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Carvalho D, Rei Pacheco A, Carvalho S, Ferreira R, Briosa Neves A. Trepopnea as a diagnostic clue for malignant disease. Rev Port Cardiol 2024; 43:213-215. [PMID: 37481237 DOI: 10.1016/j.repc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 07/24/2023] Open
Affiliation(s)
- Diana Carvalho
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal.
| | | | - Simão Carvalho
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Raquel Ferreira
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Ana Briosa Neves
- Department of Cardiology, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
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Suleman F, Carvalho D. Young graduates and economic recession: Lessons from the pandemic to prevent the (re)incidence of mental health symptoms. Int J Health Plann Manage 2024; 39:196-203. [PMID: 37957781 DOI: 10.1002/hpm.3737] [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: 04/06/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Economic conditions affect the youth labour market and can leave deep scars. This exploratory study examines the emotional responses and mental health symptoms of young graduates during their transition into the labour market in the pandemic context. It draws on 42 news articles with statements from 86 graduates from a set of European and non-European countries. The graduates had jobs or internships cancelled, numerous applications unanswered or were dismissed from jobs they had recently started. Young people adopt a variety of coping strategies, which are often invisible and cause deep suffering due to anxiety, disappointment, fear, and depression. Their apprehension and uncertainty leave them in a state of limbo. The specific impacts of the pandemic on young people's lives serve as a warning of the need to protect future generations of graduates. More support is required worldwide to manage the mental health issues that affect young graduates, especially during economic recessions.
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Affiliation(s)
- Fátima Suleman
- Instituto Universitário de Lisboa (ISCTE-IUL) and DINAMIA'CET, LISBOA, Portugal
| | - Diana Carvalho
- Instituto Universitário de Lisboa (ISCTE-IUL) and CIES-IUL, Lisbon, Portugal
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Saraiva RO, Saunders C, Varela dos Santos M, Carvalho D, Loureiro R, Ramos J. Refractory Hidradenitis Suppurativa: A Diagnosis to Consider. GE Port J Gastroenterol 2024; 31:60-64. [PMID: 38476303 PMCID: PMC10928865 DOI: 10.1159/000528432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/04/2022] [Indexed: 03/14/2024]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease associated with multiple comorbidities, and its association with lymphoma has recently been a topic of debate. However, it is still controversial whether this risk can be attributed to the disease itself or whether it has any relationship with immunosuppressive treatment. Here, we describe the case of a patient with severe perianal hidradenitis suppurativa treated with methotrexate and infliximab, whose exacerbation with persistence of severe symptoms refractory to adequate treatment led to the diagnosis of diffuse large non-Hodgkin B-cell lymphoma. It was decided to perform a colostomy to improve perianal sepsis, and immunochemotherapy was proposed.
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Affiliation(s)
- Rita Ornelas Saraiva
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Christopher Saunders
- Department of Hematology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Rafaela Loureiro
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Jaime Ramos
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
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Coelho S, Ferreira J, Lopes D, Carvalho D, Lopes M. Facing the challenges of air quality and health in a future climate: The Aveiro Region case study. Sci Total Environ 2023; 876:162767. [PMID: 36907400 DOI: 10.1016/j.scitotenv.2023.162767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Air pollution and climate change are the most important environmental issues for European citizens. Despite the air quality improvements achieved in recent years, with most pollutants' concentrations below the European Union legislated values, it is necessary to understand whether this will continue in the future due to expected climate changes impacts. In this context, this work tries to answer two main questions: (i) What is the relative contribution of emission source regions/activities to air quality, now and in the future, considering a climate change scenario?; and (ii) What additional policies are needed to support win-win strategies for air quality and climate mitigation and/or adaptation, at urban scale? For that, a climate and air quality modelling system, with source apportionment tools, was applied to the Aveiro Region, in Portugal. Main results show that in the future, due to the implementation of carbon neutrality measures, air quality in the Aveiro Region may improve, with reduction up to 4 μg.m-3 for particulate matter (PM) concentrations and 22 μg.m-3 for nitrogen dioxide (NO2), and consequently, the premature deaths due to air pollution exposure will also decrease. The expected air quality improvement will ensure that, in the future, the limit values of the European Union (EU) Air Quality Directive will not be exceeded, but the same will not happen if the proposed revision of the EU Air Quality Directive is approved. Results also shown that, in the future, industrial sector will be the one with higher relative contribution for PM concentrations and the second one for NO2. For that sector, additional emission abatement measures were tested, showing that, in the future, it is possible to comply with all the new limit values proposed by the EU.
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Affiliation(s)
- S Coelho
- CESAM & Department of Environment and Planning, University of Aveiro, Portugal.
| | - J Ferreira
- CESAM & Department of Environment and Planning, University of Aveiro, Portugal
| | - D Lopes
- CESAM & Department of Environment and Planning, University of Aveiro, Portugal
| | - D Carvalho
- CESAM & Department of Physics, University of Aveiro, Portugal
| | - M Lopes
- CESAM & Department of Environment and Planning, University of Aveiro, Portugal
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5
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Sun CX, Daniel P, Bradshaw G, Shi H, Loi M, Chew N, Parackal S, Tsui V, Liang Y, Koptyra M, Adjumain S, Sun C, Chong WC, Fernando D, Drinkwater C, Tourchi M, Habarakada D, Sooraj D, Carvalho D, Storm PB, Baubet V, Sayles LC, Fernandez E, Nguyen T, Pörksen M, Doan A, Crombie DE, Panday M, Zhukova N, Dun MD, Ludlow LE, Day B, Stringer BW, Neeman N, Rubens JA, Raabe EH, Vinci M, Tyrrell V, Fletcher JI, Ekert PG, Dumevska B, Ziegler DS, Tsoli M, Syed Sulaiman NF, Loh AHP, Low SYY, Sweet-Cordero EA, Monje M, Resnick A, Jones C, Downie P, Williams B, Rosenbluh J, Gough D, Cain JE, Firestein R. Generation and multi-dimensional profiling of a childhood cancer cell line atlas defines new therapeutic opportunities. Cancer Cell 2023; 41:660-677.e7. [PMID: 37001527 DOI: 10.1016/j.ccell.2023.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/21/2022] [Accepted: 03/07/2023] [Indexed: 04/12/2023]
Abstract
Pediatric solid and central nervous system tumors are the leading cause of cancer-related death among children. Identifying new targeted therapies necessitates the use of pediatric cancer models that faithfully recapitulate the patient's disease. However, the generation and characterization of pediatric cancer models has significantly lagged behind adult cancers, underscoring the urgent need to develop pediatric-focused cell line resources. Herein, we establish a single-site collection of 261 cell lines, including 224 pediatric cell lines representing 18 distinct extracranial and brain childhood tumor types. We subjected 182 cell lines to multi-omics analyses (DNA sequencing, RNA sequencing, DNA methylation), and in parallel performed pharmacological and genetic CRISPR-Cas9 loss-of-function screens to identify pediatric-specific treatment opportunities and biomarkers. Our work provides insight into specific pathway vulnerabilities in molecularly defined pediatric tumor classes and uncovers biomarker-linked therapeutic opportunities of clinical relevance. Cell line data and resources are provided in an open access portal.
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Affiliation(s)
- Claire Xin Sun
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Paul Daniel
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Gabrielle Bradshaw
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Hui Shi
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Melissa Loi
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Nicole Chew
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Sarah Parackal
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Vanessa Tsui
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Yuqing Liang
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Mateusz Koptyra
- Center for Data Driven Discovery in Biomedicine, Neurosurgery Department, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shazia Adjumain
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Christie Sun
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Wai Chin Chong
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Dasun Fernando
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Caroline Drinkwater
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Motahhareh Tourchi
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Dilru Habarakada
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Dhanya Sooraj
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Diana Carvalho
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London SM2 5NG, UK
| | - Phillip B Storm
- Center for Data Driven Discovery in Biomedicine, Neurosurgery Department, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Valerie Baubet
- Center for Data Driven Discovery in Biomedicine, Neurosurgery Department, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Leanne C Sayles
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Elisabet Fernandez
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London SM2 5NG, UK
| | - Thy Nguyen
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Mia Pörksen
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Paediatrics, University of Lübeck, 23562 Lübeck, Germany
| | - Anh Doan
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Duncan E Crombie
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Monty Panday
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Nataliya Zhukova
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia; Children's Cancer Centre, Monash Children's Hospital, Monash Health, Clayton, VIC 3168, Australia; Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
| | - Matthew D Dun
- Hunter Cancer Research Alliance, University of Newcastle, Callaghan, NSW 2308, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Louise E Ludlow
- Children's Cancer Centre Biobank, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Bryan Day
- QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - Brett W Stringer
- QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia
| | - Naama Neeman
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Jeffrey A Rubens
- Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Eric H Raabe
- Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Maria Vinci
- Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children's Hospital-IRCCS, 00165 Rome, Italy
| | - Vanessa Tyrrell
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Jamie I Fletcher
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Paul G Ekert
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia; Centre for Cancer Immunotherapy, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Biljana Dumevska
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - David S Ziegler
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Maria Tsoli
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Nur Farhana Syed Sulaiman
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore 229899, Singapore; VIVA-KKH Paediatric Brain and Solid Tumours Programme, Singapore 229899, Singapore
| | - Amos Hong Pheng Loh
- VIVA-KKH Paediatric Brain and Solid Tumours Programme, Singapore 229899, Singapore; Duke-NUS Medical School, Singapore 169857, Singapore
| | - Sharon Yin Yee Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore 229899, Singapore; VIVA-KKH Paediatric Brain and Solid Tumours Programme, Singapore 229899, Singapore; SingHealth-Duke NUS Neuroscience Academic Clinical Programme, Singapore 308433, Singapore; SingHealth-Duke NUS Paediatrics Academic Clinical Programme, Singapore 229899, Singapore
| | | | - Michelle Monje
- Department of Neurology, Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Adam Resnick
- Center for Data Driven Discovery in Biomedicine, Neurosurgery Department, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London SM2 5NG, UK
| | - Peter Downie
- Children's Cancer Centre, Monash Children's Hospital, Monash Health, Clayton, VIC 3168, Australia; Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
| | - Bryan Williams
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Joseph Rosenbluh
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3168, Australia
| | - Daniel Gough
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Jason E Cain
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Ron Firestein
- Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia; Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia.
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Ferraz L, Carvalho D, Carvalho S, Pacheco A, Faustino A, Neves A. Pectus excavatum with right ventricular compression-induced ventricular arrhythmias. Br J Cardiol 2023; 30:4. [PMID: 37705840 PMCID: PMC10495756 DOI: 10.5837/bjc.2023.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
A 33-year-old woman, with palpitations since the age of 15, was referred to a cardiology consultation due to very frequent ventricular extrasystoles with morphology of left bundle branch block, inferior frontal axis, late precordial transition, rS in V1, R in V6 and rS in DI. She had pectus excavatum. The cardiac magnetic resonance showed severe pectus excavatum associated with exaggerated cardiac levoposition, compression and deformation of the right cardiac chambers. However, the patient became pregnant, and follow-up was delayed.
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Affiliation(s)
- Lisa Ferraz
- Cardiology Resident Centro Hospitalar do Baixo Vouga, Avenida de Artur Ravara 35, 3810-164 Aveiro, Portugal
| | - Diana Carvalho
- Cardiology Resident Centro Hospitalar do Baixo Vouga, Avenida de Artur Ravara 35, 3810-164 Aveiro, Portugal
| | - Simāo Carvalho
- Cardiology Resident Centro Hospitalar do Baixo Vouga, Avenida de Artur Ravara 35, 3810-164 Aveiro, Portugal
| | - Adriana Pacheco
- Cardiology Resident Centro Hospitalar do Baixo Vouga, Avenida de Artur Ravara 35, 3810-164 Aveiro, Portugal
| | - Ana Faustino
- Cardiologist Centro Hospitalar do Baixo Vouga, Avenida de Artur Ravara 35, 3810-164 Aveiro, Portugal
| | - Ana Neves
- Cardiologist Centro Hospitalar do Baixo Vouga, Avenida de Artur Ravara 35, 3810-164 Aveiro, Portugal
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7
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Fernandes SR, Serrazina J, Botto IA, Leal T, Guimarães A, Garcia JL, Rosa I, Prata R, Carvalho D, Neves J, Campelo P, Ventura S, Silva A, Coelho M, Sequeira C, Oliveira AP, Portela F, Ministro P, Tavares de Sousa H, Ramos J, Claro I, Gonçalves R, Correia LA, Marinho RT, Cortez‐Pinto H, Magro F. Transmural remission improves clinical outcomes up to 5 years in Crohn's disease. United European Gastroenterol J 2022; 11:51-59. [PMID: 36575615 PMCID: PMC9892415 DOI: 10.1002/ueg2.12356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Evidence supporting transmural remission (TR) as a long-term treatment target in Crohn's disease (CD) is still unavailable. Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long-term. METHODS Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five-year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). RESULTS 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds-ratio [OR] 0.244 [0.111-0.538], p < 0.001), surgery (OR 0.132 [0.030-0.585], p = 0.008), steroid use (OR 0.283 [0.159-0.505], p < 0.001), and treatment escalation (OR 0.088 [0.044-0.176], p < 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143-0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125-0.540], p < 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262-0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259-0.925], p = 0.028) compared to NR. CONCLUSIONS TR improved clinical outcomes over 5 years of follow-up in CD patients. Distinct but significant benefits were seen with IER and IRR. This suggests that both endoscopic and radiologic remission should be part of the treatment targets of CD.
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Affiliation(s)
- Samuel Raimundo Fernandes
- Serviço de Gastrenterologia e HepatologiaHospital Santa MariaCentro Hospitalar Universitário Lisboa NorteClínica Universitária de Gastrenterologia, Faculdade de Medicina de LisboaLisboaPortugal
| | - Juliana Serrazina
- Serviço de Gastrenterologia e HepatologiaHospital Santa MariaCentro Hospitalar Universitário Lisboa NorteClínica Universitária de Gastrenterologia, Faculdade de Medicina de LisboaLisboaPortugal
| | - Inês Ayala Botto
- Serviço de Gastrenterologia e HepatologiaHospital Santa MariaCentro Hospitalar Universitário Lisboa NorteClínica Universitária de Gastrenterologia, Faculdade de Medicina de LisboaLisboaPortugal
| | - Tiago Leal
- Serviço de GastrenterologiaHospital de BragaBragaPortugal
| | | | - Joana Lemos Garcia
- Serviço de GastrenterologiaInstituto Português de Oncologia de Lisboa Francisco GentilLisboaPortugal
| | - Isadora Rosa
- Serviço de GastrenterologiaInstituto Português de Oncologia de Lisboa Francisco GentilLisboaPortugal
| | - Rita Prata
- Serviço de GastrenterologiaHospital Santo António dos CapuchosCentro Hospitalar Universitário Lisboa CentralLisboaPortugal
| | - Diana Carvalho
- Serviço de GastrenterologiaHospital Santo António dos CapuchosCentro Hospitalar Universitário Lisboa CentralLisboaPortugal
| | - João Neves
- Serviço de GastrenterologiaCentro Hospitalar Universitário do AlgarveBiomedical Center of AlgarveUniversity of AlgarvePortimãoPortugal
| | - Pedro Campelo
- Serviço de GastrenterologiaCentro Hospitalar Universitário do AlgarveBiomedical Center of AlgarveUniversity of AlgarvePortimãoPortugal
| | - Sofia Ventura
- Serviço de GastrenterologiaCentro Hospitalar Tondela ViseuViseuPortugal
| | - Andrea Silva
- Serviço de GastrenterologiaCentro Hospitalar Universitário CoimbraCoimbraPortugal
| | - Mariana Coelho
- Serviço de GastrenterologiaHospital de São BernardoSetúbalPortugal
| | | | | | - Francisco Portela
- Serviço de GastrenterologiaCentro Hospitalar Universitário CoimbraCoimbraPortugal
| | - Paula Ministro
- Serviço de GastrenterologiaCentro Hospitalar Tondela ViseuViseuPortugal
| | - Helena Tavares de Sousa
- Serviço de GastrenterologiaCentro Hospitalar Universitário do AlgarveBiomedical Center of AlgarveUniversity of AlgarvePortimãoPortugal
| | - Jaime Ramos
- Serviço de GastrenterologiaHospital Santo António dos CapuchosCentro Hospitalar Universitário Lisboa CentralLisboaPortugal
| | - Isabel Claro
- Serviço de GastrenterologiaInstituto Português de Oncologia de Lisboa Francisco GentilLisboaPortugal
| | | | - Luís Araújo Correia
- Serviço de Gastrenterologia e HepatologiaHospital Santa MariaCentro Hospitalar Universitário Lisboa NorteClínica Universitária de Gastrenterologia, Faculdade de Medicina de LisboaLisboaPortugal
| | - Rui Tato Marinho
- Serviço de Gastrenterologia e HepatologiaHospital Santa MariaCentro Hospitalar Universitário Lisboa NorteClínica Universitária de Gastrenterologia, Faculdade de Medicina de LisboaLisboaPortugal
| | - Helena Cortez‐Pinto
- Serviço de Gastrenterologia e HepatologiaHospital Santa MariaCentro Hospitalar Universitário Lisboa NorteClínica Universitária de Gastrenterologia, Faculdade de Medicina de LisboaLisboaPortugal
| | - Fernando Magro
- Serviço de GastrenterologiaHospital de São JoãoPortoPortugal,Department of Pharmacology and TherapeuticsInstitute for Molecular and Cell BiologyUniversity of PortoPortoPortugal
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8
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Rogers R, Carvalho D, Grabovska Y, Fernandez E, Izquierdo E, Mackay A, Jones C. EXTH-41. COMBINED PHARMACOLOGICAL AND GENETIC SCREENING TO IDENTIFY DEPENDENCIES AND COMBINATIONS IN ACVR1-MUTANT DIFFUSE MIDLINE GLIOMA. Neuro Oncol 2022. [PMCID: PMC9660728 DOI: 10.1093/neuonc/noac209.839] [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: 11/16/2022] Open
Abstract
Abstract
Somatic mutations in ACVR1, which encodes the serine/threonine kinase ALK2, are found in 20-25% of DMG-H3K27 patients. Treatment of ACVR1-mutant patient-derived models with multiple chemotypes of ALK2 inhibitors (ALK2i) results in reduced cell viability in vitro and extended survival in orthotopic xenografts in vivo but, as single agents, these inhibitors were unable to achieve a complete anti-tumour response. Recently we reported that combinatorial treatment of ACVR1-mutant DIPG cells with vandetanib (RTK inhibitor) and everolimus (mTOR/ABC transporter inhibitor) was synergistic both in vitro and in vivo and was shown to be a feasible combination to trial clinically in this setting. To identify specific dependencies in ACVR1-mutant cells which may be translatable with novel synergistic drug combinations alongside ALK2i, we have implemented both candidate and unbiased drug and genetic screening approaches. Using a panel of 13 patient-derived ACVR1-mutant models (and 6 wild-type controls), we identified synergy between multiple chemotypes of ALK2i (M4K2009/LDN-214117) and PI3K/mTOR (AZD8055/everolimus) and MEK inhibitors (trametinib), reflecting the common co-segregation of PIK3CA/PIK3R1 alterations in these tumours. Whole-genome CRISPR/Cas9 screening of ACVR1-mutant SU-DIPG-IV cells in combination with two ALK2i (M4K2009/LDN-193189), confirmed a specific MTOR genetic dependency, as well as for the protein phosphatase regulatory subunit PPP2R1A, known to play a role in MAPK pathway activation. Additional hits include the serine/threonine kinase PKMYT1, a negative regulator of the G2/M checkpoint via a functionally redundant phosphorylation of CDK1/CCNB1 alongside WEE1; confirmatory drug assays with the WEE1 inhibitor AZD1775 resulted in a synergistic interaction with ALK2i in ACVR1-mutant cells. Hits were integrated with DepMap using ‘gene effect’ scores (Chronos) enabling filtering of common essential genes. Preliminary pathway enrichment analysis (MAGeCKFlute) identified ALK2i-specific vulnerabilities involving TGFB1/SMAD signalling and histone deacetylation. These data highlight functionally rational and novel combinatorial possibilities for children with ACVR1-mutant DMG, with systematic preclinical assessment required for prioritisation for the clinic.
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Affiliation(s)
| | | | | | | | | | - Alan Mackay
- Insitute of Cancer Research , London , United Kingdom
| | - Chris Jones
- Insitute of Cancer Research , London , United Kingdom
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9
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Saraiva RO, Gamelas V, Canha MI, Carvalho D, Loureiro R, Coimbra J. Hepatobiliary and Pancreatic: An unusual cause of biliary obstruction. J Gastroenterol Hepatol 2022; 37:2030. [PMID: 36217251 PMCID: PMC9828722 DOI: 10.1111/jgh.16009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 01/12/2023]
Affiliation(s)
- RO Saraiva
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.EHospital de Santo António dos Capuchos – CHULC, Alameda de Santo António dos CapuchosLisboaPortugal
| | - V Gamelas
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.EHospital de Santo António dos Capuchos – CHULC, Alameda de Santo António dos CapuchosLisboaPortugal
| | - MI Canha
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.EHospital de Santo António dos Capuchos – CHULC, Alameda de Santo António dos CapuchosLisboaPortugal
| | - D Carvalho
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.EHospital de Santo António dos Capuchos – CHULC, Alameda de Santo António dos CapuchosLisboaPortugal
| | - R Loureiro
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.EHospital de Santo António dos Capuchos – CHULC, Alameda de Santo António dos CapuchosLisboaPortugal
| | - J Coimbra
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, E.P.EHospital de Santo António dos Capuchos – CHULC, Alameda de Santo António dos CapuchosLisboaPortugal
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10
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Cabral M, Carvalho D, Veiga R, Carvalho M, Ferreira W, Faria R, Ladeiras-Lopes R, Ferreira N. Oral Presentation No. 75 Impact of thoracic aortic calcification measured by computed tomography in clinical outcomes in patients undergoing cardiac surgery. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The presence of thoracic aortic calcification (TAC) has been shown to increase the risk of cardiovascular and cerebrovascular events. Few studies have evaluated the relationship between CT measured by computed tomography (CT) before cardiac surgery and clinical outcomes, and the relationship is still unclear.
This study aimed to analyse the impact on clinical outcomes of the presence of TAC in patients undergoing cardiac surgery. A retrospective unicentre analysis of patients undergoing a noncontrast CT prior to cardiac surgery was performed. TAC was quantified using a volume-rendering method. The percentiles of TAC volume (TACV) were used to determine the relative standing. Demographic data, risk factors and clinical outcomes were comparable between groups. A P-value < 0.05 is statistically significant.
The mean TACV was 2.45 ± 2.79 cm3, and the median and 75th percentiles were 1.45 and 4.06 cm3, respectively. Of the total of 121 patients, 26 (21.5%) had high TACV. Table 1 shows the baseline demographic and risk factors. There was no significant difference in risk factors and personal history between groups except for age (P-value = 0.02), hypertension (P-value = 0.04) and coronary artery disease (P-value < 0.01). Regarding clinical outcomes, there was no significant difference in clinical outcomes except for acute kidney failure (P-value = 0.04), which was not significant in multivariate analysis.
In conclusion, aortic calcification is a recurrent finding, to which there seems to be a contribution from hypertension-related vascular damage, especially in older ones. In patients undergoing cardiac surgery, TACV appears not to be related to clinical outcomes in multivariate analysis. However, large-scale studies are needed to confirm these results.
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Affiliation(s)
| | | | | | | | | | - Rita Faria
- Centro Hospitalar de Vila Nova de Gaia/Espinho
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11
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Costa H, Silva M, Santo ME, Mota T, Fernandes R, Palmeiro H, Marto S, Franco P, Carvalho D, Bispo J, Guedes J, Mimoso J, Marreiros A, Vinhas H, Jesus I. Contrast-induced nephropathy following PCI: can we calculate a safe contrast volume? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Acute kidney injury (AKI) due to contrast induced nephropathy (CIN) is a common complication after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), and is associated with prolonged hospitalizations and elevated cardio and renovascular morbidity. Scientific evidence demonstrates that the mean volume of contrast (VolC) and ratio with creatinine clearance (CrCl) (VolC/CrCl) are independent predictors of CIN, but the accepted optimal value remains controversial.
Objective
Population characterization. To evaluate whether the calculation of VolC using the VolC/ClCr ratio <3.7 used in our Cath lab during PCI of ACS allows preventing the development of AKI by CIN, and whether the development of early vs late AKI influences outcomes.
Methods
Retrospective study between 2017/2020, composed of n=378 patients who suffered ACS. Descriptve analysis was carried out regarding the demographic and clinical characteristics of the patients. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%.
Results
A total of 378 patients were identified, with a mean age of 64.5±11.2 years, 78.6% were male. 60.1% had hypertension, 48.4% dyslipidemia, 24.3% diabetes, 2.6% chronic renal failure (CRF) and 1.6% heart failure. Of these, 12.7% developed AKI (<24h in 1.9% vs ≥24h in 10,8%). Indepedent prognostic factors for development of AKI were smokers (AKI ≥24h 7 (4.8%) vs AKI<24h 2 (1.4%), p=0.001), diabetes (AKI≥24h 17 (19%) vs AKI <24h 2 (2.2%), p=0.007), CRF (AKI ≥24h 6 (60%) vs AKI <24h 1 (10%), p=0.001), CrCl (AKI ≥24h 65.8±27.1, p=0.001), ratio VolC/CrCl (AKI ≥24h 3.3±2.5, p=0.001) and LVEF (AKI ≥24h 51.4±9.7, p=0.001). Mortality afected 4.2% of the patients, and was more frequente in AKI subjects (AKI ≥24h 7 (70%) vs AKI <24h 1 (10%), p=0.001). Using a ratio <3.7 allowed to prevent AK <24h but not AKI ≥24h (AKI <24h ratio <3.7 = 3 (1%) vs ratio ≥3.7 = 9 (4.1%), p=0.001) (AKI ≥24 ratio <3.7 = 30 (25%) vs ratio ≥3.7 = 11 (9.7%), p=0.001). A ratio <2.0 allowed to prevent both early and late AKI (AKI <24h ratio <2.0 = 0 (0%) vs ratio ≥2.0 = 7 (4.5%), p=0.001) (AKI ≥24 ratio <2.0 = 11 (5.6%) vs ratio ≥2.0 = 30 (19.1%), p=0.001).
Conclusion
In patients submitted to ACS PCI, the development of AKI increases mortality, especial if AKI emerge after 24h. We report a more suitable ratio VolC/ClCr <2.0, that allow us to calculate a safe VolC that will help to prevent both early and late AKI in selected patients wtih ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Costa
- Algarve University Hospital Center , Faro , Portugal
| | - M Silva
- Algarve University Hospital Center , Faro , Portugal
| | - M E Santo
- Algarve University Hospital Center , Faro , Portugal
| | - T Mota
- Algarve University Hospital Center , Faro , Portugal
| | - R Fernandes
- Algarve University Hospital Center , Faro , Portugal
| | - H Palmeiro
- Algarve University Hospital Center , Faro , Portugal
| | - S Marto
- Algarve University Hospital Center , Faro , Portugal
| | - P Franco
- Algarve University Hospital Center , Faro , Portugal
| | - D Carvalho
- Algarve University Hospital Center , Faro , Portugal
| | - J Bispo
- Algarve University Hospital Center , Faro , Portugal
| | - J Guedes
- Algarve University Hospital Center , Faro , Portugal
| | - J Mimoso
- Algarve University Hospital Center , Faro , Portugal
| | - A Marreiros
- Algarve University Hospital Center , Faro , Portugal
| | - H Vinhas
- Algarve University Hospital Center , Faro , Portugal
| | - I Jesus
- Algarve University Hospital Center , Faro , Portugal
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12
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Santiago M, Dias CC, Alves C, Ministro P, Gonçalves R, Carvalho D, Portela F, Correia L, Lago P, Magro F. The Magnitude of Crohn's Disease Direct Costs in Health Care Systems (from Different Perspectives): A Systematic Review. Inflamm Bowel Dis 2022; 28:1527-1536. [PMID: 35179190 DOI: 10.1093/ibd/izab334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of inflammatory bowel disease (IBD) has been increasing worldwide, causing high impact on the quality of life of patients and an increasing burden for health care systems. In this systematic review, we reviewed the literature concerning the direct costs of Crohn's disease (CD) for health care systems from different perspectives: regional, economic, and temporal. METHODS We searched for original real-world studies examining direct medical health care costs in Crohn's disease. The primary outcome measure was the mean value per patient per year (PPY) of total direct health care costs for CD. Secondary outcomes comprised hospitalization, surgery, CD-related medication (including biologics), and biologics mean costs PPY. RESULTS A total of 19 articles were selected for inclusion in the systematic review. The studies enrolled 179 056 CD patients in the period between 1997 and 2016. The pooled mean total cost PPY was €6295.28 (95% CI, €4660.55-€8503.41). The pooled mean hospitalization cost PPY for CD patients was €2004.83 (95% CI, €1351.68-€2973.59). The major contributors for the total health expenditure were biologics (€5554.58) and medications (€3096.53), followed by hospitalization (€2004.83) and surgery (€1883.67). No differences were found between regional or economic perspectives, as confidence intervals overlapped. However, total costs were significantly higher after 2010. CONCLUSIONS Our review highlighted the burden of CD for health care systems from different perspectives (regional, economic, and temporal) and analyzed the impact of the change of IBD treatment paradigm on total costs. Reducing the overall burden can depend on the increase of remission rates to further decrease hospitalizations and surgeries.
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Affiliation(s)
- Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal
| | - Catarina Alves
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Ministro
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Tondela-Viseu Hospital Center, Viseu, Portugal
| | - Raquel Gonçalves
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Diana Carvalho
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Central Lisbon Hospital Center, Lisbon, Portugal
| | - Francisco Portela
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Luís Correia
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology and Hepatology, Northern Lisbon Hospital Center, Lisbon, Portugal
| | - Paula Lago
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Porto University Hospital Center, Porto, Portugal
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Gastroenterology, São João University Hospital Center, Porto, Portugal.,Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal
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13
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Carvalho D, Carvalho P, Ferraz L, Pacheco A, Carvalho S, Ferreira R, Fernandes A, Cardoso P, Neves A. Respiratory disturbance index as a predictor of atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) is a risk factor for development of atrial fibrillation (AF). Recent pacemakers have specific algorithms for detecting of OSA based on impedance measurement.
Purpose
The aim was to determine the burden of AF in patients with high respiratory disturbance index (RDI). It was also intended to determine if the onset of continuous positive airway pressure (CPAP) reduced the AF burden.
Methods
Retrospective observational study carried out through the analysis of the patient records. It included patients with pacemakers evaluated in an outpatient clinic during the first 8 months of 2018. All had the RDI algorithm. AF burden was assessed according to automatic mode switch (AMS) duration. The percentage of nights with an RDI>20/h was analysed to assess the risk of OSA.
Results
108 patients were included (mean age=70.3±9.0 years; 56.5% men). The most prevalent indication for cardiac pacing was atrioventricular node dysfunction (59.3%). The average percentage of nights with an RDI>20/h was 44.2%. The average follow-up (FU) period was 4.1 years.
Of all cardiovascular risk factors, diabetes mellitus was the only one associated with a higher incidence of AF at FU (p=0.044).
Considering just the patients with an RDI >20/h in more than 20% of nights (RDI20%), male gender was associated with higher rate of major adverse cardiovascular events [(acute myocardial infarction, stroke, acute heart failure and death) (p=0.019)].
Considering patients with AF prior to pacemaker implantation (n=34), 76% of patients had an RDI >20/h in more than 20% of nights (mean of 58.1%). 23 of these patients had long standing persistent AF at the end of FU (vs 17 at the beginnig of FU).
Considering patients who developed AF after pacemaker implantation (n=24), 58% of patients had an RDI>20/h in more than 20% of nights (mean of 45.3%). Most patients had paroxismal AF (83%).
Patients with prior paroxysmal AF or those who developed AF during FU (n=37) had a higher burden of AF at the end of FU when they had RDI >20/h in more than 50% of nights (mean burden of 24.66% vs 14.69%, p=0.005).
There was no statistically significant correlation between the percentage of nights with RDI >20/h and the Apnea Hypopnea Index (AHI) value. Patients who underwent polysomnography (n=30) had a mean AHI of 16/h (which corresponds to moderately severe OSA). 63% of patients who were referred from the pacemaker consultation to pneumology and performed polysomnography started CPAP.
CPAP use was not associated with a statistically significant reduction in any endpoints or AF burden.
Conclusion
A high RDI was associated with onset of de novo AF and higher AF burden in patients with paroxysmal AF. Thus, there is a rationale for early diagnosis and treatment of OSAS to prevent and reduce AF progression.
In this study, CPAP was not shown to significantly reduce this endpoint, probably due to reduced polysomnography and CPAP treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Carvalho
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - P Carvalho
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - L Ferraz
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - A Pacheco
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - S Carvalho
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - R Ferreira
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - A Fernandes
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - P Cardoso
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
| | - A Neves
- Centro Hospitalar do Baixo Vouga , Aveiro , Portugal
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14
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Carvalho P, Carvalho D, Ferraz L, Ladeiras Lopes R, Briosa Neves A. A rare case of cardiac arrest due to anomalous origin of the non-dominant right coronary artery. Rev Port Cardiol 2022; 41:723-724. [DOI: 10.1016/j.repc.2021.08.012] [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] [Received: 08/08/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
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15
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Carvalho D, Rafael S, Monteiro A, Rodrigues V, Lopes M, Rocha A. How well have CMIP3, CMIP5 and CMIP6 future climate projections portrayed the recently observed warming. Sci Rep 2022; 12:11983. [PMID: 35835803 PMCID: PMC9283450 DOI: 10.1038/s41598-022-16264-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/25/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the dire conclusions of the Intergovernmental Panel on Climate Change (IPCC) Assessment Reports in terms of global warming and its impacts on Earth’s climate, ecosystems and human society, a skepticism claiming that the projected global warming is alarmist or, at least, overestimated, still persists. Given the years passed since the future climate projections that served as basis for the IPCC 4th, 5th and 6th Assessment Reports were released, it is now possible to answer this fundamental question if the projected global warming has been over or underestimated. This study presents a comparison between CMIP3, CMIP5 and CMIP6 future temperature projections and observations. The results show that the global warming projected by all CMIPs and future climate scenarios here analyzed project a global warming slightly lower than the observed one. The observed warming is closer to the upper level of the projected ones, revealing that CMIPs future climate scenarios with higher GHG emissions appear to be the most realistic ones. These results show that CMIPs future warming projections have been slightly conservative up to 2020, which could suggest a similar cold bias in their warming projections up to the end of the current century. However, given the short future periods here analyzed, inferences about warming at longer timescales cannot be done with confidence, since the models internal variability can play a relevant role on timescales of 20 years and less.
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Affiliation(s)
- D Carvalho
- CESAM-Department of Physics, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
| | - S Rafael
- CESAM-Department of Environment and Planning, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - A Monteiro
- CESAM-Department of Environment and Planning, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - V Rodrigues
- CESAM-Department of Environment and Planning, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - M Lopes
- CESAM-Department of Environment and Planning, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - A Rocha
- CESAM-Department of Physics, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
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16
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Rogers R, Carvalho D, Grabovska Y, Fernandez E, Izquierdo E, Mackay A, Jones C. DIPG-40. Combined pharmacological and genetic screening to identify dependencies and combinations in ACVR1-mutant diffuse midline glioma. Neuro Oncol 2022. [PMCID: PMC9164693 DOI: 10.1093/neuonc/noac079.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Somatic mutations in ACVR1, which encodes the serine/threonine kinase ALK2, are found in 20-25% of DMG-H3K27 patients. Treatment of ACVR1-mutant patient-derived models with multiple chemotypes of ALK2 inhibitors (ALK2i) results in reduced cell viability in vitro and extended survival in orthotopic xenografts in vivo but, as single agents, these inhibitors were unable to achieve a complete anti-tumour response. Recently we reported that combinatorial treatment of ACVR1-mutant DIPG cells with vandetanib (RTK inhibitor) and everolimus (mTOR/ABC transporter inhibitor) was synergistic both in vitro and in vivo and was shown to be a feasible combination to trial clinically in this setting. To identify specific dependencies in ACVR1-mutant cells which may be translatable with novel synergistic drug combinations alongside ALK2i, we have implemented both candidate and unbiased drug and genetic screening approaches. Using a panel of patient-derived ACVR1-mutant and wild-type models, we identified synergy between multiple chemotypes of ALK2i (M4K2009/LDN-214117) and PI3K/mTOR (AZD8055/everolimus) and MEK inhibitors (trametinib), reflecting the common co-segregation of PIK3CA/PIK3R1 alterations in these tumours. Whole-genome CRISPR/Cas9 screening of ACVR1-mutant SU-DIPG-IV cells in combination with two ALK2i (M4K2009/LDN-193189), confirmed a specific MTOR genetic dependency, as well as for the protein phosphatase regulatory subunit PPP2R1A, known to play a role in MAPK pathway activation. Additional hits include the serine/threonine kinase PKMYT1, a negative regulator of the G2/M checkpoint via a functionally redundant phosphorylation of CDK1/CCNB1 alongside WEE1; confirmatory drug assays with the WEE1 inhibitor AZD1775 resulted in a synergistic interaction with ALK2i in ACVR1-mutant cells. Hits were integrated with DepMap using ‘gene-effect’ scores (Chronos) enabling filtering of common essential genes. Preliminary pathway enrichment analysis (MAGeCKFlute) identified ALK2i-specific vulnerabilities involving TGFB1/SMAD signalling and histone deacetylation. These data highlight functionally rational and novel combinatorial possibilities for children with ACVR1-mutant DMG, with systematic preclinical assessment required for prioritisation for the clinic.
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Affiliation(s)
| | | | | | | | | | - Alan Mackay
- Institute of Cancer Research , London , United Kingdom
| | - Chris Jones
- Institute of Cancer Research , London , United Kingdom
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17
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Mackay A, Temelso S, Carvalho D, Kessler K, Boult J, Izquierdo E, Pereira R, Potente EF, Burford A, Molinari V, Bjerke L, Grabovska Y, Rogers R, Crampsie S, Das M, Robinson S, Clarke M, Jones C. HGG-42. Evolutionary selection of key oncogenic alterations in patient-derived models of paediatric diffuse high grade glioma (PDHGG) subtypes in vitro and in vivo. Neuro Oncol 2022. [PMCID: PMC9164821 DOI: 10.1093/neuonc/noac079.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PDHGG are a diverse group of childhood brain tumours comprising multiple subgroups carrying distinct molecular drivers. Patient-derived models accurately recapitulating this underlying biology are critical for mechanistic/preclinical studies aimed at improving patient outcome, however their behaviour over time in the environments in which they are propagated, and how this relates to the human disease, is largely unknown. To explore this, we collected 94 models of PDHGG established as 2D/3D stem cell cultures in vitro, and generated patient-derived xenografts (PDX) in 33/62 specimens implanted orthotopically in vivo. We carried out exome/targeted sequencing, methylation profiling and RNAseq to profile cells through their first 25 passages in culture, and sequential implantation from p0-p2 in mice. In 15/83 cultures, we observed enrichment of gene expression signatures of non-malignant cells over the first 5 passages, with concurrent depletion of somatic mutations/CNAs, excluding them from further study. Validated models retained tumour-matched genotypes, CNAs and driver alterations including H3.3G34R, H3.3/H3.1K27M, BRAF and ACVR1 over time, however subclonal alterations underwent selection in culture which profoundly altered their response to targeted drug treatment. In 6/7 PDGFRA-mutant models, activating mutations were selected against between p5-20 in 2D and/or 3D, whilst MAPK pathway mutations in NF1/PIK3R1 similarly diverged over 15 passages under different growth conditions, resulting in isogenic models with differential signalling, in vivo tumorigenicity, and in vitro sensitivity to multiple MEK inhibitors. In PDXs, serial xenografting reduced the time to tumour formation by up to half, with a concomitant shift in clonal architecture. Multi-region sequencing of diffusely-infiltrating tumours showed selection for alterations such as PIK3CA/NF1 at distant sites, with evidence for convergent evolution of subclonal mutations, as in human tumours. Understanding the evolutionary dynamics of targetable/predictive alterations in PDHGG model systems is key to developing new and effective therapeutic interventions in this highly heterogenous disease.
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Affiliation(s)
- Alan Mackay
- Institiute of Cancer Research , London , United Kingdom
| | - Sara Temelso
- Institiute of Cancer Research , London , United Kingdom
| | | | - Ketty Kessler
- Institiute of Cancer Research , London , United Kingdom
| | - Jessica Boult
- Institiute of Cancer Research , London , United Kingdom
| | | | - Rita Pereira
- Institiute of Cancer Research , London , United Kingdom
| | | | - Anna Burford
- Institiute of Cancer Research , London , United Kingdom
| | | | - Lynn Bjerke
- Institiute of Cancer Research , London , United Kingdom
| | | | | | | | - Molina Das
- Institiute of Cancer Research , London , United Kingdom
| | | | | | - Chris Jones
- Institiute of Cancer Research , London , United Kingdom
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Vardon A, Guiho R, Carvalho D, Boult J, Carter R, Grabovska Y, Mackay A, Zheng G, Zhou D, Hiley C, Lythgoe M, Jones C, Hargrave D, Martinez- JP. DIPG-46. Radiation induced senescence in diffuse intrinsic pontine glioma cells reveals selective vulnerability to Bcl-XL inhibition. Neuro Oncol 2022. [PMCID: PMC9165002 DOI: 10.1093/neuonc/noac079.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diffuse intrinsic pontine glioma remains a devastating condition with a dismal five year survival rate less than 5%. New approaches for treating this aggressive disease are critical to driving progress. Conventional radiotherapy remains the cornerstone of treatment, with no chemotherapeutic agent found to improve survival. However, radiotherapy is often delivered as a palliative treatment, and disease often recurs 3-6 months after. Radiation causes DNA damage and oxidative stress yielding a senescent state of replicative arrest in susceptible cells. However, increasing evidence demonstrates malignant cells can escape senescence leading to tumour recurrence. Targeted ablation of non-replicating senescent tumour cells following radiation could negate tumour recurrence. It remains unknown whether DIPG undergoes senescence following radiation, and furthermore, whether senolytics can be utilised to target senescent DIPG cells. We employed radiation to induce a senescent state in primary human DIPG cell lines. Senescence was confirmed using SA-β-gal staining, lack of EdU incorporation and qRT-PCR to characterise the SASP in three primary human DIPG cell lines. RNA-sequencing on DIPG cells following radiation revealed senescence and SASP signatures. Likewise, expression of senescence markers has been detected in human tumours. Viable cells that survive radiation were then utilised to screen candidate senolytic drugs, only Bcl-XL inhibitors demonstrated reproducible senolytic activity in radiation treated DIPG cells. In addition, Bcl-XL degradation using PROTACs (proteolysis targeting chimeras) resulted in a significant increase in senolysis of susceptible tumour cells. Conversely, Bcl-2 inhibitors failed to show any consistent senolytic activity. We are currently performing preclinical studies in the mouse to test the efficiency of senolytics against DIPG. These results demonstrate future possibilities of targeting radiation induced senescence in DIPG, using novel senolytic therapies and highlight Bcl-XL dependency as a potential vulnerability of surviving DIPG cells following exposure to radiation.
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Affiliation(s)
| | - Romain Guiho
- University College London , London , United Kingdom
| | | | - Jessica Boult
- Institute of cancer research , London , United Kingdom
| | | | | | - Alan Mackay
- Institute of cancer research , London , United Kingdom
| | | | | | | | - Mark Lythgoe
- University College London , London , United Kingdom
| | - Chris Jones
- Institute of cancer research , London , United Kingdom
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Boult J, Carvalho D, Kessler K, Vinci M, Fernandez E, Bjerke L, Fofana M, Molinari V, Carcaboso A, Jones C, Robinson S. IMG-09. Characterisation of a panel of in vivo models of paediatric-type diffuse high-grade glioma (PDHGG) using magnetic resonance imaging. Neuro Oncol 2022. [PMCID: PMC9165046 DOI: 10.1093/neuonc/noac079.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Novel therapies for paediatric-type diffuse high-grade glioma (PDHGG) are urgently required. Orthotopic models using patient-derived material are invaluable tools in preclinical drug development as they retain key genetic/epigenetic features, eg. histone H3G34 or H3K27 alterations. Their evaluation in situ is vital and requires sensitive imaging techniques such as MRI. 12 diffuse hemispheric glioma (DHG; 2 DHG-G34) and 21 diffuse midline glioma (DMG; 17 DMG-K27M) tumours have been characterised using MRI following site-specific orthotopic implantation of patient-derived cells directly from tumour material or after minimal expansion as stem cell cultures. Of the 62 models implanted; 3 DHG and 10 DMG samples were not tumourigenic and 13 DHG/3 DMG models are currently under MRI surveillance. Tumours identified on T2-weighted (T2w)-images varied from a diffuse hyperintense signal to well-defined high contrast masses. Tumour growth in 5 DMG models was too diffuse for longitudinal monitoring with T2w-MRI. Once established, diffusion-weighted, T1/T2 mapping and contrast-enhanced MRI were used to further assess tumour phenotype. Quantitative data from 15 DMG models demonstrated higher water diffusivity and T2 than 10 DHG tumours, which suggests less tightly packed tumour cells but may also reflect the closer proximity of tumours growing in the thalamus/pons/cerebellum to the ventricular system. Lack of contrast-agent enhancement in 11 DMG and 6/10 DHG models indicated an intact blood-brain barrier (BBB), with heterogeneous disruption observed in 4 DHGs; H3-G34 had no bearing on BBB integrity. Upon serial re-implantation survival was shortened in 3/4 DHG and 2/6 DMG models, while quantitative MRI parameters remained similar. Likewise, when 2 DHG and 2 DMG models grown in 2D/3D in vitro were implanted in parallel, poorer survival/improved penetrance was associated with 3D-cultured cells with no difference in imaging phenotype. The study highlights the potential of non-invasive MRI to accurately evaluate the efficacy of novel therapeutics in these PDHGG models.
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Affiliation(s)
- Jessica Boult
- The Institute of Cancer Research , London , United Kingdom
| | - Diana Carvalho
- The Institute of Cancer Research , London , United Kingdom
| | - Ketty Kessler
- The Institute of Cancer Research , London , United Kingdom
| | - Maria Vinci
- Bambino Gesù Children’s Hospital - IRCSS , Rome , Italy
| | | | - Lynn Bjerke
- The Institute of Cancer Research , London , United Kingdom
| | - Mariama Fofana
- The Institute of Cancer Research , London , United Kingdom
| | | | | | - Chris Jones
- The Institute of Cancer Research , London , United Kingdom
| | - Simon Robinson
- The Institute of Cancer Research , London , United Kingdom
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20
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Magro F, Sottomayor C, Alves C, Santiago M, Ministro P, Lago P, Correia L, Gonçalves R, Carvalho D, Portela F, Dias CC, Dignass A, Danese S, Peyrin-Biroulet L, Estevinho MM, Leão Moreira P. Composite outcomes in observational studies of Crohn's disease: a systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848221092754. [PMID: 35601803 PMCID: PMC9118904 DOI: 10.1177/17562848221092754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to assess composite and aggregate outcomes of observational studies in Crohn's disease and to evaluate whether the number and type of variables included affect the frequency of the outcome. METHODS MEDLINE [via PubMed], Scopus and Web of Science were searched to identify observational studies that enrolled patients with Crohn's disease and evaluated a composite or aggregate outcome. The proportion of patients achieving the outcome was determined and a random-effects meta-analysis was performed to evaluate how the frequency of each outcome varies according to the reporting of predefined variables. RESULTS From 10,257 identified records, 46 were included in the qualitative analysis and 38 in the meta-analysis. The frequency for composite and aggregate outcomes was 0.445 [95% confidence interval (CI): 0.389-0.501] and 0.140 (95% CI: 0.000-0.211), respectively. When comparing composite outcomes by number of included variables, the frequency was 0.271 (95% CI: 0.000-0.405) and 0.698 (95% CI: 0.651-0.746), for one and six variables, respectively. The frequency of the composite outcome varied according to the identity of the variables being reported. Specific pairs of predefined variables had a significant effect in the frequency of composite outcomes. CONCLUSION Composite outcomes with increasing number of predefined variables show an increase in frequency. Outcomes including variables such as 'Surgery' and 'Steroids' had higher frequencies when compared with the ones that did not include these variables. These results show that the frequency of composite outcomes is dependent on the number and type of variables being reported.
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Affiliation(s)
| | | | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Paula Lago
- Department of Gastroenterology, Santo António University Hospital Center (CHUPorto), Porto, Portugal
| | - Luís Correia
- Department of Gastroenterology, Lisbon North Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Santo António dos Capuchos Hospital at Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Francisco Portela
- Department of Gastroenterology, University Hospital Centre of Coimbra, Coimbra, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Leão Moreira
- Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
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21
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Carvalho D, Carvalho P, Ferraz L, Pacheco A, Carvalho S, Ferreira R, Bastos JM, Neves AB. Rhythm control in patients with atrial fibrillation admitted to outpatient clinic. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Patients are often symptomatic leading to a reduction in quality of life. Recent studies suggests that early rhythm control therapy have a clinical benefit in patients with recently diagnosed AF.
Purpose
This study aims to evaluate outpatient with AF referred to an outpatient clinic to electrical Cardioversion. Besides that, the study aims to evaluate if outpatient referred from the emergency room had spontaneously reverted to sinus rhythm.
Material and Methods
Retrospective observational study carried out through the analysis of the clinical process. Clinical data were collected from AF patients evaluated in an outpatient clinic during the year of 2020. Statistical analysis was made using R software and RStudio.
Results
This study included 92 patients evaluated in an outpatient clinic and referred because paroxysmal, persistent and long standing AF to electrical cardioversion. Average age was 67.3 ± 10.1 years. 78 patients had atrial fibrillation and 14 patients had atrial flutter. Hypertension was the most prevalent risk factor (n=83; 79,3%), followed by dislipidemia (n=66; 71.7%), overweight (n=43; 46,7%), diabetes mellitus (n=27; 29.3%) and smoke (n=20; 21.7%). 15 patients had paroxysmal AF, 67 patients had persistent AF and 10 patients had long standing AF. CHA2DS2VASC median were 2,78 ± 1.66 and HASBLED median was 1,14 ± 0.94. The heart rate control were most frequently made with betablocker (n=78; 84.7%). 4 patients (4,3%) were medicated with digoxin and 3 patients with calcium channel blockers. 69 patients were forwarded from external consultant and 23 patients from the emergency room (ER). We verified that 12 patients (52,2%) were in sinus rhythm in admission of outpatient clinic and had spontaneously reversion to sinus rhythm. Mostly patients with paroxysmal AF were from the ER (80% of all patients, p<.001) and mostly patients with persistent and long standing AF were from external consultant (respectively 82% p<0.01 and 85% p<0,01). Symptoms improvement were evaluated by EHRA classification. Mostly patients had clinical improvement after electrical or spontaneously cardioversion (63%, p.0.02). The median EHRA score previous to CVE were "2" and after cardioversion were "1".
Conclusions
Risk factor control is the cornerstone of AF prevention. Control rhythm is important to improve clinical symptons related to AF. However, we can delay cardioversion in a recent acute episode in the emergency room. In our sample, it seems that AF with short natural story presents more in emergency room and the more chronic comes to our consultation.
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Affiliation(s)
- D Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - P Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - L Ferraz
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - A Pacheco
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - S Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - R Ferreira
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - JM Bastos
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - AB Neves
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
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22
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Santiago M, Stocker F, Ministro P, Gonçalves R, Carvalho D, Portela F, Correia L, Lago P, Trindade E, Dias CC, Magro F. Incidence Trends of Inflammatory Bowel Disease in a Southern European Country: A Mirror of the Western World? Clin Transl Gastroenterol 2022; 13:e00481. [PMID: 35347090 PMCID: PMC9132531 DOI: 10.14309/ctg.0000000000000481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/09/2022] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) affects people from all age categories worldwide. Although the incidence of the disease is stabilizing or decreasing in most Western world countries, its prevalence is still increasing because of the rise in life expectancy and better disease management. This work intends to identify the trends related to IBD incidence nationwide, analyzing regional, sex, and age distributions. METHODS Data were provided by the Portuguese Shared Services of the Ministry of Health. This study consisted of a retrospective analysis of all first consultations coded for "Chronic enteritis/ulcerative colitis" (D94) in a primary healthcare setting, between 2017 and 2020, in Portugal. The primary outcome measure was the IBD incidence rate per 100,000 inhabitants. We also calculated the incidence rate per person-year and forecasted incidence until 2024. RESULTS Between 2017 and 2019, the incidence rate of IBD in Portugal decreased from 54.9 to 48.6 per 100,000 inhabitants. The average incidence was 20 new cases of IBD per 1,000 person-year. It was predicted that, in December 2023, IBD incidence would reach 305.4 new cases (95% Prediction Interval 156.6-454.3), a similar result to the values forecasted for December 2021 (305.4, 95% Prediction Interval 197.3-413.6). DISCUSSION The incidence of IBD slightly declined from 2017 to 2019, and it is posed to stabilize in the future. The presented data are of the utmost importance for the characterization of IBD in Southern European countries and the establishment of future health policies in the setting of compounding prevalence in the Western world.
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Affiliation(s)
- Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
| | - Francisco Stocker
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal;
| | - Paula Ministro
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Tondela-Viseu Hospital Center, Viseu, Portugal;
| | - Raquel Gonçalves
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Braga Hospital, Braga, Portugal;
| | - Diana Carvalho
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Central Lisbon Hospital Center, Lisbon, Portugal;
| | - Francisco Portela
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Coimbra University Hospital Center, Coimbra, Portugal;
| | - Luís Correia
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology and Hepatology, Northern Lisbon Hospital Center, Lisbon, Portugal;
| | - Paula Lago
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Porto University Hospital Center, Porto, Portugal;
| | - Eunice Trindade
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Pediatrics, São João University Hospital Center, Porto, Portugal;
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal;
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal;
- Department of Gastroenterology, São João University Hospital Center, Porto, Portugal;
- Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal.
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23
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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Santos S, Saraiva R, Oliveira M, Carvalho D, Ramos G. Pancreatogastric Fistula with Fish-Mouth Sign. GE Port J Gastroenterol 2022; 29:362-363. [PMID: 36159197 PMCID: PMC9485959 DOI: 10.1159/000516674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
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25
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Rebelo F, Carvalho D, Noriega Machado P, Vilar E. HeroFit: A gamified solution with a mini game, to promote the change of sedentary behaviors. Ergonomics In Design 2022. [DOI: 10.54941/ahfe1001970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
One of the main barriers to non-sedentary behavior is the fact that professional work needs to be done while seated. Since non-sedentary tasks must be performed repeatedly, one should not solely exercise outside of work, as this can lead to a long period of sedentary lifestyle during working hours. In this study, a solution was thought up, HeroFit, that would motivate people to perform low intensity exercises for longer periods of time and consequently lead to a change in their routines. The results showed that the HeroFit application, had a good acceptance rate by users who have tested it. It had all the necessary features to monitor physical activity, as well as a strong gamification component, which goes further than the existing applications on the market, by incorporating a mini game where the user had a greater goal than just socialization and physical performance.
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26
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Magro F, Alves C, Santiago M, Ministro P, Lago P, Correia L, Gonçalves R, Carvalho D, Portela F, Dias CC, Dignass A, Danese S, Peyrin-Biroulet L, Estevinho MM, Moreira P. Composite outcomes in observational studies of ulcerative colitis: A systematic review and meta-analysis. United European Gastroenterol J 2021; 10:54-72. [PMID: 34907660 PMCID: PMC8830283 DOI: 10.1002/ueg2.12183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Ulcerative colitis (UC) has been the focus of numerous observational studies over the years and a common strategy employed in their design is the use of composite and aggregate outcomes. Objective This systematic review and meta‐analysis aims to identify composite and aggregate outcomes of observational studies in UC and to evaluate how the number and type of variables included and the length of follow‐up affect the frequency of patients that achieve these outcomes. Methods A systematic literature search was carried out using MEDLINE [via PubMed], Scopus, and Web of Science online databases. Observational studies that included UC patients and reported composite or aggregate outcomes were identified. A set of variables considered to be representative of progressive or disabling UC was defined, the proportion of patients attaining the outcomes was determined and a random‐effects meta‐analysis was performed by dividing the identified studies into subgroups according to different criteria of interest. Results A total of 10,264 records were identified in the systematic search, of which 33 were retained for qualitative analysis and 20 were included in the meta‐analysis. The mean frequency for composite outcomes was 0.363 [95% confidence interval (CI) 0.323‐0.403]. The frequency of composite outcome for the subgroup of studies that included the variable “Biologics” was significantly higher than for those in which this variable was not reported [0.410; 95% CI 0.364‐0.457 versus 0.298; 95% CI 0.232‐0.364; p = 0.006]. Composite outcomes were also more frequent as the follow‐up duration increased. Conclusion The frequency of composite outcomes in observational studies of UC is dependent on the specific identity of the variables being reported. Moreover, longer follow‐up periods are associated with higher frequencies of composite outcomes. The evidence provided here is useful for the design of future observational studies of UC that aim to maximize the frequency of patients that achieve composite outcomes. Summarize the established knowledge on this subject Observational studies have become a valuable source of information but also present a remarkable heterogeneity. The inconsistency on the reported outcomes between individual studies and the potential for reporting biases has led to calls for the development of core outcome sets (COS).
What are the significant and/or new findings of this study? This is the first systematic review and meta‐analysis of outcomes in observational studies of Ulcerative colitis (UC). The frequency of composite outcomes in observational studies of UC is dependent on the specific identity of the variables being reported and on the follow‐up duration. Reporting of the variable “Biologics” significantly increased the frequency of composite outcomes. These findings may be useful for the design of future observational studies of UC.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, São João University Hospital Center (CHUSJ), Porto, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
| | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Paula Lago
- Department of Gastroenterology, Santo António University Hospital Center (CHUPorto), Porto, Portugal
| | - Luís Correia
- Department of Gastroenterology, Lisbon North Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Santo António dos Capuchos Hospital at Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Francisco Portela
- Department of Gastroenterology, University Hospital Centre of Coimbra, Coimbra, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Axel Dignass
- Agaplesion Markus Hospital, Department of Medicine I, Frankfurt, Germany
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Moreira
- Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
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Russo MA, Ruivo L, Carvalho D, Martins N, Monteiro A. Decarbonizing the energy supply one pandemic at a time. Energy Policy 2021; 159:112644. [PMID: 36246728 PMCID: PMC9554235 DOI: 10.1016/j.enpol.2021.112644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 06/16/2023]
Abstract
This study explores different energy consumption vectors during the first year of the COVID-19 pandemic in Portugal. Most of the workforce started working from home and resource consumption significantly shifted towards the domestic sector. The ensuing confinement protocols caused a shift in everyday life, which in turn significantly altered the energy supply and demand landscape. This event, although catastrophic in terms of loss of human life and economic development, can provide us with valuable data to study the potential of new strategies to achieve EU 2050 Energy goals. It was investigated whether the pandemic has opened a path and provided us with a partial answer to decarbonization in the form of home office practices as a possible energy efficiency measure. The present study shows that, in Portugal, there was a 15.7% reduction of primary energy consumption (accounting for electricity, natural gas and transport fuels) compared to 2019. The data suggest that actions targeting reduced mobility, such as home office practices and the decentralization of the workforce, could be a relevant energy efficiency measure.
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Affiliation(s)
- M A Russo
- CESAM and Department of Environment and Planning, University of Aveiro, Portugal
| | - L Ruivo
- CICECO and Department of Materials and Ceramic Engineering, University of Aveiro, Portugal
| | - D Carvalho
- CESAM and Department of Physics, University of Aveiro, Portugal
| | - N Martins
- TEMA and Department of Mechanical Engineering, University of Aveiro, Portugal
| | - A Monteiro
- CESAM and Department of Environment and Planning, University of Aveiro, Portugal
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28
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Carvalho D, Bastos JM, Viegas V, Pacheco A, Ferraz L, Carvalho P, Ferreira R, Neves AB. Acute myocardial infarction at an early age – importance of acute chest pain fast track in patient management. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute coronary syndrome (ACS) has a higher incidence in middle-aged and elderly patients but 2% to 6% of ACS cases occur in people younger than 45 years of age (Y). Younger patients have different clinical characteristics when compared to older patients. Acute chest pain fast track led to a reduction in the time required for the diagnosis of acute coronary syndromes, particularly those with ST segment elevation (STEMI).
Aim
This study aims to assess the differences in risk factors and clinical characteristics between young and older ACS patients. Besides that, we try to determine if the benefits of acute chest pain fast track have extended to this younger population.
Material and methods
Retrospective observational study carried out through the analysis of the clinical process. Clinical data were collected from ACS patients under 45Y from 2010 to 2019 and from ACS patients over 45Y from 2010 to 2012. Statistical analysis was made using R software and RStudio.
Results
This study included 93 patients with ACS under 45Y and 172 patients with ACS over 45Y. A total of 265 patients were included. The male gender was predominant in both groups but with a higher prevalence in the younger ones (88% vs 73%, p<0,005). The prevalence of hypertension was higher in older ACS patients but the younger ones had more overweight (39.8% vs 17.4%, p<0,001), smoking history (84.9% vs 38.4%, p<0,001) and family history of sudden death (25.8% vs 5.8%, p<0,01). Diabetes had no statistical difference. Dyslipidemia as previous known risk factor had no statistical difference but LDL was higher in patients with less than 45Y (147.2 vs 120.7 mg/dL, p<0,001). STEMI were tendentially more prevalent in patients under 45Y (55.9% vs 44.8%, p 0.09). The anterior wall was the most frequently involved in both groups (52% vs 63%, p 0.28), followed by the inferior wall (42% vs 36%). Accordantly, anterior descending artery was the artery most frequently involved in both groups (44.1% vs 48.3%), followed by right coronary artery (24.7 vs 26.7%). STEMI patients under 45Y were submitted to an emergent coronary angiography in 89% of cases and STEMI patients over than 45Y were submitted in 70.1% of cases. Particularly for patients under 45Y, all STEMI patients were submitted to an emergent coronary angiography after 2014, which emphasis the importance of acute chest pain fast track in the emergency room. Finally, ACS patients under 45Y were less submitted to percutaneous coronary angiography compared to patients over 45Y (15.1% vs 4.7%, p<0,001).
Conclusions
Cardiovascular risk factors differ accordingly the age of ACS patients. Younger patients had more overweight and smoking history. They probably have alternative pathophysiologic mechanisms that explain differences in percutaneous coronary angiography. Acute chest pain fast track had an important role reducing morbimortality related to ACS by reducing the time until STEMI diagnose.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - J M Bastos
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - V Viegas
- University of Aveiro, Aveiro, Portugal
| | - A Pacheco
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - L Ferraz
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - P Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - R Ferreira
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - A B Neves
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
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29
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Pacheco A, Carvalho D, Carvalho P, Ferraz L, Briosa A, Bem Haja P, Bastos M. How did the first pandemic COVID wave affect acute myocardial infarction hospital assistance? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
There is a general notion that the COVID pandemic has made access to adequate health care difficult. A retrospective study looked at patients with acute myocardial infarction (AMI) admitted to a hospital, including the time between admission and diagnosis, the time until treatment, and the delay in transferring to a hospital with a catheterization laboratory in the case of ST-Elevation Myocardial Infarction (STEMI).The period analysed was March to July 2019 and March to July 2020 (first Covid pandemic wave). 197 patients, 101 in 2019 (SCA19) and 96 in 2020 (SCAcov), 142 males (72%) mean age 67.3±12.6. It was observed in 2019 29 STEMI and 72 acute myocardial infarct without ST elevation (NSTEMI) na 2020 36 STEMI and 60 NSTEMI, this proportions didn't achieve statistical meaning χ2(1)=1.719, p=0.226. When compared SCA19 versus SCAcov there were no differences between groups in relation to demographic data. The clinical presentation (none, hemodynamic instability, refractory pain, arrhythmia, mechanic complication, acute heart failure) not varied between groups χ2(6)=3.42, p=0.755. When analysed, between SCA19 and SCAcov, there were no significant time difference between the admission and the electrocardiogram execution (MSCA19 = 44.78; MSCAcov = 56.84; Tweich (132.66) = −0.73, p=0.476 g Hedge = 0.71, between time of admission and time of diagnosis MSCA19 = 264.84; MSCAcov = 254.2; Tweich (188.81) = −0.34, p=0.731 g Hedge = 0.05, and the duration of hospitalization MSCA19 = 5.90; MSCAcov = 5.78 U=9400, Z=−0.263, p<0.792.
Conclusion
In COVID times even with the all restrictions and contingencies lived in hospitals our results pointed to no significant changes in the variables analysed. Interestingly, in spite of no significant difference, a slightly more delay in ECG execution, higher prevalence of STEMI but a short time of diagnosis were observed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Pacheco
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - D Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - P Carvalho
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - L Ferraz
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - A Briosa
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | | | - M Bastos
- Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
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30
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Correia FD, Molinos M, Neves C, Janela D, Carvalho D, Luis S, Francisco GE, Lains J, Bento V. Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study. JMIR Rehabil Assist Technol 2021; 8:e31247. [PMID: 34499038 PMCID: PMC8517823 DOI: 10.2196/31247] [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: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022
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Affiliation(s)
- Fernando D Correia
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Maria Molinos
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Carlos Neves
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Diana Carvalho
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Sara Luis
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States.,TIRR Memorial Hermann, Houston, TX, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Virgilio Bento
- SWORD Health Technologies, Inc, Draper, UT, United States
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31
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Ornelas Saraiva R, Canha MI, Almeida V, Fernandes J, Dias A, Rodrigues AC, Carvalho D, Maltez F, Panarra A, Coimbra J. Gastrointestinal Symptoms and Liver Injury on Admission in a Hospitalised Population with COVID-19 Infection. ACTA MEDICA PORT 2021; 34:640-641. [PMID: 34863326 DOI: 10.20344/amp.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Rita Ornelas Saraiva
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Maria Inês Canha
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Vasco Almeida
- Infectious Diseases Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Jorge Fernandes
- Internal Medicine Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - André Dias
- Infectious Diseases Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Ana Catarina Rodrigues
- Internal Medicine Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Diana Carvalho
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Fernando Maltez
- Infectious Diseases Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - António Panarra
- Internal Medicine Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - João Coimbra
- Gastroenterology Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
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32
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Costa L, Carvalho D, Coelho E, Leal D, Lencastre L. Purulent Pericarditis: Is It Really a Disease of the Past? Eur J Case Rep Intern Med 2021; 8:002658. [PMID: 34377691 DOI: 10.12890/2021_002658] [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: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/05/2022] Open
Abstract
The authors present a case of purulent pericarditis probably secondary to respiratory infection, a rare entity in the antibiotic era. Pericardial fluid analysis identified streptococci and oral anaerobes as the causative agents. A prolonged and complicated diagnostic and therapeutic course, which included a long stay in the intensive care unit, is described, and a review of purulent pericarditis provided. Pericardial effusion, particularly in the setting of concomitant respiratory infection and immunocompromise or other risk factors, should raise the suspicion of bacterial pericarditis and prompt its timely diagnosis and treatment. Purulent pericarditis can be lethal and has potentially severe complications, so adequate antimicrobial therapy and source control are key. LEARNING POINTS Purulent pericarditis is a rare infection, mostly resulting from contiguous or haematogenous spread, with diagnosis often delayed because signs and symptoms are unspecific.Treatment must include drainage of the pericardial space, combined with systemic antibiotics.Prognosis is variable, depending largely on the speed of diagnosis and treatment, as death is almost certain without adequate source control.
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Affiliation(s)
- Laura Costa
- Unidade de Cuidados Intensivos Polivalente, Hospital de Braga, Braga, Portugal
| | - Diana Carvalho
- Serviço de Cardiologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Elisabete Coelho
- Unidade de Cuidados Intensivos Polivalente, Hospital de Braga, Braga, Portugal
| | - Dina Leal
- Unidade de Cuidados Intensivos Polivalente, Hospital de Braga, Braga, Portugal
| | - Luís Lencastre
- Unidade de Cuidados Intensivos Polivalente, Hospital de Braga, Braga, Portugal
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33
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Sena C, Carvalho D, Pereira A, Queiroz M, Seiça R. Beneficial effects of pyridoxamine in endothelial dysfunction of type 2 diabetic animal models. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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34
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Carvalho D, Marques CC, Pinto AM, Martins MJ, Leal I, Castilho P. Fears of compassion scales in psychosis: confirmatory factor analysis and psychometric properties. Curr Psychol 2021. [DOI: 10.1007/s12144-021-01979-y] [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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35
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Pinto AO, Carvalho D, Frizzo C, Lopes K, Tessari GB, Catecati T, Dhom-Lemos LC, Pasquali AKS, Quaresma PF, Stoco PH, Grisard EC, Steindel M, Wagner G. First case of canine visceral leishmaniasis in the midwestern of Santa Catarina State, Brazil. BRAZ J BIOL 2021; 82:e241162. [PMID: 34133561 DOI: 10.1590/1519-6984.241162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/28/2020] [Indexed: 11/22/2022] Open
Abstract
Canine visceral leishmaniasis (CVL) caused by Leishmania (Leishmania) infantum is transmitted by phlebotomine sandflies and a major zoonotic disease in Brazil. Due to the southward expansion of the disease within the country and the central role of dogs as urban reservoirs of the parasite, we have investigated the occurrence of CVL in two municipalities Erval Velho and Herval d'Oeste in the Midwest region of Santa Catarina state. Peripheral blood samples from 126 dogs were collected in both cities and tested for anti-L. infantum antibodies by indirect enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence reaction (IIF) and for the presence of parasite DNA by polymerase chain reaction (PCR) in peripheral blood. From examined dogs, 35.71% (45/126) were positive for at least one of the three tests and two (1.6%) were positive in all performed tests. Twelve dogs (9.5%) were positive for both ELISA and IIF, while 21 dogs were exclusively positive for ELISA (16.7%), and 15 (11.9%) for IIF. L. infantum k-DNA was detected by PCR in 9 out of 126 dogs (7.1%) and clinical symptoms compatible with CVL were observed for 6 dogs. Taken together, these results indicate the transmission of CVL in this region, highlighting the needs for epidemiological surveillance and implementation of control measures for CVL transmission in this region.
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Affiliation(s)
- A O Pinto
- Programa de Mestrado em Biociências e Saúde, Universidade do Oeste de Santa Catarina - UNOESC, Joaçaba, SC, Brasil.,Curso de Graduação em Medicina Veterinária, Universidade do Oeste de Santa Catarina - UNOESC, Campos Novos, SC, Brasil
| | - D Carvalho
- Programa de Mestrado em Biociências e Saúde, Universidade do Oeste de Santa Catarina - UNOESC, Joaçaba, SC, Brasil
| | - C Frizzo
- Programa de Mestrado em Biociências e Saúde, Universidade do Oeste de Santa Catarina - UNOESC, Joaçaba, SC, Brasil
| | - K Lopes
- Programa de Mestrado em Biociências e Saúde, Universidade do Oeste de Santa Catarina - UNOESC, Joaçaba, SC, Brasil
| | - G B Tessari
- Curso de Graduação em Medicina Veterinária, Universidade do Oeste de Santa Catarina - UNOESC, Campos Novos, SC, Brasil
| | - T Catecati
- Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
| | - L C Dhom-Lemos
- Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
| | - A K S Pasquali
- Curso de Graduação em Medicina Veterinária, Universidade do Oeste de Santa Catarina - UNOESC, Campos Novos, SC, Brasil
| | - P F Quaresma
- Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
| | - P H Stoco
- Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
| | - E C Grisard
- Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
| | - M Steindel
- Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
| | - G Wagner
- Programa de Mestrado em Biociências e Saúde, Universidade do Oeste de Santa Catarina - UNOESC, Joaçaba, SC, Brasil.,Laboratório de Protozoologia, Universidade do Federal de Santa Catarina - UFSC, Florianópolis, SC, Brasil
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36
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Vardon A, Guiho R, Carvalho D, Jones C, Hargrave D, Martinez-Barbera JP. HGG-07. RADIATION INDUCED SENESCENCE IN DIFFUSE INTRINSIC PONTINE GLIOMA CELLS REVEALS SELECTIVE VULNERABILITY TO BCL-XL INHIBITION. Neuro Oncol 2021. [PMCID: PMC8168093 DOI: 10.1093/neuonc/noab090.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diffuse intrinsic pontine glioma remains a devastating condition with a dismal five year survival rate less than 5%. New approaches for treating this aggressive disease are critical to driving progress. Conventional radiotherapy remains the cornerstone of treatment, with no chemotherapeutic agent found to improve survival. However, radiotherapy is often delivered as a palliative treatment, and disease often recurs 3–6 months after. Radiation causes DNA damage and oxidative stress yielding a senescent state of replicative arrest in susceptible cells. However, increasing evidence demonstrates malignant cells can escape senescence leading to tumour recurrence. Targeted ablation of non-replicating senescent tumour cells following radiation could negate tumour recurrence. It remains unknown whether DIPG undergoes senescence following radiation, and furthermore, whether senolytics can be utilised to target senescent DIPG cells. We employed radiation to induce a senescent state in primary human DIPG cell lines. Senescence was confirmed using SA-β-gal staining, lack of EdU incorporation and qRT-PCR to characterise the SASP in three primary human DIPG cell lines. RNA-sequencing on DIPG cells following radiation revealed senescence and SASP signatures. Viable cells that survive radiation were then utilised to screen candidate senolytic drugs, only Bcl-XL inhibitors demonstrated reproducible senolytic activity in radiation treated DIPG cells. Conversely, Bcl-2 inhibitors failed to show any consistent senolytic activity. These results demonstrate future possibilities of targeting radiation induced senescence in DIPG, using novel senolytic therapies and highlight Bcl-XL dependency as a potential vulnerability of surviving DIPG cells following exposure to radiation.
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Affiliation(s)
- Ashley Vardon
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Romain Guiho
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Chris Jones
- The Institute of Cancer Research, Sutton, UK
| | - Darren Hargrave
- Great Ormond Street Hospital NHS Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Bastos JM, Carvalho D, Aveiro M, Correia A, Damiao P. NIGHT DIASTOLIC VALUES OF AMBULATORY BLOOD PRESSURE ARE THE MORE PREDICTIVE OF THE OUTCOMES IN PREGNANCY COMPLICATED WITH HYPERTENSION. J Hypertens 2021. [DOI: 10.1097/01.hjh.0000748496.84692.8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Carvalho D, Aguiar P, Mendes-Bastos P, Palma-Carlos A, Freitas J, Ferrinho P. Quality of Life and Characterization of Patients With Atopic Dermatitis in Portugal: The QUADEP Study. J Investig Allergol Clin Immunol 2020; 30:430-438. [DOI: 10.18176/jiaci.0443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: To investigate the quality of life (QOL) of and to characterize patients with atopic dermatitis (AD) in Portugal. Methods: This was a cross-sectional study of patients with AD and other eczemas. Skindex-29, Skindex-teen, and the Childhood Atopic Dermatitis Impact Scale (CADIS) were the instruments used to assess QOL in adults, teenagers, and children, respectively. The SF-12 was also used, and disease severity was evaluated using the Patient-Oriented SCORAD (PO-SCORAD) instrument. Associations with QOL were assessed based on the odds ratio (OR). P values <.05 and 95%CIs were considered statistically significant. Results: The study population comprised 162 participants aged 0.5-74 years. We found that 37.3% of AD patients consider their disease disabling and that more than half of the patients feel stigmatized by society. The mean Skindex score for AD was 39.68, and the impact on QOL was severe in 44%. “Symptoms” was the most affected category in adults. AD was moderate to severe in 87% of the sample. One of the factors that most influenced poorer QOL in AD was age: with increasing age, the Skindex is likely to increase (OR, 1.03; 95%CI, 1.00-1.06). “Considering the disease a disability” was also associated (OR, 6.72; 95%CI, 2.56-17.63). QOL worsens with increasingly affected body area (OR, 1.07; 95%CI, 1.03-1.11) and the presence of edema (OR, 2.0; 95%CI, 1.23-3.40). Conclusions: This is the first study to provide data on QOL in patients with AD in Portugal. Our data show an expected negative impact. More awareness-raising activities are needed to increase knowledge, decrease stigmatization, and, consequently, address the factors involved in the QOL of patients with AD.
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Mackay A, Grabovska Y, Clarke M, Carvalho D, Temelso S, Jones C. PATH-17. INTRAGENIC COPY NUMBER BREAKPOINT ANALYSIS OF METHYLATION DATA FROM CNS TUMOURS IDENTIFIES NOVEL SUBGROUP-SPECIFIC CANDIDATE FUSION GENE ENRICHMENTS. Neuro Oncol 2020. [PMCID: PMC7715082 DOI: 10.1093/neuonc/noaa222.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methylation array-based molecular profiling has redefined the classification of brain tumours and now forms an important part of their integrated diagnosis, providing both subgroup assignment and genome wide DNA copy number profiles. These latter data can be used to identify intragenic breakpoints which are frequently associated with structural variations resulting in therapeutically targetable oncogenic fusion genes. To systematically assess the landscape of these alterations, we combined publicly available methylation datasets resulting in a total of 5660 CNS tumours, around half paediatric, and including >1000 high grade glioma and DIPG. These were analysed by standard methodology (MNP, conumee), and intragenic breakpoint enrichment was compared within methylation subgroups, superfamilies, and tumours with no high-scoring classification. Benchmarking included sequence-verified cases such as infant hemispheric gliomas (IHG) with ALK(15%) and ROS1(7%) fusions, and pathognomic alterations associated with specific entities such as RELA-EPN, MYB-LGG and HGNET-MN1. We identified previously unreported enrichments of well-recognised fusion targets such as NTRK2in GBM_MID and NTRK3in DMG_K27 (both 5%), METin A_IDH / A_IDH_HG (3–5%), and FGFR1/3in GBM_G34 (8–9%). Novel recurrent kinase gene candidates to be verified and explored further include IGF1Rin 2–12% cases spanning glioma subgroups, and TIE1in poorly classified tumours. This latter ‘NOS’ group were also enriched in various transcription factor targets of breakpoints, including TCF4and PLAGL2. Despite limitations due to sample quality, resolution or balanced translocations, breakpoint analysis of methylation copy number profiles provides simple screening for structural rearrangements which may directly influence targeted therapy in paediatric CNS tumours.
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Affiliation(s)
- Alan Mackay
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Sara Temelso
- Institute of Cancer Research, London, United Kingdom
| | - Chris Jones
- Institute of Cancer Research, London, United Kingdom
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Carvalho D, Mackay A, Temelso S, Izquierdo E, Fernandez EP, Rogers R, Boult J, Salom JF, Simon N, Clarke M, Molinari V, Kessler K, Burford A, Bjerke L, Fofana M, Hubank M, Pears J, Moore A, Carcaboso AM, Marshall L, Carceller F, Robinson S, Hargrave D, Vinci M, Jones C. MODL-20. A BIOBANK OF ~100 PATIENT-DERIVED MODELS REPRESENTING BIOLOGICAL HETEROGENEITY AND DISTINCT THERAPEUTIC DEPENDENCIES IN PAEDIATRIC HIGH GRADE GLIOMA AND DIPG. Neuro Oncol 2020. [PMCID: PMC7715119 DOI: 10.1093/neuonc/noaa222.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Paediatric high-grade glioma comprise multiple biological and clinical subgroups, the majority of which urgently require novel therapies. Patient-derived models represent useful tools for mechanistic and preclinical investigations based upon their retention of key genetic/epigenetic features and their amenability to high-throughput approaches. We have collected ~100 in vitro models representing multiple subtypes (H3.3/H3.2/H3.1K27M, H3.3G34R/V, BRAF, MYCN_amp, NTRK_fusion, hypermutator, others) established under 2D (laminin) and/or 3D (neurosphere) conditions, credentialed by phenotypic (growth, invasion/migration) and molecular (methylation array, DNA sequencing, RNAseq) comparison to the original tumour sample. These were derived from patients at our local hospitals (n=29), as part of national co-clinical trials (n=19), from international collaborating centres (n=11), or shared directly by research groups worldwide (n=45). These have variously been subjected to pharmacological (approved/experimental drug libraries) and/or genetic screening (whole-genome CRISPR) to identify specific biological dependencies. Many have been established as orthotopic xenografts in vivo (PDX), with detailed pathological and radiological correlations with the clinical disease, and with tumorigenic latencies ranging from 48–435 days. This resource has allowed us to identify genotype-specific synthetic lethalities and responses to targeted inhibitors, including olaparib (PARP) with ATRX, nutlin-3 (MDM2) with PPM1D, AZD1775 (WEE1) with TP53, and CYC065 (CDK9) with MYCN-amplification. Combinatorial screening highlighted synergies in ACVR1-mutant DIPG between novel ALK2 inhibitors and ONC201 (DRD2). Rapid screening allows for feedback of drug sensitivities to treating clinicians at relapse, whilst mechanistic underpinning of these interactions and use of the models to identify specific mediators of resistance will allow for rational future trial design.
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Affiliation(s)
| | - Alan Mackay
- Institute of Cancer Research, London, United Kingdom
| | - Sara Temelso
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Jessica Boult
- Institute of Cancer Research, London, United Kingdom
| | | | - Natalie Simon
- Institute of Cancer Research, London, United Kingdom
| | | | | | - Ketty Kessler
- Institute of Cancer Research, London, United Kingdom
| | - Anna Burford
- Institute of Cancer Research, London, United Kingdom
| | - Lynn Bjerke
- Institute of Cancer Research, London, United Kingdom
| | | | - Michael Hubank
- Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Jane Pears
- Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Andrew Moore
- The University of Queensland, Brisbane, Australia
| | | | | | | | | | | | - Maria Vinci
- Bambino Gesù Children’s Hospital, Rome, Italy
| | - Chris Jones
- Institute of Cancer Research, London, United Kingdom
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Khadka P, Reitman Z, Lu S, Buchan G, Hartley R, Bear H, Georgis Y, Jarmale S, Schoolcraft K, Miller P, Gonzalez E, Gionet G, Qian K, Melanson R, Keshishian H, Carvalho D, Condurat A, Goodale A, Abid T, Piccioni F, Chi S, Carr S, Haas-Kogan D, Ebert B, Kieran M, Jones C, Ligon K, Beroukhim R, Phoenix T, Bandopadhayay P. DIPG-53. CHARACTERIZING THE ROLE OF PPM1D MUTATIONS IN THE PATHOGENESIS OF DIFFUSE INTRINSIC PONTINE GLIOMAS (DIPGS). Neuro Oncol 2020. [PMCID: PMC7715627 DOI: 10.1093/neuonc/noaa222.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We have previously found that up to 15% of all DIPGs harbor mutations in PPM1D, resulting in the expression of an activated and truncated PPM1D (PPM1Dtr). Here we evaluate the mechanisms through which PPM1Dtr enhances glioma formation and identify its associated therapeutic vulnerabilities. METHODS We have developed multiple in vitro and in vivo models of PPM1D-mutant DIPGs and applied quantitative proteomic and functional genomic approaches to identify pathways altered by PPM1Dtr and associated dependencies. RESULTS PPM1D mutations are clonal events that are anti-correlated to TP53 mutations. We find ectopic expression of PPM1Dtr to be sufficient to enhance glioma formation and to be necessary in PPM1D-mutant DIPG cells. In addition, endogenous truncation of PPM1D is sufficient to enhance glioma formation in the presence of mutant H3F3A and PDGFRA. PPM1Dtr overexpression attenuates g-H2AX formation and suppresses apoptosis and cell-cycle arrest in response to radiation treatment. Deep scale phosphoproteomics analyses reveal DNA-damage and cell cycle pathways to be most significantly associated with PPM1Dtr. Furthermore, preliminary analysis of genome-wide loss-of-function CRISPR/Cas9 screens in isogenic GFP and PPM1Dtr overexpressing mouse neural stem cells reveal differential dependency on DNA-damage response genes in the PPM1Dtr overexpressing cells. Consistent with PPM1D’s role in stabilizing MDM2, PPM1D-mutant DIPG models are sensitive to a panel of MDM2 inhibitors (Nutlin-3a, RG7388, and AMG232). CONCLUSION Our study shows that PPM1Dtr is both an oncogene and a dependency in PPM1D- mutant DIPG, and there are novel therapeutic vulnerabilities associated with PPM1D that may be exploited.
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Affiliation(s)
- Prasidda Khadka
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sophie Lu
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Rachel Hartley
- University of Cincinnati, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Heather Bear
- University of Cincinnati, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Kathleen Schoolcraft
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | | | - Kenin Qian
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | - Amy Goodale
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Tanaz Abid
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | | | - Susan Chi
- Dana-Farber Cancer Institute, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
| | - Steven Carr
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Daphne Haas-Kogan
- Dana-Farber Cancer Institute, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
| | - Benjamin Ebert
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Mark Kieran
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Chris Jones
- Institute of Cancer Research, London, United Kingdom
| | - Keith Ligon
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Rameen Beroukhim
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Timothy Phoenix
- University of Cincinnati, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Pratiti Bandopadhayay
- Dana-Farber Cancer Institute, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
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Izquierdo E, Carvalho D, Mackay A, Temelso S, Boult JKR, Molinari V, Stubbs M, Depani S, O’Hare P, Robinson SP, Hubank M, Hargrave D, Jones C. MODL-19. DIPG HARBOUR ALTERATIONS TARGETABLE BY MEK INHIBITORS, WITH ACQUIRED RESISTANCE MECHANISMS OVERCOME BY COMBINATORIAL UP- OR DOWN-STREAM INHIBITION. Neuro Oncol 2020. [PMCID: PMC7715767 DOI: 10.1093/neuonc/noaa222.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The survival of children with DIPG remains dismal, with new treatments desperately needed. In the era of precision medicine, targeted therapies represent an exciting treatment opportunity, yet resistance can rapidly emerge, playing an important role in treatment failure. In a prospective biopsy-stratified clinical trial (BIOMEDE), we combined detailed molecular profiling (methylation BeadArray, exome, RNAseq, phospho-proteomics) linked to drug screening in newly-established patient-derived models of DIPG in vitro and in vivo. We identified a high degree of in vitro sensitivity to the MEK inhibitor trametinib (GI50 16-50nM) in samples which harboured genetic alterations targeting the MAPK pathway, including the non-canonical BRAF_G469V mutation, and those affecting PIK3R1. Treatment of PDX models and the patient with trametinib at relapse, however, failed to elicit a significant response. We generated trametinib-resistant clones (62-188-fold, GI50 2.4–5.2µM) in the BRAF_G469V model through continuous drug exposure, and identified acquired mutations in MEK1/2 (MEK1_K57N, MEK1_I141S and MEK2_I115N) with sustained pathway up-regulation. These cells showed the hallmarks of mesenchymal transition, with overexpression of key proteins involved in invasion/migration, such as collagen-family proteins, integrins, MMPs and AHNAK2, amongst others. Resistant clones were conversely sensitive to the upstream receptor tyrosine kinase inhibitor dasatinib (GI50 36-93nM), and combinations of trametinib with dasatinib and the downstream ERK inhibitor ulixertinib showed synergistic effects in vitro. These data highlight the MAPK pathway as a therapeutic target in DIPG, and show the importance of parallel resistance modelling and rational combinatorial treatments likely to be required for meaningful clinical translation.
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Affiliation(s)
| | - Diana Carvalho
- The Institute of Cancer Research, London, United Kingdom
| | - Alan Mackay
- The Institute of Cancer Research, London, United Kingdom
| | - Sara Temelso
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Mark Stubbs
- The Institute of Cancer Research, London, United Kingdom
| | - Sarita Depani
- Great Ormond Street Hospital, London, United Kingdom
| | | | | | | | | | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
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Izquierdo E, Carvalho D, Mackay A, Temelso S, Boult JKR, Molinari V, Stubbs M, Grabovska Y, Yu L, Choudhary J, Depani S, o’Hare P, Robinson SP, Hubank M, Hargrave D, Jones C. DDRE-07. DIPG HARBOUR ALTERATIONS TARGETABLE BY MEK INHIBITORS, WITH ACQUIRED RESISTANCE MECHANISMS OVERCOME BY COMBINATORIAL INHIBITION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The survival of children with diffuse intrinsic pontine glioma (DIPG) remains dismal, with new treatments desperately needed. In the era of precision medicine, targeted therapies represent an exciting treatment opportunity, yet resistance can rapidly emerge, playing an important role in treatment failure. In a prospective biopsy-stratified clinical trial, we combined detailed molecular profiling (methylation BeadArray, exome, RNAseq, phospho-proteomics) linked to drug screening in newly-established patient-derived models of DIPG in vitro and in vivo. We identified a high degree of in vitro sensitivity to the MEK inhibitor trametinib (GI50 16-50nM) in samples, which harboured genetic alterations targeting the MAPK pathway, including the non-canonical BRAF_G469V mutation, and those affecting PIK3R1 and NF1. However, treatment of PDX models and of a patient with trametinib at relapse failed to elicit a significant response. We generated trametinib-resistant clones (62-188-fold, GI50 2.4–5.2µM) in the BRAF_G469V model through continuous drug exposure, and identified acquired mutations in MEK1/2 (MEK1_K57N, MEK1_I141S and MEK2_I115N) with sustained pathway up-regulation. These cells showed the hallmarks of mesenchymal transition, and expression signatures overlapping with inherently trametinib-insensitive primary patient-derived cells that predicted an observed sensitivity to dasatinib. Combinations of trametinib with dasatinib and the downstream ERK inhibitor ulixertinib showed highly synergistic effects in vitro. These data highlight the MAPK pathway as a therapeutic target in DIPG, and show the importance of parallel resistance modelling and rational combinatorial treatments likely to be required for meaningful clinical translation.
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Affiliation(s)
| | - Diana Carvalho
- The Institute of Cancer Research, London, United Kingdom
| | - Alan Mackay
- The Institute of Cancer Research, London, United Kingdom
| | - Sara Temelso
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Mark Stubbs
- The Institute of Cancer Research, London, United Kingdom
| | - Yura Grabovska
- The Institute of Cancer Research, London, United Kingdom
| | - Lu Yu
- The Institute of Cancer Research, London, United Kingdom
| | | | - Sarita Depani
- Great Ormond Street Hospital, London, United Kingdom
| | | | | | - Michael Hubank
- Royal Marsden Hospital NHS Trust, London, United Kingdom
| | | | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
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Carvalho D, Richardson P, Olaciregui NG, Stankunaite R, Lavarino CE, Molinari V, Corley E, Ruddle R, Donovan A, Pal A, Raynaud FI, Overington JP, Phelan A, Sheppard D, Mackinnon A, Hubank M, Cruz O, Madrid AML, Mueller S, Carcaboso AM, Carceller F, Jones C. EXTH-46. ARTIFICIAL INTELLIGENCE-BASED IDENTIFICATION OF COMBINED VANDETANIB AND EVEROLIMUS IN THE TREATMENT OF ACVR1-MUTANT DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Somatic mutations in ACVR1, encoding the serine/threonine kinase ALK2 receptor, are found in a quarter of children with the currently incurable brain tumour diffuse intrinsic pontine glioma (DIPG). Treatment of ACVR1-mutant DIPG patient-derived models with multiple inhibitor chemotypes leads to a reduction in cell viability in vitro and extended survival in orthotopic xenografts in vivo, though there are currently no specific ACVR1 inhibitors licensed for DIPG. Using an Artificial Intelligence-based platform to search for approved compounds which could be used to treat ACVR1-mutant DIPG, the combination of vandetanib and everolimus was identified as a possible therapeutic approach. Vandetanib, an approved inhibitor of VEGFR/RET/EGFR, was found to target ACVR1 (Kd=150nM) and reduce DIPG cell viability in vitro, but has been trialed in DIPG patients with limited success, in part due to an inability to cross the blood-brain-barrier. In addition to mTOR, everolimus inhibits both ABCG2 (BCRP) and ABCB1 (P-gp) transporter, and was synergistic in DIPG cells when combined with vandetanib in vitro. This combination is well-tolerated in vivo, and significantly extended survival and reduced tumour burden in an orthotopic ACVR1-mutant patient-derived DIPG xenograft model. Based on these preclinical data, three patients with ACVR1-mutant DIPG were treated with vandetanib and everolimus. These cases may inform on the dosing and the toxicity profile of this combination for future clinical studies. This bench-to-bedside approach represents a rapidly translatable therapeutic strategy in children with ACVR1 mutant DIPG.
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Affiliation(s)
| | | | | | | | | | | | | | - Ruth Ruddle
- Institute of Cancer Research, London, United Kingdom
| | - Adam Donovan
- Institute of Cancer Research, London, United Kingdom
| | - Akos Pal
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | - Michael Hubank
- Royal Marsden Hospital NHS Trust, London, United Kingdom
| | | | | | - Sabine Mueller
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of in-hospital management in ST Segment Elevation Myocardial Infarction in Portuguese hospitals over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To assess the evolution of in-hospital management of ST Segment Elevation Myocardial Infarction (STEMI) over the years in Portuguese hospitals and its impact on in-hospital complications and mortality
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of acute coronary syndrome since 2002 until 2019 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical data, revascularization strategy, medication during hospitalization. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess tendencies in categorical variables, and Kruskal-Wallis tests were used to assess tendencies in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 24425 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive increase in patients treated with aspirin, P2Y12 inhibitors (from 22.2% to 97.6% – p<0.001), beta blockers 62.% to 72.4% – p<0.001), ACE inhibitors (68.9% to 78.2% – p<0.001) and statins (72.1% to 88.4% – p<0.001), a progressive decrease in GP 2a3b inhibitors (20.9 to 14.6% – p<0.001), enoxaparin (55.2% to 29.9% – p<0.001), nitrates (82.7% to 16.1% – p<0.001), calcium channel blockers (5.0% to 3.1% – p<0.001) and inotropes (12.0% to 5.6% – p<0.001).
There was an increase of the use primary coronary angioplasty (36.4% to 73.2% – p<0.001), and of drug eluting stents (0% to 70.1% – p<0.001) a decrease in the use of fibrinolysis (75.7% to 1.6% – p<0.001), bare metal stents (88.1% to 0.3% – p<0.001) and intra-aortic balloon pump (1.8% to 0% – p=0.009), but not in invasive mechanical ventilation (2.5% to 1.9% – p=0.142).
Less patients had moderate to severely impaired left ventricle ejection fraction (28.8% to 14.9% – p<0.001), and there was a significant reduction in almost all in-hospital complications: re-infarction (2.0% to 1.0% – p<0.001); heart failure (36.2% to 9.9% – p<0.001); cardiogenic shock (10.8% to 3.9% – p<0.001); AV block (5.8% to 2.5% – p<0.001); mechanical complications (2.8% to 0.4% – p<0.001); stroke (1.3% to 0.4% – p<0.001); in-hospital mortality (9.9% to 3.8% – p<0.001); as well as length of stay ([4–10] days to [3–6] days – p<0.001). Exceptions were and increase in major bleeding (0.9% to 1.8% – p<0.001) and resuscitated cardiac arrest (3.9% to 4.5%, p=0.001).
Conclusion
In 17 years, we report a progressive evolution of the in-hospital treatment of STEMI patients in Portuguese hospitals, with a higher prescription of guideline recommended medications, use of invasive reperfusion techniques and last generation stents, resulting in a lower rate of in-hospital complications and mortality.
In-hospital outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Registo Nacional de Síndromes Coronárias Agudas - Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Menezes Fernandes R, Mota T, Bispo J, Azevedo P, Bento D, Guedes J, Carvalho D, Marques N, Santos W, Mimoso J, Jesus I. Premature acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The prevalence of acute coronary syndrome (ACS) at an early age is rising, resulting in higher morbidity and mortality rates.
Purpose
To characterize patients admitted with premature ACS, comparing with those with non-premature ACS.
Methods
A retrospective study encompassing patients of a National Registry of ACS was performed. We compared two groups: one composed of men <55 and women <65 years-old; and other with men ≥55 and women ≥65 years-old at the ACS admission. Clinical characteristics, in-hospital evolution and 1-year clinical outcomes were analysed. Primary endpoint was the composite of in-hospital mortality, stroke and re-myocardial infarction (MI). Secondary endpoints were re-MI, stroke, in-hospital and 1-year mortality, 1-year cardiovascular (CV) and non-CV readmissions.
Results
A total of 26523 patients were enrolled and 6637 (25%) had premature ACS, with a mean age of 49±7 years-old. It was found a larger prevalence of smoking habits, obesity and dyslipidemia, but not diabetes. ST-segment elevation MI (STEMI) was the main admission diagnosis (51,2% vs 40,3%), with more frequent activations of the STEMI network (17,1% vs 12,8%) and a consequently shorter time from symptom onset to admission (483 vs 584 min). Coronary angiogram was largely performed in younger patients (91,4% vs 82,1%), mainly revealing one-vessel disease (49,3% vs 34,3%). They had lower Killip-Kimbal (KK) class (6% vs 18,1% with KK class >1) and mostly preserved left ventricular ejection fraction (LVEF) (67,3% vs 58,6%). Major bleeding (0,9% vs 1,7%), sustained ventricular tachycardia (1,1% vs 1,5%) and mechanical complications (0,2% vs 0,7%) were uncommon. Composite endpoint was more frequent in non-premature ACS patients (6,2% vs 1,9%). Non-premature age, KK class >1, multivessel disease and depressed LVEF were independent predictors of primary endpoint (each with p<0,001). Younger patients had inferior rates of in-hospital mortality (1% vs 4,7%), re-MI (0,5% vs 1%) and stroke (0,4% vs 0,7%). One-year mortality (1,7% vs 9,1%), and 1-year CV (9,7% vs 15,5%) and non-CV readmissions (3,7% vs 8,2%) were also lower. All comparative data presented have a statistically significant p-value (p<0,012).
Conclusions
Premature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, primary prevention is essential to correct modifiable CV risk factors and reduce coronary events in these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - T Mota
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J.S Bispo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - P.M Azevedo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - D Bento
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J Guedes
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - D Carvalho
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - N Marques
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - W Santos
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J Mimoso
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - I Jesus
- Algarve University Hospital Center, Cardiology, Faro, Portugal
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal.
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001).
At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001).
Conclusion
Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality.
6 Month Outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Amodru V, Petrossians P, Colao A, Delemer B, Maione L, Neggers SJCMM, Decoudier B, Kamenicky P, Castinetti F, Hana V, Pivonello R, Carvalho D, Brue T, Beckers A, Chanson P, Cuny T. Discordant biological parameters of remission in acromegaly do not increase the risk of hypertension or diabetes: a study with the Liege Acromegaly Survey database. Endocrine 2020; 70:134-142. [PMID: 32562181 DOI: 10.1007/s12020-020-02387-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Acromegaly is a rare disease due to growth hormone (GH)-secreting pituitary adenoma. GH and IGF-1 levels are usually congruent, indicating either remission or active disease; however, a discrepancy between GH and IGF-1 may occur. We aimed to evaluate the outcome of diabetes mellitus (DM) and hypertension (HT) in acromegalic patients with congruent GH and/or IGF-1 levels vs. discordant biochemical parameters. METHODS Retrospective analysis of the data of 3173 patients from the Liege Acromegaly Survey (LAS) allowed us to include 190 patients from 8 tertiary referral centers across Europe, treated by surgery, with available data concerning DM and HT both at diagnosis and at the last follow-up (LFU). We recorded the number of anti-HT and anti-DM drugs used at the first evaluation and at LFU for every patient. RESULTS Ninety-nine patients belonged to the REM group (concordant parameters), 65 patients were considered as GHdis (high random GH/controlled IGF-1), and 26 patients were considered as IGF-1dis (high IGF-1/controlled random GH). At diagnosis, 72 patients (37.8%) had HT and 54 patients had DM (28.4%). There was no statistically significant difference in terms of the number of anti-HT and anti-DM drugs at diagnosis versus LFU (mean duration: 7.3 ± 4.5 years) between all three groups. CONCLUSION The long-term outcome of DM and HT in acromegaly does not tend to be more severe in patients with biochemical discordance in comparison with patients considered as in remission on the basis of concordant biological parameters, suggesting that patients with biochemical discordance do not require a closer follow-up.
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Affiliation(s)
- V Amodru
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - P Petrossians
- Department of Endocrinology, CHU de Liège, Université de Liege, Liège, Belgium
| | - A Colao
- Dipartimento Di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University "Federico II", Naples, Italy
| | - B Delemer
- Service d'endocrinologie, CHU de Reims, Reims, France
| | - L Maione
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - S J C M M Neggers
- Section of Endocrinology Department of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Decoudier
- Service d'endocrinologie, CHU de Reims, Reims, France
| | - P Kamenicky
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - F Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - V Hana
- Third Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R Pivonello
- Dipartimento Di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, University "Federico II", Naples, Italy
| | - D Carvalho
- Department of Endocrinology Diabetes and Metabolism, Centro Hospitalar Universitário S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - T Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France
| | - A Beckers
- Department of Endocrinology, CHU de Liège, Université de Liege, Liège, Belgium
| | - P Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - T Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Service d'endocrinologie, Hôpital de la Conception, Marseille, France.
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Lucas J, Sousa P, Sequeira R, Isoppo C, Quinaz Romana G, Carvalho D, Fernandes AC. Impact of ferric carboxymaltose in patient blood management in Portuguese hospitals. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The use of transfusions leads to excessive blood consumption, implying risks such as infections and immunological reactions, so it should be used only when strictly necessary. Patient Blood Management (PBM) aims to minimize the use of allogeneic blood and improve clinical outcomes, with better cost-effectiveness, using three essential points: improving hematopoiesis, minimize blood loss in and optimize the hemoglobin reserves of each patient. The aim of this work is to assess the preoperative haemoglobin optimization using ferric carboxymaltose as part of PBM implementation, in elective orthopaedic, cardiac and colorectal surgery in Portuguese hospitals.
Methods
This is an observational study materialized in a retrospective and multicenter cohort with data collection from medical records. The population and sample will be patients over 18 years from elective orthopaedic, cardiac and colorectal surgeries, treated according with local standards before PBM implementation were assigned to the pre-PBM cohort and patients after PBM implementation with ferric carboxymaltose to preoperative haemoglobin optimization to the PBM cohort. The criteria for selecting hospitals will be the implementation of PBM during the study period.
Expected Results
Based on a previous review, it is expected that the results of the use of ferric carboxymaltose to correct iron deficiency anaemia for preoperative haemoglobin optimization will contribute positively to reducing the number of transfusions, the length of hospital stays and will have a direct impact on economic results.
Conclusions
The use of ferric carboxymaltose and other ferric compounds, as part of PBM program, has demonstrated a positive impact on patients' outcomes (morbility and mortality), adverse events and on economic results. This study might show that clinical guidelines and programs like PBM are a major contribution not just for hemovigilance and blood safety but also for patient safety and health quality.
Key messages
This work is focused on Portuguese hospitals and aims to assess the impact of ferric carboxymaltose and its benefit on PBM strategy. Specially this study intends to conduct the assessment on health outcomes and costs.
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Affiliation(s)
- J Lucas
- NOVA National School of Public Health, Lisbon, Portugal
| | - P Sousa
- NOVA National School of Public Health, Lisbon, Portugal
- Public Health Research Centre, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA University, Lisbon, Portugal
| | - R Sequeira
- NOVA National School of Public Health, Lisbon, Portugal
| | - C Isoppo
- NOVA National School of Public Health, Lisbon, Portugal
| | | | - D Carvalho
- NOVA National School of Public Health, Lisbon, Portugal
| | - A Campos Fernandes
- NOVA National School of Public Health, Lisbon, Portugal
- Public Health Research Centre, NOVA National School of Public Health, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA University, Lisbon, Portugal
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50
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Paço M, Rodrigues A, Oliveira C, Carvalho D, Ferreira J, Simões M, Araújo FA, Chaves P. Cross-cultural adaptation and validation of the VISA-A questionnaire for Portuguese-speaking (Portugal) patients with Achilles tendinopathy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction Achilles tendinopathy is considered one of the most frequent injuries in individuals who practice regular physical activity, thus the existence of an instrument that allows the evaluation of the degree of severity of the lesion is important. The VISA-A was developed for English-speaking population to evaluate patients with this condition, and there is a need to adapt this tool to Portuguese (Portugal).
Objectives To cross-cultural adapt and validate the VISA-A questionnaire for Portuguese-speaking (Portugal) Achilles tendinopathy patients.
Methodology The VISA-A questionnaire was translated and cross-culturally adapted into Portuguese (VISA-A-Por) according to specific guidelines, using six steps: Translation, synthesis, back translation, expert committee review, pretesting (n = 10), and appraisal of the adaptation process. The resulting VISA-A-Por was then subjected to an analysis of the psychometric properties (construct validity, reproducibility [agreement and reliability], internal consistency and floor and ceiling effects) in 57 Achilles tendinopathy patients and 58 asymptomatic people. Participants completed the questionnaire at baseline and after a minimum interval of 48 hours.
Results The Visa-A-Por semantic and content validity was considered good by the expert committee and has construct validity shown by the differences between groups (p < 0,001). The questionnaire presented good internal consistency, with a Cronbach α of 0,88. Concerning reproducibility, agreement levels were considered optimal which can be verified in the Bland Altman graph, the standard error measurement (6,49) and the minimally important change (17,99 points), as well as the excellent ICC value (0,88). No ceiling-floor effect was found.
Conclusion The VISA-A-Por questionnaire has been shown to be equivalent to the original questionnaire, which indicates that it is a valid and reliable measure for the evaluation of the severity and functional impact of patellar tendinopathy in Portuguese-speaking (Portugal) patients.
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Affiliation(s)
- M Paço
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
| | - A Rodrigues
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
| | - C Oliveira
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
| | - D Carvalho
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
| | - J Ferreira
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
| | - M Simões
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
| | - FA Araújo
- ISPUP-EPIUnit, University of Porto, Porto, Portugal
| | - P Chaves
- CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra - Paredes, Portugal
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