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Gu X, Watson C, Agrawal U, Whitaker H, Elson WH, Anand S, Borrow R, Buckingham A, Button E, Curtis L, Dunn D, Elliot AJ, Ferreira F, Goudie R, Hoang U, Hoschler K, Jamie G, Kar D, Kele B, Leston M, Linley E, Macartney J, Marsden GL, Okusi C, Parvizi O, Quinot C, Sebastianpillai P, Sexton V, Smith G, Suli T, Thomas NPB, Thompson C, Todkill D, Wimalaratna R, Inada-Kim M, Andrews N, Tzortziou-Brown V, Byford R, Zambon M, Lopez-Bernal J, de Lusignan S. Postpandemic Sentinel Surveillance of Respiratory Diseases in the Context of the World Health Organization Mosaic Framework: Protocol for a Development and Evaluation Study Involving the English Primary Care Network 2023-2024. JMIR Public Health Surveill 2024; 10:e52047. [PMID: 38569175 PMCID: PMC11024753 DOI: 10.2196/52047] [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: 08/30/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Prepandemic sentinel surveillance focused on improved management of winter pressures, with influenza-like illness (ILI) being the key clinical indicator. The World Health Organization (WHO) global standards for influenza surveillance include monitoring acute respiratory infection (ARI) and ILI. The WHO's mosaic framework recommends that the surveillance strategies of countries include the virological monitoring of respiratory viruses with pandemic potential such as influenza. The Oxford-Royal College of General Practitioner Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA) has provided sentinel surveillance since 1967, including virology since 1993. OBJECTIVE We aim to describe the RSC's plans for sentinel surveillance in the 2023-2024 season and evaluate these plans against the WHO mosaic framework. METHODS Our approach, which includes patient and public involvement, contributes to surveillance objectives across all 3 domains of the mosaic framework. We will generate an ARI phenotype to enable reporting of this indicator in addition to ILI. These data will support UKHSA's sentinel surveillance, including vaccine effectiveness and burden of disease studies. The panel of virology tests analyzed in UKHSA's reference laboratory will remain unchanged, with additional plans for point-of-care testing, pneumococcus testing, and asymptomatic screening. Our sampling framework for serological surveillance will provide greater representativeness and more samples from younger people. We will create a biomedical resource that enables linkage between clinical data held in the RSC and virology data, including sequencing data, held by the UKHSA. We describe the governance framework for the RSC. RESULTS We are co-designing our communication about data sharing and sampling, contextualized by the mosaic framework, with national and general practice patient and public involvement groups. We present our ARI digital phenotype and the key data RSC network members are requested to include in computerized medical records. We will share data with the UKHSA to report vaccine effectiveness for COVID-19 and influenza, assess the disease burden of respiratory syncytial virus, and perform syndromic surveillance. Virological surveillance will include COVID-19, influenza, respiratory syncytial virus, and other common respiratory viruses. We plan to pilot point-of-care testing for group A streptococcus, urine tests for pneumococcus, and asymptomatic testing. We will integrate test requests and results with the laboratory-computerized medical record system. A biomedical resource will enable research linking clinical data to virology data. The legal basis for the RSC's pseudonymized data extract is The Health Service (Control of Patient Information) Regulations 2002, and all nonsurveillance uses require research ethics approval. CONCLUSIONS The RSC extended its surveillance activities to meet more but not all of the mosaic framework's objectives. We have introduced an ARI indicator. We seek to expand our surveillance scope and could do more around transmissibility and the benefits and risks of nonvaccine therapies.
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Affiliation(s)
- Xinchun Gu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Conall Watson
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, United Kingdom
| | - William H Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester, United Kingdom
| | | | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lottie Curtis
- Royal College of General Practitioners, London, United Kingdom
| | - Dominic Dunn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Katja Hoschler
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Beatrix Kele
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma L Marsden
- Royal College of General Practitioners, London, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Omid Parvizi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Catherine Quinot
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | | | - Vanashree Sexton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom
| | - Timea Suli
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Catherine Thompson
- Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom
| | - Daniel Todkill
- Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom
| | - Rashmi Wimalaratna
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Nick Andrews
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | | | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria Zambon
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | - Jamie Lopez-Bernal
- Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Castro D, Gysi D, Ferreira F, Ferreira-Santos F, Ferreira TB. Centrality measures in psychological networks: A simulation study on identifying effective treatment targets. PLoS One 2024; 19:e0297058. [PMID: 38422083 PMCID: PMC10903921 DOI: 10.1371/journal.pone.0297058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/26/2023] [Indexed: 03/02/2024] Open
Abstract
The network theory of psychopathology suggests that symptoms in a disorder form a network and that identifying central symptoms within this network might be important for an effective and personalized treatment. However, recent evidence has been inconclusive. We analyzed contemporaneous idiographic networks of depression and anxiety symptoms. Two approaches were compared: a cascade-based attack where symptoms were deactivated in decreasing centrality order, and a normal attack where symptoms were deactivated based on original centrality estimates. Results showed that centrality measures significantly affected the attack's magnitude, particularly the number of components and average path length in both normal and cascade attacks. Degree centrality consistently had the highest impact on the network properties. This study emphasizes the importance of considering centrality measures when identifying treatment targets in psychological networks. Further research is needed to better understand the causal relationships and predictive capabilities of centrality measures in personalized treatments for mental disorders.
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Affiliation(s)
- Daniel Castro
- University of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Deisy Gysi
- Center for Complex Network Research, Northeastern University, Boston, Massachusetts, United States of America
| | - Filipa Ferreira
- University of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Fernando Ferreira-Santos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Tiago Bento Ferreira
- University of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
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Duarte AC, Alegria S, Vinagre F, Ferreira F, Cordeiro A. Can subcutaneous treprostinil be an alternative for treating pulmonary hypertension in patients with systemic sclerosis-related interstitial lung disease? ARP Rheumatol 2024:CE230356. [PMID: 38368559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Pulmonary hypertension (PH) is one of the most feared complications of systemic sclerosis (SSc). There are currently specific drugs approved for PH group I (pulmonary arterial hypertension - PAH), but for PH related to lung disease (group III) the use of vasodilators is still controversial and not routinely recommended in patients with non-severe PH. However, SSc-PH-interstitial lung disease (ILD) has a poorer survival compared with SSc-PAH, making the management of these patients a challenge, ideally carried out in a reference centre. Herein we report the case of a a 45-year-old female with systemic sclerosis-myositis overlap syndrome, with documented lung involvement (ILD with fibrotic nonspecific interstitial/organizing pneumonia pattern), who was diagnosed with pre-capillary PH. She started sequential combination vasodilator therapy including parenteric prostanoid, with clinical benefit and without evidence of ILD worsening.
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Martinho M, Calé R, Grade Santos J, Rita Pereira A, Alegria S, Ferreira F, José Loureiro M, Judas T, Ferreira M, Gomes A, Morgado G, Martins C, Gonzalez F, Lohmann C, Delerue F, Pereira H. Underuse of reperfusion therapy with systemic thrombolysis in high-risk acute pulmonary embolism in a Portuguese center. Rev Port Cardiol 2024; 43:55-64. [PMID: 37940074 DOI: 10.1016/j.repc.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Reperfusion therapy is generally recommended in acute high-risk pulmonary embolism (HR-PE), but several population-based studies report that it is underused. Data on epidemiology, management and outcomes of HR-PE in Portugal are scarce. OBJECTIVE To determine the reperfusion rate in HR-PE patients, the reasons for non-reperfusion, and how it influences outcomes. METHODS In this retrospective cohort study of consecutive HR-PE patients admitted to a thromboembolic disease referral center between 2008 and 2018, independent predictors for non-reperfusion were assessed by multivariate logistic regression. PE-related mortality and long-term MACE (cardiovascular mortality, PE recurrence and chronic thromboembolic disease) were calculated according to the Kaplan-Meier method. Differences stratified by reperfusion were assessed using the log-rank test. RESULTS Of 1955 acute PE patients, 3.8% presented with hemodynamic instability. The overall reperfusion rate was 50%: 35 patients underwent systemic thrombolysis, one received first-line percutaneous embolectomy and one rescue endovascular treatment. Independent predictors of non-reperfusion were: age, with >75 years representing 12 times the risk of non-treatment (OR 11.9, 95% CI 2.7-52.3, p=0.001); absolute contraindication for thrombolysis (31.1%), with recent major surgery and central nervous system disease as the most common reasons (OR 16.7, 95% CI 3.2-87.0, p<0.001); and being hospitalized (OR 7.7, 95% CI 1.4-42.9, p=0.020). At a mean follow-up of 2.5±3.3 years, the survival rate was 33.8%. Although not reaching statistical significance for hospital mortality, mortality in the reperfusion group was significantly lower at 30 days, 12 months and during follow-up (relative risk reduction of death of 64% at 12 months, p=0.013). Similar results were found for MACE. CONCLUSIONS In this population, the recommended reperfusion therapy was performed in only 50% of patients, with advanced age and absolute contraindications to fibrinolysis being the main predictors of non-reperfusion. In this study, thrombolysis underuse was associated with a significant increase in short- and long-term mortality and events.
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Affiliation(s)
- Mariana Martinho
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Tiago Judas
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | - Melanie Ferreira
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Gomes
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | - Gonçalo Morgado
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Cristina Martins
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Filipe Gonzalez
- Intensive Care Unit, Hospital Garcia de Orta, Almada, Portugal
| | - Corinna Lohmann
- Intensive Care Unit, Hospital Garcia de Orta, Almada, Portugal
| | - Francisca Delerue
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, Universidade de Lisboa, Lisboa, Portugal
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Vasques AC, Cavaco P, Duarte T, Duarte Branco V, Miranda Baleiras M, Pinto M, Ferreira F, Falcão MDF, Dias Domingues T, Martins A. The Use of Herbal Medicines Among Cancer Patients. Cureus 2024; 16:e53455. [PMID: 38435139 PMCID: PMC10909387 DOI: 10.7759/cureus.53455] [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] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Background and objective The use of herbal medicines has been increasing among cancer patients, as a way to control cancer and treatment-related symptoms; however, many patients are reluctant to disclose this use to their medical practitioners. The fact that oncological treatments have a narrow therapeutic margin, associated with the lack of control and clinical evidence concerning these supplements, makes medication-herbal interactions a reality. These interactions could lead to increased toxicity or a decreased effectiveness of oncological treatment. In light of this, we aimed to assess the prevalence of herbal medicine use in a patient population at a Portuguese central hospital: Centro Hospitalar Lisboa Ocidental. Materials and methods Patients with breast, prostate, or colorectal cancer diagnoses between August 2022 and July 2023 and undergoing oncological treatment were included. Data were collected through a survey during their first appointment, as well as by consulting the patients' clinical files. An interaction evaluation was carried out to assess potential medication-herbal interactions. Finally, a statistical analysis was performed to identify predictive factors for the use of herbal medicines. Results Among the 65 patients included in the study, 52% were females, and the median age of the cohort was 65 years. Breast cancer was the most prevalent diagnosis and the majority of the patients were undergoing palliative treatment. We found that 46% of patients used herbal medicines regularly: to strengthen the immune system, detoxification of the body, and treat insomnia and constipation. A medication-herbal interaction was found in 37% of the cases, the most frequent being doxorubicin-vitamin C, through an antioxidant mechanism. The univariable analysis failed to show any predictive factors associated with the use of herbal medicines. Conclusions This study sheds light on herbal medicine use among cancer patients and the reality of medication-herbal interactions. There is an urgent need for further research and evidence-based medical protocols regarding herbal medicine use, especially in complex cases such as cancer patients, to provide better and safer care.
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Affiliation(s)
| | - Patricia Cavaco
- Hospital Pharmacy, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Tânia Duarte
- Medical Oncology, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | | | | | - Marta Pinto
- Medical Oncology, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Filipa Ferreira
- Medical Oncology, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | | | - Tiago Dias Domingues
- Statistics and Operations Research, Faculty of Sciences of the University of Lisbon, Lisbon, PRT
| | - Ana Martins
- Medical Oncology, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
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Ferreira F, Paulo N, Ndrio A. Crystals unveiled: looking at urine can be quite useful. J Bras Nefrol 2024; 46:98. [PMID: 38427580 PMCID: PMC10962409 DOI: 10.1590/2175-8239-jbn-2023-0160en] [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: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Filipa Ferreira
- Centro Hospitalar Universitário de São João, Departamento de
Nefrologia, Porto, Portugal
| | - Núria Paulo
- Centro Hospitalar Universitário de São João, Departamento de
Nefrologia, Porto, Portugal
| | - Altin Ndrio
- Centro Hospitalar Universitário de São João, Departamento de
Patologia Clínica, Porto, Portugal
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Cunha NF, Rodrigues MJLF, Ferreira F, Viana-Gomes J, Linhares JMM, Franco S, Oliveira F, Soares N, Vasilevskiy MI, Rebouta L. Test station to characterize the emission of a LiDAR. Appl Opt 2024; 63:17-29. [PMID: 38175001 DOI: 10.1364/ao.505749] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024]
Abstract
A test station setup devised to measure the emission characteristics and beam propagation parameters of a light detection and ranging (LiDAR) system is presented. The main blocks of the station to measure the accessible emission, wavelength peak and FWHM, pulse duration, pulse repetition rate, horizontal and vertical angular resolution, field of view, beam propagation factor M 2, beam waist size, waist location, and divergence are described. The performance of this test station was demonstrated using a commercial spinning LiDAR, a Velodyne VLP-16, which successfully enables these measurements for a laser beam with a wavelength of 913 nm.
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Alves D, Ferreira F, Pereira C, Lopes A, Nogueira C, Vilarinho L. Pharmacogenetic Variants Can Influence Optical Medication Use. Endocr Metab Immune Disord Drug Targets 2023; 24:EMIDDT-EPUB-136733. [PMID: 38111112 DOI: 10.2174/0118715303271934231211085226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Single Nucleotide Polymorphisms (SNPs) are used as drug susceptibility biomarkers in metabolic diseases. Alterations in the gene encoding triggers the enzyme flavin monooxygenase 3 (FMO3), involved in the Sulindac metabolization, which also is responsible for the inherited metabolic disorder. Trimethylaminuria (TMAu, OMIM: 602079). DPYD gene variants are associated with the enzyme dihydropyrimidine dehydrogenase deficiency (DPD; OMIM: 274270). This autosomal recessive metabolic disorder, ultimately leads to the inability to metabolize fluoropyrimidines, which causes severe toxicity in individuals treated with these drugs. METHODS Variants in genes responsible for the expression of enzymes that encode transporters or receptors involved in the metabolization pathways of certain drugs may condition the individuals response to certain drugs, compromising the therapeutic response and clinical prognosis. Thus the sequencing and identification of variants become relevant, not only gain knowledge on effects of these variants' on disease causality but also in terms of its side effects resulting from the coding enzymes responsible for drug metabolization. RESULTS It was found that patients with the c.472G>A (p.Glu158Lys) and c.923A>G (p.Glu308Gly) polymorphisms, in homozygosity, in FMO3 gene did not develop polyps, thus have a protective effect in the treatment of Familial Adenomatous Polyposis (PAF). However, in the case of the DPYD gene, c.1905+1G>A (IVS14+1G>A), c.1679T>G (p.Ile560Ser), c.2846A>T (p.Asp949Val) e c.1236G>A/HapB3 variants can be lethal in cancer patients indicated for fluoropyrimidine-based chemotherapy. CONCLUSION Knowledge on the drug mechanisms will affect the therapeutic response of patients treated with a given drug. Thus, pharmacogenetics is an essential tool in personalized medicine, since molecular studies allows the clinician to predict the probability of efficacy and toxicity of certain drugs, resulting higher efficiency in individualizing treatment and also improving the safety of the patient. From a personalized medicine perspective, the study of the characteristics of the drug and its metabolization site, the genes involved in the encoding of enzymes responsible for its metabolization will be of great interest.
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Affiliation(s)
- Diana Alves
- Medical Science Department, University of Aveiro, 3810- 193 Aveiro, Portugal
| | - Filipa Ferreira
- Newborn Screening, Metabolic and Genetics Unit, Department of Human Genetics, National Institute of Health Dr Ricardo Jorge, 4000-055 Porto, Portugal
| | - Cristina Pereira
- Newborn Screening, Metabolic and Genetics Unit, Department of Human Genetics, National Institute of Health Dr Ricardo Jorge, 4000-055 Porto, Portugal
| | - Altina Lopes
- Newborn Screening, Metabolic and Genetics Unit, Department of Human Genetics, National Institute of Health Dr Ricardo Jorge, 4000-055 Porto, Portugal
| | - Célia Nogueira
- Research and Development Unit, Department of Human Genetics, National Institute of Health Dr Ricardo Jorge, Porto, Portugal
| | - Laura Vilarinho
- Newborn Screening, Metabolic and Genetics Unit, Department of Human Genetics, National Institute of Health Dr Ricardo Jorge, 4000-055 Porto, Portugal
- Research and Development Unit, Department of Human Genetics, National Institute of Health Dr Ricardo Jorge, Porto, Portugal
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Pargana J, Calé R, Martinho M, Santos J, Lourenço C, Castro Pereira JA, Araújo P, Morgado J, Pereira E, Judas T, Alegria S, Ferreira F, Delerue F, Pereira H. Prevalence and predictors of chronic thromboembolic pulmonary hypertension following severe forms of acute pulmonary embolism. Rev Port Cardiol 2023; 42:947-958. [PMID: 37652118 DOI: 10.1016/j.repc.2023.06.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The true prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) in the Portuguese population remains unknown. We aimed to assess the prevalence and predictors of CTEPH two years after a symptomatic high- (HR) or intermediate-high risk (IHR) PE. METHODS We conducted a retrospective cohort study of patients admitted with PE between 2014 and 2019 to a Portuguese referral center for pulmonary hypertension. RESULTS In this single-center registry of 969 patients admitted with PE (annual incidence of 46/100000 population), 194 had HR (5.4%) and IHR (14.7%) PE. After excluding patients who died or had no follow-up in the first three months, 129 patients were included in the analysis. The overall prevalence of suspected CTEPH by clinical assessment, Doppler echocardiography and V/Q lung scan was 6.2% (eight patients). CTEPH was confirmed by right heart catheterization in four of these (3.1%). Increased pulmonary artery systolic pressure (PASP) at admission (OR 1.12; 95% CI 1.04-1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95% CI 1.53-36.41; p=0.013) were predictors of CTEPH. PASP >60 mmHg at admission identified patients with CTEPH at follow-up with sensitivity and specificity of 83.3% and 76.3%, respectively. All patients diagnosed with CTEPH had at least two radiological findings suggestive of CTEPH at the index event. CONCLUSIONS In our cohort, the prevalence of CTEPH in survivors of severe forms of acute PE was 6.2%. PASP above 60 mmHg and supporting radiological findings on the index computed tomography scan are highly suggestive of acute-on-chronic CTEPH.
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Affiliation(s)
- Joana Pargana
- Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Lisbon University, Portugal
| | - Rita Calé
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
| | - Mariana Martinho
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - João Santos
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Cândida Lourenço
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | | | - Patrícia Araújo
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - João Morgado
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Ernesto Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisboa, Portugal
| | - Tiago Judas
- Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Filipa Ferreira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Francisca Delerue
- Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Faculdade de Medicina, Lisbon University, Portugal; Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
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Ferreira F, Gonçalves Bacelar C, Lisboa-Gonçalves P, Paulo N, Quental R, Nunes AT, Silva R, Tavares I. Renal manifestations in adults with mitochondrial disease from the mtDNA m.3243A>G pathogenic variant. Nefrologia 2023; 43 Suppl 2:1-7. [PMID: 38355238 DOI: 10.1016/j.nefroe.2024.01.017] [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: 01/24/2023] [Accepted: 03/15/2023] [Indexed: 02/16/2024] Open
Abstract
Mitochondrial diseases are a phenotype and genotype heterogeneous group of disorders that typically have a multisystemic involvement. The m.3243A>G pathogenic variant is the most frequent mitochondrial DNA defect, and it causes several different clinical syndromes, such as mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS), and the maternally inherited diabetes and deafness (MIDD) syndromes. Not frequently reported, renal involvement in these diseases is probably underestimated, yet it increases morbidity. It generally manifests as subnephrotic proteinuria and progressive deterioration of kidney function. Adult presentation of mitochondrial diseases is hard to recognize, especially in oligosymptomatic patients or those with exclusive kidney involvement. However, suspicion should always arise when family history, particularly on the maternal side, and multisystemic symptoms, most often of the central nervous system and skeletal muscles, are present. In this review we discuss the clinical diagnosis and approach of patients with renal manifestations in the context of the mtDNA m.3243A>G pathogenic variant.
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Affiliation(s)
- Filipa Ferreira
- Serviço de Nefrologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | | | - Pedro Lisboa-Gonçalves
- Serviço de Nefrologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Núria Paulo
- Serviço de Nefrologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rita Quental
- Serviço de Genética Médica, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Ana Teresa Nunes
- Serviço de Nefrologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; Grupo de Investigação e Desenvolvimento em Nefrologia e Doenças Infeciosas, I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Roberto Silva
- Serviço de Anatomia Patológica, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Isabel Tavares
- Serviço de Nefrologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Grupo de Investigação e Desenvolvimento em Nefrologia e Doenças Infeciosas, I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Brito Avô L, Pereira L, Oliveira A, Ferreira F, Filipe P, Coelho Rodrigues I, Couto E, Ferreira F, Airosa Pardal A, Morgado P, Moreira S. Portuguese Consensus on Acute Porphyrias: Diagnosis, Treatment, Monitoring and Patient Referral. ACTA MEDICA PORT 2023; 36:753-764. [PMID: 37924314 DOI: 10.20344/amp.20323] [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: 06/21/2023] [Accepted: 09/11/2023] [Indexed: 11/06/2023]
Abstract
Acute porphyrias are a group of rare genetic metabolic disorders, caused by a defect in one of the enzymes involved in the heme biosynthesis, which results in an abnormally high accumulation of toxic intermediates. Acute porphyrias are characterized by potentially life-threatening attacks and, for some patients, by chronic manifestations that negatively impact daily functioning and quality of life. Clinical manifestations include a nonspecific set of gastrointestinal, neuropsychiatric, and/or cutaneous symptoms. Effective diagnostic methods are widely available, but due to their clinical heterogeneity and non-specificity, many years often elapse from symptom onset to diagnosis of acute porphyrias, delaying the treatment and increasing morbidity. Therefore, increased awareness of acute porphyrias among healthcare professionals is paramount to reducing disease burden. Treatment of acute porphyrias is centered on eliminating the potential precipitants, symptomatic treatment, and suppressing the hepatic heme pathway, through the administration of hemin or givosiran. Moreover, properly monitoring patients with acute porphyrias and their relatives is fundamental to preventing acute attacks, hospitalization, and long-term complications. Considering this, a multidisciplinary panel elaborated a consensus paper, aiming to provide guidance for an efficient and timely diagnosis of acute porphyrias, and evidence-based recommendations for treating and monitoring patients and their families in Portugal. To this end, all authors exhaustively reviewed and discussed the current scientific evidence on acute porphyrias available in the literature, between November 2022 and May 2023.
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Affiliation(s)
- Luís Brito Avô
- Serviço de Medicina Interna. Hospital CUF Tejo. Lisboa; Unidade de Doenças Raras. Hospital CUF Tejo. Lisboa; Nucleo de Estudos de Doenças Raras da Sociedade Portuguesa de Medicina Interna. Lisboa. Portugal
| | - Luísa Pereira
- Nucleo de Estudos de Doenças Raras da Sociedade Portuguesa de Medicina Interna. Lisboa; Unidade de Cuidados Paliativos. Hospital CUF Tejo. Lisboa. Portugal
| | - Anabela Oliveira
- Serviço de Medicina I. Centro de Referência de Doenças Hereditárias do Metabolismo. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Filipa Ferreira
- Unidade de Rastreio Neonatal, Metabolismo e Genética. Departamento de Genética Humana. Instituto Nacional de Saúde Doutor Ricardo Jorge. Porto. Portugal
| | - Paulo Filipe
- Unidade de Investigação de Dermatologia. Instituto de Medicina Molecular João Lobo Antunes. Lisboa. Portugal
| | - Inês Coelho Rodrigues
- Serviço de Gastrenterologia. Centro Hospitalar e Universitário de Lisboa Norte. Lisboa. Portugal
| | - Eduarda Couto
- Departamento de Medicina Interna. Serviço de Hematologia Clínica. Centro Hospitalar Póvoa de Varzim - Vila do Conde. Póvoa de Varzim. Portugal
| | - Fátima Ferreira
- Serviço de Hematologia Clínica. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - André Airosa Pardal
- Serviço de Hematologia Clínica. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Pedro Morgado
- Instituto de Investigação em Ciências da Vida e Saúde. Escola de Medicina. Universidade do Minho. Braga; Laboratório Associado do Governo Português ICVS/3B's. Braga/Guimarães; Serviço de Psiquiatria. Hospital de Braga. Braga. Portugal
| | - Sónia Moreira
- Nucleo de Estudos de Doenças Raras da Sociedade Portuguesa de Medicina Interna. Lisboa; Serviço de Medicina Interna. Centro de Referência de Doenças Hereditárias do Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra; Faculdade de Medicina. Universidade de Coimbra. Coimbra. . Portugal
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12
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Gonçalves MM, Marcão A, Sousa C, Nogueira C, Ferreira F, Fonseca H, Rocha H, Vilarinho L. Portuguese Neonatal Screening Programme: A Retrospective Cohort Study of 18 Years of MS/MS. Endocr Metab Immune Disord Drug Targets 2023; 23:EMIDDT-EPUB-134549. [PMID: 37711117 DOI: 10.2174/1871530323666230914114505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The Portuguese Neonatal Screening Programme (PNSP) identifies patients with rare diseases through nationwide screening. Currently, 27 diseases are diagnosed, amongst which are 24 Inborn Errors of Metabolism (IEM), covering approximately 100% of neonates (1). In 2004, the national laboratory implemented a new screening method, tandem mass spectrometry (MS/MS) to test for amino acids and acylcarnitines. This new protocol revolutionized the PNSP and allowed for the analysis of an increased number of IEM, with clear improvements in treatment timings and clinical outcomes (2). METHODS From 2004 to 2022, 1 764 830 neonates were screened with MS/MS technology. Those who displayed biochemical profiles indicating an IEM were subjected to molecular characterization via genomic DNA extraction, PCR amplification, and direct Sanger sequencing method of dried blood spot samples. RESULTS/CASE REPORT A cohort of 681 newborns were diagnosed with an IEM. MCAD deficiency is the most frequent, with 233 confirmed diagnoses, showing predominantly c.985A>G (p.K329E) mutation of the ACADM gene in homozygosity. Approximately 1/3 of the 33 confirmed cases of Glutaric Aciduria type I present homozygous for the c.1204C>T (p.Arg402Trp) mutation in GCDH. Around 60% of cases of MAT II/III deficiency display the dominant mutation of the MAT1A gene, c.791G>A (p.Arg264His). These genetic profiles and others were determined as diagnostic confirmation for 24 of the IEM screened. CONCLUSION This data shows the molecular epidemiology of patients with confirmed IEM diagnosis identified by neonatal screening. Some diseases out of the scope of the PNSP were also detected as a differential diagnosis after biochemical suspicion in the dried blood spot sample. The retrospective analysis of the PNSP allows for an overview of 18 years of achievements accomplished by the national screening for IEM since MS/MS was implemented. For some pathologies with low incidence, it's difficult to trace a discernible pattern. However, presenting de novo mutations for these diseases might provide insights on how to approach different phenotypes. The aim of this work is to establish the molecular epidemiology of metabolic diseases screened.
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Affiliation(s)
| | - Ana Marcão
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
| | - Carmen Sousa
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
| | - Célia Nogueira
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
| | - Filipa Ferreira
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
| | - Helena Fonseca
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
| | - Hugo Rocha
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
| | - Laura Vilarinho
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Oporto, Portugal
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Martinho M, Calé R, Ferreira F, Alegria S, Santos A, Vieira AC, Repolho D, Vitorino S, Saraiva C, Pereira H. Chronic thromboembolic pulmonary hypertension - the challenging approach of a young patient with distal disease. Pulmonology 2023; 29:435-437. [PMID: 37031000 DOI: 10.1016/j.pulmoe.2023.03.001] [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: 01/07/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/10/2023] Open
Affiliation(s)
- M Martinho
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - R Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - F Ferreira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - S Alegria
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - A Santos
- Radiology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - A C Vieira
- Pulmonology Department, Hospital Garcia de Orta, Almada, Portugal
| | - D Repolho
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - S Vitorino
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - C Saraiva
- Radiology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - H Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
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14
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Neves MT, Ferreira A, Branco V, Abreu M, Alves FR, Baptista C, Graça J, Ferreira F, Malheiro M, Martins A. Utility of Prophylactic Percutaneous Gastrostomy in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy: A Multicenter Analysis. Cureus 2023; 15:e44637. [PMID: 37671078 PMCID: PMC10476146 DOI: 10.7759/cureus.44637] [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] [Accepted: 09/03/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Patients with head and neck cancer (HNC) have an elevated incidence of cachexia and malnutrition due to the tumor's location interfering with oral feeding. Concurrent chemoradiation (CCRT) can have an emetic effect and cause dysphagia and oral mucositis. Adequate nutrition improves immunity, raises the response to therapy, reduces adverse effects, and improves survival. Numerous studies have suggested the utility of nutritional support from percutaneous endoscopic gastrostomy (PEG) in HNC patients. Although PEG is usually considered a safe procedure, it has a mortality rate of 0-2.2% and a risk of other procedure-related complications of 17-40%. Our work intends to evaluate the utility of PEG in patients with locally advanced HNC who underwent CCRT. METHODS We performed a cohort study at three institutions. We included patients with HNC who underwent definitive CCRT treatment from January 2013 to December 2022. The study consisted of an observational, descriptive, retrospective analysis of prespecified clinical data. Descriptive statistics were used to compare the data between the PEG group and the non-PEG group. Analysis of covariance (ANCOVA) was used for covariance analysis. Fisher's exact test was used to compare proportional data and Student's t-test was used to assess the differences in continuous data. Survival analysis was performed using the Kaplan-Meier estimator. P-values of <0.05 were considered to be indicative of statistical significance. The SPSS Statistics version 28.0 (Armonk, NY: IBM Corp.) was used to perform all statistical evaluations. RESULTS We identified 90 eligible patients diagnosed with local advanced HNC who had received definitive CCRT with three weekly cycles of cisplatin as follows: 44 with a prophylactic PEG tube and 46 without a prophylactic PEG tube. Most patients were male (84.4%) and 50% of patients were diagnosed with stage IVa HNC at the time of diagnosis. There wasn't an effect of PEG placement on BMI at the end of CCRT after controlling for the effect of baseline BMI (F {1.84}=0.065 {p=0.799}). In the study population, BMI was significantly lower after CCRT (21.30 kg/m2 vs. 23.97 kg/m2), t (86)=12.389, p<0.001. In the subgroup with baseline BMI <18.5 kg/m2 (15 patients), 90% of patients with prophylactic PEG were able to complete the three planned cycles of chemotherapy vs. 66.7% in the non-PEG group. Ten patients in the PEG group (22.7%) referred feeding tube dependency. Patients with dysphagia were 3.2 times more likely to have placed prophylactic PEG (p=0.007). The difference in overall survival and progression-free survival between the two groups was not statistically significant (p=0.57 and p=0.497, respectively). CONCLUSION In this study using real-world data, we found a potentially protective effect of PEG in underweight patients with locally advanced HNC performing CCRT in order to complete three cycles of treatment.
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Affiliation(s)
- Maria Teresa Neves
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - André Ferreira
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Vanessa Branco
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Maria Abreu
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Fátima R Alves
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | | | - Joana Graça
- Medical Oncology, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
| | - Filipa Ferreira
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Mariana Malheiro
- Medical Oncology, Hospital CUF Tejo, Lisbon, PRT
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Ana Martins
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
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Vasques A, Lagarto M, Pinto M, Ferreira F, Martins A. The Successful Treatment of a Case of Prostate Cancer With Brain Metastasis at Diagnosis. Cureus 2023; 15:e42022. [PMID: 37593296 PMCID: PMC10430886 DOI: 10.7759/cureus.42022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Brain metastasis in prostate cancer is quite a rare entity, especially when it manifests at diagnosis. The symptoms are usually non-focal and vary based on the location affected. It is almost always associated with a poor prognosis, with an overall survival of less than a year. The ideal management modality for these patients is not well established but a combination of surgery, radiation, and chemotherapy may be possible options based on the extent and systemic involvement. Brain screening is not done systematically in prostate cancer and more research is needed to understand the outcome this decision would lead to. We report a case of a patient diagnosed with prostate cancer with single metastasis to the brain that manifested as headache and vomiting. The patient was treated with surgery, adjuvant irradiation of the surgical bed, and androgen deprivation therapy. He later underwent intensity-modulated radiation therapy (IMRT) to the prostate and has been remarkably relapse-free for four years.
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Affiliation(s)
- Ana Vasques
- Medical Oncology, Hospital São Francisco Xavier, Lisbon, PRT
| | | | - Marta Pinto
- Medical Oncology, Centro Hospitalar Tondela - Viseu, Viseu, PRT
| | - Filipa Ferreira
- Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisbon, PRT
| | - Ana Martins
- Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisbon, PRT
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Barba Teba R, López Arsuaga L, Firket L, Ferreira F, Moest W, Stoneman S, Georgopoulou GA, Bratsiakou A, Gallieni M. Vascular access hands-on training for young nephrologists: The fellows' experience of the N-PATH project REVAC module. J Vasc Access 2023:11297298231180325. [PMID: 37337422 DOI: 10.1177/11297298231180325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Chronic kidney disease is a major public health problem, as population studies record a prevalence of 7.2% in individuals over 30 years and is expected to increase in the future. Many of them will end up undergoing hemodialysis treatment, and vascular access is not only an essential requirement for the technique, but also a determining factor in their prognosis; for all these reasons, every nephrologist should have both theoretical and practical knowledge of vascular access; however, the practical training is generally uneven and dependent on the hospital in which you train. It is within this context that the N-PATH (Nephrology Partnership for Advancing Technology in Healthcare) program was born with the objective of training 40 young European nephrologists in theoretical and practical aspects of Interventional Nephrology. To fulfill its mission, the 2-year program is composed of four modules of 6 months each including theoretical courses and hands-on training: Renal Expert in Molecular Pathology (REMAP), Renal Expert in Vascular Access (REVAC), Renal Expert in Medical Ultrasound (REMUS), and Renal Expert in Peritoneal Dialysis (REPED). By bringing together young nephrologists from all over Europe, the goal is also to create a strong network and promote Nephrology career at the European level. This publication highlights the experience of fellows who attended the REVAC hands-on training in Milan, focused on simulation and virtual reality for vascular access, and its impact on their nephrology training.
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Affiliation(s)
- Raquel Barba Teba
- Division of Nephrology, Infanta Leonor University Hospital, Madrid, Spain
| | | | - Louis Firket
- Division of Nephrology, CH Citadelle, Liège, Belgium
| | - Filipa Ferreira
- Division of Nephrology, São João University Hospital, Porto, Portugal
| | - Wouter Moest
- Division of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sinead Stoneman
- Division of Nephrology, Cork University Hospital, Cork, Ireland
| | | | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences, Università di Milano, Milano, Italy
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Hoang U, Williams A, Smylie J, Aspden C, Button E, Macartney J, Okusi C, Byford R, Ferreira F, Leston M, Xie CX, Joy M, Marsden G, Clark T, de Lusignan S. The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship (PIAMS) in UK Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46938. [PMID: 37327029 DOI: 10.2196/46938] [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: 03/02/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Molecular point-of-care testing (POCT) used in primary care can inform whether a patient presenting with an acute respiratory infection has influenza. A confirmed clinical diagnosis, particularly early in the disease, could inform better antimicrobial stewardship. Social distancing and lockdowns during the COVID-19 pandemic have disturbed previous patterns of influenza infections in 2021. However, data from samples taken in the last quarter of 2022 suggest that influenza represents 36% of sentinel network positive virology, compared with 24% for respiratory syncytial virus. Problems with integration into the clinical workflow is a known barrier to incorporating technology into routine care. OBJECTIVE This study aims to report the impact of POCT for influenza on antimicrobial prescribing in primary care. We will additionally describe severe outcomes of infection (hospitalization and mortality) and how POCT is integrated into primary care workflows. METHODS The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care is an observational study being conducted between December 2022 and May 2023 and involving 10 practices that contribute data to the English sentinel network. Up to 1000 people who present to participating practices with respiratory symptoms will be swabbed and tested with a rapid molecular POCT analyzer in the practice. Antimicrobial prescribing and other study outcomes will be collected by linking information from the POCT analyzer with data from the patient's computerized medical record. We will collect data on how POCT is incorporated into practice using data flow diagrams, unified modeling language use case diagrams, and Business Process Modeling Notation. RESULTS We will present the crude and adjusted odds of antimicrobial prescribing (all antibiotics and antivirals) given a POCT diagnosis of influenza, stratifying by whether individuals have a respiratory or other relevant diagnosis (eg, bronchiectasis). We will also present the rates of hospital referrals and deaths related to influenza infection in PIAMS study practices compared with a set of matched practices in the sentinel network and the rest of the network. We will describe any difference in implementation models in terms of staff involved and workflow. CONCLUSIONS This study will generate data on the impact of POCT testing for influenza in primary care as well as help to inform about the feasibility of incorporating POCT into primary care workflows. It will inform the design of future larger studies about the effectiveness and cost-effectiveness of POCT to improve antimicrobial stewardship and any impact on severe outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46938.
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Affiliation(s)
- Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alice Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jessica Smylie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carole Aspden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Charis Xuan Xie
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Marsden
- Royal College of General Practitioners, London, United Kingdom
| | - Tristan Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- University Hospital Southampton, National Health Service Foundation Trust, Southampton, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Gomes M, Mendes A, Ferreira F, Branco J, Tonin FS, Pedro ME. The Role of Benralizumab in Eosinophilic Immune Dysfunctions: A Case Report-Based Literature Review. Case Rep Med 2023; 2023:8832242. [PMID: 37138643 PMCID: PMC10151146 DOI: 10.1155/2023/8832242] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/24/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Abstract
In the past years, the knowledge of eosinophils playing a primary pathophysiologic role in several associated conditions has led to the development of biologics targeting therapies aiming at normalizing the immune response, reducing chronic inflammation, and preventing tissue damage. To better illustrate the potential relationship between different eosinophilic immune dysfunctions and the effects of biological therapies in this scenario, here, we present a case of a 63-year-old male first referred to our department in 2018 with a diagnosis of asthma, polyposis, and rhinosinusitis and presenting a suspicion of nonsteroidal anti-inflammatory drugs' allergy. He also had a past medical history of eosinophilic gastroenteritis/duodenitis (eosinophilia counts >50 cells/high-power field HPF). The use of multiple courses of corticosteroid therapy failed to completely control these conditions. In October 2019, after starting benralizumab (an antibody directed against the alpha chain of the IL-5 cytokine receptor) as add-on treatment for severe eosinophilic asthma, important clinical improvements were reported both on the respiratory (no asthma exacerbations) and gastrointestinal systems (eosinophilia count 0 cells/HPF). Patients' quality of life also increased. Since June 2020, systemic corticosteroid therapy was reduced without worsening of gastrointestinal symptoms or eosinophilic inflammation. This case warns of the importance of early recognition and appropriate individualized treatment of eosinophilic immune dysfunctions and suggests the conduction of further larger studies on the use of benralizumab in gastrointestinal syndromes aiming at better understanding its relying mechanisms of action in the intestinal mucosa.
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Affiliation(s)
- Margarida Gomes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon, Portugal
| | - Filipa Ferreira
- Serviço de Gastroenterologia, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Joana Branco
- Serviço de Gastroenterologia, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Fernanda S. Tonin
- H & TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - M. Elisa Pedro
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon, Portugal
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Barker M, Rehrig G, Ferreira F. Speakers prioritise affordance-based object semantics in scene descriptions. Lang Cogn Neurosci 2023; 38:1045-1067. [PMID: 37841974 PMCID: PMC10572038 DOI: 10.1080/23273798.2023.2190136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/18/2023] [Indexed: 10/17/2023]
Abstract
This work investigates the linearisation strategies used by speakers when describing real-world scenes to better understand production plans for multi-utterance sequences. In this study, 30 participants described real-world scenes aloud. To investigate which semantic features of scenes predict order of mention, we quantified three features (meaning, graspability, and interactability) using two techniques (whole-object ratings and feature map values). We found that object-level semantic features, namely those affordance-based, predicted order of mention in a scene description task. Our findings provide the first evidence for an object-related semantic feature that guides linguistic ordering decisions and offer theoretical support for the role of object semantics in scene viewing and description.
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Affiliation(s)
- M. Barker
- Department of Psychology, University of California, Davis
| | - G. Rehrig
- Department of Psychology, University of California, Davis
| | - F. Ferreira
- Department of Psychology, University of California, Davis
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20
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Camara RP, Coelho FDN, Cruz-Martins N, Marques-Alves P, Castro G, Baptista R, Ferreira F. Incidence of Bloodstream Infection in Patients with Pulmonary Hypertension under Intravenous Epoprostenol or Iloprost—A Multicentre, Retrospective Study. Int J Mol Sci 2023; 24:ijms24076434. [PMID: 37047407 PMCID: PMC10094981 DOI: 10.3390/ijms24076434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Intravenous synthetic prostacyclin analogs (iPCAs), such as epoprostenol, treprostinil and iloprost have been widely used for the treatment of pulmonary arterial hypertension (PAH). Despite having good outcomes, continuous infusion of iPCAs has been associated with some adverse effects. Bloodstream infection (BSI) is one of the most severe complications, although poorly recognized, especially under iloprost administration, which few studies have addressed. This study aimed to compare the BSI incidence rates between intravenous iloprost and epoprostenol administration. Patients with pulmonary hypertension (PH) functional class III or IV receiving intravenous iloprost or epoprostenol through Hickman catheter, between 2004 and 2019, were retrospectively selected from two PH treatment centers. From a total of 36 patients (13 for iloprost and 23 for epoprostenol), 75% (n = 27) fulfilled the PAH criteria, mainly belonging to the idiopathic group. Overall BSI rate was 1.5/1000 days of treatment (3.38 and 0.09/1000 days for iloprost and epoprostenol, respectively). Patients receiving iloprost were at a higher risk of developing BSI than those receiving epoprostenol (HR: 12.5; 95% CI: 1.569–99.092). A higher mortality rate from BSI was also identified in the iloprost group (p = 0.04). Twenty-seven patients developed BSI, with 92% of them requiring hospitalization. A total of 29 agents were found, 10 Gram-positive (mainly Staphylococcus aureus; n = 5) and 19 Gram-negative (mainly Pseudomonas aeruginosa; n = 6) bacteria. Iloprost administration was linked to a significantly higher incidence of BSI, worse prognosis, and more BSI-related deaths than epoprostenol. BSI due to Gram-negative, commensal, low-virulence bacteria was also higher in the iloprost group. In short, physicians should be aware when prescribing iPCA to guarantee their patients’ safety and best medical care.
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Affiliation(s)
- Raquel Paulinetti Camara
- Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Pulmonology Department, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal
- Correspondence: (R.P.C.); (N.C.-M.)
| | - Francisco das Neves Coelho
- Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Polyvalent Intensive Care Unit, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, 1349-019 Lisbon, Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, 4099-002 Porto, Portugal
- Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Rua Central de Gandra, 4585-116 Gandra, Portugal
- TOXRUN—Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, 4585-116 Gandra, Portugal
- Correspondence: (R.P.C.); (N.C.-M.)
| | - Patrícia Marques-Alves
- Pulmonary Vascular Disease Unit, Cardiology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Graça Castro
- Pulmonary Vascular Disease Unit, Cardiology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Rui Baptista
- Cardiology Department, Centro Hospitalar de Entre o Douro e Vouga, 4520-211 Santa Maria da Feira, Portugal
- Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- ICBR—Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3004-561 Coimbra, Portugal
| | - Filipa Ferreira
- Cardiology Departament, Hospital Garcia de Orta, 2805-267 Almada, Portugal
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21
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Couto ML, Silva M, Barbosa MJ, Ferreira F, Fragoso AS, Azenha Rama T. Defining hereditary alpha-tryptasemia as a risk/modifying factor for anaphylaxis: are we there yet? Eur Ann Allergy Clin Immunol 2023. [PMID: 36927821 DOI: 10.23822/eurannaci.1764-1489.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Summary Hereditary α-tryptasemia (HαT) is a common autosomal dominant genetic trait with variable penetrance associated with increased serum baseline tryptase (SBT) levels. Clinical manifestations may range from an absence of symptoms to overtly severe and recurrent anaphylaxis. Symptoms have been claimed to result from excessive activation of EGF-like module-containing mucin-like hormone receptor-like 2 (EMR2) and protease-activated receptor 2 (PAR-2) receptors by α/β-tryptase heterotetramers. Herein, we aimed to review the evidence on whether HαT can be considered a hereditary risk factor or a modifying factor for anaphylaxis. Increased SBT levels have been linked to an increased risk of anaphylaxis. Likewise, recent studies have shown that HαT might be associated with a higher risk of developing anaphylaxis and more severe anaphylaxis. The same has also been shown for patients with clonal mast cell disorders, in whom the co-existence of HαT might lead to a greater propensity for severe, potentially life-threatening anaphylaxis. However, studies leading to such conclusions are generally limited in sample size, while other studies have shown opposing results. As such, further studies investigating the potential association of HαT with anaphylaxis caused by different triggers, and different severity grades, in both patients with clonal mast cell (MC) activation syndromes and the general population are still needed.
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Affiliation(s)
- M L Couto
- Basic and Clinical Immunology Service, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Silva
- Basic and Clinical Immunology Service, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M J Barbosa
- Basic and Clinical Immunology Service, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Ferreira
- Basic and Clinical Immunology Service, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A S Fragoso
- Basic and Clinical Immunology Service, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - T Azenha Rama
- Basic and Clinical Immunology Service, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Immunoalergology Service, São João University Hospital Center, Porto, Portugal.,EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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22
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Geretti AM, Austin H, Villa G, Smith C, Sabin C, Tsang R, Sherlock J, Ferreira F, Byford R, Meza-Torres B, Whyte M, de Lusignan S. Hepatitis B virus infection in general practice across England: An analysis of the Royal College of General Practitioners Research and Surveillance Centre real-world database. J Infect 2023; 86:476-485. [PMID: 36906152 DOI: 10.1016/j.jinf.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/01/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES We analysed hepatitis B surface antigen (HBsAg) screening and seropositivity within a network of 419 general practices representative of all regions of England. METHODS Information was extracted using pseudonymised registration data. Predictors of HBsAg seropositivity were explored in models that considered age, gender, ethnicity, time at the current practice, practice location and associated deprivation index, and presence of nationally endorsed screen indicators including pregnancy, men who have sex with men (MSM), history of injecting drug use (IDU), close HBV contact or imprisonment, and diagnosis of blood-borne or sexually transmitted infections. RESULTS Among 6,975,119 individuals, 192,639 (2.8%) had a screening record, including 3.6- 38.6% of those with a screen indicator, and 8065 (0.12%) had a seropositive record. The odds of seropositivity were highest in London, in the most deprived neighbourhoods, among minority ethnic groups, and in people with screen indicators. Seroprevalence exceeded 1% in people from high prevalence countries, MSM, close HBV contacts, and people with a history of IDU or HIV, HCV, or syphilis diagnosis. Overall, 1989/8065 (24.7%) had a recorded referral to specialist hepatitis care. CONCLUSIONS In England, HBV infection is associated with poverty. There are unrealised opportunities to promote access to diagnosis and care for those affected.
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Affiliation(s)
- Anna Maria Geretti
- Dept. of Infectious Diseases, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
| | - Harrison Austin
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Giovanni Villa
- Dept. of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton United Kingdom
| | - Colette Smith
- Institute for Global Health, University College London (UCL), London, United Kingdom
| | - Caroline Sabin
- Institute for Global Health, University College London (UCL), London, United Kingdom; NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL, a partnership with UKSHA, London, United Kingdom
| | - Ruby Tsang
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julian Sherlock
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Filipa Ferreira
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bernardo Meza-Torres
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Martin Whyte
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Dept. of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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23
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Ivan DC, Berve KC, Walthert S, Monaco G, Borst K, Bouillet E, Ferreira F, Lee H, Steudler J, Buch T, Prinz M, Engelhardt B, Locatelli G. Insulin-like growth factor-1 receptor controls the function of CNS-resident macrophages and their contribution to neuroinflammation. Acta Neuropathol Commun 2023; 11:35. [PMID: 36890580 PMCID: PMC9993619 DOI: 10.1186/s40478-023-01535-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
Signaling by insulin-like growth factor-1 (IGF-1) is essential for the development of the central nervous system (CNS) and regulates neuronal survival and myelination in the adult CNS. In neuroinflammatory conditions including multiple sclerosis (MS) and its animal model experimental autoimmune encephalomyelitis (EAE), IGF-1 can regulate cellular survival and activation in a context-dependent and cell-specific manner. Notwithstanding its importance, the functional outcome of IGF-1 signaling in microglia/macrophages, which maintain CNS homeostasis and regulate neuroinflammation, remains undefined. As a result, contradictory reports on the disease-ameliorating efficacy of IGF-1 are difficult to interpret, together precluding its potential use as a therapeutic agent. To fill this gap, we here investigated the role of IGF-1 signaling in CNS-resident microglia and border associated macrophages (BAMs) by conditional genetic deletion of the receptor Igf1r in these cell types. Using a series of techniques including histology, bulk RNA sequencing, flow cytometry and intravital imaging, we show that absence of IGF-1R significantly impacted the morphology of both BAMs and microglia. RNA analysis revealed minor changes in microglia. In BAMs however, we detected an upregulation of functional pathways associated with cellular activation and a decreased expression of adhesion molecules. Notably, genetic deletion of Igf1r from CNS-resident macrophages led to a significant weight gain in mice, suggesting that absence of IGF-1R from CNS-resident myeloid cells indirectly impacts the somatotropic axis. Lastly, we observed a more severe EAE disease course upon Igf1r genetic ablation, thus highlighting an important immunomodulatory role of this signaling pathway in BAMs/microglia. Taken together, our work shows that IGF-1R signaling in CNS-resident macrophages regulates the morphology and transcriptome of these cells while significantly decreasing the severity of autoimmune CNS inflammation.
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Affiliation(s)
- Daniela C Ivan
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Kristina Carolin Berve
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Sabrina Walthert
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Gianni Monaco
- Institute of Neuropathology, University of Freiburg, Freiburg, Germany
| | - Katharina Borst
- Institute of Neuropathology, University of Freiburg, Freiburg, Germany
| | - Elisa Bouillet
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Filipa Ferreira
- Institute of Laboratory Animal Science, University of Zurich, Zurich, Switzerland
| | - Henry Lee
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Jasmin Steudler
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Thorsten Buch
- Institute of Laboratory Animal Science, University of Zurich, Zurich, Switzerland
| | - Marco Prinz
- Institute of Neuropathology, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Britta Engelhardt
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland
| | - Giuseppe Locatelli
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland.
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24
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Calé R, Pereira H, Ferreira F, Loureiro MJ. Blueprint for developing an effective pulmonary embolism response network. Rev Port Cardiol 2023:S0870-2551(23)00123-3. [PMID: 36893841 DOI: 10.1016/j.repc.2022.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/24/2021] [Accepted: 06/17/2022] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Acute pulmonary embolism (PE) is a major cause of morbidity and mortality in Portugal. It is the third most common cause of cardiovascular death after stroke and myocardial infarction. However, the management of acute PE remains poorly standardized, and there is a lack of access to mechanical reperfusion when indicated. METHODS AND RESULTS This working group analyzed the current clinical guidelines for the use of percutaneous catheter-directed treatment in this setting and proposed a standardized approach for severe forms of acute PE. This document also proposes a methodology for the coordination of regional resources in order to create an effective PE response network, based on the hub-and-spoke organization design. CONCLUSION This model can be applied at the regional level, but it is desirable to extend it to the national level.
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Affiliation(s)
- Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, University of Lisbon, Lisbon, Portugal
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
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25
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Grade Santos J, Briosa A, Ramalho S, Gonçalves Ferreira A, Namora J, Calé R, Ferreira F, Pereira H. Unearthing an interrupted aortic arch in an elderly patient - Listen, watch and feel. Rev Port Cardiol 2023; 42:487-488. [PMID: 36828184 DOI: 10.1016/j.repc.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/11/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
| | - Alexandra Briosa
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Sara Ramalho
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - João Namora
- Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal
| | - Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
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26
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Nunes S, Faria CC, Pimentel J, Roque RF, Alaiz H, Salazar I, Pereira T, Ferreira F, Roque L. Medulloblastoma Development in a Patient with a Constitutional Balanced t(5;22)(q35.1;q11.2) Involving the NF2 Gene. Case Rep Oncol 2023; 16:36-44. [PMID: 36748018 PMCID: PMC9898807 DOI: 10.1159/000527564] [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] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/10/2022] [Indexed: 02/05/2023] Open
Abstract
Neurofibromatosis type 2 (NF2) is a brain tumor predisposing syndrome caused by inactivating alterations of the NF2 gene mapped at chromosome 22q. Currently, no genetic information exists on medulloblastomas occurring in NF2 patients. We herein report on the genetic alterations observed in a girl in which the NF2 gene was de novo altered due to a constitutional translocation: t(5;22)(q35.1;q11.2). This girl had a particularly aggressive disease course. At the age of 4, she had already been diagnosed with three lesions classified as schwannomas and a meningioma. At 10 years old, she developed a medulloblastoma. She died at the age of 14 due to a refractory acute myeloid leukemia (AML). From the genetic point of view, we observed that (1) the NF2 gene was rearranged in all patient samples: blood, tumor, and leukemic cells; (2) loss of 3' region of NF2 and the downstream regions of chromosome 22 were only detected in medulloblastoma cells; (3) the known cancer AML-related gene: NPM1 which is mapped at 5q35.1 was not the target of any alteration in our patient. Our data suggest that inactivation of the NF2 gene was relevant for the medulloblastoma pathogenesis. Furthermore, we know that malignant cancers are the result of a multi-epi-genetic sequence of events, and although, unquestionably limited to the genetic findings in one case. We may hypothesize, that as described for a fraction of medulloblastomas, the alteration of a gene mapped at 5q might also have been relevant for medulloblastoma development in our patient.
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Affiliation(s)
- Sofia Nunes
- Pediatric Neuro-Oncology Unit, Instituto Português de Oncologia de Lisboa (IPO), Lisbon, Portugal
| | - Claudia C. Faria
- Neurosurgery Department, Centro Hospitalar Universitário Lisboa Norte (CHULN): Institute for Molecular Medicine, João Lobo Antunes, Medical University of Lisbon, Lisbon, Portugal
| | - José Pimentel
- Neuropathology Laboratory, Department of Neurology, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Rafael Fidalgo Roque
- Neuropathology Laboratory, Department of Neurology, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Helena Alaiz
- Cytogenetics Laboratory, Department of Hemato-Oncology, Instituto Português de Oncologia de Lisboa (IPO), Lisbon, Portugal
| | - Isabel Salazar
- Cytogenetics Laboratory, Department of Hemato-Oncology, Instituto Português de Oncologia de Lisboa (IPO), Lisbon, Portugal
| | - Teresa Pereira
- Cytogenetics Laboratory, Department of Hemato-Oncology, Instituto Português de Oncologia de Lisboa (IPO), Lisbon, Portugal
| | - Filipa Ferreira
- Molecular Biology Laboratory, Department of Hemato-Oncology, Instituto Português de Oncologia de Lisboa (IPO), Lisbon, Portugal
| | - Lúcia Roque
- Cytogenetics Laboratory, Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa (IPO), Lisbon, Portugal
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de Lusignan S, Ashraf M, Ferreira F, Tripathy M, Yonova I, Rafi I, Kassianos G, Joy M. Impact of General Practitioner Education on Acceptance of an Adjuvanted Seasonal Influenza Vaccine among Older Adults in England. Behav Sci (Basel) 2023; 13:bs13020130. [PMID: 36829359 PMCID: PMC9952828 DOI: 10.3390/bs13020130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/06/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Seasonal vaccination against influenza and in-pandemic COVID-19 vaccination are top public health priorities; vaccines are the primary means of reducing infections and also controlling pressures on health systems. During the 2018-2019 influenza season, we conducted a study of the knowledge, attitudes, and behaviours of 159 general practitioners (GPs) and 189 patients aged ≥65 years in England using a combination of qualitative and quantitative approaches to document beliefs about seasonal influenza and seasonal influenza vaccine. GPs were surveyed before and after a continuing medical education (CME) module on influenza disease and vaccination with an adjuvanted trivalent influenza vaccine (aTIV) designed for patients aged ≥65 years, and patients were surveyed before and after a routine visit with a GP who participated in the CME portion of the study. The CME course was associated with significantly increased GP confidence in their ability to address patients' questions and concerns about influenza disease and vaccination (p < 0.001). Patients reported significantly increased confidence in the effectiveness and safety of aTIV after meeting their GP. Overall, 82.2% of the study population were vaccinated against influenza (including 137 patients vaccinated during the GP visit and 15 patients who had been previously vaccinated), a rate higher than the English national average vaccine uptake of 72.0% that season. These findings support the value of GP-patient interactions to foster vaccine acceptance.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
- Royal College of General Practitioners, Research and Surveillance Centre, London NW1 2FB, UK
- Correspondence: ; Tel.: +44-01865-617-283 (ext. 17-283)
| | | | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Manasa Tripathy
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Ivelina Yonova
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Imran Rafi
- Royal College of General Practitioners, Research and Surveillance Centre, London NW1 2FB, UK
- Institute for Medical and Biomedical Education, St George’s University of London, London SW17 0RE, UK
| | - George Kassianos
- Royal College of General Practitioners, Research and Surveillance Centre, London NW1 2FB, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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Muacevic A, Adler JR, Severino E, Vasques C, Neves MT, Ferreira A, Vasconcelos de Matos L, Ferreira F, Miranda H, Martins A. Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer. Cureus 2023; 15:e33916. [PMID: 36819384 PMCID: PMC9936570 DOI: 10.7759/cureus.33916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/19/2023] Open
Abstract
Background Diabetes mellitus (DM) is a prognostic factor for some malignancies, but its clinical implications in metastatic colorectal cancer (mCRC) patients are less clear. Therefore, we conducted a retrospective study to evaluate the impact of pre-existing type 2 diabetes mellitus (T2DM) on the survival outcomes of patients with newly diagnosed mCRC. Methodology We retrospectively included patients with newly diagnosed mCRC between January 2017 and June 2021 and with pre-existing T2DM. Data on the characteristics of patients, clinicopathological features, and drug exposure were collected from the electronic medical records. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS) and treatment-related adverse events (TRAEs). Results Among 187 mCRC patients, 54 (28.8%) had T2DM. The median follow-up was 25 months. We observed 150 OS events and 168 PFS events. Diabetes significantly and negatively impacted PFS and OS. The median for PFS (mPFS) was eight and 16 months for T2DM and no T2DM patients, respectively (p < 0.0001; log-rank test). The median overall survival (mOS) was 15 and 29 months for T2DM and no T2DM patients, respectively (p < 0.0001; log-rank test). Patients with diabetes were more often overweight or obese (59.3% vs. 24.8%; p < 0.01) and had a poorer performance status (53.7% vs. 21.1% with Eastern Cooperative Oncology Group Performance Status 1; p < 0.01). Additionally, T2DM patients had more high-risk pathological features, including G3 grading tumors (27.7% vs. 12.0%; p = 0.01), lymph node involvement (p < 0.01), BRAF-mutated (35.1% vs. 6.8%; p < 0.01), and right-sided CRC (63.0% vs. 30.1%; p < 0.01). We found no statistically significant differences in TRAEs. Nevertheless, a significantly higher rate of grade 2-4 peripheral neuropathy (22.2% vs. 5.3%; p < 0.01) was reported in T2DM patients. Conclusions T2DM is a negative prognostic factor for survival in mCRC. The paper provides empirical evidence in favor of the joint control of both pathologies. Further research is needed to establish the robustness of our results.
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Silva Jr AAG, Silva FV, Maciel MP, Ferreira F, Oliveira LLS, Oliveira PHA, Dornelas MEO, Lopes KDS. The Effect of Space Allowance During Pre-Slaughter Transport of European Quail Breeders on Welfare, Carcass Traits and Meat Quality. Braz J Poult Sci 2023. [DOI: 10.1590/1806-9061-2022-1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Muacevic A, Adler JR, Pinto M, Ferreira F, Martins A. Her2 Status Discrepancy Between Core Needle Biopsy and Surgically Resected Mastectomy Specimen: A Clinical Case. Cureus 2023; 15:e33501. [PMID: 36756030 PMCID: PMC9903343 DOI: 10.7759/cureus.33501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
The biomarker concordance between core needle biopsy (CNB) and surgical specimen (SS), in breast cancer, has long been a matter of discussion because of its influence on oncologic treatment choice. Particularly, human epidermal growth factor receptor 2 (Her2) status is quite important, because of the impact on breast cancer classification and target therapy. Many factors could influence the difference in biomarker status between samples, such as the technic itself, sample procedures and intratumoral heterogeneity. Neoadjuvant chemotherapy (NAC) can also contribute to this variation and should be taken into consideration. We report a clinical case of a 33-year-old man who was diagnosed with right breast cancer, initially Her2 negative in the CNB. Therefore, the NAC was completed without anti-Her2 treatment. Later, after the mastectomy, revision of the SS was found to be positive for Her2, after the silver in situ hybridization (SISH) technique. Consequently, the patient lost the chance of doing anti-Her2 therapy in the neoadjuvant setting, reducing his possibility to achieve a complete pathologic response and later jeopardizing his clinical outcome.
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Febra C, Spinu V, Ferreira F, Gil V, Maio R, Penque D, Macedo A. Predictive Value for Increased Red Blood Cell Distribution Width in Unprovoked Acute Venous Thromboembolism at the Emergency Department. Clin Appl Thromb Hemost 2023; 29:10760296231193397. [PMID: 37691287 PMCID: PMC10494517 DOI: 10.1177/10760296231193397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Acute venous thromboembolism (VTE) is a common worldwide disease admitted to emergency departments (ED), usually presenting as pulmonary embolism or lower limb deep vein thrombosis (DVT). Due to the lack of typical clinical and biomarker diagnostic features of unprovoked VTE, early identification is challenging and has direct consequences on correct treatment delay. Longitudinal, prospective, observational study. Patients admitted to ED with a suspicion of unprovoked acute VTE between October 2020 and January 2021 were included. Clinical and laboratorial variables were compared between VTE positive and negative diagnoses. Red cell distribution width (RDW) cut point was determinate through a receiver operating characteristic analysis. RDW accuracy, sensitivity, and specificity were calculated. Fifty-eight patients were analyzed. And 82.8% of suspected patients with VTE were diagnosed with an acute thrombotic event confirmed by imaging examination. In patients with VTE, RDW at admission in ED was higher than with other diagnosis, respectively, 14.3% (13.2-15.1) and 13.5% (13.0-13.8). Platelet count was the only additional characteristic that revealed difference between the 2 groups (264×109/L for VTE and 209×109/L for non-VTE). Logistic regression models showed good discriminatory values for RDW≥14%, with an area under the curve (AUC) = 0.685 (95% confidence interval, 0.535-0.834). These findings were more pronounced in isolated DVT, with a sensitivity of 76.9%, specificity 100%, and accuracy 85.7%. Our study demonstrated a significant association between an early high RDW and the diagnosis of acute unprovoked DVT. RDW ≥ 14% has an independent predictor of unprovoked VTE in adult patients.
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Affiliation(s)
- Cláudia Febra
- Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Verónica Spinu
- Department of Emergency Medicine, Hospital Beatriz Angelo, Loures, Portugal
| | - Filipa Ferreira
- Department of Emergency Medicine, Hospital Beatriz Angelo, Loures, Portugal
| | - Victor Gil
- Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Cardiovascular Risk and Thrombosis, Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Rui Maio
- Department of General Surgery, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Deborah Penque
- Laboratory of Proteomics, Department of Human Genetics, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Ana Macedo
- Algarve Biomedical Center (ABC), Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal
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de Figueiredo MG, Paula S, Almeida S, Gomes F, Ferreira F, Luz J, Cunha D, Baltazar O, Almeida L. Clinical Case 21—An unusual cause for hypoxemia and breathlessness. Cardiovasc Res 2022. [PMCID: PMC9620315 DOI: 10.1093/cvr/cvac157.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
75-year-old woman with past medical history of ischemic stroke in 2019, when complementary diagnostic tests were performed and it was found that the patient had a patent foramen ovale (PFO). Current hospitalization due to COVID-19 pneumonia, which was complicated by bacterial co-infection and intermediate-low risk right main pulmonary artery thromboembolism. The patient was successfully treated, with improvement of the clinical condition and evident imaging resolution of pulmonary cavitations and recanalization of the right pulmonary artery. However, something intriguing was observed: the patient presented dyspnea in the upright position and a decline in transcutaneous oxygen saturation from 96% in the supine position to 85% in orthostatism, with reversal of these findings with the recumbency. This led to the suspicion of platypnea-orthodeoxia syndrome. A transesophageal echocardiogram with bubble test was then performed, revealing an atrial shunt in the supine position without Valsalva maneuver. With these evidences, the diagnosis of platypnea-orthodeoxia syndrome was made. Even though the patient was >60 years, due to important right-to-left shunt, the history of stroke and the current platypnea-orthodeoxia, it was decided to close the PFO. The day after the procedure, the patient was placed in the upright position, maintaining an oxygen saturation of 96%. This case is an example that the decision of closing PFO must be individualized, not focusing only on patient's age, but also on his medical history and current situation, as indicated in the 2022 Guidelines for the Management of Patent Foramen Ovale.
Transesophageal echocardiogram showing interatrial communication. ![]()
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Affiliation(s)
| | - Sofia Paula
- Department of Cardiology, Centro Hospitalar Barreiro Montijo EPE , Barreiro , Portugal
| | - Samuel Almeida
- Department of Cardiology, Centro Hospitalar Barreiro Montijo EPE , Barreiro , Portugal
| | - Francisco Gomes
- Department of Internal Medicina, Centro Hospitalar Barreiro Montijo EPE , Barreiro , Portugal
| | - Filipa Ferreira
- Department of Cardiology, Hospital Garcia de Orta EPE , Almada , Portugal
| | - João Luz
- Department of Cardiology, Hospital Garcia de Orta EPE , Almada , Portugal
| | - Diogo Cunha
- Department of Cardiology, Hospital Garcia de Orta EPE , Almada , Portugal
| | - Oliveira Baltazar
- Department of Cardiology, Hospital Garcia de Orta EPE , Almada , Portugal
| | - Lurdes Almeida
- Department of Cardiology, Centro Hospitalar Barreiro Montijo EPE , Barreiro , Portugal
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Martinho M, Cotrim N, Ferreira M, Calé R, Ferreira F, Grilo V, Gisca E, Fonseca AG, Gomes A, Judas T, Pereira H, Delerue F. Oral Presentation No. 112 Treatment of pulmonary embolism after paradoxical stroke. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
A patent foramen ovale (PFO) is often diagnosed in cryptogenic strokes and concurrent pulmonary embolism (PE) may be associated. Although often asymptomatic and with low recurrence risk, the best therapy is controversial.
Purpose
To study the results of oral anticogulation (OAC) in this population.
Methods
Retrospective single-centre study (2015–2020) of pts with asymptomatic PE diagnosed after a paradoxical stroke due to a PFO.
Results
Forty pts were included. Mean age was 56 ± 11 years and 55% were female. At diagnosis, 27.5%, 50.0%, 17.5% and 5.9% had none, weak, moderate and strong predisposing factors for PE, respectively. Most pts had peripheral events: 60.0% subsegmental, 37.5% segmental and 2.5% lobar.
Regarding treatment, 97.5% initiated OAC (90.0% direct OAC, 7.5% vitamin K antagonist); 1 pt single antiaggregation; 30% had percutaneous PFO closure.
Mean clinical follow-up (FUP) was 32 ± 22 months. There was 1 recurrent PE and 1 non-cardiovascular death. Mean time under OAC (TUOAC) was 27 ± 26 months. The only predictor of OAC suspension was PFO closure (17.9% vs. 50.0%, P = 0.037). Of these pts, 50.0% suspended OAC after the procedure (TUOAC 23.2 ± 17.9 months); the remaining had a TUOAC of 28.9 ± 29.9 months. Age or PE predisposing factors were not associated with OAC suspension or TUOAC. There were 3 clinically relevant haemorrhagic events (1 BARC3a,1 BARC3b, 1 BARC3c). TUOAC was neither associated with bleeding (P = 0.307) nor with perfusion defects resolution in FUP scintigraphy (55.5 vs. 16.0 months, P = 0.172).
Conclusions
TUOAC was not associated with perfusion defects resolution, ischemic or bleeding events. Management of these pts needs more evidence and consensus.
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Martinho M, Alegria S, Ferreira F, Calé R, Repolho D, Pereira AR, Briosa A, Santos JG, Ferreira B, Cunha DS, Baltazar O, Ilchyshyn N, Luz JM, Loureiro MJ, Pereira H. Poster No. 115 Switch the risk: from PDE5i to Riociguat in real world pulmonary hypertension. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Switching from phosphodiesterase-5 inhibitors (PDE5i) to Riociguat is associated with increased efficacy in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).
Objective
To show clinical efficacy of replacing PDE5i to Riociguat in a portuguese PH-dedicated centre.
Methods
Retrospective single-centre study of PAH and inoperable/persistent/recurrent CTEPH patients (pts) who switched vasodilator therapy. Parameters were stratified according to the 2022 PH guidelines and stratification as low/intermediate/high-risk PH followed the COMPERA registry, before switching, at 3–6 months of follow-up (FUP) and until the last clinical evaluation, balloon pulmonary angioplasty (BPA), heart transplant or death.
Results
Of 13 pts, 75.0% had CTEPH (4 pts had persistent disease after surgical endarterectomy), 16.7% had PAH and 1pt had mixed PAH/CTEPH. Mean age was 56.2 ± 16.3years and 83.3% were females. Mean time until switch was 33.5 ± 25.5 months. Previous therapy was: 33.3% Sildenafil, 41.7% Sildenafil/Bosentan and 25% Sildenafil/Bosentan/prostanoid. Before switching, 66.7% had intermediate and 33.3% low-risk PH; at a FUP of 4.4 ± 1.7 months, 8.3% had intermediate and 91.7% low-risk PH. There was a significant benefit in the COMPERA risk (1.50[1.33;1.62] vs. 1.22[1.09;1.40], P = 0.011). Long-term FUP was performed in 8 pts at 48.2 ± 35.6 months (death 1pt, transplant 1pt, BPA 3 pts). Medical treatment was Riociguat in 33.3%, Riociguat and Bosentan in 58.3%, and 1pt with Riociguat, Bosentan and Treprostinil. Clinical benefit was significant at long-term FUP when compared to the initial evaluation (1.22[1.09;1.40], P = 0.011), but not to the first FUP.
Conclusion
This study corroborates previous evidence regarding the vasodilator switch and also suggests that the treatment goal is maintained throughout long-term FUP.
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Martinho M, Calé R, Pereira AR, Ferreira F, Alegria S, Morgado G, Martins C, Ferreira M, Gomes A, Judas T, Gonzalez F, Lohmann C, Repolho D, Santos P, Pereira E, Loureiro MJ, Pereira H. Oral Presentation No. 114 Small-bore aspiration thrombectomy versus catheter-directed thrombolysis in intermediate-high risk acute Pulmonary Embolism. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT) are treatment options in intermediate-high risk pulmonary embolism (IHRPE).
Purpose
Compare the efficacy and safety of CDT and MT in IHRPE.
Methods
Retrospective single-centre study of consecutive IHRPE patients (pts) since 2018, treated with CDT (5Fr Cragg-McNamara device) or MT (Indigo MT system, Penumbra 8Fr). Clinical success at 48h was defined as survival and haemodynamic (HD) stabilization, oxygenation improvement or decrease in pulmonary hypertension (PH)/right heart strain. MACE during follow-up (FUP) was a composite endpoint of cardiovascular mortality, PE recurrence, chronic thromboembolic PH and heart failure hospitalization. Safety endpoint was defined as Major bleeding (BARC3).
Results
Of 25 pts, 60% were submitted to MT and 40% to CDT. Age (68.6 ± 15.6 vs. 62.7 ± 16.4, P = 0.381), Charlson Comorbidity Index (4.2 ± 1.9 vs. 2.9 ± 2.0, P = 0.121) and PESI score (103.2 ± 40.6 vs. 119.8 ± 46.2, P = 0.410) were similar. MT had increased fluoroscopy time (43.0 ± 19.1 vs. 10.1 ± 6.2 min, P < 0.001) and procedure time (115 ± 63 vs. 45 ± 18 min, P = 0.009). Success at 48 h was similar (80% MT vs. 90% CDT; P = 0.626). Severe adverse events related with the technique happened in 2 pts in MT (1 death, 1 macroembolization) and 1pt in CDT developed HD instability. Haemoglobin fall was higher in MT (1.8 ± 1.3 vs. 0.7 ± 0.8 g/dL, P = 0.018), but BARC3 and transfusion were identical. In-hospital mortality was 8% (2 pts in MT, P = 0.229). Mean FUP was 229 ± 147days, with higher MACE in MT (40% vs. 0%, P = 0.051).
Conclusions
Despite similar efficacy at short-term, adverse events related to the procedure seemed higher in MT group. CDT was less time consuming.
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Grade Santos J, Cale R, Martinho M, Ferreira B, Cunha D, Briosa A, Goncalves De Sousa B, Leote J, Pestana Santos C, Cruz D, Araujo P, Santos J, Judas T, Ferreira F, Pereira H. What are the NEWS in pulmonary embolism risk stratification? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The patients with Pulmonary Thromboembolism (PE) stratified as intermediate-high risk with the European Society of Cardiology classification represent an heterogenous population, with the majority having a benign outcome however some evolving in clinical deterioration. Several risk scores have been developed to try and refine the population most at risk but they are deemed sub-optimal.
Purpose
Our aim was to assess the capacity of the National Early Warning Score (NEWS) in predicting a composite end-point of 30-days cardiovascular mortality, rescue thombolysis and/or haemodynamic instability, in a population of intermediate-high risk PE, as compared with other risk evaluation scores as the PESI and SHIeLD scores.
Methods
We performed a retrospective analysis between 2014 and 2019 of all patients admitted for intermediate-high risk PE, in a single expert centre. The patients who underwent fibrinolysis as per clinician discretion (without haemodynamically instability or clinical evidence of clinical deterioration) were excluded. Medical records were analysed for clinical data and outcomes. The predictive accuracy of all scores were assessed using the area under curve (AUC) of receiver operating characteristics (ROC) curve. The association between NEWS and composite end-point at 30-days was analyzed using a Cox regression model.
Results
Of the 1132 patients assessed and admitted with PE, 116 patients fulfilled all inclusion criteria and none of the exclusion criteria and were analysed. The mean age was 69±16 years at time of diagnosis with a female preponderance (62.9%). Most patients were treated with anticoagulation (97.4%), 68% with low molecular weight heparin and the remaining with unfractionated heparin. The average NEWS score was 7±3, the average PESI score was 110±34 and the average SHIeLD score was 14±13. A primary composite end-point occurred in 18 patients (15.5%). The NEWS score showed the greatest predictive power for the occurrence of an event (OR 1.35; 95% CI 1.11–1.64, p=0.003) compared with the SHIeLD score (OR 1.0; 95% CI 1.00–1.07, p=0.035) and the PESI score (OR 1.02; 95% CI 1.00–1.03, p=0.03); it also showed a greatest discriminative capacity with the ROC curve analysis (Figure 1A) demonstrating an AUC of 0.70, vs 0.65 and 0.62 respectively. The survival analysis demonstrated a Hazard Ratio of 1.29 (95% CI 1.10–1.52; p=0.002) signifying a 29% increased risk of an event per each NEWS class increase, with the Kaplan Meier curves widening significantly in the different terciles of the score (Figure 1B).
Conclusions
In PE patients with intermediate-high risk the NEWS score demonstrated a greater predictive power and discriminative capacity than other commonly used risk scores. The NEWS score may help to identify patients in this risk category who might benefit from a reperfusion strategy, but larger studies are needed to confirm this hypothesis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - R Cale
- Hospital Garcia de Orta , Almada , Portugal
| | - M Martinho
- Hospital Garcia de Orta , Almada , Portugal
| | - B Ferreira
- Hospital Garcia de Orta , Almada , Portugal
| | - D Cunha
- Hospital Garcia de Orta , Almada , Portugal
| | - A Briosa
- Hospital Garcia de Orta , Almada , Portugal
| | | | - J Leote
- Hospital Garcia de Orta , Almada , Portugal
| | | | - D Cruz
- Hospital Garcia de Orta , Almada , Portugal
| | - P Araujo
- Hospital Garcia de Orta , Almada , Portugal
| | - J Santos
- Hospital Garcia de Orta , Almada , Portugal
| | - T Judas
- Hospital Garcia de Orta , Almada , Portugal
| | - F Ferreira
- Hospital Garcia de Orta , Almada , Portugal
| | - H Pereira
- Hospital Garcia de Orta , Almada , Portugal
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de Lusignan S, McGovern A, Hinton W, Whyte M, Munro N, Williams ED, Marcu A, Williams J, Ferreira F, Mount J, Tripathy M, Konstantara E, Field BCT, Feher M. Barriers and Facilitators to the Initiation of Injectable Therapies for Type 2 Diabetes Mellitus: A Mixed Methods Study. Diabetes Ther 2022; 13:1789-1809. [PMID: 36050586 PMCID: PMC9500132 DOI: 10.1007/s13300-022-01306-z] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/25/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Initiation of injectable therapies in type 2 diabetes (T2D) is often delayed, however the reasons why are not fully understood. METHODS A mixed methods study performed in sequential phases. Phase 1: focus groups with people with T2D (injectable naïve [n = 12] and experienced [n = 5]) and healthcare professionals (HCPs; nurses [n = 5] and general practitioners (GPs) [n = 7]) to understand their perceptions of factors affecting initiation of injectables. Phase 2: video-captured GP consultations (n = 18) with actor-portrayed patient scenarios requiring T2D treatment escalation to observe the initiation in the clinical setting. Phase 3: HCP surveys (n = 87) to explore external validity of the themes identified in a larger sample. RESULTS Focus groups identified patients' barriers to initiation; fear, lack of knowledge and misconceptions about diabetes and treatment aims, concerns regarding lifestyle restrictions and social stigma, and feelings of failure. Facilitators included education, good communication, clinician support and competence. HCP barriers included concerns about weight gain and hypoglycaemia, and limited consultation time. In simulated consultations, GPs performed high-quality consultations and recognised the need for injectable initiation in 9/12 consultations where this was the expert recommended option but did not provide support for initiation themselves. Survey results demonstrated HCPs believe injectable initiation should be performed in primary care, although many practitioners reported inability to do so or difficulty in maintaining skills. CONCLUSION People with T2D have varied concerns and educational needs regarding injectables. GPs recognise the need to initiate injectables but lack practical skills and time to address patient concerns and provide education. Primary care nurses also report difficulties in maintaining these skills. Primary care HCPs initiating injectables require additional training to provide practical demonstrations, patient education and how to identify and address concerns. These skills should be concentrated in the hands of a small number of primary care providers to ensure they can maintain their skills.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
- Royal College of General Practitioners, Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK.
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- The Institute of Clinical and Biological Sciences, University of Exeter, Exeter, UK
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Martin Whyte
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Neil Munro
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | | | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Julie Mount
- Eli Lilly and Company, Basingstoke, Hampshire, UK
| | - Manasa Tripathy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | | | - Benjamin C T Field
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Department of Diabetes and Endocrinology, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Aspden C, Anand S, Ferreira F, Jamie G, Byford R, Joy M, De Lusignan S. Interdisciplinary Informatics to Support Primary Care Sentinel Surveillance of Respiratory Infectious Disease Including COVID-19: Donabedian Evaluation. Stud Health Technol Inform 2022; 298:137-141. [PMID: 36073472 DOI: 10.3233/shti220923] [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] [Indexed: 06/15/2023]
Abstract
The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe's oldest sentinel systems, providing sentinel surveillance since 1967. We report the interdisciplinary informatics required to run such a system. We used the Donabedian framework to describe the interdisciplinary informatics roles that support the structures, processes and outcomes of the RSC. Over the course of the COVID-19 pandemic University, RCGP, information technology specialists, SQL developers, analysts, practice liaison team, network member primary care providers, and their registered patients have nearly quadrupled the size of the RSC from working with 5 million to 19 million peoples pseudonymised health data. We have produced outputs used by the UK Health Security Agency to describe the epidemiology of COVID-19 and report vaccine effectiveness. We have also supported a trial of community-based therapies for COVID-19 and other observational studies. The home of the primary care sentinel surveillance network is with a clinical informatics research group. Interdisciplinary informatics teamwork was required to support primary care sentinel surveillance; such teams can accelerate the scale, scope and digital maturity of surveillance systems as demonstrated by the RSC across the COVID-19 pandemic.
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Affiliation(s)
- Carole Aspden
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sneha Anand
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Filipa Ferreira
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gavin Jamie
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rachel Byford
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Mark Joy
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Simon De Lusignan
- Clinical Informatics & Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London, UK
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Ferreira F, Gysi D, Castro D, Ferreira TB. The nosographic structure of posttraumatic stress symptoms across trauma types: An exploratory network analysis approach. J Trauma Stress 2022; 35:1115-1128. [PMID: 35246860 DOI: 10.1002/jts.22818] [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] [Received: 10/06/2020] [Revised: 12/06/2021] [Accepted: 01/11/2022] [Indexed: 11/12/2022]
Abstract
The nosographic structure of posttraumatic stress disorder (PTSD) remains unclear, and attempts to determine its symptomatic organization have been unsatisfactory. Several explanations have been suggested, and the impact of trauma type is receiving increasing attention. As little is known about the differential impact trauma type in the nosographic structure of PTSD, we explored the nosology of PTSD and the effect of trauma type on its symptomatic organization. We reanalyzed five cross-sectional psychopathological networks involving different trauma types, encompassing a broad range of traumatic events in veterans, war-related trauma in veterans, sexual abuse, terrorist attacks, and various traumatic events in refugees. The weighted topological overlap was used to estimate the networks and attribute weights to their links. Coexpression differential network analysis was used to identify the common and specific network structures of the connections across different trauma types and to determine the importance of symptoms across the networks. We found a set of symptoms with more common connections with other symptoms, suggesting that these might constitute the prototypical nosographic structure of PTSD. We also found a set of symptoms that had a high number of specific connections with other symptoms; these connections varied according to trauma type. The importance of symptoms across the common and specific networks was ascertained. The present findings offer new insights into the symptomatic organization of PTSD and support previous research on the impact of trauma type on the nosology of this disorder.
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Affiliation(s)
- Filipa Ferreira
- Social Sciences Department, University Institute of Maia, Maia, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Deisy Gysi
- Center for Complex Network Research, Northeastern University, Boston, Massachusetts, USA
| | - Daniel Castro
- Social Sciences Department, University Institute of Maia, Maia, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Tiago Bento Ferreira
- Social Sciences Department, University Institute of Maia, Maia, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
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Whyte MB, Joy M, Hinton W, McGovern A, Hoang U, van Vlymen J, Ferreira F, Mount J, Munro N, de Lusignan S. Early and ongoing stable glycaemic control is associated with a reduction in major adverse cardiovascular events in people with type 2 diabetes: A primary care cohort study. Diabetes Obes Metab 2022; 24:1310-1318. [PMID: 35373891 PMCID: PMC9320871 DOI: 10.1111/dom.14705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 12/22/2022]
Abstract
AIM To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in the risk of major adverse cardiovascular events (MACE). MATERIALS AND METHODS A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database-a large, English primary care network-was conducted. We followed newly diagnosed patients with type 2 diabetes, on or after 1 January 2005, aged 25 years or older at diagnosis, with HbA1c measurements at both diagnosis and after 1 year, plus five or more measurements of HbA1c thereafter. Three glycaemic bands were created: groups A (HbA1c < 58 mmol/mol [<7.5%]), B (HbA1c ≥ 58 to 75 mmol/mol [7.5%-9.0%]) and C (HbA1c ≥ 75 mmol/mol [≥9.0%]). Movement between bands was determined from diagnosis to 1 year. Additionally, for data after the first 12 months, a glycaemic variability score was calculated from the number of successive HbA1c readings differing by 0.5% or higher (≥5.5 mmol/mol). Risk of MACE from 1 year postdiagnosis was assessed using time-varying Cox proportional hazards models, which included the first-year transition and the glycaemic variability score. RESULTS From 26 180 patients, there were 2300 MACE. Compared with group A->A transition over 1 year, those with C->A transition had a reduced risk of MACE (HR 0.75; 95% CI 0.60-0.94; P = .014), whereas group C->C had HR 1.21 (0.81-1.81; P = .34). Compared with the lowest glycaemic variability score, the greatest variability increased the risk of MACE (HR 1.51; 1.11-2.06; P = .0096). CONCLUSION Early control of HbA1c improved cardiovascular outcomes in type 2 diabetes, although subsequent glycaemic variability had a negative effect on an individual's risk.
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Affiliation(s)
- Martin B. Whyte
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Mark Joy
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - William Hinton
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Andrew McGovern
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Uy Hoang
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Jeremy van Vlymen
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Neil Munro
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Simon de Lusignan
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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41
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Martinho M, Calé R, Ferreira F, Pereira H. Large free-floating right atrial mass presenting as intermediate-high risk pulmonary embolism: is reperfusion a better definite strategy? BMJ Case Rep 2022; 15:15/5/e249225. [DOI: 10.1136/bcr-2022-249225] [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] Open
Abstract
We present a woman in her 60s diagnosed with an intermediate-high risk acute pulmonary embolism and a large, non-serpiginous right atrial (RA) mass. Conservative therapy with unfractionated heparin was started and further assessment of the mass with cardiac MRI suggested thrombus as the most likely diagnosis. Despite 1 month of anticoagulation, mass size remained stable and surgical RA embolectomy and left pulmonary endarterectomy was performed. Histopathology confirmed thrombus. The patient died 10 weeks after surgery.
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42
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Alves CFA, Serra R, Bayat R, Ferreira F, Cavaleiro A, Carvalho S. Synergetic effect of thickness and oxygen addition on the electrochemical behaviour of tantalum oxide coatings deposited by HiPIMS in DOMS mode. Electrochim Acta 2022. [DOI: 10.1016/j.electacta.2022.140497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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43
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Santos JG, Ferreira F, Alegria S, Pereira H. Anomalous origin of the left pulmonary artery from the ascending thoracic aorta and a right patent ductus arteriosus associated with pulmonary hypertension in a woman of childbearing age: an unprecedented approach. BMJ Case Rep 2022; 15:15/5/e247070. [DOI: 10.1136/bcr-2021-247070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A female patient in her early 30s, with a medical history of pulmonary arterial hypertension associated with congenital heart disease, lost to follow-up, was referred to a pulmonary hypertension reference centre. The patient presented at a WHO functional class of II in a low-risk category. A transthoracic echocardiogram demonstrated severe pulmonary hypertension with right ventricular dysfunction. A cardiac MRI demonstrated a right aortic arch with anomalous origin of the left pulmonary artery from the ascending thoracic aorta and a patent ductus arteriosus. A right heart catheterisation confirmed the presence of severe pulmonary hypertension. The patient was started on combined vasodilator therapy with an improvement in symptoms and remaining in a low-risk category. This represents one of the oldest described cases of such an anomaly and the first description of response to vasodilator therapy, highlighting the importance of a structured approach in a reference centre for achieving optimal outcomes.
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44
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Pereira AR, Calé R, Ferreira F, Pereira H. Balloon pulmonary angioplasty in inoperable chronic thromboembolic pulmonary hypertension. BMJ Case Rep 2022; 15:e247318. [PMID: 35379679 PMCID: PMC8981286 DOI: 10.1136/bcr-2021-247318] [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] [Accepted: 02/24/2022] [Indexed: 11/04/2022] Open
Abstract
Balloon pulmonary angioplasty (BPA) is an emerging treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension after pulmonary thromboendarterectomy. We report two patients with inoperable and severe CTEPH who were submitted to the BPA programme after optimised treatment with long-term oxygen therapy (LTOT) and pulmonary vasodilator drugs, including prostacyclin analogues. They experienced a significant improvement in exercise capacity, oxygenation, right ventricular function and pulmonary haemodynamics. This improvement allowed withdrawal from LTOT and prostacyclin analogues therapies and, consequently, improved patients' quality of life and reduced future health-related costs. The reported clinical cases intend to highlight the effectiveness of BPA in patients with inoperable CTEPH for whom the only available therapy was, until recently, the pulmonary vasodilator drugs.
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Affiliation(s)
- Ana Rita Pereira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Setúbal, Portugal
| | - Rita Calé
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Setúbal, Portugal
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Setúbal, Portugal
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Setúbal, Portugal
- Cardiovascular Center of the University of Lisbon, Lisboa, Portugal
- Lisbon School of Medicine of the University, Lisboa, Portugal
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45
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Bispo DC, Jesus CSH, Correia M, Ferreira F, Bonifazio G, Goodfellow BJ, Oliveira MB, Mano JF, Gil AM. NMR Metabolomics Assessment of Osteogenic Differentiation of Adipose-Tissue-Derived Mesenchymal Stem Cells. J Proteome Res 2022; 21:654-670. [PMID: 35061379 PMCID: PMC9776527 DOI: 10.1021/acs.jproteome.1c00832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This Article presents, for the first time to our knowledge, an untargeted nuclear magnetic resonance (NMR) metabolomic characterization of the polar intracellular metabolic adaptations of human adipose-derived mesenchymal stem cells during osteogenic differentiation. The use of mesenchymal stem cells (MSCs) for bone regeneration is a promising alternative to conventional bone grafts, and untargeted metabolomics may unveil novel metabolic information on the osteogenic differentiation of MSCs, allowing their behavior to be understood and monitored/guided toward effective therapies. Our results unveiled statistically relevant changes in the levels of just over 30 identified metabolites, illustrating a highly dynamic process with significant variations throughout the whole 21-day period of osteogenic differentiation, mainly involving amino acid metabolism and protein synthesis; energy metabolism and the roles of glycolysis, the tricarboxylic acid cycle, and oxidative phosphorylation; cell membrane metabolism; nucleotide metabolism (including the specific involvement of O-glycosylation intermediates and NAD+); and metabolic players in protective antioxidative mechanisms (such as glutathione and specific amino acids). Different metabolic stages are proposed and are supported by putative biochemical explanations for the metabolite changes observed. This work lays the groundwork for the use of untargeted NMR metabolomics to find potential metabolic markers of osteogenic differentiation efficacy.
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Affiliation(s)
- Daniela
S. C. Bispo
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Catarina S. H. Jesus
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Marlene Correia
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Filipa Ferreira
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Giulia Bonifazio
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal,Department
of Biotechnology Lazzaro Spallanzani, University
of Pavia, Corso Str.
Nuova, 65, 27100 Pavia PV, Italy
| | - Brian J. Goodfellow
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Mariana B. Oliveira
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - João F. Mano
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal
| | - Ana M. Gil
- Department
of Chemistry, CICECO - Aveiro Institute of Materials (CICECO/UA), University of Aveiro, Campus Universitario de Santiago, 3810-193 Aveiro, Portugal,
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Pou B, Ferreira F, Quinones E, Gratadour D, Martin M. Adaptive optics control with multi-agent model-free reinforcement learning. Opt Express 2022; 30:2991-3015. [PMID: 35209428 DOI: 10.1364/oe.444099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
We present a novel formulation of closed-loop adaptive optics (AO) control as a multi-agent reinforcement learning (MARL) problem in which the controller is able to learn a non-linear policy and does not need a priori information on the dynamics of the atmosphere. We identify the different challenges of applying a reinforcement learning (RL) method to AO and, to solve them, propose the combination of model-free MARL for control with an autoencoder neural network to mitigate the effect of noise. Moreover, we extend current existing methods of error budget analysis to include a RL controller. The experimental results for an 8m telescope equipped with a 40x40 Shack-Hartmann system show a significant increase in performance over the integrator baseline and comparable performance to a model-based predictive approach, a linear quadratic Gaussian controller with perfect knowledge of atmospheric conditions. Finally, the error budget analysis provides evidence that the RL controller is partially compensating for bandwidth error and is helping to mitigate the propagation of aliasing.
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47
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Silva AA, Silva FV, Maciel MP, Ferreira F, Oliveira LLS, Silva Jr AA, Aspiazú I, Oliveira PHA. Impact of Pre-transport Feed Withdrawal on Welfare and Meat Characteristics of European Quails. Braz J Poult Sci 2022. [DOI: 10.1590/1806-9061-2021-1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- AA Silva
- Universidade Estadual de Montes Claros, Brazil
| | - FV Silva
- Universidade Estadual de Montes Claros, Brazil
| | - MP Maciel
- Universidade Estadual de Montes Claros, Brazil
| | - F Ferreira
- Universidade Federal de Minas Gerais, Brazil
| | | | - AA Silva Jr
- Universidade Estadual de Montes Claros, Brazil
| | - I Aspiazú
- Universidade Estadual de Montes Claros, Brazil
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Briosa A, Ferreira F, Santos J, Alegria S, Loureiro MJ, Repolho D, Pereira H. Severe and Apparently Irreversible Pulmonary Arterial Hypertension in a Patient with Ostium Secundum Atrial Septal Defect – A Successful Case of Treat and Close Strategy. Clin Med Insights Circ Respir Pulm Med 2022; 16:11795484221141298. [DOI: 10.1177/11795484221141298] [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: 06/19/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022] Open
Abstract
Irreversible pulmonary arterial hypertension is considered a contraindication for surgical or percutaneous closure of atrial septal defects (ASD) due to risk of right heart failure. We present a case of 37 years-old woman who was referred to our center due to progressive worsening fatigue and high probability of pulmonary hypertension on a transthoracic echocardiogram. The diagnostic work-up revealed the presence of an ostium secundum atrial septal defect and severe pre-capillary pulmonary hypertension on right heart cathetherization (RHC). The patient was considered inoperable and started medical therapy with sildenafil and bosentan. After one year of treatment, she repeated RHC that showed a significant reduction in pulmonary vascular resistance making her eligible for closure. Surgical closure of ASD with a fenestra was performed with success. Our case emphasizes the importance of individual assessment even if cases where initial evaluation is unfavorable to closure in accordance with the guidelines.
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Affiliation(s)
- Alexandra Briosa
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Filipa Ferreira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - João Santos
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Sofia Alegria
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | | | - Débora Repolho
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
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Calé R, Ferreira F, Pereira AR, Repolho D, Sebaiti D, Alegria S, Vitorino S, Santos P, Pereira H, Brenot P, Loureiro MJ. Safety and efficacy of balloon pulmonary angioplasty in a Portuguese pulmonary hypertension expert center. Rev Port Cardiol 2021; 40:727-737. [PMID: 34857110 DOI: 10.1016/j.repce.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Balloon pulmonary angioplasty (BPA) is an alternative therapy in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. The aim of this study was to assess the short-term efficacy and safety of a BPA program. METHODS This prospective single-center study included all BPA sessions performed in CTEPH patients between 2017 and 2019. Clinical assessment including WHO functional class, plasma biomarkers, 6-min walk test (6MWT) and right heart catheterization was performed at baseline and six months after the last BPA session. RESULTS A total of 57 BPA sessions were performed in 11 CTEPH patients (64% with inoperable disease, 82% under pulmonar vasodilator therapy). Nine patients completed both the BPA program and a minimum six-month follow-up period. There were significant improvements in WHO functional class (p=0.004) and 6MWT (mean increase of 42 m; p=0.050) and a trend for significant hemodynamic improvement: 25% decrease in mean pulmonary artery pressure (mPAP) (p=0.082) and 42% decrease in pulmonary vascular resistance (PVR) (p=0.056). In the group of patients with severely impaired hemodynamics (three patients with mPAP >40 mmHg), the reduction was significant: 51% in mPAP (p=0.013) and 67% in PVR (p=0.050). Prostacyclin analogs and long-term oxygen therapy were withdrawn in all patients. Minor complications were recorded in 25% of patients. There were no major complications or deaths. CONCLUSIONS A BPA strategy on top of pulmonary vasodilator therapy further improves symptoms, exercise capacity and hemodynamics with an acceptable risk-benefit ratio in patients with inoperable CTEPH or residual/recurrent PH after surgery.
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Affiliation(s)
- Rita Calé
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal.
| | - Filipa Ferreira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Débora Repolho
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Daniel Sebaiti
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia Alegria
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sílvia Vitorino
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Santos
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Hélder Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal; CCUL, CAML, Universidade de Lisboa, Lisboa, Portugal
| | - Philippe Brenot
- Serviço de Radiologia, Hospital Marie Lannelongue, Le Plessis Robinson, França; Universidade Paris-Sud, Faculdade de Medicina, Universidade Paris-Saclay, Le Kremlin-Bicêtre, França
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50
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Bauwens J, de Lusignan S, Sherlock J, Ferreira F, Künzli N, Bonhoeffer J. Co-administration of routine paediatric vaccines in England often deviates from the immunisation schedule. Vaccine X 2021; 9:100115. [PMID: 34622200 PMCID: PMC8481960 DOI: 10.1016/j.jvacx.2021.100115] [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] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/13/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Vaccine co-administration can facilitate the introduction of new vaccines in immunisation schedules and improve coverage. We analysed real life data to quantify the extent of routine paediatric vaccine co-administrations as recommended and as never recommended in the immunisation schedule in England, and assessed factors for recommended and never recommended vaccine co-administrations. Immunisation data for all scheduled routine paediatric vaccines between 2008 and 2018 was obtained from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We included 6'257'828 doses administered to 1'005'827 children. Twenty-one percent of vaccines were given separately, 79% were co-administered. Sixty-four percent of vaccines scheduled for co-administration were co-administered as recommended while 15% were administered separately. Among all vaccine co-administrations, 75% happened as recommended in the schedule, 4% were never recommended, while 21% deviated from the schedule. Vaccine co-administration according to the schedule varied greatly between vaccines. Forty-eight percent of English children received at least one of their vaccine co-administrations not as recommended in the immunisation schedule, with 19% of children receiving none of their co-administered vaccines as recommended. Late administration of one or more vaccines increased the odds for deviated co-administrations (OR 1.60) and strongly increased the odds for never recommended co-administrations (OR 5.34). Differences between genders, NHS regions, and IMD quintiles were statistically significant but small. Suboptimal co-administration rates for routine paediatric vaccines are a missed opportunity and should be optimised by concerted public health action.
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Key Words
- COVER, Cover of Vaccination Evaluated Rapidly
- Children
- Co-administration. Immunisation Schedule
- DTaP/HepB/IPV/Hib, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b conjugate vaccine
- DTaP/IPV or dTaP/IPV, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, and inactivated poliovirus vaccine
- DTaP/IPV/Hib, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and Haemophilus influenzae type b conjugate vaccine
- GP, General Practitioner
- HPV, Human papillomavirus vaccine
- Hib/MenC, Haemophilus influenzae type b conjugate, and bivalent meningococcal conjugate vaccine
- IMD, Index of Multiple Deprivation
- IQR, Interquartile Range
- MMR, Measles, mumps, and rubella vaccine
- MenACWY, Quadrivalent meningococcal conjugate vaccine
- MenB, Serogroup B meningococcal vaccine
- MenC, Serogroup C meningococcal vaccine
- Minors
- OR, Odds Ratio
- PCV, Pneumococcal conjugate vaccine
- PHE, Public Health England
- RCGP, Royal College of General Practitioners
- RSC, Research and Surveillance Centre
- RV, Rotavirus vaccine
- Td/IPV, Tetanus and diphtheria toxoids and inactivated poliovirus vaccine
- Vaccination
- Vaccines
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Affiliation(s)
- Jorgen Bauwens
- University of Basel, Switzerland
- University of Basel Children's Hospital, Switzerland
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
- Royal College of General Practitioners, United Kingdom
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Nino Künzli
- University of Basel, Switzerland
- Swiss Tropical and Public Health Institute, Switzerland
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