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Ansari J, Sheikh M, Riley E, Guo N, Traynor A, Carvalho B. A retrospective cohort study of the anesthetic management of postpartum tubal ligation. Int J Obstet Anesth 2024; 58:103974. [PMID: 38508961 DOI: 10.1016/j.ijoa.2023.103974] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Neuraxial anesthesia with reactivation of a labor epidural catheter is commonly utilized for postpartum tubal ligations (PPTL), although the optimal anesthetic approach is unknown. We assessed institutional anesthesia practices for PPTL, and evaluated the failure rates of reactivation of labor epidural catheters, de novo spinal anesthesia, and spinal anesthesia after failed blocks. METHODS We conducted a single-center retrospective cohort analysis of 300 consecutive patients who underwent a PPTL and 100 having spinal anesthesia for cesarean delivery. Anesthetic management data (existing labor epidural catheter reactivation, de novo spinal anesthesia or general anesthesia) were collected from electronic medical records. Anesthetic block failure rates were determined for each anesthetic technique. RESULTS The failure rate was 15% for de novo spinal anesthesia and 23% after failed reactivation of a labor epidural catheter or spinal anesthesia. The epidural catheter reactivation failure rate was 35%. The failure rate of spinal anesthesia for cesarean delivery was 4%. Drug dosage, epidural catheter use in labor, time since epidural catheter placement or delivery, labor neuraxial technique (combined spinal-epidural, epidural), supplemental top-up doses during labor, and anesthesiologist experience did not predict neuraxial anesthesia failures. CONCLUSIONS Our analysis revealed an unexpectedly high neuraxial anesthesia failure rate even when de novo spinal anesthesia was used for PPTL. The results are consistent with other institutions' recent findings, and are higher than spinal anesthesia failure rates associated with cesarean delivery. Further studies are required to determine optimal anesthesia dosing strategies, and to understand the mechanisms behind high neuraxial anesthesia failures for PPTL.
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Affiliation(s)
- J Ansari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - M Sheikh
- Department of Obstetrical and Gynecological Anesthesiology, Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - E Riley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - A Traynor
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
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2
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O'Carroll JE, Zucco L, Warwick E, Radcliffe G, Moonesinghe SR, El-Boghdadly K, Guo N, Carvalho B, Sultan P. Ethnicity, socio-economic deprivation and postpartum outcomes following caesarean delivery: a multicentre cohort study. Anaesthesia 2024; 79:486-497. [PMID: 38359531 DOI: 10.1111/anae.16241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
Disparities relating to postpartum recovery outcomes in different socio-economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio-economic status and postpartum recovery. Eligible patients were enrolled and baseline demographic, obstetric and medical history data were collected 18 h and 30 h following delivery. Patients completed postpartum quality of life and recovery measures in person on day 1 (EuroQoL EQ-5D-5L, including global health visual analogue scale; Obstetric Quality of Recovery-10 item score; and pain scores) and by telephone between day 28 and day 32 postpartum (EQ-5D-5L and pain scores). Socio-economic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Data from 1000 patients who underwent caesarean delivery were included. There were more patients of Asian, Black and mixed ethnicity in the more deprived quintiles. Patients of White ethnicities had shorter postpartum duration of hospital stay compared with patients of Asian and Black ethnicities (35 (28-56 [18-513]) h vs. 44 (31-71 [19-465]) h vs. 49 (33-75 [23-189]) h, respectively. In adjusted models at day 30, patients of Asian ethnicity had a significantly greater risk of moderate to severe pain (numerical rating scale ≥ 4) at rest and on movement (odds ratio (95%CI) 2.42 (1.24-4.74) and 2.32 (1.40-3.87)), respectively). There were no differences in readmission rates or incidence of complications between groups. Patients from White ethnic backgrounds experience shorter postpartum duration of stay compared with patients from Asian and Black ethnic groups. Ethnic background impacts pain scores and recovery at day 1 postpartum and following hospital discharge, even after adjusting for socio-economic group. Further work is required to understand the underlying factors driving differences in pain and recovery and to develop strategies to reduce disparities in obstetric patients.
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Affiliation(s)
- J E O'Carroll
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London
| | - L Zucco
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Warwick
- Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK
| | - G Radcliffe
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- University College London Hospitals, London, UK
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London
| | - K El-Boghdadly
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - N Guo
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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3
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Ciechanowicz S, Kim J, Mak K, Blake L, Carvalho B, Sultan P. Outcomes and outcome measures utilised in randomised controlled trials of postoperative caesarean delivery pain: a scoping review. Int J Obstet Anesth 2024; 57:103927. [PMID: 37852907 DOI: 10.1016/j.ijoa.2023.103927] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Inadequately treated postoperative pain following caesarean delivery can delay recovery and the ability to care for a newborn. Effectiveness studies of interventions to treat postoperative caesarean delivery pain measure different outcomes, limiting data pooling for meta-analysis. We performed a comprehensive review of existing outcomes with the aim of recommending core outcomes for future research. METHODS A scoping review to identify all outcomes reported in randomised controlled trials (RCTs) and clinical trial registries of interventions to treat or prevent postoperative caesarean delivery pain, with postoperative pain as a primary outcome measure. We searched PubMed, Web of Science, CINAHL, LILACS, Embase, CDSR and CRCT for studies from May 2016 to 2021. Outcomes were extracted and frequencies tabulated. RESULTS Ninety RCTs and 11 trial registries were included. In total, 392 outcomes (375 inpatient and 17 outpatient) were identified and categorised. The most reported outcome domain was analgesia (n = 242/375, 64.5%), reported in 96% of inpatient studies, with analgesic consumption accounting for 108/375, 28.8% of analgesia outcomes. The second most common domain was pain intensity (n = 120/375, 32%), reported in 97% of inpatient studies, using the visual analogue scale (68/120, 59%) and the numerical reporting scale (37/120, 25%). Maternal and neonatal adverse effects accounted for 65/375 (17.3%) and 19/375 (5.1%) of inpatient outcomes, respectively. CONCLUSIONS Outcomes reported in RCTs for postoperative caesarean delivery pain vary widely. The results of this review suggest that standardisation is needed to promote research efficiency and aid future meta-analyses to identify optimal postoperative caesarean delivery pain management.
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Affiliation(s)
- S Ciechanowicz
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK.
| | - J Kim
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK
| | - K Mak
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK
| | - L Blake
- University of Arkansas for the Medical Sciences, UAMS Library, Little Rock, AR, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical School, CA, USA
| | - P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical School, CA, USA
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4
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Lucas D, Carvalho B, Tuna R, Linhares P. Metabolic Syndrome and Survival in Glioblastoma Patients: Retrospective Cohort Study and Review of the Literature. Cureus 2024; 16:e53641. [PMID: 38449965 PMCID: PMC10917394 DOI: 10.7759/cureus.53641] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Several studies point to metabolic syndrome as a risk factor for the development and progression of several types of cancer. Its association with glioblastoma has yet to be determined, and only two studies investigate the impact of metabolic syndrome on the survival of glioblastoma patients, indicating a trend toward decreased survival in patients with metabolic syndrome. The aim of this study was to determine whether patients with glioblastoma and metabolic syndrome had a worse clinical outcome. Methods We retrospectively reviewed the clinical records of 180 patients diagnosed with glioblastoma. Metabolic syndrome was defined according to the American Heart Association, as the presence of at least three of the following criteria: diabetes, hypertension, hyperlipidemia, and obesity. We analyzed the overall survival and progression-free survival of patients with and without metabolic syndrome. Results Of 180 patients, 20 (11.1%) met the diagnostic criteria for metabolic syndrome. The overall survival of patients with metabolic syndrome was 19.8 months, and without metabolic syndrome was 17.7 months (p-value=0.085). The progression-free survival of patients with metabolic syndrome was 9.9 months, and without metabolic syndrome was 7.9 months (p-value=0.076). Conclusion Our results showed no prognostic relevance of metabolic syndrome in patients with glioblastoma, although there was a trend towards increased overall survival and progression-free survival in patients with metabolic syndrome.
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Affiliation(s)
- Diana Lucas
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Bruno Carvalho
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Rui Tuna
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Paulo Linhares
- Neurosurgery, Centro Hospitalar Universitário de São João, Porto, PRT
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5
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Sultan P, Guo N, Kawai M, Barwick FH, Carvalho B, Mackey S, Kallen MA, Gould CE, Butwick AJ. Prevalence and predictors for postpartum sleep disorders: a nationwide analysis. J Matern Fetal Neonatal Med 2023; 36:2170749. [PMID: 36710393 DOI: 10.1080/14767058.2023.2170749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the prevalence and predictors of postpartum sleep disorders. DESIGN A retrospective cohort study. SETTING Postpartum. POPULATION Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.
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Affiliation(s)
- P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Kawai
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - F H Barwick
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - A J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Weiniger CF, Carvalho B, Ronel I, Greenberger C, Aptekman B, Almog O, Kagan G, Shalev S. Erratum to "A randomized trial to investigate needle redirections/re-insertions using a handheld ultrasound device versus traditional palpation for spinal anesthesia in obese women undergoing cesarean delivery" [Int. J. Obstetric Anesth. 49 (2022) 103229]. Int J Obstet Anesth 2023; 56:103903. [PMID: 37516605 DOI: 10.1016/j.ijoa.2023.103903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Affiliation(s)
- C F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - I Ronel
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - C Greenberger
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - B Aptekman
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - O Almog
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - G Kagan
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - S Shalev
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Baruselli PS, de Abreu LÂ, de Paula VR, Carvalho B, Gricio EA, Mori FK, Rebeis LM, Albertini S, de Souza AH, D’Occhio M. Applying assisted reproductive technology and reproductive management to reduce CO 2-equivalent emission in dairy and beef cattle: a review. Anim Reprod 2023; 20:e20230060. [PMID: 37720728 PMCID: PMC10503887 DOI: 10.1590/1984-3143-ar2023-0060] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Methane emission from beef and dairy cattle combined contributes around 4.5-5.0% of total anthropogenic global methane. In addition to enteric methane (CH4) produced by the rumen, cattle production also contributes carbon dioxide (CO2) (feed), nitrous oxide (N2O) (feed production, manure) and other CH4 (manure) to the total greenhouse gas (GHG) budget of beef and dairy production systems. The relative contribution in standard dairy systems is typically enteric CH4 58%, feed 29% and manure 10%. Herds with low production efficiency can have an enteric CH4 contribution up to 90%. Digestibility of feed can impact CH4 emission intensity. Low fertility herds also have a greater enteric CH4 contribution. Animals with good feed conversion efficiency have a lower emission intensity of CH4/kg of meat or milk. Feed efficient heifers tend to be lean and have delayed puberty. Fertility is a major driver of profit in both beef and dairy cattle, and it is highly important to apply multi-trait selection when shifting herds towards improved efficiency and reduced CH4. Single nucleotide polymorphisms (SNPs) have been identified for feed efficiency in cattle and are used in genomic selection. SNPs can be utilized in artificial insemination and embryo transfer to increase the proportion of cattle that have the attributes of efficiency, fertility and reduced enteric CH4. Prepubertal heifers genomically selected for favourable traits can have oocytes recovered to produce IVF embryos. Reproductive technology is predicted to be increasingly adopted to reduce generation interval and accelerate the rate of genetic gain for efficiency, fertility and low CH4 in cattle. The relatively high contribution of cattle to anthropogenic global methane has focussed attention on strategies to reduce enteric CH4 without compromising efficiency and fertility. Assisted reproductive technology has an important role in achieving the goal of multiplying and distributing cattle that have good efficiency, fertility and low CH4.
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Affiliation(s)
- Pietro Sampaio Baruselli
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Laís Ângelo de Abreu
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Vanessa Romário de Paula
- Instituto Paulista de Ensino e Pesquisa, Empresa Brasileira de Pesquisa Agropecuária – EMBRAPA, Juiz de Fora, MG, Brasil
| | - Bruno Carvalho
- Instituto Paulista de Ensino e Pesquisa, Empresa Brasileira de Pesquisa Agropecuária – EMBRAPA, Juiz de Fora, MG, Brasil
| | - Emanuelle Almeida Gricio
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fernando Kenji Mori
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Lígia Mattos Rebeis
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Sofía Albertini
- Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Michael D’Occhio
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney, Australia
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8
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San-José A, Mayor P, Carvalho B, El Bizri HR, Antunes AP, Antunez Correa M, Aquino R, Bodmer RE, Boubli JP, Carvalho EAR, Campos-Silva JV, Constantino PAL, de Paula MJ, Desbiez ALJ, Fang T, Gómez-Puerta LA, Knoop SB, Longin G, Morcatty TQ, Maranhão L, Massocato GF, Munari DP, Nunes AV, Puertas P, Oliveira MA, Pezzuti JCB, Richard-Hansen C, Santos G, Valsecchi J, von Mühlen EM, Bosmediano J, Rodó X. Climate determines transmission hotspots of Polycystic Echinococcosis, a life-threatening zoonotic disease, across Pan-Amazonia. Proc Natl Acad Sci U S A 2023; 120:e2302661120. [PMID: 37549288 PMCID: PMC10438396 DOI: 10.1073/pnas.2302661120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/28/2023] [Indexed: 08/09/2023] Open
Abstract
Polycystic Echinococcosis (PE), a neglected life-threatening zoonotic disease caused by the cestode Echinococcus vogeli, is endemic in the Amazon. Despite being treatable, PE reaches a case fatality rate of around 29% due to late or missed diagnosis. PE is sustained in Pan-Amazonia by a complex sylvatic cycle. The hunting of its infected intermediate hosts (especially the lowland paca Cuniculus paca) enables the disease to further transmit to humans, when their viscera are improperly handled. In this study, we compiled a unique dataset of host occurrences (~86000 records) and disease infections (~400 cases) covering the entire Pan-Amazonia and employed different modeling and statistical tools to unveil the spatial distribution of PE's key animal hosts. Subsequently, we derived a set of ecological, environmental, climatic, and hunting covariates that potentially act as transmission risk factors and used them as predictors of two independent Maximum Entropy models, one for animal infections and one for human infections. Our findings indicate that temperature stability promotes the sylvatic circulation of the disease. Additionally, we show how El Niño-Southern Oscillation (ENSO) extreme events disrupt hunting patterns throughout Pan-Amazonia, ultimately affecting the probability of spillover. In a scenario where climate extremes are projected to intensify, climate change at regional level appears to be indirectly driving the spillover of E. vogeli. These results hold substantial implications for a wide range of zoonoses acquired at the wildlife-human interface for which transmission is related to the manipulation and consumption of wild meat, underscoring the pressing need for enhanced awareness and intervention strategies.
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Affiliation(s)
- Adrià San-José
- Climate and Health Program, ISGlobal, Barcelona08003, Spain
| | - Pedro Mayor
- Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, Bellaterra08193, España
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
| | - Bruno Carvalho
- Climate and Health Program, ISGlobal, Barcelona08003, Spain
| | - Hani R. El Bizri
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- School of Science, Engineering and Environment, University of Salford, SalfordM5 4WT, United Kingdom
| | - André Pinassi Antunes
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Instituto Nacional de Pesquisas da Amazônia, Manaus, Amazonas69067-375, Brazil
| | - Miguel Antunez Correa
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
- Programa Putumayo Amazonas, Instituto del Bien Común, Loreto15072, Perú
| | - Rolando Aquino
- Instituto de Investigaciones de Trópico y de Altura, Universidad Nacional Mayor de San Marcos, Iquitos575, Peru
| | - Richard E. Bodmer
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
| | - Jean P. Boubli
- School of Science, Engineering and Environment, University of Salford, SalfordM5 4WT, United Kingdom
| | - Elildo A. R. Carvalho
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Centro Nacional de Pesquisa e Conservação de Mamíferos Carnívoros, Instituto Chico Mendes de Conservação da Biodiversidade, Atibaia, SP12952-011, Brazil
| | | | - Pedro A. L. Constantino
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- US Forest Service - International Programs1 Thomas Circle NW, Suite 400, Washington, DC20005
| | - Milton José de Paula
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Instituto Federal de Educação Ciência e Tecnologia do Pará, Altamira, Pará68377-630, Brazil
| | - Arnauld L. J. Desbiez
- Instituto de Conservação de Animais Silvestres, Campo Grande, Mato Grosso do Sul79040-290, Brazil
| | - Tula Fang
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
| | - Luis A. Gómez-Puerta
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima01, Peru
| | - Simon B. Knoop
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
| | - Guillaume Longin
- Parc Amazonien de Guyane, Maripasoula, French Guiana97370, France
| | - Thais Q. Morcatty
- Oxford Wildlife Trade Research Group, Oxford Brookes University, OxfordOX3 0BP, United Kingdom
| | - Louise Maranhão
- Research Group on Terrestrial Vertebrate Ecology, Mamirauá Sustainable Development Institute, Tefé, Amazonas69553-225, Brasil
| | - Gabriel Favero Massocato
- Instituto Federal de Educação Ciência e Tecnologia do Pará, Altamira, Pará68377-630, Brazil
- Instituto de Conservação de Animais Silvestres, Campo Grande, Mato Grosso do Sul79040-290, Brazil
| | - Daniel P. Munari
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
| | - André Valle Nunes
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Laboratory of Biodiversity Monitoring and Food Security, Knowledge Center on Biodiversity, Belo Horizonte31270-901, Brazil
| | - Pablo Puertas
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
| | - Marcela A. Oliveira
- Comunidad de Manejo de Fauna Silvestre en la Amazonía y en Latinoamérica, Iquitos16002, Peru
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Centro Universitário Aparício Carvalho, Porto Velho76811-678, Brasil
- Programa de Pós-Graduação em Conservação e Uso de Recursos Naturais, Universidade Federal de Rondônia, Porto Velho76800-000, Brasil
| | - Juarez C. B. Pezzuti
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Núcleo de Altos Estudos Amazônicos, Universidade Federal do Pará, Belém66075110, Brasil
| | - Cécile Richard-Hansen
- Service Espèces à Enjeux, Direction de la Recherche et Appui Scientifique, Office Français de la Biodiversité/Unité Mixte de Recherche Ecologie des Forêts de Guyane, Kourou, French Guiana97310, France
| | - Geovanna Santos
- Centro Universitário São Lucas, Porto Velho, Rondônia76805-846, Brazil
| | - João Valsecchi
- Rede de Pesquisa em Biodiversidade, Conservação e Uso da Fauna da Amazônia, Manaus69067-375, Brasil
- Research Group on Terrestrial Vertebrate Ecology, Mamirauá Sustainable Development Institute, Tefé, Amazonas69553-225, Brasil
| | | | - John Bosmediano
- Departamento de Ciencias e Ingeniería, Universidad Científica de Perú, Iquitos16007, Peru
| | - Xavier Rodó
- Climate and Health Program, ISGlobal, Barcelona08003, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona08010, Spain
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9
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O'Carroll JE, Zucco L, Warwick E, Arbane G, Moonesinghe SR, El-Boghdadly K, Guo N, Carvalho B, Sultan P. Quality of recovery following childbirth: a prospective, multicentre cohort study. Anaesthesia 2023. [PMID: 37226593 DOI: 10.1111/anae.16039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/26/2023]
Abstract
To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK-based multicentre cohort study. This study was performed during a 2-week period in October 2021 to assess in- and outpatient post-delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10-item measure (ObsQoR-10); EuroQoL (EQ-5D-5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self-reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5-61.0 [17.7-513.4]), 40.3 (28.5-59.1 [17.8-220.9]), and 35.9 (27.1-54.1 [17.9-188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR-10 score was 75 ([62-86] 4-100) on day 1, with the lowest ObsQoR-10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.
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Affiliation(s)
- J E O'Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - L Zucco
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Warwick
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, NHS Foundation Trust, London, UK
| | - G Arbane
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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10
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Alves B, Peixoto J, Macedo S, Pinheiro J, Carvalho B, Soares P, Lima J, Lima RT. High VEGFA Expression Is Associated with Improved Progression-Free Survival after Bevacizumab Treatment in Recurrent Glioblastoma. Cancers (Basel) 2023; 15:cancers15082196. [PMID: 37190125 DOI: 10.3390/cancers15082196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Glioblastoma (GB) is one of the deadliest human cancers. Many GB patients do not respond to treatment, and inevitably die within a median of 15-18 months post-diagnosis, highlighting the need for reliable biomarkers to aid clinical management and treatment evaluation. The GB microenvironment holds tremendous potential as a source of biomarkers; several proteins such as MMP-2, MMP-9, YKL40, and VEGFA have been identified as being differentially expressed in GB patient samples. Still to date, none of these proteins have been translated into relevant clinical biomarkers. This study evaluated the expression of MMP-2, MMP-9, YKL40, and VEGFA in a series of GBs and their impact on patient outcome. High levels of VEGFA expression were significantly associated with improved progression-free survival after bevacizumab treatment, thus having potential as a tissue biomarker for predicting patients' response to bevacizumab. Noteworthily, VEGFA expression was not associated with patient outcome after temozolomide treatment. To a lesser extent, YKL40 also provided significant information regarding the extent of bevacizumab treatment. This study highlights the importance of studying secretome-associated proteins as GB biomarkers and identifies VEGFA as a promising marker for predicting response to bevacizumab.
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Affiliation(s)
- Bárbara Alves
- i3S-Instituto de Investigação e Inovação em Saúde, 4200 Porto, Portugal
- Cancer Signalling & Metabolism Group, IPATIMUP, Institute of Molecular Pathology and Immunology of the University of Porto, 4200 Porto, Portugal
- School of Allied Health Sciences, Polytechnic Institute of Porto, 4200 Porto, Portugal
| | - Joana Peixoto
- i3S-Instituto de Investigação e Inovação em Saúde, 4200 Porto, Portugal
- Cancer Signalling & Metabolism Group, IPATIMUP, Institute of Molecular Pathology and Immunology of the University of Porto, 4200 Porto, Portugal
| | - Sofia Macedo
- i3S-Instituto de Investigação e Inovação em Saúde, 4200 Porto, Portugal
- Cancer Signalling & Metabolism Group, IPATIMUP, Institute of Molecular Pathology and Immunology of the University of Porto, 4200 Porto, Portugal
| | - Jorge Pinheiro
- Department of Pathology, Centro Hospitalar Universitário S. João, 4200 Porto, Portugal
| | - Bruno Carvalho
- Department of Neurosurgery, Centro Hospitalar Universitário S. João, 4200 Porto, Portugal
- FMUP-Faculty of Medicine of the University of Porto, 4200 Porto, Portugal
| | - Paula Soares
- i3S-Instituto de Investigação e Inovação em Saúde, 4200 Porto, Portugal
- Cancer Signalling & Metabolism Group, IPATIMUP, Institute of Molecular Pathology and Immunology of the University of Porto, 4200 Porto, Portugal
- Department of Pathology, FMUP-Faculty of Medicine of the University of Porto, 4200 Porto, Portugal
| | - Jorge Lima
- i3S-Instituto de Investigação e Inovação em Saúde, 4200 Porto, Portugal
- Cancer Signalling & Metabolism Group, IPATIMUP, Institute of Molecular Pathology and Immunology of the University of Porto, 4200 Porto, Portugal
- Department of Pathology, FMUP-Faculty of Medicine of the University of Porto, 4200 Porto, Portugal
| | - Raquel T Lima
- i3S-Instituto de Investigação e Inovação em Saúde, 4200 Porto, Portugal
- Cancer Signalling & Metabolism Group, IPATIMUP, Institute of Molecular Pathology and Immunology of the University of Porto, 4200 Porto, Portugal
- Department of Pathology, FMUP-Faculty of Medicine of the University of Porto, 4200 Porto, Portugal
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11
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Carvalho B, dos Santos P, da Silva G, Senes C, Visentainer J, Santos O. Validation of an Analytical Method by Headspace Gas Chromatography with Flame Ionization and Evaluation of Matrix Effect of Volatile Compounds in Cat Food. J BRAZIL CHEM SOC 2023. [DOI: 10.21577/0103-5053.20230026] [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: 03/02/2023] Open
Abstract
This study describes the validation of a headspace gas chromatography with flame ionization (HS-GC-FID) method for the determination of propanal, pentanal, hexanal, octanal, and trans-2-nonenal originated by lipid oxidation from cat food samples, as well as the evaluation of the matrix effect in the results. This method was applied to the analysis of commercial cat food and proved to be suitable for the determination of these volatile compounds in different samples. Mean recoveries between 88 and 109% were obtained and repeatability expressed as relative standard deviation was always lower than 6.95%. The intra- and inter-assay precisions ranged from 0.44 to 20.88% and from 0.45 to 20.52%, respectively. In addition, the matrix effect of cat food samples was determined by comparing the slopes of the standard addition method, and the external calibration curve and its influences were verified. These results highlight the high potential of this method, which allows the determination of lipid oxidation products in cat food samples directly, without requiring prior sample preparation techniques.
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Wisse PHA, de Klaver W, van Wifferen F, Meiqari L, Bierkens M, Greuter MJE, Carvalho B, van Leerdam ME, Spaander MCW, Dekker E, Coupé VMH, de Wit M, Meijer GA. The multitarget fecal immunochemical test versus the fecal immunochemical test for programmatic colorectal cancer screening: a cross-sectional intervention study with paired design. BMC Cancer 2022; 22:1299. [PMID: 36503495 PMCID: PMC9743627 DOI: 10.1186/s12885-022-10372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many screening programs for colorectal cancer (CRC) use the fecal immunochemical test (FIT) to triage individuals for colonoscopy. Although these programs reduce CRC incidence and CRC-related mortality, the detection of advanced precursor lesions (advanced adenomas and advanced serrated polyps) by FIT could be improved. As an alternative for FIT, the antibody-based multitargetFIT (mtFIT) has been proposed. The mtFIT measures three protein markers: hemoglobin, calprotectin, and serpin family F member 2. In a retrospective diagnostic accuracy study in a large colonoscopy-controlled series (n = 1284), mtFIT showed increased sensitivity for advanced neoplasia (AN), at equal specificity, compared to FIT (42.9% versus 37.3%; p = 0.025). This increase was mainly due to a higher sensitivity of mtFIT for advanced adenomas (37.8% versus 28.1% for FIT; p = 0.006). The present mtFIT study aims to prospectively validate these findings in the context of the Dutch national CRC screening program. METHOD The mtFIT study is a cross-sectional intervention study with a paired design. Eligible subjects for the Dutch FIT-based national CRC screening program are invited to perform mtFIT in addition to FIT. Samples are collected at home, from the same bowel movement, and are shipped to a central laboratory by postal mail. If either one or both tests are positive, participants are referred for colonoscopy. Detailed colonoscopy and pathology data are centrally stored in a national screening database (ScreenIT; Topicus, Deventer, the Netherlands) that is managed by the screening organization, and will be retrieved for this study. We aim to determine the relative sensitivity for AN, comprising of CRC, advanced adenomas and advanced serrated polyps, of mtFIT compared to FIT at an equal positivity rate. Additionally, we will use the Adenoma and Serrated Pathway to Colorectal CAncer model to predict lifetime health effects and costs for programmatic mtFIT- versus FIT-based screening. The target sample size is 13,131 participants. DISCUSSION The outcome of this study will inform on the comparative clinical utility of mtFIT versus FIT in the Dutch national CRC screening program and is an important step forward in the development of a new non-invasive stool test for CRC screening. TRIAL REGISTRATION Clinicaltrials.gov ; NCT05314309, registered April 6th 2022, first inclusions March 25th 2022 https://clinicaltrials.gov/ct2/results?cond=&term=NCT05314309&cntry=&state=&city=&dist =.
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Affiliation(s)
- P. H. A. Wisse
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX the Netherlands ,grid.5645.2000000040459992XDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, GD 3015 the Netherlands
| | - W. de Klaver
- grid.5645.2000000040459992XDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, GD 3015 the Netherlands ,grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, AZ 1105 the Netherlands
| | - F. van Wifferen
- grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, HV 1081 the Netherlands
| | - L. Meiqari
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX the Netherlands
| | - M. Bierkens
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX the Netherlands
| | - M. J. E. Greuter
- grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, HV 1081 the Netherlands
| | - B. Carvalho
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX the Netherlands
| | - M. E. van Leerdam
- grid.430814.a0000 0001 0674 1393Department of Gastro-intestinal Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX 1066 the Netherlands
| | - M. C. W. Spaander
- grid.5645.2000000040459992XDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, GD 3015 the Netherlands
| | - E. Dekker
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, AZ 1105 the Netherlands
| | - V. M. H. Coupé
- grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, HV 1081 the Netherlands
| | - M. de Wit
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX the Netherlands
| | - G. A. Meijer
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX the Netherlands
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Ciechanowicz S, Pandal P, Carvalho B, Blake L, Van Damme S, Taylor J, Sultan P. Assessment of fatigue in postpartum women using patient-reported outcome measures: a systematic review utilising Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Fatigue: Biomedicine, Health & Behavior 2022. [DOI: 10.1080/21641846.2022.2142030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. Ciechanowicz
- Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK
| | - P. Pandal
- Clinical Research Associate, Stanford University School of Medicine, Stanford, CA, USA
| | - B. Carvalho
- Stanford University School of Medicine, Stanford, CA, USA
| | - L. Blake
- UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S. Van Damme
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - J. Taylor
- Faculty of Health, University of Canberra, Canberra, Australia
| | - P. Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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14
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Bastos AGP, Carvalho B, Silva R, Leitão D, Linhares P, Vaz R, Lima J. Endoglin (CD105) and proliferation index in recurrent glioblastoma treated with anti-angiogenic therapy. Front Oncol 2022; 12:910196. [PMID: 36147918 PMCID: PMC9486379 DOI: 10.3389/fonc.2022.910196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction CD105 is an angiogenic biomarker that is useful to determine the microvessel density (MVD) within a tumor, namely, in highly vascularized tumors like glioblastoma (GBM). However, its expression has shown inconsistent associations with the prognosis of GBM patients. The aim of this study was to evaluate the value of MVD-CD105 (microvessel density assessed with anti-CD105 antibody) and Ki-67 (proliferation index marker) as prognostic and therapy response biomarkers, specifically in primary tumors and in recurrent tumoral specimens of a cohort of GBM patients treated with bevacizumab upon recurrence. Materials and methods We conducted a retrospective study of 102 consecutive GBM patients treated with bevacizumab upon recurrence at CHUSJ between 2010 and 2017. Demographic, clinical, and survival data of all patients were collected and analyzed. The tissue expression of MVD-CD105 and Ki-67 in primary and recurrent specimens was correlated with progression-free survival after temozolomide (PFS-1), progression-free survival after bevacizumab (PFS-2), and overall survival (OS). Results The immunohistochemical expression score for MVD-CD105 was similar in primary and recurrent tumoral specimens (mean scores of 15 and 16, respectively). Likewise, the mean Ki-67 expression was similar in primary (mean of 31% of tumor cells) and recurrent tumoral specimens (mean of 29% of tumor cells). MVD-CD105 expression in primary tumors had no impact on PFS-1, PFS-2, or OS. At recurrence, patients whose tumors showed increased MVD-CD105 had worse median PFS-2 (2 vs. 8 months, p = 0.045) and OS (17 vs. 26 months, p = 0.007) compared to those whose tumors showed lower MVD-CD105. CD105 tumoral pattern and localization had no impact on prognosis. Ki-67 expression was not associated with differences in survival outcomes. Conclusion In this study, higher MVD-CD105 expression in recurrent GBM patients seems to be associated with a worse PFS-2 and OS while portending no prognostic significance in the primary tumors. This highlights the importance of keeping track of the molecular evolution of the tumor over the course of the disease.
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Affiliation(s)
| | - Bruno Carvalho
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurosurgery, Centro Hospitalar Universitário S. João, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), R. Alfredo Allen Porto, Porto, Portugal
- *Correspondence: Bruno Carvalho,
| | - Roberto Silva
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Dina Leitão
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Paulo Linhares
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurosurgery, Centro Hospitalar Universitário S. João, Porto, Portugal
- Neurosciences Center-CUF Hospital, Porto, Portugal
| | - Rui Vaz
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurosurgery, Centro Hospitalar Universitário S. João, Porto, Portugal
- Neurosciences Center-CUF Hospital, Porto, Portugal
| | - Jorge Lima
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), R. Alfredo Allen Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
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Mathias LAST, Carlos RV, Siaulys MM, Gabriades P, Guo N, Domingue B, O'Carroll J, Carvalho B, Sultan P. Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese). Anaesth Crit Care Pain Med 2022; 41:101085. [PMID: 35487408 DOI: 10.1016/j.accpm.2022.101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties. METHODS After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24 h (±6 h) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese. RESULTS One hundred thirteen enrolled women completed the surveys at 24 h and 29 women at 25 h (100% response rate). VALIDITY (i) convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r = -0.587) and GHVAS score (r = 0.568) at 24 h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p < 0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r = 0.191; p = 0.043). (iv) Cross-cultural validity: differential item functioning analysis suggested bias in 2 items. Reliability: (i) internal consistency was good (Cronbach's alpha = 0.82 and inter-item correlation = 0.31). (ii) Split-half reliability was very good (Spearman-Brown Prophesy Reliability Estimate = 0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient = 0.87). (iv) Floor and ceiling effects: < 5% women scored either 0 or 100 (lowest and highest scores, respectively). CONCLUSION ObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.
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Affiliation(s)
- L A S T Mathias
- Department of Anesthesiology, Pro Matre Paulista, Grupo Santa Joana, Sao Paulo, SP, Brazil
| | - R V Carlos
- Department of Anesthesiology, Pro Matre Paulista, Grupo Santa Joana, Sao Paulo, SP, Brazil; Department of Anesthesiology, Universidade de Sao Paulo, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil
| | | | - P Gabriades
- Department of Anesthesiology, Pro Matre Paulista, Grupo Santa Joana, Sao Paulo, SP, Brazil
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Domingue
- Graduate School of Education, Stanford University, USA
| | - J O'Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Ortner C, Padilla C, Carvalho B. Cardiac ultrasonography in obstetrics – a necessary skill for the present and future anesthesiologist. Int J Obstet Anesth 2022; 50:103545. [DOI: 10.1016/j.ijoa.2022.103545] [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] [Received: 01/07/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
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17
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O'Carroll J, Zucco L, Warwick E, Guo N, Carvalho B, Sultan P. O.3 Quality standards in obstetric anaesthesia - national adherence to key indicators for quality improvement in obstetric units. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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O'Carroll J, Zucco L, Warwick E, Guo N, Carvalho B, Sultan P. P.63 A multicentre evaluation of quality of recovery following caesarean delivery. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ribeiro BB, Pereira RD, Vaz R, Carvalho B, Pereira NR. Nonemergent craniotomy surgical site infection: a retrospective cohort study. Porto Biomed J 2022; 7:e152. [PMID: 38304161 PMCID: PMC10830068 DOI: 10.1097/j.pbj.0000000000000152] [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: 07/09/2020] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of surgical site infection after craniotomy (SSI-CRAN) varies widely and is associated with major consequences. The aim of this study is to estimate the SSI-CRAN rate at the neurosurgery department of a tertiary center and to establish its risk factors. Methods All consecutive adult patients who underwent elective craniotomy for tumor resection at a tertiary center from January 2018 to October 2019 were retrospectively assessed. Demographic, clinical, and surgical data were collected. The main outcome of our study was the development of SSI within 30days postsurgery, as defined by the European Centre for Disease Prevention and Control guidelines. Univariate and multivariate analyses were performed to establish risk factors for SSI-CRAN. Results From the 271 patients enrolled in this study, 15 (5.5%) developed SSI-CRAN within 30days postsurgery, 11 (73.3%) of which were organ-space. The most common causative microorganisms isolated were gram-positive cocci, particularly Staphylococcus epidermidis (n = 4, 66.7%). In the univariate analysis, absence of normothermia and cerebrospinal fluid (CSF) leak were associated with SSI-CRAN. In the multivariate analysis, normothermia was the only protective factor and CSF leak was the only independent risk factor for SSI-CRAN. Conclusion The cumulative incidence of SSI-CRAN within 30days postsurgery was 5.5%. CSF leak and the absence of normothermia were the only independent risk factors for SSI-CRAN. The data provided in this study should be considered in the design of preventive strategies aimed to reduce the incidence of SSI.
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Affiliation(s)
| | - Raquel Duro Pereira
- Antimicrobial Resistance and Infection Prevention and Control Unit, Epidemiology Centre, Centro Hospitalar Universitário São João
- Infectious Diseases Department, Centro Hospitalar Universitário São João
| | - Rui Vaz
- Faculty of Medicine, University of Porto
- Neurosurgery Department, Centro Hospitalar Universitário São João
- Neurosciences Centre, CUF Hospital
| | - Bruno Carvalho
- Faculty of Medicine, University of Porto
- Neurosurgery Department, Centro Hospitalar Universitário São João
| | - Nuno Rocha Pereira
- Antimicrobial Resistance and Infection Prevention and Control Unit, Epidemiology Centre, Centro Hospitalar Universitário São João
- Infectious Diseases Department, Centro Hospitalar Universitário São João
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
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O’Carroll J, Carvalho B, Sultan P. Enhancing recovery after cesarean delivery – A narrative review. Best Pract Res Clin Anaesthesiol 2022; 36:89-105. [DOI: 10.1016/j.bpa.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
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21
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Antunes RNS, Fukasawa JT, Aguiar DC, Messias MBBF, Rodrigues GH, Costardi JVV, Carvalho B. DETECÇÃO DE INFILTRAÇÃO RETINIANA EM PACIENTE COM LEUCEMIA LINFOCÍTICA AGUDA (LLA) POR CITOMETRIA DE FLUXO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.261] [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: 11/29/2022] Open
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22
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Weiniger CF, Carvalho B, Ronel I, Greenberger C, Aptekman B, Almog O, Kagan G, Shalev S. A randomized trial to investigate needle redirections/re-insertions using a handheld ultrasound device versus traditional palpation for spinal anesthesia in obese women undergoing cesarean delivery. Int J Obstet Anesth 2021; 49:103229. [PMID: 34670725 DOI: 10.1016/j.ijoa.2021.103229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/05/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasound may be useful to identify the spinal anesthesia insertion point, particularly when landmarks are not palpable. We tested the hypothesis that the number of needle redirections/re-insertions is lower when using a handheld ultrasound device compared with palpation in obese women undergoing spinal anesthesia for cesarean delivery. METHODS Study recruits were obese (body mass index (BMI) >30 kg/m2) women with impalpable bony landmarks who were undergoing spinal anesthesia for elective cesarean delivery. Women were randomized to ultrasound or palpation. The primary study outcome was a composite between-group comparison of total number of needle redirections (any withdrawal and re-advancement of the needle and/or introducer within the intervertebral space) or re-insertions (any new skin puncture in the same or different intervertebral space) per patient. Secondary outcomes included insertion site identification time and patient verbal numerical pain score (0-10) for comfort during surgical skin incision. RESULTS Forty women completed the study. The mean BMI (standard deviation) for the ultrasound group was 39.8 (5.5) kg/m2 and for the palpation group 37.3 (5.2) kg/m2. There was no difference in the composite primary outcome (median (interquartile range) [range]) between the ultrasound group (4 (2-13) [2-22]) and the (6 (4-10) [1-17]) palpation group (P=0.22), with the 95% confidence interval of the difference 2 (-1.7 to 5.7). There were no differences in the secondary outcomes. CONCLUSIONS Handheld ultrasound did not demonstrate any advantages over traditional palpation techniques for spinal anesthesia in an obese population undergoing cesarean delivery, although the study was underpowered to show a difference.
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Affiliation(s)
- C F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - I Ronel
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - C Greenberger
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - B Aptekman
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - O Almog
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - G Kagan
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - S Shalev
- Division of Anesthesia, Critical Care and Pain, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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23
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Sultan P, Jensen SE, Taylor J, El-Sayed Y, Carmichael S, Cella D, Angst MS, Gaudilliere B, Lyell DJ, Carvalho B. Proposed domains for assessing postpartum recovery: a concept elicitation study. BJOG 2021; 129:9-20. [PMID: 34536324 DOI: 10.1111/1471-0528.16937] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To propose postpartum recovery domains. DESIGN Concept elicitation study. SETTING Semi-structured interviews. POPULATION Ten writing committee members and 50 stakeholder interviews (23 postpartum women, nine general obstetricians, five maternal and fetal medicine specialists, eight nurses and five obstetric anaesthetists). METHODS Alternating interviews and focus group meetings until concept saturation was achieved (no new themes discussed in three consecutive interviews). Interviews were digitally recorded and transcribed, and an iterative coding process was used to identify domains. MAIN OUTCOME MEASURES The primary outcome was to identify recovery domains. We also report key symptoms and concerns. Discussion frequency and importance scores (0-100; 0 = not important; 100 = vitally important to recovery) were used to rank domains. Discussion frequency was used to rank factors helping and hindering recovery, and to determine the greatest challenges experienced postpartum. RESULTS Thirty-four interviews and two focus group meetings were performed. The 13 postpartum recovery domains identified, (ranked highest to lowest) were: psychosocial distress, surgical/medical factors, infant feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance, sexual function and cognition. The most frequently discussed factors facilitating postpartum recovery were: family support, lactation/breastfeeding support and partner support. The most frequently discussed factor hindering recovery was inadequate social support. The most frequent challenges reported were: breastfeeding (week 1), breastfeeding (week 3) and sleep (week 6). CONCLUSIONS We propose 13 domains that comprehensively describe recovery in women delivering in a single centre within the USA. This provides a novel framework to study the postpartum recovery process. TWEETABLE ABSTRACT We propose 13 postpartum recovery domains that provide a framework to study the recovery process following childbirth.
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Affiliation(s)
- P Sultan
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - S E Jensen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Taylor
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - S Carmichael
- Pediatrics, Obstetrics and Gynecology and Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - D Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M S Angst
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - B Gaudilliere
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - D J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
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24
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Vassallo F, França R, Lovatto CV, Carvalho B, Cardoso A, Cunha CLD. Percutaneous Treatment to Inferior Vena Cava Perforation by Intracardiac Echocardiography Catheter after an Unsuccessful Conservative Approach. J Cardiac Arrhtythmias 2021. [DOI: 10.24207/jca.v34i2.3450] [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: 11/19/2022] Open
Abstract
Catheter ablation is a well-established treatment for drug refractory arrhythmia, and intracardiac echocardiography is one of the tools used for this purpose. Despite a high volume of procedures performed worldwide, the incidence of vascular complications is still very low. We describe a case report of a percutaneous treatment to an inferior vena cava perforation by an intracardiac echocardiogram catheter after the failure of a conservative approach.
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25
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Sultan P, Ando K, Sultan E, Hawkins J, Blake L, Barwick F, Kawai M, Carvalho B. A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Sleep 2021; 44:6278483. [PMID: 34013345 DOI: 10.1093/sleep/zsab128] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women. METHODS We searched 4 databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least 1 psychometric measurement property of a PROM. An overall rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM. RESULTS We identified 15 validation studies of 8 PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by 5 PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS) and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for non-commercial research, that achieved a Class A recommendation. CONCLUSION The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.
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Affiliation(s)
- P Sultan
- Associate Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - K Ando
- Assistant Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - E Sultan
- Clinical Instructor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - J Hawkins
- Medical Student. Stanford University School of Medicine, Stanford, CA, USA
| | - L Blake
- Associate Professor. UAMS Medical Library, UAMS, Little Rock, AR, USA SCIENC ES
| | - F Barwick
- Clinical Associate Professor, Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine
| | - M Kawai
- Clinical Associate Professor, Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine
| | - B Carvalho
- Professor. Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
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26
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Bandeira Farias MPC, Carvalho B, Neto A. Profile of Intestinal Microbiota and Anxiety Level in Overweight Children and Adolescents. J Endocr Soc 2021. [PMCID: PMC8265708 DOI: 10.1210/jendso/bvab048.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Justification: Obesity is considered a worldwide epidemic, with a significant increase in its prevalence in the last 30 years in both children and adolescents. Anxiety disorders can be considered both a cause and a consequence of obesity. The intestinal microbiota has been identified as a participant in the inflammatory process of both obesity and depression / anxiety disorders. Objective: Describe and compare the intestinal microbiota profile of overweight/obese children/teenagers with and without signs of anxiety. METHODOLOGICAL PROCEDURES: descriptive, observational, cross-sectional study with an analytical character (comparison of groups), carried out during the months of January to October of the year 2019. 30 overweight/obesity children/teenagers (BMI greater than P85 – WHO 2007), between seven and 17 years old, convenience sampling. None of the participants had taken antibiotics during the past eight weeks of participation on the study or had chronic or endocrine disease that was not being adequately treated. The participants were divided into two groups: the first group consists of children/adolescents with excess weight without signs of anxiety (n 16) and the second group consists of children/adolescents with excess weight with signs of anxiety (n 14), assessed by a Screen for Child Anxiety Related Emotional Disorders (SCARED) screening questionnaire. Results: The group with signs of anxiety showing higher HOMA IR compared to the group without signs of anxiety with values of 5.05 ± 2.08 and 3.47 ± 1.6 (p = 0.041), respectively. There was a statistically significant difference for beta diversity of the intestinal microbiota profile using the CHAO method (p = 0.025) and the Jackknife method (p = 0.01) between the groups with signs of anxiety and without signs of anxiety. Conclusion: difference was found between the intestinal microbiota diversity of obese children / adolescents with signs of anxiety in relation to the intestinal microbiota diversity of obese children / adolescents without signs of anxiety. This finding suggests a possible involvement of the imbalance of the intestinal microbiota with anxiety disorders and depression in children/adolescents with weight excess.
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27
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Valente Aguiar P, Carvalho B, Monteiro P, Linhares P, Camacho Ó, Vaz R. Hyperbaric oxygen treatment: Results in seven patients with severe bacterial postoperative central nervous system infections and refractory mucormycosis. Diving Hyperb Med 2021; 51:86-93. [PMID: 33761547 DOI: 10.28920/dhm51.1.86-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/08/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Resistant bacterial infections following brain and spine surgery and spontaneous mucormycosis with central nervous system (CNS) involvement represent a serious treatment challenge and more efficient therapeutic approaches ought to be considered. Hyperbaric oxygen treatment (HBOT) has shown promise as a complementary therapy. This case series evaluated whether HBOT contributed to infection resolution in seven patients with refractory CNS infectious conditions. METHODS Clinical results for seven patients referred for HBOT between 2010 to 2018 to treat refractory postoperative brain and spine infections or spontaneously developing mucormycosis were retrospectively analysed. The patients' clinical files and follow-up consultations were reviewed to assess evolution and outcome. RESULTS Seven patients were referred with a median age of 56 years. The median follow-up was 20 months. Four patients had postoperative infections and three had rhino-orbital-cerebral mucormycosis (ROCM). HBOT was used as an adjunctive treatment to antimicrobial therapy in all patients. Prior to HBOT, all patients had undergone an average of four operations due to infection refractoriness and had completed an average of five months of antimicrobial therapy. After HBOT, infection resolution was obtained in six patients without additional operations, while one patient with ROCM stopped HBOT after the third session due to intolerance. Three patients stopped antimicrobial therapy while four were maintained on prophylactic treatment. CONCLUSIONS Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.
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Affiliation(s)
- Pedro Valente Aguiar
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal.,Corresponding author: Dr Pedro D Valente Aguiar, Department of Neurosurgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal,
| | - Bruno Carvalho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal
| | - Pedro Monteiro
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal
| | - Paulo Linhares
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal.,Neurosciences Centre, Hospital CUF, Oporto, Portugal
| | - Óscar Camacho
- Hyperbaric Medical Unit, Unidade Local de Saúde de Matosinhos, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Faculty of Medicine, Oporto University, Oporto, Portugal.,Neurosciences Centre, Hospital CUF, Oporto, Portugal
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Carvalho B, Lopes JM, Silva R, Peixoto J, Leitão D, Soares P, Fernandes AC, Linhares P, Vaz R, Lima J. The role of c-Met and VEGFR2 in glioblastoma resistance to bevacizumab. Sci Rep 2021; 11:6067. [PMID: 33727583 PMCID: PMC7966794 DOI: 10.1038/s41598-021-85385-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Dismal prognosis of glioblastoma (GBM) prompts for the identification of response predictors and therapeutic resistance mechanisms of current therapies. The authors investigated the impact of c-Met, HGF, VEGFR2 expression and microvessel density (MVD) in GBM patients submitted to second-line chemotherapy with bevacizumab. Immunohistochemical expression of c-Met, HGF, VEGFR2, and MVD was assessed in tumor specimens of GBM patients treated with bevacizumab, after progression under temozolomide. Survival analysis was evaluated according to the expression of the aforementioned biomarkers. c-Met overexpression was associated with a time-to-progression (TTP) after bevacizumab of 3 months (95% CI, 1.5-4.5) compared with a TTP of 7 months (95% CI, 4.6-9.4) in patients with low or no expression of c-Met (p = 0.05). VEGFR2 expression was associated with a TTP after bevacizumab of 3 months (95% CI, 1.8-4.2) compared with a TTP of 7 months (95% CI, 5.7-8.3) in patients with no tumoral expression of VEGFR2 (p = 0.009). Concomitant c-Met/VEGFR2 overexpression was associated with worse overall survival (13 months) compared with concomitant c-Met/VEGFR2 negative expression (19 months; p = 0.025). Our data support the hypothesis that c-Met and VEGFR2 overexpression have a role in the development of glioblastoma early resistance and might predict poorer responses to anti-angiogenic therapies.
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Affiliation(s)
- Bruno Carvalho
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Department of Neurosurgery, Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Instituto de Investigação E Inovação Em Saúde (i3S), Porto, Portugal. .,Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal.
| | - José Manuel Lopes
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Pathology, Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Investigação E Inovação Em Saúde (i3S), Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - Roberto Silva
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Pathology, Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Joana Peixoto
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Investigação E Inovação Em Saúde (i3S), Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - Dina Leitão
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Paula Soares
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Investigação E Inovação Em Saúde (i3S), Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - Ana Catarina Fernandes
- Department of Oncology, Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Paulo Linhares
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Neurosurgery, Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Neurosciences Center-CUF Hospital, Estrada da Circunvalação 14341, 4100-180, Porto, Portugal
| | - Rui Vaz
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Neurosurgery, Centro Hospitalar Universitário S. João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Neurosciences Center-CUF Hospital, Estrada da Circunvalação 14341, 4100-180, Porto, Portugal
| | - Jorge Lima
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Instituto de Investigação E Inovação Em Saúde (i3S), Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
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Sultan P, Carvalho B. Pain after vaginal delivery and during breastfeeding: underexplored and underappreciated. Int J Obstet Anesth 2021; 46:102969. [PMID: 33794439 DOI: 10.1016/j.ijoa.2021.102969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine. Stanford University School of Medicine, Stanford, CA, USA.
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Belote BL, Soares I, Tujimoto-Silva A, Tirado AGC, Martins CM, Carvalho B, Gonzalez-Esquerra R, Rangel LFS, Santin E. Field evaluation of feeding spray-dried plasma in the starter period on final performance and overall health of broilers. Poult Sci 2021; 100:101080. [PMID: 33799116 PMCID: PMC8044691 DOI: 10.1016/j.psj.2021.101080] [Citation(s) in RCA: 6] [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: 07/11/2020] [Revised: 01/23/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
The effect of feeding spray-dried plasma (SDP) during the starter period was evaluated with a commercial broiler integrator on performance and overall health of broilers. The I See Inside (ISI) methodology assessing gut health in broilers was used as a tool to evaluate the impact of dietary interventions under commercial conditions. One hundred farms with approximately 1.1 million broilers were used at a Brazilian broiler integrator. Two groups of farms were fed either a control or an SDP diet containing 1% SDP, from 0 to 10 d of age. Diets were formulated to have similar nutritional density, containing zinc bacitracin and CuSO4 from 0 to 28 d. After 10 d, both groups were fed common commercial diets. Performance data were analyzed together or by type of ventilation system: positive pressure or negative pressure. Birds were sent to market as they reached 3.05 kg; therefore, age at slaughter (AS) was evaluated as a dependent variable along with other performance measures. From the 100 farms in the trial, 35 (16 control and 19 SDP farms) were selected for the assessment of broilers health, biosecurity, and local management. For that, 6 broilers per farm at 14 ± 2 d of age were necropsied and ileum sampled for the ISI methodology evaluation. Biosecurity and management were also evaluated to obtain the influence of those parameters on animal health. SDP-fed birds demonstrated improved feed conversion ratio, reduced mortality, and 1 d less for AS (P < 0.05) vs. control group (P < 0.05) regardless of the type of ventilation. During necropsy, birds fed SDP showed lower coccidiosis and locomotor system lesions as the overall ISI score compared to controls. Histologic intestinal alterations were also lower in SDP-fed broilers (P < 0.05). In conclusion, feeding 1% SDP in the starter period to broilers resulted in improved performance and health under both good and bad management and biosecurity standards independent of the type of ventilation. Overall, there was good agreement between the ISI method and performance improvements observed.
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Affiliation(s)
- Bruna L Belote
- Universidade Federal do Parana, Curitiba, Parana, Brazil.
| | - Igor Soares
- Universidade Federal do Parana, Curitiba, Parana, Brazil
| | | | | | | | - Bruno Carvalho
- Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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Silveira M, Ferreira CG, Montella T, Carvalho B, De Marchi P. P10.02 A comparison Between the Cost of Lung Cancer Treatment and how much is made Available by Brazilian Government. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.491] [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: 10/21/2022]
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32
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Desai N, Carvalho B. Conversion of labour epidural analgesia to surgical anaesthesia for emergency intrapartum Caesarean section. BJA Educ 2021; 20:26-31. [PMID: 33456912 DOI: 10.1016/j.bjae.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- N Desai
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - B Carvalho
- Stanford University School of Medicine, Stanford, CA, USA
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33
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Sultan P, Sultan E, Carvalho B. Regional anaesthesia for labour, operative vaginal delivery and caesarean delivery: a narrative review. Anaesthesia 2021; 76 Suppl 1:136-147. [PMID: 33426655 DOI: 10.1111/anae.15233] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
This narrative review discusses recent evidence surrounding the use of regional anaesthesia in the obstetric setting, including intrapartum techniques for labour and operative vaginal delivery, and caesarean delivery. Pudendal nerve blockade, ideally administered by an obstetrician, should be considered for operative vaginal delivery if neuraxial analgesia is contraindicated. Regional techniques are increasingly utilised in clinical practice for caesarean delivery to minimise opioid consumption, reduce pain, improve postpartum recovery and facilitate earlier discharge as part of enhanced recovery protocols. The evidence surrounding transversus abdominis plane and quadratus lumborum blockade supports their use when: long-acting neuraxial opioids cannot be administered due to contraindications; if emergency delivery necessitates general anaesthesia; or as a postoperative rescue technique. Current data suggest quadratus lumborum blockade is no more effective than transversus abdominis plane blockade after caesarean delivery. Transversus abdominis plane blockade, wound catheter insertion and single shot wound infiltration are all effective techniques for reducing postoperative opioid consumption, with transversus abdominis plane blockade favoured, followed by wound catheters and then wound infiltration. Ilio-inguinal and iliohypogastric, erector spinae plane and rectus sheath blockade all require further studies to determine their efficacy for caesarean delivery in the presence or absence of long-acting neuraxial opioids. Future studies are needed to: compare approaches for individual techniques; determine which combinations of techniques and dosing regimens result in optimal analgesic and recovery outcomes following delivery; and elucidate the populations that benefit most from regional anaesthesia in the obstetric setting.
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Affiliation(s)
- P Sultan
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - E Sultan
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA, USA
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Affiliation(s)
- B Carvalho
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Carvalho B, Almeida H, Andrade ESDS, Zarzar P, Vieira SCM, Heimer MV, Colares V. Prevalence of Dental Trauma in 1485 Brazilian Adolescents Aged Between 15 and 19 Years Old and Associated Factors. Oral Health Prev Dent 2020; 18:707-712. [PMID: 32895653 DOI: 10.3290/j.ohpd.a45100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Investigate dental trauma among adolescents aged 15-19 years and associated factors. METHODS The study was conducted in Recife, Brazil and the sample comprised 1485 adolescents of both sexes. The data was collected by clinical examination and interviews were conducted in-between classes by a single trained assessor. Two questionnaires (AUDIT and ASSIT 2.0) were used to investigate the involvement of adolescents with alcohol, tobacco and illicit drugs. The classification proposed by Andreasen was used to identify dental injuries. The sample size was calculated using 95% interval level. Pearson's chi-square test and Fisher's exact test were used to confirm the association between the variables. RESULTS The prevalence of dental injuries was 17.8%. The main causes of trauma were playing with others (20.8%) and falls (25.4%). A statistically significant percentage of adolescents reported using illicit drugs (13.9%), 15.9% used tobacco and 56.8% used alcoholic beverages. However, no statistically significant difference between the consumption of this drugs and dental injuries (p >0.005) was found. CONCLUSION The prevalence of dental trauma in adolescents was high, with no association with drugs use.
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Linhares P, Carvalho B, Vaz R, Costa BM. Glioblastoma: Is There Any Blood Biomarker with True Clinical Relevance? Int J Mol Sci 2020; 21:E5809. [PMID: 32823572 PMCID: PMC7461098 DOI: 10.3390/ijms21165809] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Glioblastoma (GBM) is the most frequent malignant primary brain tumor in adults, characterized by a highly aggressive, inflammatory and angiogenic phenotype. It is a remarkably heterogeneous tumor at several levels, including histopathologically, radiographically and genetically. The 2016 update of the WHO Classification of Tumours of the Central Nervous System highlighted molecular parameters as paramount features for the diagnosis, namely IDH1/2 mutations that distinguish primary and secondary GBM. An ideal biomarker is a molecule that can be detected/quantified through simple non- or minimally invasive methods with the potential to assess cancer risk; promote early diagnosis; increase grading accuracy; and monitor disease evolution and treatment response, as well as fundamentally being restricted to one aspect. Blood-based biomarkers are particularly attractive due to their easy access and have been widely used for various cancer types. A number of serum biomarkers with multiple utilities for glioma have been reported that could classify glioma grades more precisely and provide prognostic value among these patients. At present, screening for gliomas has no clinical relevance. This is because of the low incidence, the lack of sensitive biomarkers in plasma, and the observation that gliomas may develop apparently de novo within few weeks or months. To the best of our knowledge, there is no routine use of a serum biomarker for clinical follow-up. The purpose of this paper is to review the serum biomarkers described in the literature related to glioblastoma and their possible relationship with clinical features.
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Affiliation(s)
- Paulo Linhares
- Neurosurgery Department, Centro Hospitalar São João, Alameda Prof Hernani Monteiro, 4200–319 Porto, Portugal; (P.L.); (R.V.)
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Oporto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Bruno Carvalho
- Neurosurgery Department, Centro Hospitalar São João, Alameda Prof Hernani Monteiro, 4200–319 Porto, Portugal; (P.L.); (R.V.)
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Oporto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar São João, Alameda Prof Hernani Monteiro, 4200–319 Porto, Portugal; (P.L.); (R.V.)
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Oporto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Bruno M. Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, 4710-057 Braga, Portugal
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Sultan P, Sharawi N, Blake L, Carvalho B. Enhanced recovery after caesarean delivery versus standard care studies: a systematic review of interventions and outcomes. Int J Obstet Anesth 2020; 43:72-86. [DOI: 10.1016/j.ijoa.2020.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
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El-Boghdadly K, Desai N, Halpern S, Blake L, Odor PM, Bampoe S, Carvalho B, Sultan P. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis . Anaesthesia 2020; 76:393-403. [PMID: 32621529 DOI: 10.1111/anae.15160] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 12/12/2022]
Abstract
Caesarean delivery is the most commonly performed inpatient surgical procedure globally. Pain after caesarean delivery is moderate to severe if not adequately treated, and is a primary anaesthetic concern for patients. Transversus abdominis plane and quadratus lumborum blocks are fascial plane blocks that have the potential to improve analgesia following caesarean delivery. Although proponents of the quadratus lumborum block suggest that this technique may provide better analgesia compared with transversus abdominis plane block, there are limited data directly comparing these two techniques. We, therefore, performed a systematic review and network meta-analysis to compare transversus abdominis plane and quadratus lumborum block approaches, seeking randomised controlled trials comparing both techniques to each other, or to control, with or without intrathecal morphine. In all, 31 trials with 2188 patients were included and our primary outcome, the cumulative intravenous morphine equivalent consumption at 24 h, was reported in 12 trials. In the absence of intrathecal morphine, transversus abdominis plane and quadratus lumborum blocks were equivalent, and both were superior to control (moderate-quality evidence). In the presence of intrathecal morphine, no differences were found between control, transversus abdominis plane and quadratus lumborum blocks (moderate-quality evidence). Similar results were found for resting and active pain scores at 4-6 h, 8-12 h, 24 h and 36 h, although quadratus lumborum block was associated with lower pain scores at 36 h when compared with transversus abdominis plane block (very low-quality evidence). However, transversus abdominis plane block was associated with a reduced incidence of postoperative nausea and vomiting (moderate-quality evidence) and sedation when compared with inactive control following intrathecal morphine administration (low-quality evidence). There are insufficient data to draw definitive conclusions, but transversus abdominis plane and quadratus lumborum block appear to be superior to control in the absence of intrathecal morphine, but provide limited additional benefit over inactive control when intrathecal morphine is also used.
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Affiliation(s)
- K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - N Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - S Halpern
- Department of Anesthesiology, and Pain Medicine, University of Toronto, ON, Canada
| | - L Blake
- University of Arkansas for Medical Sciences Library, Little Rock, AR, USA
| | - P M Odor
- Department of Anaesthesia, University College Hospital, London, UK
| | - S Bampoe
- Department of Anaesthesia, University College Hospital, London, UK
| | - B Carvalho
- Department of Anesthesiology, Stanford University, CA, USA
| | - P Sultan
- Department of Anesthesiology, Stanford University, CA, USA
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Tuna R, Carvalho B, Castro L, Vaz R, Linhares P. Primary gliosarcoma of the optic nerve – Case report. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100688] [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: 10/25/2022] Open
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Komatsu R, Carvalho B, Flood PD. Re: Association between opioid use after intrapartum cesarean delivery and repeat cesarean delivery: a retrospective cohort study. Int J Obstet Anesth 2020; 43:30. [PMID: 32570048 DOI: 10.1016/j.ijoa.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Komatsu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P D Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Nanji J, Guo N, Riley E, Carvalho B. Impact of intra-operative dexamethasone after scheduled cesarean delivery: a retrospective study. Int J Obstet Anesth 2020; 41:39-46. [DOI: 10.1016/j.ijoa.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/03/2019] [Accepted: 06/16/2019] [Indexed: 01/22/2023]
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Carvalho B, Jantarada C, Azevedo J, Maia P, Guimarães L. Comparison of peribulbar block and general anaesthesia in mechanical vitrectomy: a prospective observational study. ACTA ACUST UNITED AC 2020; 67:63-67. [PMID: 31955889 DOI: 10.1016/j.redar.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/02/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Vitrectomy surgery is a common procedure for the treatment of several types of ophthalmologic conditions. It can be performed under regional anaesthesia with peribulbar block (PB) or general anaesthesia (GA). There are no evidence-based recommendations on the optimal anaesthesia strategy for this procedure. The aim of this study was to compare the advantages of PB and GA for vitrectomy surgery. MATERIALS AND METHODS A prospective observational study was conducted on adults submitted for mechanical vitrectomy between January 2017 and December 2017. Demographic and perioperative data were collected, namely ASA physical status, median arterial pressure, heart rate, postoperative opioid consumption, postoperative nausea and vomiting, times of induction, surgery, recovery, and hospital stay and costs considering medication and material needed. Statistical analysis was performed using SPSS v.25, with chi-square, Fisher and Mann-Whitney U tests, according to the type of variables analysed. RESULTS AND DISCUSSION We included 179 patients submitted for mechanical vitrectomy: 91 (51%) with PB and 88 (49%) under GA. Patients submitted to PB were older (69.0 vs. 64.5 years, p=.006) and presented with higher ASA physical status (p=.001). For haemodynamic outcomes, patients submitted to PB presented with less variation of median arterial pressure (-3.0 vs. -13.5mmHg, p=.000) and with no significant differences in heart rate (-2.0 vs. -3.0 bpm, p=.825). In the postoperative period, the PB group presented with decreased need of postoperative analgesia (0.0 vs. 5.0, p=.026) and a lower incidence of nausea and vomiting (1.0 vs. 12.0, p=.001). Times related to anaesthesia and surgery were better in PB group, with shorter induction time (10.0 vs. 11.0min, p=.000), surgery time (56.5 vs. 62.0min, p=.001), recovery time (10.0 vs. 75.5min, p=.000), and hospital stay (2.0 vs. 3.0 days, p=.000). When analysing costs, PB was less expensive than GA (4.65 vs. 12.09 euros, p=.021) CONCLUSION: PB is a reliable and safe alternative to GA for patients undergoing mechanical vitrectomy, permitting good anaesthesia and akinesia conditions during surgery, better haemodynamic stability, and less postoperative complications, especially in older patients and those with more comorbidities.
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Affiliation(s)
- B Carvalho
- Departamento de Anestesiología, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - C Jantarada
- Departamento de Anestesiología, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J Azevedo
- Departamento de Anestesiología, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - P Maia
- Departamento de Anestesiología, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - L Guimarães
- Departamento de Anestesiología, Centro Hospitalar Universitário de São João, Porto, Portugal; Facultad de Medicina, Universidad de Porto, Hospital de S. João, Porto, Portugal
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Carvalho B, Kinsella SM. Obstetric Anaesthetists' Association/National Perinatal Epidemiology Unit collaborative project to develop key indicators for quality of care in obstetric anaesthesia: first steps in the right direction. Anaesthesia 2019; 75:573-575. [PMID: 31797362 DOI: 10.1111/anae.14935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- B Carvalho
- Stanford University School of Medicine, Stanford, CA, USA
| | - S M Kinsella
- Department of Anaesthesia, St Michael's Hospital, University Hospitals Bristol Foundation Trust, Bristol, UK
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Kist M, Bekemeyer Z, Ralls L, Carvalho B, Rodriguez ST, Caruso TJ. Virtual reality successfully provides anxiolysis to laboring women undergoing epidural placement. J Clin Anesth 2019; 61:109635. [PMID: 31662229 DOI: 10.1016/j.jclinane.2019.109635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/21/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Kist
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - Z Bekemeyer
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - L Ralls
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - B Carvalho
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - S T Rodriguez
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - T J Caruso
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America.
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Borges C, Simões J, Reis J, Costa I, Lemos C, Soares P, Silva R, Carvalho B, Fernandes C, Costa A, Caeiro C, Sarmento C. Venous thromboembolism and intracranial hemorrhage in patients with high-grade glioma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Branco M, Linhares P, Carvalho B, Santos P, Costa BM, Vaz R. Serum lactate levels are associated with glioma malignancy grade. Clin Neurol Neurosurg 2019; 186:105546. [PMID: 31605893 DOI: 10.1016/j.clineuro.2019.105546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/29/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Recent studies have suggested that high grade gliomas are associated with elevated serum lactate concentrations. The aim of the present study is to assess these findings in a sample of patients. PATIENTS AND METHODS We reviewed the anesthetic charts of patients with low-grade and high-grade glioma who underwent resection surgery and collected serum lactate concentration before tumor resection, as well as other demographic and tumor-related data (age, gender, WHO grade, and size of the tumor). A statistical comparison between patients with normal (<2 mmol/L) and elevated (≥ 2 mmol/L) serum lactate was performed. RESULTS We included a total of 152 patients (mean age 49.07 years). 62.5% of patients (n = 95) had a high-grade glioma and 37.5% (n = 67) a low-grade glioma. The multivariate regression showed that high grade gliomas had significantly higher lactate concentration (p < 0.01). The OR for elevated pre-resection serum lactate increased from 4.94 to 14.33 after adjusting for age and pre-surgical corticosteroid use, and the AUC for the final regression model was 0.98. CONCLUSION This study reinforces the role of serum lactate as a potential biomarker of brain tumors malignancy, and its results encourage further research on this subject, in order to improve the understanding of this phenomenon and to assess its potential as prognostic and therapeutic monitoring tool.
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Affiliation(s)
- Mariana Branco
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal.
| | - Paulo Linhares
- Faculdade de Medicina da Universidade do Porto, Portugal; Serviço de Neurocirurgia, Centro Hospitalar de São João, Portugal
| | - Bruno Carvalho
- Serviço de Neurocirurgia, Centro Hospitalar de São João, Portugal
| | - Patrícia Santos
- Serviço de Anestesiologia, Centro Hospitalar de São João, Portugal
| | - Bruno M Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal
| | - Rui Vaz
- Faculdade de Medicina da Universidade do Porto, Portugal; Serviço de Neurocirurgia, Centro Hospitalar de São João, Portugal
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Ortner CM, Macias P, Neethling E, Krishnamoorthy V, Carvalho B, Swanevelder JL, Dyer RA. Ocular sonography in pre-eclampsia: a simple technique to detect raised intracranial pressure? Int J Obstet Anesth 2019; 41:1-6. [PMID: 31704252 DOI: 10.1016/j.ijoa.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/07/2019] [Accepted: 09/08/2019] [Indexed: 11/16/2022]
Affiliation(s)
- C M Ortner
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA, USA; Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
| | - P Macias
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - E Neethling
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Canada
| | | | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - J L Swanevelder
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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Fitzgerald JP, Fedoruk KA, Jadin SM, Carvalho B, Halpern SH. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia 2019; 75:109-121. [PMID: 31531852 DOI: 10.1111/anae.14841] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Abstract
Spinal anaesthesia for caesarean section commonly causes maternal hypotension. This systematic review and network meta-analysis compared methods to prevent hypotension in women receiving spinal anaesthesia for caesarean section. We selected randomised controlled trials that compared an intervention to prevent hypotension with another intervention or inactive control by searching MEDLINE and Embase, Web of Science to December 2018. There was no language restriction. Two reviewers extracted data on trial characteristics, methods and outcomes. We assessed risk of bias for individual trials (Cochrane tool) and quality of evidence (GRADE checklist). We assessed 109 trials (8561 women) and 12 different methods that resulted in 30 direct comparisons. Methods ranked by OR (95%CI) from most effective to least effective were: metaraminol 0.11 (0.04-0.26); norepinephrine 0.13 (0.06-0.28); phenylephrine 0.18 (0.11-0.29); leg compression 0.25 (0.14-0.43); ephedrine 0.28 (0.18-0.43); colloid given before induction of anaesthesia 0.38 (0.24-0.61); angiotensin 2, 0.12 (0.02-0.75); colloid given after induction of anaesthesia 0.52 (0.30-0.90); mephentermine 0.09 (0.01-1.30); crystalloid given after induction of anaesthesia 0.78 (0.46-1.31); and crystalloid given before induction of anaesthesia 1.16 (0.76-1.79). Phenylephrine caused maternal bradycardia compared with control, OR (95%CI) 0.23 (0.07-0.79). Ephedrine lowered umbilical artery pH more than phenylephrine, standardised mean difference (95%CI) 0.78 (0.47-1.49). We conclude that vasopressors should be given to healthy women to prevent hypotension during caesarean section with spinal anaesthesia.
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Affiliation(s)
- J P Fitzgerald
- Department of Anesthesia, Sunnybrook Health Sciences Centre and the University of Toronto, ON, Canada
| | - K A Fedoruk
- Department of Anesthesia, Sunnybrook Health Sciences Centre and the University of Toronto, ON, Canada
| | - S M Jadin
- Department of Anesthesia, Sunnybrook Health Sciences Centre and the University of Toronto, ON, Canada
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S H Halpern
- Department of Anesthesia, Sunnybrook Health Sciences Centre and the University of Toronto, ON, Canada
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Kleiman AM, Chisholm CA, Dixon AJ, Sariosek BM, Thiele RH, Hedrick TL, Carvalho B, Tiouririne M. Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery. Int J Obstet Anesth 2019; 43:39-46. [PMID: 31522935 DOI: 10.1016/j.ijoa.2019.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/27/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite significant improvements in outcomes following non-obstetric surgery with implementation of enhanced recovery after surgery (ERAS) protocols, development of these protocols for cesarean delivery is lacking. We evaluated implementation of an ERAS protocol for patients undergoing elective cesarean delivery, specifically the effect on opioid consumption, pain scores and length of stay as well as complications and re-admissions. METHODS An ERAS protocol was developed and implemented for women undergoing elective cesarean delivery. The protocol construction included specific evidence-based items applicable to peripartum management and these were grouped into the three major phases of patient care: antepartum, intrapartum and postpartum. A before-and-after study design was used to compare maternal outcomes. To account for confounders between groups, a propensity matched scoring analysis was used. The primary outcome was postpartum opioid use in mg-morphine equivalents (MMEQ). RESULTS We included 357 (n=196 before; n=161 after) women who underwent elective cesarean delivery. A significant difference in opioid consumption (28.4 ± 24.1 vs 46.1 ± 37.0 MMEQ, P <0.001) and in per-day postoperative opioid consumption (10.9 ± 8.7 vs 15.1 ± 10.3 MMEQ, P <0.001), lower peak pain scores (7 [5-9] vs 8 [7-9], P=0.007) and a shorter hospital length of stay (2.5 ± 0.5 vs 2.9 ± 1.2 days, P <0.001) were found after the introduction of the ERAS protocol. CONCLUSIONS Implementation of ERAS protocols for elective cesarean delivery is associated with significant improvements in analgesic and recovery outcomes. These improvements in quality of care suggest ERAS protocols should be considered for elective cesarean delivery.
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Affiliation(s)
- A M Kleiman
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA.
| | - C A Chisholm
- Department of Obstetrics & Gynecology, University of Virginia Health System, Charlottesville, VA, USA
| | - A J Dixon
- Department of Biomedical Engineering, University of Virginia, Thornton Hall, Charlottesville, VA, USA
| | - B M Sariosek
- Department of Surgical Services, University of Virginia, VA, USA
| | - R H Thiele
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - T L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - B Carvalho
- Department of Anesthesiology, Stanford University, Stanford, CA, USA
| | - M Tiouririne
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
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Sharawi N, Klima L, Shah R, Blake L, Carvalho B, Sultan P. Evaluation of patient‐reported outcome measures of functional recovery following caesarean section: a systematic review using the consensus‐based standards for the selection of health measurement instruments (COSMIN) checklist. Anaesthesia 2019; 74:1439-1455. [DOI: 10.1111/anae.14807] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- N. Sharawi
- Department of Anesthesiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - L. Klima
- Department of Anesthesiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - R. Shah
- Department of Anaesthesia University College London Hospital LondonUK
| | - L. Blake
- University of Arkansas for Medical Sciences Little Rock ARUSA
| | - B. Carvalho
- Stanford University School of Medicine Stanford CAUSA
| | - P. Sultan
- Stanford University School of Medicine Stanford CA USA
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