumatic Stress Disorder. Front Mol Neurosci 2021; 14:745219. [PMID: 34630037 PMCID: PMC8498196 DOI: 10.3389/fnmol.2021.745219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common anxiety mental disorder and can be manifested after exposure to a real or perceived life-threatening event. Increased noradrenaline and adrenaline in plasma and urine have been documented in PTSD. Dopamine-β-hydroxylase (DBH) catalyzes the conversion of dopamine to noradrenaline and consequently, DBH inhibition reduces catecholamines. Our aim was to evaluate if nepicastat treatment decreases PTSD signs in an animal model. Wild-type (129x1/SvJ) female mice were submitted to PTSD induction protocol. DBH-inhibitor nepicastat (30 mg/kg) or vehicle (0.2% HPMC) were administered once daily since day 0 until day 7 or 12. The percentage of freezing was calculated on days 0, 1, 2, and 7, and behavioral tests were performed. Quantification of nepicastat in plasma and DBH activity in the adrenal gland was evaluated. Catecholamines were quantified by HPLC with electrochemical detection. mRNA expression of Npas4 and Bdnf in hippocampus was evaluated by qPCR.Mice in the PTSD-group and treated with nepicastat showed a decrease in freezing, and an increase in the time spent and entries in open arms in elevated plus maze test. In mice treated with nepicastat, adrenal gland DBH activity was decreased, and catecholamines were also decreased in plasma and tissues. On day 7, in mice treated with nepicastat, there was an increase of Npas4 and Bdnf mRNA expression in the hippocampus.In conclusion, DBH inhibitor nepicastat has an effect consistent with a decrease in the persistence of traumatic memories and anxiety-like behavior in this PTSD mice model. The disruption of traumatic memories through interference with the formation, consolidation, retrieval, and/or expression processes may be important to decrease PTSD symptoms and signs. The increase in Npas4 and Bdnf mRNA expression in the hippocampus may be important to develop a weaker traumatic contextual memory after nepicastat treatment.
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Affiliation(s)
- Raquel Martinho
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Gabriela Correia
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Rafaela Seixas
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Ana Oliveira
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Soraia Silva
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
| | - Paula Serrão
- Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | | | | | - Mónica Moreira-Rodrigues
- Laboratory of General Physiology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS/UP), Porto, Portugal.,Center for Drug Discovery and Innovative Medicines, University of Porto (MedInUP), Porto, Portugal
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De Almeida Fernandes D, Leal V, Oliveiros B, Silva S, Goncalves L, Fontes Ribeiro C, Antonio N. Circulating endothelial progenitor cells as predictors of long-term cardiovascular mortality after myocardial infarction: which definition should we use? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Endothelial progenitor cells (EPCs) are bone marrow-derived cells that play a crucial role in vascular repair after an acute myocardial infarction (AMI). Recent studies suggest that circulating EPCs levels may be useful as a surrogate biomarker for cardiovascular (CV) events. Nevertheless, the lack of a consensual definition and phenotypic characterization of EPCs hampers its use in clinical practice. CD34+KDR+, CD45dimCD34+KDR+ and CD34+CD133+KDR+ are among the most used antigenic phenotypes to define circulating EPCs but the best phenotype to predict CV outcomes remains to be determined.
Purpose
To determine the EPCs' surface phenotype that best predicts long-term CV death after an AMI, and to evaluate its optimal cut-off point.
Methods
One-hundred AMI patients were prospectively enrolled in the study. Circulating EPCs were quantified through high-performance flow cytometer within the first 24 hours of admission using different surface markers combinations allowing to simultaneously compare three EPCs definitions: 1) CD34+KDR+, 2) CD45dimCD34+KDR+, 3) CD34+CD133+KDR+. Mean follow-up time was 8.0±2.2 years.
Results
The mean age of our population was 59.7±11.0, the majority of patients were male (90%), 65% had ST-elevation myocardial infarction (STEMI) and 35% non-ST segment elevation myocardial infarction (NSTEMI). Diabetes mellitus was present in 38% and hypertension in 67% of the studied sample. During the long-term follow-up, 34 patients had re-admissions due to cardiovascular causes, 11 of them for AMI. Thirty-one patients had major adverse cardiovascular events (MACE) and 19 died.
Using ROC curves, the CD34+KDR+ phenotype showed the biggest area under the curve regarding prediction of CV mortality (0.722; p=0.010; confidence interval 95% (CI95%): 0.554 to 0.890). Patients with lower levels of EPCs according to this definition (≤0.022%) are 7 times more likely to die from CV causes at any time (hazard ratio = 7.55; p=0.008; CI95% 1.69 to 33.83).
Conclusion
The CD34+KDR+ phenotype appears to be the best definition of circulating EPCs for predicting long-term CV mortality after AMI. Further studies with larger samples are needed to clarify the optimal cut-off point for determining patients at risk and its role in everyday Cardiology.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Bolsa de Estudo João Porto da Sociedade Portuguesa de Cardiologia CD34+KDR+ as a predictor of CV death
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Affiliation(s)
| | - V Leal
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal
| | - B Oliveiros
- Coimbra Hospital and University Center, Coimbra, Portugal
| | - S Silva
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | | | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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Morgado Gomes AR, Antonio NSC, Silva S, Madeira M, Sousa P, Elvas L, Goncalves L. Myocardial injury after pulmonary vein isolation: fire versus ice. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The cornerstone of atrial fibrillation (AF) catheter ablation is pulmonary vein isolation (PVI), either using point-by-point radiofrequency ablation (RF) or single-shot ablation devices, such as cryoballoon ablation (CB). However, achieving permanent transmural lesions is difficult and pulmonary vein (PV) reconnection is common. Elevation of high-sensitivity Troponin I (hsTnI) may be used as a surrogate marker for transmural lesions. Still, data regarding the comparison of hsTnI increase after PVI with RF or cryo-energy is controversial.
Purpose
The aim of this study is to compare the magnitude of hsTnI elevation after PVI with CB versus RF using ablation index guidance.
Methods
Prospective study of 60 patients admitted for first ablation procedure of paroxysmal or persistent AF in a single tertiary Cardiology Department. Thirty patients were submitted to PVI using CB and 30 patients were submitted to RF, using CARTO® mapping system and ablation index guidance. Patients with atrial flutter were excluded. Baseline characteristics were compared between groups, as well as hsTnI before and after the procedure.
Results
Mean age was 57.9±12.3 years old, 62% of patients were male and 77% had paroxysmal AF. There were no significant differences between groups regarding gender, age, prevalence of hypertension, dyslipidaemia, diabetes, obesity or AF type. There was also no significant difference in electrical cardioversion need during the procedure. HsTnI median value before ablation was 1.90±1.98 ng/dL. Postprocedural hsTnI was significantly higher in CB-group (6562.7±4756.2 ng/dL versus 1564.3±830.7 ng/dL in RF-group; P=0.001). Regarding periprocedural complications, there was only one case of mild pericardial effusion in RF-group associated with postablation hsTnI of 1180.0 ng/dL.
Conclusions
High-sensitivity Troponin I was significantly elevated after PVI, irrespective of the ablation technique. In CB-group, hsTnI elevation was significantly higher than in RF-group. This disparity may reflect more extensive lesions with cryoablation, without compromising safety. Longterm studies are needed to understand whether this hsTnI elevation is predictive of a lower AF recurrence rate.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Silva
- University of Coimbra, Coimbra, Portugal
| | - M Madeira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - P Sousa
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Elvas
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Tavares M, Leite L, Cesca M, Campos F, Santana D, Saldanha E, Guimarães P, Sá D, Simões M, Viana R, Loose S, Rocha F, Silva S, Piroll R, Fogassa C, Pondé N, Sanches S, Toledo C, Makdissi F, Lima V. 176P Pathological complete response to neoadjuvant systemic therapy in 1160 initial and locally advanced breast cancer patients: Real life data on outcomes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Introduction Autism Spectrum Disorders (ASD) have been associated with decreased spontaneous attention to social stimuli. Several studies further suggest that a higher expression of autism traits (AT) in the neurotypical population (NTP) may also be related to decreased social attention, although the evidence is still scarce, especially when considering faces as task-irrelevant distractors. Objectives This study aimed to explore the relationship between the expression of AT in the NTP and exogenous attention to social stimuli. Methods Fifty-one adult participants were recruited and asked to complete the Autism Spectrum Quotient (AQ), to measure AT, and to perform an attentional capture task. In the latter, they were instructed to detect a target letter in the middle of perceptually similar (high perceptual load) or dissimilar (low perceptual load) distractor letters. In 25% of the trials, task-irrelevant distractors, consisting of images of faces (social) or houses (non-social), were shown flanking the letter stimuli. Results Response times were found to be affected by distractor-response compatibility, increasing for contralateral distractors, but decreasing for ipsilateral distractors, in relation to trials with no distractors (baseline). Importantly, these trends were magnified for distractor faces in the group with less AT, considering the social skills dimension of AQ, while the same tendency was observed in the group with higher AT, but for distractor houses. Conclusions Our results support an altered attentional performance in the subclinical phenotype of the autism spectrum. Furthermore, they also add to existing literature documenting similar attentional abnormalities in both the clinical and subclinical extremes of the spectrum, hinting possible shared mechanisms. Disclosure No significant relationships.
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Brandão J, Gangneux JP, Arikan-Akdagli S, Barac A, Bostanaru AC, Brito S, Bull M, Çerikçioğlu N, Chapman B, Efstratiou MA, Ergin Ç, Frenkel M, Gitto A, Gonçalves CI, Guégan H, Gunde-Cimerman N, Güran M, Irinyi L, Jonikaitė E, Kataržytė M, Klingspor L, Mares M, Meijer WG, Melchers WJG, Meletiadis J, Meyer W, Nastasa V, Babič MN, Ogunc D, Ozhak B, Prigitano A, Ranque S, Rusu RO, Sabino R, Sampaio A, Silva S, Stephens JH, Tehupeiory-Kooreman M, Tortorano AM, Velegraki A, Veríssimo C, Wunderlich GC, Segal E. Mycosands: Fungal diversity and abundance in beach sand and recreational waters - Relevance to human health. Sci Total Environ 2021; 781:146598. [PMID: 33812107 DOI: 10.1016/j.scitotenv.2021.146598] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 12/10/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
The goal of most studies published on sand contaminants is to gather and discuss knowledge to avoid faecal contamination of water by run-offs and tide-retractions. Other life forms in the sand, however, are seldom studied but always pointed out as relevant. The Mycosands initiative was created to generate data on fungi in beach sands and waters, of both coastal and freshwater inland bathing sites. A team of medical mycologists and water quality specialists explored the sand culturable mycobiota of 91 bathing sites, and water of 67 of these, spanning from the Atlantic to the Eastern Mediterranean coasts, including the Italian lakes and the Adriatic, Baltic, and Black Seas. Sydney (Australia) was also included in the study. Thirteen countries took part in the initiative. The present study considered several fungal parameters (all fungi, several species of the genus Aspergillus and Candida and the genera themselves, plus other yeasts, allergenic fungi, dematiaceous fungi and dermatophytes). The study considered four variables that the team expected would influence the results of the analytical parameters, such as coast or inland location, urban and non-urban sites, period of the year, geographical proximity and type of sediment. The genera most frequently found were Aspergillus spp., Candida spp., Fusarium spp. and Cryptococcus spp. both in sand and in water. A site-blind median was found to be 89 Colony-Forming Units (CFU) of fungi per gram of sand in coastal and inland freshwaters, with variability between 0 and 6400 CFU/g. For freshwater sites, that number was 201.7 CFU/g (0, 6400 CFU/g (p = 0.01)) and for coastal sites was 76.7 CFU/g (0, 3497.5 CFU/g). For coastal waters and all waters, the median was 0 CFU/ml (0, 1592 CFU/ml) and for freshwaters 6.7 (0, 310.0) CFU/ml (p < 0.001). The results advocate that beaches should be monitored for fungi for safer use and better management.
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Affiliation(s)
- J Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; Centre for Environmental and Marine Studies (CESAM) - Department of Animal Biology, University of Lisbon, Lisbon, Portugal.
| | - J P Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - S Arikan-Akdagli
- Mycology Laboratory at Department of Medical Microbiology of Hacettepe University Medical School, Ankara, Turkey
| | - A Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropical Diseases, Faculty of Medicine, University of Belgrade, Serbia
| | - A C Bostanaru
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - S Brito
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - M Bull
- Quantal Bioscience, North Parramatta, Australia
| | - N Çerikçioğlu
- Mycology Laboratory at Department of Medical Microbiology of Marmara University Medical School, Istanbul, Turkey
| | - B Chapman
- Quantal Bioscience, North Parramatta, Australia
| | - M A Efstratiou
- Department of Marine Sciences, University of the Aegean, University Hill, Mytilene, Greece
| | - Ç Ergin
- Department of Medical Microbiology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - M Frenkel
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Gitto
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Ireland; UCD Conway Institute, University College Dublin, Ireland
| | - C I Gonçalves
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - H Guégan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - N Gunde-Cimerman
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - M Güran
- Faculty of Medicine, Eastern Mediterranean University, Famagusta, Northern Cyprus, Mersin 10, Turkey
| | - L Irinyi
- Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Clinical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - E Jonikaitė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - M Kataržytė
- Marine Research Institute, Klaipėda University, Klaipėda, Lithuania
| | - L Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicin, Karolinska Institutet, Stockholm, Sweden
| | - M Mares
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - W G Meijer
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Ireland; UCD Conway Institute, University College Dublin, Ireland
| | - W J G Melchers
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - J Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - W Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Clinical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - V Nastasa
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - M Novak Babič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Slovenia
| | - D Ogunc
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - B Ozhak
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - A Prigitano
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - S Ranque
- Aix Marseille Univ, IHU-Méditerranée Infection, AP-HM, IRD, SSA, VITROME, Marseille, France
| | - R O Rusu
- Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Romania
| | - R Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - A Sampaio
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), UTAD, Vila Real, Portugal
| | - S Silva
- Department of Epidemiology, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - J H Stephens
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland; UCD Earth Institute, University College Dublin, Ireland; UCD Conway Institute, University College Dublin, Ireland
| | - M Tehupeiory-Kooreman
- Medical Microbiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - A M Tortorano
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - A Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece and Mycology Laboratory, BIOMEDICINE S.A., Athens, Greece
| | - C Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - G C Wunderlich
- Quantal Bioscience, North Parramatta, Australia; Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Clinical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - E Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lopes J, Silva S, Monteiro J, Pinto IM, Silva RA. Digital pathology in the immunohistochemical evaluation of biomarkers in breast cancer. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab120.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Currently, the evaluation of biomarkers HER-2 and ER is critical for targeting therapy for breast cancer and is performed by experienced pathologists, which takes time and causes a certain interobserver variability. The use of histological slide scanners coupled with the application of software for immunoexpression quantification can be profitable in pathological laboratories routine. This study aims to compare the quantification of HER-2 and ER immunoexpression employing automatic algorithms, using as standard the evaluation performed by a pathologist.
Methods
From the archive since 2016 to 2018 were retrieved 75 immunostained slides for HER-2 and 76 immunostained slides for ER with invasive breast carcinoma diagnosis. The slides were scanned in Aperio CS2 and the immunostaining signal was quantified in Aperio Imagescope using a membrane and nuclear algorithm, respectively. The concordance between the scores obtained and the previous assessment was calculated by Cohen’s Kappa coefficient as well as the sensitivity and specificity for each algorithm.
Results
Both algorithms showed an almost perfect concordance with the conventional method (k = 0.94 for HER-2; k = 0.92 for ER). Digital evaluations presented a sensitivity of 100% for both biomarkers, and a specificity of 100% for HER-2 and 80% for ER.
Conclusions
This assay showed that applying signal quantification software for HER-2 and ER in digitized slides is accurate, as these tools have potential to be implemented in laboratory routine. However, it will be necessary to increase the sample to obtain more reliable values and extend this study to the PR and Ki67 biomarkers since both carry prognostic and predictive information as well.
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Affiliation(s)
- J Lopes
- School of Health, Polytechnic Institute of Porto (ESS
- P.PORTO)
- IMP Diagnostics
| | - S Silva
- Department of Pathological, Cytological and Thanatological Anatomy, ESS
- P.PORTO
- Department of Anatomic Pathology, Centro Hospitalar Universitário de S. João
| | | | | | - R A Silva
- Department of Pathological, Cytological and Thanatological Anatomy, ESS
- P.PORTO
- Research Centre in Health and Environment (CISA), School of Health (ESS), Polytechnic Institute of Porto (P.PORTO)
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Pinto AS, Cunha M, Oliveira Pinheiro F, Bernardes M, Assunção H, Martinho J, Tenazinha MC, Duarte Monteiro AM, Silva S, Martins FR, Silva L, Couto M, Faria M, Araújo F, Fontes T, Faria D, Tavares-Costa J. POS0640 EFFECTIVENESS AND SAFETY OF ORIGINAL AND BIOSIMILAR ETANERCEPT IN bDMARD-NAÏVE PATIENTS IN A REAL-WORLD COHORT OF PORTUGAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3706] [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] [Indexed: 11/04/2022]
Abstract
Background:The patent expiration of the original etanercept in Europe has facilitated the development of biosimilar products. Non-significant differences in efficacy and safety were noted in clinical trials which are not expected to influence clinical performance. Nonetheless, daily practice data should be gathered to support the claim for biosimilarity.Objectives:To compare the effectiveness and safety of original and biosimilar etanercept, in biological-Disease Modifying Antirheumatic Drug (bDMARD)-naïve patients.Methods:A retrospective multicenter non-interventional study, using data collected prospectively from Reuma.pt (The Rheumatic Diseases Portuguese Register) was done, including patients with: age ≥ 18 years old; diagnosis of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Spondyloarthritis (SpA) (axial or peripheral); active disease who initiated treatment with etanercept as first line of biological treatment after 2010. Kaplan-Meyer was used to calculate the persistence rate in treatment. Disease activity at baseline and follow-up data at 6, 12, 18 and 24 months of treatment was compared using the chi-square for categorical variables and t-student or Mann-Whitney tests for continuous variables. Reasons for discontinuing therapy were summarized using descriptive statistics. Statistical significance was assumed for 2-sided p-values >0.05.Results:We included 1694 patients (413 on biosimilar and 1280 on original etanercept) 864 with RA, 335 with PsA and 494 with SpA. The population’s baseline characteristics were not significantly different among both groups, except concomitant treatment in RA (higher use of conventional DMARDs in biosimilar group and higher use of NSAIDs in original group) and in SpA patients (higher use of corticosteroids in original group).At baseline, a higher joint count was found in patients treated with original etanercept with a statistical difference for swollen (p=0.03) and tender (p=0.01) joints count (SJC and TJC, respectively) in RA and in TJC in SpA patients (p=0.02). In RA patients, CDAI and SDAI were higher in patients who started original (p=0.03; p=0.04, respectively). Pain measured by visual analogic scale was higher in SpA patients treated with biosimilar (p=0.03).The 3-year PR was not significantly different between both treatment groups in RA, PsA and SpA (Figure1). In RA, PR in biosimilar was 72.6%, with a median time-on-drug (TOD) of 28.3 months; for original etanercept PR was 63.6%, with a median TOD of 27.4 months (p=0.566). In PsA patients, the PR for biosimilar was 70.6%, with a median TOD of 27.6 months, and in original drug 67.0%, with a median TOD of 28.1 months (p=0.743). In SpA patients, the PR were 78.4% for biosimilar (median TOD of 27.4 months) and 71.5% for original treatment (median TOD of 28.0 months (p=0.816)).Figure 1.Drug survival in biosimilar and original etanercept in Rheumatoid Arthritis, Psoriatic Arthritis and SpondyloarthritisIn RA patients, we did not find differences between the two treatment groups for the proportion of patients in remission or low disease activity by CDAI ≤10, SDAI≤11 or DAS28 <3.2 at 6, 12, 18 and 24 months of treatment. For PsA, no differences were found in the same timelines for DAPSA≤14, DAS28<3.2, BASDAI<4, ASDAS<2.1 or PsARC response. Also, in SpA patients, no differences were found in BASDAI<4, BASFI<4, ASDAS<2.1, ASDAS response and BASDAI response in all the timelines with the exception of BASDAI response at 18 months, which was achieved in fewer patients in biosimilar therapy (p=0.02).Overall, 535 (31.6%) patients stopped etanercept (428 patients on original and 107 patients on biosimilar). Discontinuations due to inefficacy were the most frequent, but there were no significant differences between both groups as for adverse events. Discontinuations due to “other reasons” were higher for the original group, both in RA (p=0.01) and in SpA (p=0.04).Conclusion:Biosimilar and original used as first-line biological treatment showed similar effectiveness and safety in our long-term cohort of patients with RA, PsA, and SpADisclosure of Interests:None declared
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Vicedo-Cabrera AM, Scovronick N, Sera F, Royé D, Schneider R, Tobias A, Astrom C, Guo Y, Honda Y, Hondula DM, Abrutzky R, Tong S, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Lavigne E, Correa PM, Ortega NV, Kan H, Osorio S, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti N, Pascal M, Schneider A, Katsouyanni K, Samoli E, Mayvaneh F, Entezari A, Goodman P, Zeka A, Michelozzi P, de’Donato F, Hashizume M, Alahmad B, Diaz MH, De La Cruz Valencia C, Overcenco A, Houthuijs D, Ameling C, Rao S, Ruscio FD, Carrasco-Escobar G, Seposo X, Silva S, Madureira J, Holobaca IH, Fratianni S, Acquaotta F, Kim H, Lee W, Iniguez C, Forsberg B, Ragettli MS, Guo YLL, Chen BY, Li S, Armstrong B, Aleman A, Zanobetti A, Schwartz J, Dang TN, Dung DV, Gillett N, Haines A, Mengel M, Huber V, Gasparrini A. The burden of heat-related mortality attributable to recent human-induced climate change. Nat Clim Chang 2021; 11:492-500. [PMID: 34221128 PMCID: PMC7611104 DOI: 10.1038/s41558-021-01058-x] [Citation(s) in RCA: 196] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/20/2021] [Indexed: 05/19/2023]
Abstract
Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991-2018. Across all study countries, we find that 37.0% (range 20.5-76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.
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Affiliation(s)
- A. M. Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - N. Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - F. Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Statistics, Computer Science and Applications ‘G. Parenti’, University of Florence, Florence, Italy
| | - D. Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - R. Schneider
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Φ-Lab, European Space Agency (ESA-ESRIN), Frascati, Italy
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- European Centre for Medium-Range Weather Forecast (ECMWF), Reading, UK
| | - A. Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - C. Astrom
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Y. Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Y. Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - D. M. Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - R. Abrutzky
- Facultad de Ciencias Sociales, Instituto de Investigaciones Gino Germani, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - S. Tong
- Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | | | | | - E. Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - P. Matus Correa
- Department of Public Health, Universidad de los Andes, Santiago, Chile
| | - N. Valdes Ortega
- Department of Public Health, Universidad de los Andes, Santiago, Chile
| | - H. Kan
- School of Public Health, Fudan University, Shanghai, China
| | - S. Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - J. Kyselý
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - A. Urban
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - H. Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - E. Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - J. J. K. Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Finnish Meteorological Institute, Helsinki, Finland
| | - N. Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - M. Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - A. Schneider
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - K. Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- MRC-PHE Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - E. Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - F. Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - A. Entezari
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - P. Goodman
- School of Physics, Technological University Dublin, Dublin, Ireland
| | - A. Zeka
- Institute for Environment, Health and Societies, Brunel University London, London, UK
| | - P. Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - F. de’Donato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - M. Hashizume
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - B. Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - M. Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico
| | - C. De La Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico
| | - A. Overcenco
- Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Republic of Moldova
| | - D. Houthuijs
- Centre for Sustainability and Environmental Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - C. Ameling
- Centre for Sustainability and Environmental Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - S. Rao
- Norwegian Institute of Public Health, Oslo, Norway
| | - F. Di Ruscio
- Norwegian Institute of Public Health, Oslo, Norway
| | - G. Carrasco-Escobar
- Health Innovation Laboratory, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - X. Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - S. Silva
- Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - J. Madureira
- Department of Enviromental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - I. H. Holobaca
- Faculty of Geography, Babes-Bolay University, Cluj-Napoca, Romania
| | - S. Fratianni
- Department of Earth Sciences, University of Torino, Turin, Italy
| | - F. Acquaotta
- Department of Earth Sciences, University of Torino, Turin, Italy
| | - H. Kim
- Graduate School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - W. Lee
- Graduate School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - C. Iniguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Statistics and Computational Research, Universitat de Valencia, Valencia, Spain
| | - B. Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M. S. Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Y. L. L. Guo
- Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan,Taiwan
| | - B. Y. Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan,Taiwan
| | - S. Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - B. Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A. Aleman
- Department of Preventive Medicine, School of Medicine, University of the Republic, Montevideo, Uruguay
| | - A. Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - J. Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - T. N. Dang
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - D. V. Dung
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - N. Gillett
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, British Colombia, Canada
| | - A. Haines
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Φ-Lab, European Space Agency (ESA-ESRIN), Frascati, Italy
| | - M. Mengel
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - V. Huber
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Department of Physical, Chemical and Natural Systems, Universidad Pablo de Olavide, Seville, Spain
| | - A. Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
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Garcia Bras P, Sousa L, Mano T, Monteiro A, Rito T, Ilhao Moreira R, Rio P, Silva S, Martins C, Coito S, Capile E, Agapito A, Ferreira R. Cardiopulmonary exercise testing in repaired tetralogy of Fallot: a valuable tool for pulmonary regurgitation severity assessment. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction and purpose
The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients.
Methods
A retrospective chart review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected.
Results
Cardiopulmonary exercise testing was performed in 54 adult repaired TOF patients (59% male), with a mean follow-up of 60 ± 33 months. The mean age was 34 ± 9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28 ± 7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%). 12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death.
Peak VO2 consumption (pVO2) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, 95% CI 0.879-1.036, p= 0.262) or PVR (HR 0.92, 95% CI 0.829-1.028, p = 0.914), while percent of predicted pVO2 significantly correlated with severity of pulmonary regurgitation (HR 0.95, 95% CI 0.918-0.993, p = 0.020) and PVR (HR 0.94, 95% CI 0.886-0.992, p = 0.025).
VE/VCO2 slope was not a significant predictor of severity of pulmonary regurgitation (HR 1.03, 95% CI 0.929-1.130, p = 0.622) or PVR (HR 1.04, 95% CI 0.952-1.128, p = 0.414) or) and neither cardiorespiratory optimal point (HR 0.94, 95% CI 0.786-1.120, p = 0.480) nor maximum end-tidal carbon dioxide pressure (PETCO2) (HR 0.93, 95% CI 0.846-1.037, p = 0.213) correlated with severity of pulmonary regurgitation or PVR.
Conclusion
Percent of predicted peak VO2 had the highest predictive power of all CPET parameters analysed in adult repaired TOF patients. Preoperative CPET could be an accessible way to identify high-risk patients earlier for PVR and should therefore be included in the routine assessment of these patients.
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Affiliation(s)
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Monteiro
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Silva
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Martins
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Coito
- Hospital de Santa Marta, Lisbon, Portugal
| | - E Capile
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira J, Rio P, Castelo A, Cardoso I, Silva S, Ferreira RC. Exercise end-tidal carbon dioxide pressure: a new prognostic marker after acute myocardial infarction? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although several cardiopulmonary exercise testing (CPET) parameters have already proved to predict prognosis, there is increasing interest in finding variables that do not require maximal effort. End-tidal carbon dioxide pressure (PETCO2), an indirect indicator of cardiac output, is one of such variables. Studies in heart failure populations already suggest its role as a prognostic factor. However, data concerning other populations are still scarce.
Purpose
To assess the association between exercise PETCO2, cardiac biomarkers and systolic function following acute myocardial infarction (AMI) and to evaluate its potential prognostic role in this population.
Methods
A retrospective single-centre analysis was conducted including patients who underwent symptom-limited CPET early after AMI. We assessed PETCO2 at baseline (PETCO2-B), at anaerobic threshold (PETCO2-AT) and at peak exercise and calculated the difference between PETCO2-AT and PETCO2-B (PETCO2-difference). We analysed their association with B-natriuretic peptide (BNP), maximal troponin after AMI as well as with left ventricular ejection fraction (LVEF) 1 year after.
Results
We included 40 patients with a mean age of 56 years (87.5% male), assessed with CPET a median of 3 months after AMI (80% of which were ST-elevation myocardial infarctions). Average respiratory exchange ratio was 1,1 with 48% of patients not reaching maximal effort. Mean PETCO2-AT was 37mmHg, with a mean increase from baseline of 6mmHg (PETCO2-difference). There was a significant positive correlation between all the PETCO2 variables measured and BNP values at time of AMI and on follow-up (best correlation for PETCO2-AT with BNP at AMI hospitalization, r = 0.608, p < 0.001). Maximal troponin was not correlated with PETCO2. Both PETCO2-AT and PETCO2-difference were significantly and positively correlated with LVEF 1-year post-AMI (r = 0.421, p = 0.040 and r = 0.511, p = 0.011, respectively).
Conclusion
PETCO2-AT and PETCO2-difference are both correlated with BNP, an established prognostic marker, and with medium-term systolic function after AMI, suggesting their potential prognostic role in this population. Further studies with larger samples are required to confirm the results of this pilot study and assess PETCO2 as a definite predictor of prognosis after AMI.
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Affiliation(s)
- J Ferreira
- Hospital Center of Setubal, Cardiology, Setubal, Portugal
| | - P Rio
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - I Cardoso
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - S Silva
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - RC Ferreira
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
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Humboldt SV, Costa A, Silva S. Ambivalence among intergenerational relationships in old age. Eur Psychiatry 2021. [PMCID: PMC9479817 DOI: 10.1192/j.eurpsy.2021.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction This study focuses on ambivalence among intergenerational relationships in old age. Objectives This study aims to analyze the perspectives of intergenerational relationships between older adults and adult children. For this purpose, a qualitative research was carried out, which analyzes these relations at a cross-national level. Methods Four hundred and twenty four older participants aged 65-97 years, were interviewed. Participants were of three different nationalities and lived in the community. All the interviews went through the process of verbatim transcription and subsequent content analysis. Results Two dimensions of generational ambivalence were revealed from the study; support and the conflict dimensions. Findings of content analysis produced six themes, which represent intergenerational relations between older adults and adult children: older adults-adult children interaction quality; family integration; care and support; definition of limits; distance and alienation; and communication difficulties. Conclusions This study highlighted the diversity of experiences in old age, in relation to intergenerational relationships and underlined the conflicting expectations from older adults in relation to their adult children. Disclosure No significant relationships.
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Mariano PC, Silva S, Leitão F, Carvalho J, Calmeiro M, Antunes I, André M. Insuficiência Cardíaca Crónica em Hospitalização Domiciliária. GM 2021. [DOI: 10.29315/gm.v8i1.373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUÇÃO: A insuficiência cardíaca crónica é considerada, a nível mundial, a principal causa de internamento em doentes com idade superior a 65 anos. A Unidade de Hospitalização Domiciliária (UHD) foi criada com o objetivo de minimizar as complicações hospitalares, proporcionar maior qualidade de vida e atingir melhores resultados funcionais.MATERIAL E MÉTODOS: Estudo retrospetivo de um ano de hospitalização domiciliária da Unidade Local de Saúde de Castelo Branco, destacando apenas doentes internados por descompensação da insuficiência cardíaca crónica.RESULTADOS: Neste período foram internados 99 doentes, 23,3% por descompensação da insuficiência cardíaca crónica. Eram do sexo masculino, 52,1%. A idade média foi de 79,8 anos (±10,6). O tempo médio de internamento foi de 6,7 dias (±3). As principais causas da insuficiência cardíaca foram: hipertensão arterial (43,4%) e arritmias (30,4%). O principal fator de descompensação foi infeções (69,5%). Estiveram sob perfusão inicial de furosemida, 56,5%. Evoluíram favoravelmente 95,6% (n=22) dos doentes e 4,3% (n=1) foi transferido para o internamento convencional. Segundo a escala de NEWS, 7,9%-12,7% dos doentes tinham risco de serem admitidos em unidade de cuidados intermédios/intensivos ou morrer entre 60 dias. O índice de comorbilidades de Charlson foi de 3-10 pontos e a sobrevivência num período de 10 anos estimava-se em 0%-77%. Noventa dias após a alta, 69,5% não regressaram à urgência nem foram reinternados.CONCLUSÃO: A hospitalização domiciliária em doentes com insuficiência cardíaca é vantajosa por proporcionar maior conforto ao doente e reduzir as complicações. Estudos demonstraram que a hospitalização domiciliária aumentou o tempo entre as readmissões, melhorou a qualidade de vida dos doentes e reduziu os custos das hospitalizações.
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Lalayiannis AD, Fewtrell M, Biassoni L, Silva S, Goodman N, Shroff R, Crabtree NJ. Studying bone mineral density in young people: The complexity of choosing a pQCT reference database. Bone 2021; 143:115713. [PMID: 33122089 DOI: 10.1016/j.bone.2020.115713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many chronic illnesses affect bone health, and commonly lead to mineralization abnormalities in young people. As cortical and trabecular bone may be differentially affected in certain diseases, an imaging technique that allows for detailed study of the bone structure is required. Peripheral quantitative computed tomography (pQCT) overcomes the limitations of dual energy X-ray absorptiometry (DXA) and is perhaps more widely available for use in research than bone biopsy. However, in contrast to DXA, where there are large reference datasets, this is not the case for pQCT. METHODS Fifty-five children and young adults aged 7 to 30 years had the non-dominant tibia scanned at the 3% & 4% sites for trabecular bone mineral density and the 38% site for cortical bone mineral density and bone mineral content. Image acquisition and analysis was undertaken according to the protocols of two of the largest reference datasets for tibial pQCT. The Z-scores generated were compared to examine the differences between protocols and the differences from the expected median of zero in a healthy population. RESULTS The trabecular bone mineral density Z-scores generated by the two protocols were similar. The same was true for cortical mineral content Z-scores at the 38% site. Cortical bone mineral density was significantly different between protocols and likely affected by differences in the ethnicity of our cohort compared to the reference datasets. Only one reference dataset extended from childhood to young adulthood. Only trabecular bone mineral density, periosteal and endosteal circumference Z-scores from one methodology were not significantly biased when tested for deviation of the median from zero. CONCLUSIONS pQCT is a useful tool for studying trabecular and cortical compartments separately but, there are variations in pQCT scanning protocols, analysis methodology, and a paucity of reference data. Reference datasets may not be generalizable to local study populations, even when analysed using identical analysis protocols.
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Affiliation(s)
- A D Lalayiannis
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK.
| | - M Fewtrell
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - L Biassoni
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - S Silva
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - N Goodman
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - R Shroff
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - N J Crabtree
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Gonçalves J, Silva S, Gouveia F, Bicker J, Falcão A, Alves G, Fortuna A. A combo-strategy to improve brain delivery of antiepileptic drugs: Focus on BCRP and intranasal administration. Int J Pharm 2020; 593:120161. [PMID: 33307160 DOI: 10.1016/j.ijpharm.2020.120161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/26/2020] [Revised: 11/12/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022]
Abstract
The breast cancer resistance protein (BCRP) is an efflux transporter expressed at the apical surface of human brain endothelial cells of the blood-brain barrier (BBB). It was proposed as one of the transporters responsible for the development of drug resistance to several central nervous system (CNS) drugs, including antiepileptic drugs (AEDs). In this context, the present work aimed to characterize the interaction between new-generation AEDs, lacosamide, levetiracetam and zonisamide, and BCRP, in order to investigate whether intranasal administration can successfully avoid the impact of BCRP on brain drug distribution, preventing the development of refractory epilepsy. Firstly, BCRP substrates and/or inhibitors were identified resorting to intracellular accumulation and bidirectional transport assays on Madin-Darby canine kidney (MDCK) cells and the transfected cell line with human ABCG2 (MDCK-BCRP). Furthermore, in vivo pharmacokinetic studies were carried out for BCRP substrates with and without elacridar, a well-known P-gp and BCRP modulator, to assess the impact of efflux inhibition on brain drug distribution. The extent of drug equilibration between plasma and brain was compared after intravenous (IV) and intranasal administration to mice. Among the three tested AEDs, zonisamide was the only AED identified as BCRP substrate in vitro, as demonstrated by the net flux ratio of 2.73, which decreased 53.85 % in the presence of a BCRP inhibitor, Ko143. Lacosamide revealed to inhibit BCRP in all tested concentrations (2.5-75 µM), exhibiting a significant increase (p < 0.001) of the intracellular accumulation of a BCRP substrate (Hoechst 33342) in MDCK-BCRP cells. Levetiracetam did not behave as a BCRP substrate nor inhibitor. After IV administration, the plasma concentrations of zonisamide were unaffected by elacridar, but its extent of brain exposure increased three-fold (as assessed by AUCt, 674.12 vs 284.47 µg.min/mL). These results corroborate the previous in vitro findings, suggesting that BCRP is involved in the transport of zonisamide through the BBB. In opposition, no significant changes were found in plasma or brain concentrations after the administration of zonisamide by intranasal route, indicating that the influence of BCRP is less relevant than for IV route. In addition, direct nose-to-brain delivery of zonisamide, given by the direct transport percentage, was approximately 49 %. Altogether, these assays demonstrated that the impact of BCRP on the delivery of zonisamide to the brain is lower after intranasal administration, probably due to direct nose-to-brain transport. Therefore, the intranasal administration of AEDs may be a relevant strategy to avoid the impact of efflux transporters at the BBB and the development of drug resistance.
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Affiliation(s)
- Joana Gonçalves
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Soraia Silva
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Filipa Gouveia
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Joana Bicker
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Amílcar Falcão
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Ana Fortuna
- University of Coimbra, Faculty of Pharmacy, Coimbra, Portugal; University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal.
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Jourdes A, Lafaurie M, Martin-Blondel G, Delobel P, Faruch M, Charpentier S, Minville V, Silva S, Thalamas C, Sommet A, Moulis G. Clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 infection at Toulouse University hospital (France). Results from the Covid-clinic-Toul cohort. Rev Med Interne 2020; 41:732-740. [PMID: 33077266 PMCID: PMC7540209 DOI: 10.1016/j.revmed.2020.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide from epicenter of Wuhan, China since December 2019. The aim of our study was to describe the clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 pneumonia at the Toulouse university hospital, France. Patients and methods We selected the patients included from March 7, 2020 to April 20, 2020 in the retrolective Covid-clinic-Toul cohort that follows all hospitalized patients with SARS-CoV-2 infection at the Toulouse Hospital. Cases were confirmed by real-time reverse transcriptase polymerase chain reaction. We report demographics, clinical, biological and radiological features, as well as unfavorable outcome at Day 14 after admission (admission in an intensive care unit, mechanical ventilation, death). Results Among 263 hospitalized patients, the median age was 65 years and 155 (58.9%) were males. Two hundred and twenty-seven patients (86.3%) had at least one comorbidity. The median time from first symptom to hospital admission was 7.0 days (interquartile range: 4–10). On day 14 after admission, 111 patients (42.2%) had been transferred to intensive care unit (ICU), including 50 (19.0%) on Day 1; 61 (23.1%) needed mechanical ventilation and 19 patients (7.2%) had died. Patients admitted to ICU at Day 1 of admission (n = 50) were more frequently men (66.0% vs 57.3%), smokers (25.0% vs 7.1%), with obesity (42.0% vs 24.7%) and had a higher mean level of C-reactive protein (median: 110.9 mg/L vs 46.2 mg/L). Conclusion This cohort provides epidemiological data on SARS-CoV-2 in hospitalized patients in a University hospital in the South of France.
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Affiliation(s)
- A Jourdes
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - M Lafaurie
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France.
| | - G Martin-Blondel
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - P Delobel
- Service des maladies infectieuses et tropicales, CHU de Toulouse, Toulouse, France
| | - M Faruch
- Service de radiologie et imagerie médicale, CHU de Toulouse, Toulouse, France
| | - S Charpentier
- Service des urgences, CHU de Toulouse, Toulouse, France
| | - V Minville
- Service de réanimation, CHU de Toulouse, Toulouse, France
| | - S Silva
- Service de réanimation, CHU de Toulouse, Toulouse, France
| | - C Thalamas
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France
| | - A Sommet
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de pharmacologie médicale et clinique, CHU de Toulouse, Toulouse, France
| | - G Moulis
- Centre d'investigation clinique 1436, CHU de Toulouse, Toulouse, France; Service de médecine interne, CHU de Toulouse, Toulouse, France
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Ferreira R, Rodrigues C, Correia-Santos P, Moreira M, Silva S. Individual preparedness for natural disasters: a cross-sectional study from Portugal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Individual preparedness is critical in mitigating the adverse effect of natural disasters (ND). Factors influencing preparedness are complex and multifaceted, with certain groups having different needs and vulnerabilities. We aimed to explore the factors associated with individual ND preparedness in residents from Vila Nova Gaia (VNG), Portugal.
Methods
A cross-sectional study was conducted in VNG, Portugal, in January 2020 (N = 192; ≥18 years). Data on sociodemographic characteristics, risk perception, and preparedness were collected using a structured questionnaire, in parishes randomly selected. Crude and adjusted odds ratio (OR) and respective 95% confidence intervals (CI) were estimated using logistic regression models.
Results
About 33% of participants aged ≥65 years and 66% had low education. Results show that 20% had a survival kit. In univariate comparisons, older (11% vs. 24%, p=.029) and lower educated participants (≤12th grade: 13% vs. >12th grade: 32%, p=.002) were less likely to have a survival kit; only education remained associated after adjustment for age (OR = 2.61, 95%CI:1.22-5.58). About 21% had a family plan for disaster and only education level is associated (≤12th grade: 17% vs. >12th grade: 29%, p=.040). Almost 35% had a family member with basic life support training; older age, lower education and higher risk perception were negatively associated and these remained after adjustment (≥65 vs. <65 years OR = 0.36, 95%CI:0.16-0.77; ≤12th vs. >12th grade OR = 0.40, 95%CI:0.21-0.78; risk perception OR = 0.66, 95%CI:0.45-0.95). Only 22% participated in community drills; older people (6% vs. 31%, p<.001) and less educated (14% vs. 39%, p<.001) were less likely to have ever participated, which persisted in multivariate model.
Conclusions
Our findings revealed a low-level of ND preparedness, and older and less educated people seem to present worse preparedness. This highlights the need to design specific public health interventions among these groups.
Key messages
We found a low-level of individual preparedness for natural disasters in VNG, Portugal. Community-based public health interventions are needed to improve individual preparedness for natural disasters. Specific interventions targeting older and less educated people should be designed to decrease their vulnerability facing a natural disaster.
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Affiliation(s)
- R Ferreira
- Portuguese Red Cross, Vila Nova de Gaia, Portugal
| | - C Rodrigues
- Portuguese Red Cross, Vila Nova de Gaia, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - P Correia-Santos
- Portuguese Red Cross, Vila Nova de Gaia, Portugal
- CiPsi, University of Minho, Braga, Portugal
| | - M Moreira
- Portuguese Red Cross, Vila Nova de Gaia, Portugal
| | - S Silva
- Portuguese Red Cross, Vila Nova de Gaia, Portugal
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Torres AR, Kislaya I, Silva S, Gomez V, Machado A, Nunes B, Guiomar R, Rodrigues AP. Influenza burden estimates in Portugal: seasons 2013/14 to 2018/19. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Reliable influenza burden estimates are essential for a true understanding of the influenza epidemics' impact; informed decision-making and effective risk communication. This study aimed to estimate the influenza burden in Portugal in 2013/14 - 2018/19 seasons.
Methods
We estimated seasonal influenza burden, ranging from medically attended influenza cases in primary care to influenza-attributable deaths, using surveillance data. Data were collected for influenza like illness (ILI) epidemic periods, determined by the Moving Epidemic Method. Medically attended influenza cases were estimated by multiplying the number of ILI cases in primary care by the percentage of influenza-positive samples. Hospitalized severe acute respiratory infections (SARI) positive for influenza estimates were computed, multiplying the number of SARI by the percentage of influenza-positive samples. To determine influenza-attributable deaths, a Poisson regression model was used.
Results
The median number of medically attended influenza cases in primary care was 33,668 (325.8 cases per 10,000 population), ranging between 21,393 in 2017/18, [Influenza B and A(H1) co-dominance] and 61,768 in 2014/15 [Influenza B and A(H3) co-dominance]. The median number of SARI positive for influenza was 8,724 (84.4 cases per 10,000 population), ranging between 7,099 in 2013/14 [A(H1) and A(H3) co-dominance], and 9,125 in 2014/15. The median number of influenza-attributable deaths was 3,311 (32.0 cases per 10,000 population), ranging between 96 in 2015/16 [A(H1) dominance], and 5,224 in 2014/15.
Conclusions
Higher mortality, and higher rate of medically attended influenza cases, were found in seasons with A(H3) circulation. Little variability was observed in the number of influenza-positive SARI. The relationship between the number of SARI and the number of deaths requires further investigation. This work highlights the need of health surveillance systems for a better understanding of the influenza impact.
Key messages
Lower burden of influenza is found in seasons with A(H1) co-dominance. Higher burden of influenza is found in seasons with A(H3) circulation. Health surveillance systems are essential to provide data for a better understanding of the epidemiology and extent of seasonal influenza.
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Affiliation(s)
- A R Torres
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - I Kislaya
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - S Silva
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - V Gomez
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - A Machado
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - B Nunes
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - R Guiomar
- Department of Infectious Diseases, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
| | - A P Rodrigues
- Department of Epidemiology, National Health Institute Dr. Ricardo Jorge, Lisbon, Portugal
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De Freitas C, Amorim M, Leão Teles E, Maia T, Machado H, Silva S. Public preferences for involvement in the governance of health data. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Public involvement in the governance of epidemiological and public health studies can foster needs-driven research, enhance participants' recruitment, reduce attrition and improve the quality of and ethics in research and surveillance. However, it can also reinforce health inequalities if it fails to ensure public representation across socioeconomic gradients. This study aimed to assess patients' and carers' preferences for involvement in collective health data governance, and its associated factors, to strengthen the evidence base for policy development.
Methods
Between June 2019 and January 2020, 644 people (157 patients and 487 carers; participation rate=89.3%) followed at two reference centres for rare diseases in a university hospital from Northern Portugal were enrolled in an observational cross-sectional study. Data about willingness to participate in data governance was collected through four intersecting options: periodic or sporadic meetings, by either giving opinions (consultation) or participating in decision-making (deliberation). Data were analysed using descriptive and inferential statistics.
Results
From a total of 629 respondents, 39% are willing to get involved through at least one of the four participatory options and 16% do not want to participate. Patients and carers do not differ in their preferences for involvement. Sex and education are associated with willingness to participate, after adjustment for participant type (patient/carer), occupation and trust in national and international institutions (OR:1.60; 95%CI 1.05-2.45 for men vs. women and OR:1.65; 95%CI 1.07-2.56 for >12 vs. ≤12 educational years). Participants' preferred option for participation is consultative sporadic meetings (29.5%).
Conclusions
Anticipating which social groups are likely to become under-represented in participatory exercises is crucial to inform policy aimed at promoting inclusive involvement in health data governance.
Key messages
Men and higher educated participants are more willing to participate. Forecasting potential for subgroup under-representation is crucial to develop policy for inclusive participatory data governance.
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Affiliation(s)
- C De Freitas
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educa, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- CIES-IUL, Instituto Universitário de Lisboa, Lisbon, Portugal
| | - M Amorim
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - E Leão Teles
- Centro de Referencia Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - T Maia
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - H Machado
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - S Silva
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educa, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Amorim M, Silva S, Maia T, de Freitas C. Benefits and risks of sharing genetic data for research purposes: the views of patients and carers. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Public health genomics research has the potential to predict, prevent, diagnose and treat a large number of diseases. This demands access to large genomic datasets. Understanding people's motivations for and concerns with sharing genetic data is essential to promote engagement and to develop ethical, legal and social frameworks for genomic research. This study aims to assess patients' and carers' views about the benefits and risks associated with genetic data sharing for research purposes.
Methods
A cross-sectional study was performed with 157 patients and 487 carers (participation rate=89.3%) followed at two rare genetic diseases reference centres in Portugal (June 2019-January 2020). Participants selected, from five options, the two most important benefits and risks associated with sharing genetic data for research. Data were analysed using descriptive and inferential statistics.
Results
Potential to discover a cure for untreatable diseases was viewed as the most relevant benefit by patients and carers (87%), followed by the possibility to develop new drugs and treatments (46%). Lack of security and control regarding access to information was the most reported risk (63%), particularly by patients, younger participants, students and those less willing to share their data (p < 0.05). The possibility of extracting information that exceeds the research objectives was the second most reported risk (58%), specifically by carers, participants with high education, employed, with upper white-collar occupations and who were involved in patient organizations (p < 0.05).
Conclusions
Young patients' concerns about data security and control may reduce their willingness to share genetic data. Socially advantaged carers worry about their data being used for purposes other than research. Assessing patients' and carers' views about genetic data sharing is important to meet their expectations for data protection and use and to guarantee respect for their rights.
Key messages
Patients and carers expect genetic research to contribute for discovering a cure for untreatable diseases and for developing new drugs and treatments. Patients are concerned about genetic data security and control and carers are worried about their genetic data being used for purposes other than research.
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Affiliation(s)
- M Amorim
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - S Silva
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Department Ciências da Saúde Pública e Forenses, e Educ. Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - T Maia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - C de Freitas
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Department Ciências da Saúde Pública e Forenses, e Educ. Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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De Freitas C, Silva S, Leão Teles E, Maia T, Amorim M. Participation in data generation and information sharing: are patients and carers willing to engage? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Health systems are moving towards a personalisation of care. Personalised care relies on data-intensive research, which depends on active participation by citizens in data generation and information sharing. Collecting and sharing one's data for research can deliver several benefits. However, it also comes at a cost in time and effort that may burden different population subsets to varying degrees. This study aimed to assess patients' and carers' willingness to generate and share health data, and its associated factors, to inform the design of inclusive engagement strategies.
Methods
A cross-sectional study was performed with 157 patients and 487 carers (participation rate=89.3%) followed at 2 rare diseases reference centres in Portugal (06/2019-01/2020). Participants were asked about willingness to collect their health data. Those who responded yes/maybe also reported, from 0 (not willing) to 4 (always willing), on willingness to share it for the following purposes: diagnosis/treatment, non-profit research and for-profit research related to their disease and to other diseases. Data were analysed using descriptive and inferential statistics.
Results
From 567 respondents, 42.7% are willing to collect their health data, 34.7% are unsure and 22.6% do not want to participate in data generation. More educated participants, with white-collar occupations, satisfied/very satisfied with their health and those with higher social trust levels are significantly more willing to engage in data collection (p < 0.05). Participants are less prone to share information for for-profit research on their disease (Median[P25-P75]: 3.0[2.0-4.0]) or others (Median[P25-P75]: 2.0[1.0-3.0]), in particular carers (p < 0.05).
Conclusions
Participants are more willing to share information for diagnosis/treatment and non-profit research. Efforts to engage people in data generation and sharing should be directed towards disadvantaged groups to reduce biases related to skewed populations.
Key messages
Willingness to participate in data generation and sharing is influenced by social indicators. Engagement by less advantaged groups should be promoted to avoid biases related to skewed populations.
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Affiliation(s)
- C De Freitas
- EPIUnit - Institute of Public Health of University of Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- CIES-IUL, Instituto Universitário de Lisboa, Lisbon, Portugal
| | - S Silva
- EPIUnit - Institute of Public Health of University of Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - E Leão Teles
- Centro de Referencia Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - T Maia
- EPIUnit - Institute of Public Health of University of Porto, Porto, Portugal
| | - M Amorim
- EPIUnit - Institute of Public Health of University of Porto, Porto, Portugal
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