Blood and CSF anti-neuronal antibodies testing in psychotic syndromes: a retrospective analysis from a tertiary psychiatric hospital

A Consensus of Psychoimmunology Experts (Pollak et al., 2019) established a set of red flags and proposed diagnostic criteria for psychosis of autoimmune origin (AIP). Previous studies on AIP are limited by the scarcity of CSF analysis, preventing the valorization of blood anti-neuronal antibodies (Ab). The aims of this study are to determine the relative frequency and characterize AIP in a cohort of psychotic patients that underwent CSF workup. This work is a retrospective study in a tertiary psychiatric hospital. Clinical and paraclinical data were collected from medical records, and patients were classified according to Pollak et al. (2019) criteria. From 68 patients, ten (14.7%) had positive anti-neuronal antibodies (Ab): n = 5 in CSF and blood (n = 4 anti-NMDAr, n = 1 -GAD65), and n = 5 in blood only (n = 1 anti-GABAb, n = 1 -GAD65, n = 1 -SOX1, n = 1 -NMDAr, n = 1 -zic4). After 5- (2-10)-year follow-up, n = 6/68 (8.8%) had AIP diagnosis in context of autoimmune encephalitis (AE), and the remaining (n = 4/10, blood-only Ab) alternative diagnoses (n = 2 dementia, n = 1 schizophrenia, n = 1 intellectual disability). Ten of the 13 patients that fulfilled criteria for possible AIP were mimics, and only three AE had criteria for probable AIP. All AIP developed neurological manifestations (mostly cognitive dysfunction); EEG was usually abnormal (66.7%), and all had normal MRI. We found statistically significant associations between AIP/AE and systemic autoimmune disease, presentation with seizures and EEG abnormalities. All AE developed neurological symptoms alongside psychosis. Ab positivity occurred predominantly in AE but also in other neuropsychiatric disorders. Clinical suspicion based on the knowledge of the described presentations of established Ab is crucial in the psychotic patient approach.

Nanotechnology-based techniques for hair follicle regeneration

The hair follicle (HF) is a multicellular complex structure of the skin that contains a reservoir of multipotent stem cells. Traditional hair repair methods such as drug therapies, hair transplantation, and stem cell therapy have limitations. Advances in nanotechnology offer new approaches for HF regeneration, including controlled drug release and HF-specific targeting. Until recently, embryogenesis was thought to be the only mechanism for forming hair follicles. However, in recent years, the phenomenon of wound-induced hair neogenesis (WIHN) or de novo HF regeneration has gained attention as it can occur under certain conditions in wound beds. This review covers HF-specific targeting strategies, with particular emphasis on currently used nanotechnology-based strategies for both hair loss-related diseases and HF regeneration. HF regeneration is discussed in several modalities: modulation of the hair cycle, stimulation of progenitor cells and signaling pathways, tissue engineering, WIHN, and gene therapy. The HF has been identified as an ideal target for nanotechnology-based strategies for hair regeneration. However, some regulatory challenges may delay the development of HF regeneration nanotechnology based-strategies, which will be lastly discussed.

End-Organ Damage in Hypertension: An Insight on a Differentiated Outpatient Consultation

OBJECTIVE

The objective of this study was to determine the prevalence of end-organ damage in hypertensive patients attending an outpatient consultation.

MATERIALS AND METHODS

Patients were selected from an outpatient consultation at a tertiary hospital care center. All patients who consulted between July 2022 and March 2023 were included. Data on demographic characteristics, blood pressure records, hypertension etiology, medication use, and the presence of target organ damage were collected.

RESULTS

A total of 73 patients were included in the study, with 34 patients being male (46.6%) and 39 patients being female (53.4%). The mean age of the patients was 49.8 years. Among the cases of hypertension, 14 (19.2%) were classified as secondary arterial hypertension (AH). The most common cause of secondary AH was obstructive sleep apnea (OSA) (42.9%). Approximately 23.2% of patients had documented end-organ damage potentially related to hypertension, with kidney disease being the most frequent (n = 10, 13.7%). The most commonly prescribed pharmacological classes were angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists (n = 46, 63%).

CONCLUSION

Despite numerous studies and trials on arterial hypertension, it remains a significant contributor to morbidity and mortality, necessitating the continued awareness of its long-term implications.

Hyperglycemic Hemichorea: A Case Report

Chorea is a hyperkinetic movement disorder characterized by a continuous flow of rapid, random, and involuntary bodily contractions, usually affecting the distal limbs. When these movements are more proximal or assume a larger amplitude with a flinging or kicking character, they're referred to as ballism. These disorders can be associated with several causes, ranging from genetic and neurovascular to toxic, autoimmune, and metabolic. Non-ketotic hyperglycemic hemichorea-hemiballismus is a rare consequence of decompensated diabetes mellitus with a poorly understood pathogenesis but with characteristic MRI T1 and T2 hyperintense abnormalities in the contralateral basal ganglia. We present the case of a 74-year-old woman with a history of poorly controlled type 2 diabetes mellitus, dyslipidemia, and arterial hypertension who was admitted to the emergency room due to a two-day history of rapid non-stereotypical involuntary movements of the left side of her body. A neurological exam showed large amplitude and repetitive left-side body movements. Glycemia was 541 mg/dL with no ketosis. Her glycosylated hemoglobin was 14%. A brain CT excluded acute abnormalities. Brain MRI showed a discrete T1 hyperintense signal involving the right corpus striatum, compatible with non-ketotic hyperglycemic hemichorea-hemiballism syndrome. After metabolic optimization with insulin and haloperidol, the movements resolved. Early recognition and metabolic control are essential to the resolution of choreiform movements. Our aim is to raise awareness for hyperglycemic hemichorea-hemiballismus, in which decompensated diabetes is the early sign of diagnosis.

Hydrocephalus: a rare complication of primary central nervous system vasculitis

Hydrocephalus is a known complication of central nervous system (CNS) vasculitis secondary to infectious diseases. We present an unusual case of primary CNS vasculitis (PCNSV) complicated by communicating hydrocephalus. A patient in their 50s with a few months' history of headache, psychomotor slowing and frequent falls presented with an acute left temporo-parieto-occipital infarction. Angiography revealed multiple arterial irregularities in the anterior circulation bilaterally, CSF was inflammatory and the remaining study was negative, fulfilling criteria for possible PCNSV. One month after successful treatment with corticosteroid, there was worsening of gait, urinary incontinence and neuropsychiatric symptoms. The investigation was remarkable only for active hydrocephalus. An external ventricular shunt was placed, followed by a ventriculoperitoneal shunt, and cyclophosphamide was started with subsequent recovery. Our discussion is that communicating hydrocephalus in PCNSV, due to impaired CSF flow, should be considered on subacute/chronic worsening of patients with PCNSV.

Bioengineered exosomal-membrane-camouflaged abiotic nanocarriers: neurodegenerative diseases, tissue engineering and regenerative medicine

A bio-inspired strategy has recently been developed for camouflaging nanocarriers with biomembranes, such as natural cell membranes or subcellular structure-derived membranes. This strategy endows cloaked nanomaterials with improved interfacial properties, superior cell targeting, immune evasion potential, and prolonged duration of systemic circulation. Here, we summarize recent advances in the production and application of exosomal membrane-coated nanomaterials. The structure, properties, and manner in which exosomes communicate with cells are first reviewed. This is followed by a discussion of the types of exosomes and their fabrication methods. We then discuss the applications of biomimetic exosomes and membrane-cloaked nanocarriers in tissue engineering, regenerative medicine, imaging, and the treatment of neurodegenerative diseases. Finally, we appraise the current challenges associated with the clinical translation of biomimetic exosomal membrane-surface-engineered nanovehicles and evaluate the future of this technology.

Safety of Gold Nanoparticles: From In Vitro to In Vivo Testing Array Checklist

In recent years, gold nanoparticles (AuNPs) have aroused the interest of many researchers due to their unique physicochemical and optical properties. AuNPs are being explored in a variety of biomedical fields, either in diagnostics or therapy, particularly for localized thermal ablation of cancer cells after light irradiation. Besides the promising therapeutic potential of AuNPs, their safety constitutes a highly important issue for any medicine or medical device. For this reason, in the present work, the production and characterization of physicochemical properties and morphology of AuNPs coated with two different materials (hyaluronic and oleic acids (HAOA) and bovine serum albumin (BSA)) were firstly performed. Based on the above importantly referred issue, the in vitro safety of developed AuNPs was evaluated in healthy keratinocytes, human melanoma, breast, pancreatic and glioblastoma cancer cells, as well as in a three-dimensional human skin model. Ex vivo and in vivo biosafety assays using, respectively, human red blood cells and Artemia salina were also carried out. HAOA-AuNPs were selected for in vivo acute toxicity and biodistribution studies in healthy Balb/c mice. Histopathological analysis showed no significant signs of toxicity for the tested formulations. Overall, several techniques were developed in order to characterize the AuNPs and evaluate their safety. All these results support their use for biomedical applications.

Hyperthyroidism in McCune-Albright Syndrome - a case report

OBJECTIVES

We intend to describe a case of McCune-Albright Syndrome (MAS), a rare disease characterized by fibrous dysplasia (FD), cutaneous hyperpigmentation and hyperfunctioning endocrinopathies (HFE).

CASE PRESENTATION

We report the case of a 13-year-old male child who presented with a café-au-lait macule in the lumbosacral region and disabling polyostotic FD, requiring several surgical interventions and bisphosphonates from the age of 3 years (Y) + 9 months (M) due to persistent and severe pain. Hyperthyroidism (HT) became apparent at 5 Y + 1 M with a T3/T4 ratio greater than 20. Treatment with anti-thyroid drugs (ATD) was carried out for 7 Y and there was a progressive improvement in pain complaints 8 M after starting ATD, allowing treatment with pamidronate to be discontinued. Total thyroidectomy was performed at 12 Y + 5 M.

CONCLUSIONS

This is a case of MAS-associated HT that reflects the deleterious effect of thyroid hormone excess on FD, reinforcing the need of having a low threshold for suspicion of HFE that may arise.

Potato Chips Byproducts as Feedstocks for Developing Active Starch-Based Films with Potential for Cheese Packaging

The potato chip industry generates brownish frying residues, which are usually landfilled. While spent frying oil has value as biodiesel, the defatted brownish water-soluble extract (BrE) does not yet have an application. In this work, it was hypothesized that BrE can be a source of compounds for active packaging. BrE is composed of carbohydrates (66.9%), protein (5.7%), and a small amount of phenolics and esterified fatty acids. When incorporated into starch-based formulations and casted, BrE at 5%, 10%, and 15% w/w (dry starch weight) conferred a yellowish coloration while maintaining the transparency of neat films. The BrE increased the films’ traction resistance, elasticity, and antioxidant activity while decreasing their hydrophilicity. Furthermore, starch/15% BrE-based films showed diminished water vapor and good UV-light barrier properties. Their contact with sliced cheese did not change the products’ hardness during storage (14 days). Weight loss of the cheese was observed after 7 days of storage, stabilizing at 6.52%, contrary to the cheese packed in polyamide (PA)/polyethylene (PE), already used in food packaging. The cheese packed in the starch/15% BrE-based films showed a significant yellowish darkening and lower content of volatile oxidation products compared to the PA/PE. Therefore, BrE revealed to have compounds with the potential to tune the performance of starch-based films for food packaging.

Locust bean milling-derived dust as a raw material for the development of biodegradable bioplastics with antioxidant activity

BACKGROUND

Non-value agrifood byproducts are rich in biomolecules such as proteins and polysaccharides, and possess film-forming ability, motivating their use in the development of biodegradable plastics. This work studied the feasibility of using locust bean milling-derived dust (LBMD) as a source of biomolecules suitable for developing biodegradable plastics.

RESULTS

LBMD is composed of 56% protein, 28% carbohydrate, 10% moisture, 6% lipid, and 2% ash. In addition, phenolic compounds are also present. The carbohydrates are mainly composed by (1 → 4)-mannose, (1 → 4,6)-mannose, and t-galactose glycosidic linkages. Depending on the LBMD concentration used, when employed in casting biodegradable plastics, LBMD yields transparent yellowish bioplastics with 90% elongation at break and surface water contact angles ranging from 60° to 90°. Additionally, LBMD-based bioplastics display antioxidant activity, inhibiting cationic 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radicals up to 61% in just 24 h. LBMD-based bioplastics are disintegrated when incubated on the soil surface for 34 weeks, perhaps acting as a soil nutrient.

CONCLUSION

LBMD represents a potential source of biomolecules for producing transparent, flexible, water tolerant, antioxidant, and biodegradable bioplastics, opening up opportunities to implement a novel circular strategy to valorize this locust bean industry byproduct. © 2022 Society of Chemical Industry.

Transesophageal Echocardiogram: Still a Powerful Tool in the 21st Century for the Diagnosis of Aortic Dissection

A 63-year-old woman with a history of previous anaphylactic reaction to iodate contrast presented with sudden back pain during exertion associated with elevated D-dimer levels. Transthoracic echocardiogram was unremarkable. She was unable to perform a computerized tomography for further evaluation of the aorta due to her allergic background. Transesophageal echocardiogram disclosed a type B aortic dissection. This case report recalls the importance of transesophageal echocardiography in the algorithm for diagnosing aortic dissection in scenarios where CT is not possible.

Medical therapy for secondary prevention in patients with myocardial infarction with non-obstructive coronary artery disease: long-term outcome of a Portuguese centre

Background

The outcomes of dual anti-platelet therapy (DAPT), β-blocker, renin-angiotensin-aldosterone system (RAAS) inhibitor and statin therapy are unknown in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). The aim of this study was to examine the effects of secondary prevention therapy at discharge on long-term outcomes in MINOCA.

Methods

Patients with MINOCA undergoing early coronary angiography between 2009 and 2016 were extracted from a clinical database. Patients were followed until 2018 for outcome events. All patients with a MINOCA diagnosis and without history of atrial fibrillation were included. A total of 646 consecutive patients were enrolled. The primary end point was major adverse cardiac events (MACE) defined as all-cause mortality, myocardial infarction (MI), stroke, and heart failure (HF). Secondary endpoints comprised all individual endpoints for the composite end-point. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis and Cox regression models.

Results

Mean age was 67.9±13.4 years and 31.6% were women. No patient was lost to follow-up. Mean left ventricular ejection fraction was 47.8±13.1%. At discharge, 87.2%, 82.5% and 79.5% of the patients were on statins, RAAS inhibitors and β-blockers, respectively. The majority (72.8%) were discharged on DAPT. During follow-up (Mdn 59 months), 303 (46.9%) patients experienced a MACE and 208 (33.4%) died. MI occurred in 98 patients (17.8%) and stroke in 31 patients (5.6%). HF admissions were also common (82, 14.9%). The hazard ratio (HR) for major adverse cardiac events was 0.31 (0.23–0.41) in patients on statins, RAAS inhibitors and β-blockers. For patients on DAPT the HR was 0.61 (0.48–0.78). In univariate Cox regression analyses, a reduced risk of MACE was found in patients using combined secondary prevention therapies (HR 0.58, 0.46–0.74). Regarding the individual endpoints, combined secondary prevention therapy reduced the risk of stroke (HR 0.45, 0.22–0.99, P=0.04) but not risk of future MI nor HF admissions. Patients in the combined therapy group had a higher median survival (66 months, IQR 27–82 months) than the group without secondary prevention (34.5 months, IQR 6.8–74 months; P<0.001 of Log Rank test for equality of survivor functions). In a multiple Cox regression analysis including RAAS inhibitors, statins, DAPT and β-blockers in the model, none of these drugs was associated with lower MACE, except for RAAS inhibitors.

Conclusions

The results indicate long-term beneficial effects of treatment with secondary prevention medical therapies in patients with MINOCA. Properly powered randomized clinical trials are warranted.

Funding Acknowledgement

Type of funding sources: None.

Assessment of nutritional status of oncology patients at hospital admission: A Portuguese real-world study

Background

Nutritional status in patients with cancer has a determining role in the evolution of the disease and tolerance to treatments. Severity of undernutrition impacts morbidity and mortality in cancer patients and can limit patient response to the optimal therapies if nutritional issues are not appropriately addressed and managed. Despite the importance of malnutrition for the clinical evolution of oncology patients, there is not yet a universally accepted standard method for evaluating malnutrition in such patients. The aim of this study was to stratify the nutritional status of inpatients at an Oncology Department.

Methods

This is an observational study with 561 cancer patients, assessed at admission to a Medical Oncology Department from November 2016 to February 2020. All patients were considered eligible. Non-compliant and/or comatose patients were excluded. Nutritional status was assessed using the PG-SGA, BMI classified with the WHO criteria, and calculation of the percentage of weight loss in the previous 3–6 months.

Results

A total of 561 patients (303 F: 258 M; mean age 65 ± 13 years) were included. One-third of the patients, n=191/561 (34%), lost 6% of their weight in the month prior to admission and 297/561 (53%) patients lost 10.2% of weight in the previous 6 months. Mean BMI was 24.1 ± 5.8 kg/m²; N = 280/561 (50%) patients had regular BMI according to the WHO criteria. N = 331/561 (59%) patients reported eating less in the month prior to admission. N = 303/561 (54%) had moderate/severe deficits of muscle and adipose compartments. The PG-SGA identified 499/561 (89%) patients as moderately/severely malnourished, of which 466/561 (83%) patients scored ≥9 points, meeting criteria for a critical need for nutritional support. Fifteen percent of patients scored >4 points, indicating a need for directed therapy for symptom control and only 1% scored <2 points (maintenance nutritional counseling).

Conclusion

In this oncological setting, a higher proportion of patients were nutritionally-at-risk or with moderate/severe malnutrition. The large majority of patients in this study presented with a critical need for nutritional intervention. These findings highlight the need for an integrated assessment of nutritional status at patient referral. This will allow early and timely nutrition care, which is recommended to prevent or reverse further deterioration of the condition and to optimize treatment administration.

Macrophage Cell Membrane-Cloaked Nanoplatforms for Biomedical Applications

Biomimetic approaches utilize natural cell membrane-derived nanovesicles to camouflage nanoparticles to circumvent some limitations of nanoscale materials. This emergent cell membrane-coating technology is inspired by naturally occurring intercellular interactions, to efficiently guide nanostructures to the desired locations, thereby increasing both therapeutic efficacy and safety. In addition, the intrinsic biocompatibility of cell membranes allows the crossing of biological barriers and avoids elimination by the immune system. This results in enhanced blood circulation time and lower toxicity in vivo. Macrophages are the major phagocytic cells of the innate immune system. They are equipped with a complex repertoire of surface receptors, enabling them to respond to biological signals, and to exhibit a natural tropism to inflammatory sites and tumorous tissues. Macrophage cell membrane-functionalized nanosystems are designed to combine the advantages of both macrophages and nanomaterials, improving the ability of those nanosystems to reach target sites. Recent studies have demonstrated the potential of these biomimetic nanosystems for targeted delivery of drugs and imaging agents to tumors, inflammatory, and infected sites. The present review covers the preparation and biomedical applications of macrophage cell membrane-coated nanosystems. Challenges and future perspectives in the development of these membrane-coated nanosystems are addressed.

Exosomal glypican-1 discriminates pancreatic ductal adenocarcinoma from chronic pancreatitis

BACKGROUND AND AIMS

Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19-9 biomarker.

METHODS

This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19-9) were performed.

RESULTS

The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p<0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p<0.0001); this outperforms CA 19-9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p<0.0001). The superiority of% GPC1+crExos over CA 19-99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV).

CONCLUSION

Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation.

P-534 Noninvasive preimplantation genetic testing for aneuploidies (NIPGT-A) x Preimplantation genetic testing for aneuploidies (PGT-A): NIPGT-A is more reliable than PGT-A

Study question

Does NIPGT-A have lower false-positive rates (FPR) than PGT-A?

Summary answer

When DNA from whole embryo cells was used as the gold-standard, the FPR of NIPGT-A was 3.57-times smaller than that obtained with PGT-A.

What is known already

After many years of using PGT-A, there are still many concerns, such as risks of invasive action and difficulties in the correct interpretation of mosaicism, which could lead to errors in the interpretation of false-positive and false-negative results. Recently, a new technology (NIPGT-A) has arisen using cell-free DNA present in the spent culture media of human blastocysts. Unlike PGT-A that uses only trophoblastic cells, NIPGT-A reflects the ploidy status of trophoblastic cells and inner cell mass, suggesting that this new technology could be less prone to errors and thus more reliable than invasive tests.

Study design, size, duration

This multicentric cohort study included a total of 56 blastocysts vitrified on day/5 that were previously biopsied for PGT-A(all these embryos presented a diagnosis of aneuploidy). The embryos were donated under informed consent by patients following the Human Medical Authority regulations. Blastocysts were thawed and cultured in 15μl drops of culture medium under oil. After their expansion(4-8hours), the blastocysts and their corresponding spent media were transferred to PCR tubes and stored at -20ºC until analysis.

Participants/materials, setting, methods

The DNA of all samples (spent culture medium and whole embryo) was amplified by the MALBAC® technology(Yikon Genomics). The DNA concentration of the amplified product was measured using Qubit 3.0 Fluorometer(Thermo Fisher Scientific). The samples were subjected to next-generation sequencing(NGS) using Illumina MiSeq® System. The ploidy status results obtained from ChromGo™ software(Yikon Genomics) for spent culture medium and whole embryo were compared to determine the accuracy of NIPGT-A for screening chromosomal abnormalities in each embryo.

Main results and the role of chance

DNA from all 56 spent media samples and whole embryos were successfully amplified. Comparing the results of NIPGT-A and whole embryos sequencing, the positive predictive value (PPV) was 93.5% and the FPR was 6.5% (Table 1). On the other hand, comparing the whole embryo and PGT-A results, the PPV was 76.8%, and the FPR was 23.2% (Table 2). NIPGT-A had a negative predictive value (NPV) of 100% and a false negative rate (FNR) of 0%.

Limitations, reasons for caution

Despite the sample size could be considered small, comparative analyses between the results of invasive/noninvasive PGT-A with whole embryo are rare. All donated embryos were classified as aneuploidy. Additionally, the cut-off for aneuploidy in cases of PGT-A could be variable(multicentre-study). Euploid embryos have not been donated for research to date.

Wider implications of the findings

NIPGT-A has a lower FPR than PGT-A and does not require micromanipulation skills, avoiding trophectoderm biopsy trauma and seems to provide more accurate results corresponding to the ploidy status of the whole embryo. Thereby NIPGT-A should be considered as the test of choice for genetic evaluation of the embryo.

Trial registration number

Not Applicable

Physical Exercise Program on Fall Prevention Using Technological Interface: Pretest Study

Background

Prevention of falls among older adults has boosted the development of technological solutions, requiring testing in clinical contexts and robust studies that need prior validation of procedures and data collection tools.

Objective

The objectives of our study were to test the data collection procedure, train the team, and test the usability of the FallSensing Games app by older adults in a community setting.

Methods

This study was conducted as a pretest of a future pilot study. Older adults were recruited in a day care center, and several tests were applied. Physical exercise sessions were held using the interactive FallSensing Games app. Nurse training strategies was completed.

Results

A total of 11 older adults participated. The mean age was 75.08 (SD 3.80) years, mostly female (10/11, 91%) and with low (3-6 years) schooling (10/11, 91%). Clinically, the results show a group of older adults with comorbidities. Cognitive evaluation of the participants through the Mini Mental State Examination showed results with an average score of 25.64 (SD 3.5). Functional capacity assessed using the Lawton Instrumental Activities of Daily Living Scale (overall score from 0-23, with lower scores reflecting worse capacity to perform activities) showed impairment in different instrumental activities of daily living (average score 14.27). The data collection tool proved to enable easy interpretation; however, its structure needed small adjustments to facilitate the data collection process. Despite the length of the questionnaire, its implementation took an average of 21 minutes. For the assessment of the prevalence of fear of falling, the need to add a question was identified. The performance of functional tests under the guidance and presence of rehabilitation nurses ensured the safety of the participants. The interactive games were well accepted by the participants, and the physical exercises allowed data collection on the functionality of the older adults, such as the number of repetitions in the tests, range of movement (angle), duration of the movements, and execution of each cycle. Concerning the training of the nurses, it was crucial that they had experience with the platform, specifically the position of the chair facing the platform, the position of the feet, the posture of participants, and the use of sensors.

Conclusions

In the future pilot study, the researchers point out the need to design a study with mixed methods (quantitative and qualitative), thus enriching the study results.

New iron(III) anti-cancer aminobisphenolate/phenanthroline complexes: Enhancing their therapeutic potential using nanoliposomes

Malignant melanoma is an aggressive and deadly form of skin cancer and novel and improved therapeutic options are needed. A promising strategy involves the use of metallodrugs combined with liposomes for targeted delivery to cancer cells. In this work, a family of iron(III) complexes was synthesized bearing a trianionic aminobisphenolate ligand (L) and phenanthroline-type co-ligands (NN). Four ternary iron complexes of general formula [Fe(L)(NN)] were obtained: [Fe(L)(amphen)] (1), [Fe(L)(phen)] (2), [Fe(L)(Clphen)] (3), and [Fe(L)(Mephen)] (4), as well as a fifth complex [Fe(L)(NEt₃)(H₂O)] (5) without the bidentate co-ligand. All complexes were characterized by analytic and spectroscopic techniques and demonstrated to be stable in aqueous environment. Complexes 1 and 2 were able to bind DNA and presented high cytotoxic activity towards human cancer cells. Complex 1 (IronC) was selected for incorporation into different liposomal formulations, which were fully characterized and screened against murine melanoma cells. The IronC liposomal formulation with the highest incorporation efficiency (∼95%) and a low IC₅₀ value (7.1 ± 0.7 μM) was selected for in vivo evaluation. In a syngeneic murine melanoma model the liposomal formulation of IronC yielded the highest impairment on tumour progression when compared with the control, temozolomide, and with the iron complex in free form.

Dual Diagnosis, Double Trouble

Introduction

Many individuals with severe mental illness (SMI) have substance use disorder comorbidity. Dual diagnosis makes the approach and management of these patients even more challenging since the lack of improvement in either pathologies can lead to a deterioration of both.

Objectives

To illustrate, through the presentation of two cases, the clinical challenges in managing a patient with dual diagnosis

Methods

Clinical case presentation through retrospective review of clinical notes and non-systematic literature review on this topic

Results

We present the clinical cases of two women diagnosed with Bipolar Disorder and (poly)Substance Use Disorder since adolescence, who have a history of multiple hospitalizations due to mostly maniform symptoms. The complexity of case management is evident, both at the pharmacological level and in psychosocial intervention. This is aggravated by the difficulty in maintaining adherence to the therapeutic project and frequent relapses.

Conclusions

Current evidence points to the beneficial effect of a combined pharmacological and psychosocial approach, which must be comprehensive, individualized and require differentiation at various levels that are difficult to achieve and make the treatment of these situations an even greater challenge.

Using illustrative examples, this review draws attention to the practical difficulties in managing situations where substance use is associated with SMI.

Disclosure

No significant relationships.

Prevention and monitoring of metabolic syndrome in patients with severe mental ilness - presentation of our study protocol

Introduction

Cardiovascular diseases are the leading cause of death in individuals with SMI. The sedentary lifestyle that usually guides these individuals associated with the use of some psychotropic drugs increases the risk of adverse events related to these pathologies

Objectives

Presentation of the Study Protocol for the Implementation of a Psychoeducational Group directed to Prevention and Monitoring Metabolic Syndrome (MS) in patients with SMI

Methods

It is intended to implement a psychoeducational program, which includes a 30-minute walk, focused on healthy lifestyle habits, for 16 weeks.

It is intended to include SMI individuals, from a convenience sample, who present any of these criteria: Excess weight; At risk or diagnosed with DM; Sedentary lifestyle; Smoker. Data regarding socio-demographic, clinical and motivational for and about physical activity will be collected from the intervention group. Patients who refuse to join the study will only receive information about lifestyle changes at the beginning and will continue with their usual care.

Results

According to available literature, it is expected that the monitoring and control of these parameters will translate into a benefit in reducing cardiovascular risk factors and optimizing the treatment of MS, contributing to the empowerment of patients in managing their disease and increasing their quality and years of life.

Conclusions

The impact of lifestyle changes proved to be effective and are sometimes lasting, with objective gains in quality of life of these patients. The main measure to face this issue, improve the well-being and physical health of these individuals, is to reduce weight and increase baseline physical activity.

Disclosure

No significant relationships.

Risk of suicide during pregnacy and postpartum period

Introduction

Pregnancy and the postpartum are generally characterized by positive feelings and expectations but they may also disguise maternal stress and difficulties. These are typical periods for the onset or relapse of psychiatric symptoms and disorders. Even though suicide during pregnancy and postpartum is rare, it is among the leading causes of maternal perinatal mortality.

Objectives

To provide an overview on the risk of suicide during pregnancy and postpartum.

Methods

PubMed database was searched using combinations of the terms “suicide”, combined with “pregnancy” and “depression”.

Results

The major risk factors for suicidal ideation are previous suicide attempts, self-harm, current or past history of psychiatric disorder, young maternal age, being unmarried, an unplanned pregnancy, substance use disorders, lack effective psychosocial support and discontinuation of psychotropic drugs. Pregnant women with suicidality behavior have also an increased risk for various adverse obstetric outcomes, including miscarriage, preterm delivery, maternal hemorrhage, and stillbirth. Furthermore, the postpartum period is often associated with the onset of mood and psychotic disorders with an increased risk of both suicide and infanticide. Women who have suffered from serious psychiatric conditions either after childbirth or in other phases of life should be informed about the possibility of relapse after subsequent pregnancies, thus presenting a higher risk of suicide.

Conclusions

During pregnancy and postpartum, it is fundamental to investigate suicide risk, including suicidal ideation, thoughts, and intent, especially (but not only) in women affected by mental pathology. Moreover, maternal suicide behaviour affects the child’s neuropsychological development and can also increase the infant´s suicide risk.

Disclosure

No significant relationships.

Long-term outcomes in patients with potential reversible causes of bradycardia

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hyperkalemia and negative chronotropic drugs are well known causes of reversible bradycardia. Their synergic combination may result in BRASH syndrome (Bradycardia, Renal failure, Atrioventricular blockade, Shock, and Hyperkalemia), a consequence of the vicious cycle between bradycardia, renal failure and worsening hyperkalemia, leading ultimately to multiorgan dysfunction. In potentially reversible bradycardia, drug discontinuation or metabolic correction is recommended before permanent pacemaker (PPM) implantation.

Objectives

To determine the long-term prognosis in patients with potentially reversible symptomatic bradycardia.

Methods

We retrospectively reviewed 176 patients who presented to the emergency department with symptomatic bradycardia, between January 2015 and August 2016. Patients without any reversible cause of bradycardia were excluded. Participants were stratified into three groups according to the reversible causes of bradycardia: patients with hyperkalemia, with or without acute renal injury (ARI) (group 1); patients taking negative chronotropic drugs, with or without ARI (group 2); patients with BRASH syndrome (combination of hyperkalemia and negative chronotropic drugs, with or without ARI) (group 3). The primary endpoint was PPM implantation after discharge. Secondary endpoints included: bradycardia-related rehospitalization, heart failure (HF) hospitalization, all-cause mortality and a composite of all the previous endpoints.

Results

A total of 105 patients were included (52.4% female; mean age 79.8±8.6 years). Group 1 was comprised by 15 patients (14.3%), group 2 by 69 patients (65.7%) and group 3 by 21 patients (20%, figure 1). The incidence of each event is presented in figure 2. During a mean follow-up of 3.2±2.1 years, PPM was implanted in 60 patients (57.1%) – 51 during hospital stay (85%) and 9 after discharge (15%). Across all groups, approximately 50% of the patients needed PPM implantation at some point, without significant differences between groups (p=0.508). Group 3 had the lowest need of in-hospital PPM (38.1%) but the highest bradycardia-related readmissions (9.5%). Nevertheless, post-discharge PPM implantation was still higher in group 1 (33.3%), followed by group 3 (22.2%). There were no significant differences in the post-discharge PPM implantation rate between groups (p=0.76). In groups 1 and 3 the composite endpoint (73.3% and 76.2%, respectively) was significantly more frequent than in group 2 (44.9%, p=0.046 and p=0.012, respectively).

Conclusions

Nearly half of the patients with an episode of reversible bradycardia needed a PPM at some point. Given the advanced age of most patients with bradycardia secondary to metabolic derangement and/or drug toxicity, it is possible that this unveils underlying conduction system disease, which is likely to recur without PPM implantation.

Inflammation in acute coronary syndrome: prognostic significance

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.

Purpose

The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.

Methods

Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.

Results

In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p&lt;0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.

Conclusions

In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown.

Purpose

Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic.

Methods

A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session.

A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021).

Results

A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction.

There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period.

When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001).

Conclusion

In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.

Developing a social prescribing local system in a European Mediterranean country: a feasibility study to promote active and healthy aging

BACKGROUND

Social Prescribing (SP) is an innovative strategy to respond to the non-clinical health needs of the population. A Social Prescribing Local System (SPLS) can be defined as a set of joined community, health, and social organizations to foster SP-oriented activities. This study aimed to develop and assess the feasibility of an SPLS implemented in a Mediterranean country, to promote health and wellbeing and contribute to active and healthy aging.

METHODS

A mixed-methods approach was followed, including three sequential components: 1) Cross-sectional online survey targeting health professionals (HP) working in a primary health care cluster, Portugal's southern region; 2) Pilot study implementing an on-the-job training program for HP, designed to meet identified training needs in the survey; 3) Focus group (FG) with the HP who participated in the pilot study, two individual interviews, with an elderly patient and a community provider for assessing the satisfaction with the pilot test.

RESULTS

Sixty-five HP completed the survey; of these, 13 completed the theoretical part of the on-the-job training program; and six (out of these 13) completed the full program. Five HP participated in the FG, one patient and one community provider were interviewed. The surveyed HP perceived as facilitators to implement SP: an automatic system of notifications to prompt the use of SP, contribute to patient satisfaction, human and community resources' stability. The survey also highlighted barriers to SP implementation: length of appointments, shortage of human resources, data records confidentiality, low patient adherence rates, bureaucratic issues, time constraints, and financial costs. Participants were satisfied with the training. Identified SPLS implementation benefits were grouped into four dimensions (from the qualitative approach): gains for patients' health and wellbeing, support for the health services, sustainability of the community resources, and HP' professional satisfaction.

CONCLUSIONS

Our study took the first steps towards the implementation of an SPLS. Findings reinforce that training HP in SP and on-the-job training seems feasible. This approach was well received and appears to represent a suitable and sustainable strategy. It can promote professional satisfaction, support health services, contribute to the stability of community resources, improve health and promote active and healthy aging.

Factors related to hospital readmission of patients with acute coronary syndrome: a prospective cohort study

Background

Hospital readmissions of patients with acute coronary syndrome (ACS) are frequent and associated with poor clinical outcomes and increased costs to the healthcare services. Identifying factors that might be associated with hospital readmission is important to support preventive interventions.

Purpose

To identify factors related to hospital readmission of patients with ACS.

Methods

A prospective cohort study. Patients hospitalized with ACS for the first time were included in the study. The outcome, hospital readmission for ACS, was assessed at 30 days, 6 months and 1 year after index discharge. Modifiable cardiovascular risk factors (arterial hypertension, dyslipidemia, diabetes mellitus, smoking, degree of addiction to smoking, use of alcohol, physical inactivity, obesity, stress, depression, excessive daytime sleepiness, obstructive sleep apnea syndrome, hormone replacement) and non-modifiable risk factors (age, race, family history of coronary heart disease) were evaluated as potential predictors of the outcome. Other variables that might have contributed to readmission were also included: marital status, family income, occupation, education, adherence to medication and type of treatment (clinical, percutaneous coronary intervention or coronary artery bypass grafting). The association between hospital readmission and potential predictors was assessed using the Log-Rank test and Cox's simple regression model. Factors whose associations had a p-value of less than 0.20 in the simple regression and other variables of clinical interest were evaluated in a Cox multiple regression model, with p&lt;0.05 considered significant. The study was approved by two Research Ethics Committees.

Results

216 patients were included and the incidence of readmission was 15.7%. Most of the patients were male, white, married, had an income between two and four minimum wages, and a mean age of 60 years. Half of the patients had high adherence to medication. The cardiovascular risk factors identified in most patients were sedentary lifestyle (79.6%), arterial hypertension (63.4%) and obstructive sleep apnea (51.9%). The only independent predictor for readmission was surgical treatment (p=0.026).

Conclusions

Participants had several cardiovascular risk factors and the predictor of hospital readmission was surgical treatment. Identifying the predictive factors of a given population helps nurses in planning and guiding hospital discharge.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPq)

Bisphosphonates and atrial fibrillation risk: a final word

Background

Bisphosphonates (BPs) are widely prescribed drugs that decrease bone fracture risk in osteoporosis patients. Nevertheless, the class has been associated with a plethora of adverse effects, including incidental atrial fibrillation (AF). This epidemiologic link has, however, been met with skepticism by some authors.

Purpose

To perform a meta-analysis aimed at ascertaining the extent to which BPs might increase the odds of AF.

Methods

We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to the first of March, 2021, for randomized controlled trials comparing oral or intravenous BPs with placebo or a no-treatment control, in what concerns AF risk. In order to be included in the quantitative analysis, studies were required to feature a minimum patient follow-up of 6 months. De novo AF diagnoses served as the primary endpoint. Data related to individual BPs were further investigated separately, with respect to this outcome. Study-specific Mantel-Haenszel odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model.

Results

42 RCTs, encompassing 52.436 patients (32.071 randomized to BPs), were regarded as eligible for quantitative synthesis. Of note, 2 pooled analyses, one of 4 trials with ibandronate and the other of 6 trials with risedronate, were included. Individual BP representation may be depicted as follows: Alendronate, 23 trials, with 14.599 patients; Risedronate, 7 trials, with 15.350 patients; Zoledronic acid, 7 trials, with 13.059 patients; Ibandronate, 4 trials, with 8.754 patients; and Minedronate, 1 trial, with 674 patients. 748 de novo AF diagnoses were reported, in total. In the main analysis, BPs were not found to be significantly associated with an increase in AF odds (OR 1.10, 95% CI 0.95–1.28, P 0.21, i2 0%). As for individual BPs, Alendronate (OR 1.09, 95% CI 0.82–1.45, P 0.55, i2 0%), Risedronate (OR 0.81, 95% CI 0.35–1.86, P 0.61, i2 31%), Ibandronate (OR 0.89, 95% CI 0.52–1.52, P 0.67) and Minedronate (0 AF events reported, both in the active and in the control group) were also not shown to meaningfully enhance AF risk. On the contrary, Zoledronic acid utilization was associated with a significant, though small, increase in new AF cases (OR 1.29, 95% CI 1.01–1.64, P 0.04, i2 0%).

Conclusion

The professed BP-driven increase in AF odds is not apparent in a fairly populated randomized setting. In fact, a barely significant increment in AF risk seems only to occur with the most potent BP (Zoledronic acid). Therefore, AF development concerns should not refrain doctors from prescribing this highly effective pharmacological class.

Funding Acknowledgement

Type of funding sources: None.

Prognostic significance of percutaneous coronary intervention associated blood loss in acute coronary syndrome

Background

Antiplatelet and anticoagulants are one of the mainstay treatment of acute coronary syndrome (ACS), however they are associated with a significant increase of bleeding risk. While anaemia is a recognized predictor of adverse outcomes, it is unknown if a variation of haemoglobin (HB) levels, even without associated anaemia, has the same impact.

Purpose

The aim of this study was to determine the prognostic impact of HB variation after percutaneous coronary intervention (PCI) in ACS patients.

Methods

Retrospective analysis of 822 consecutive patients admitted due to ACS and treated with PCI, in a single coronary intensive care unit. Delta HB – ΔHB – (HB at admission – HB 24 hours after PCI) was calculated. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether ΔHB was independent from other known factors in predicting the outcome.

Results

In the studied sample, 75.4% were male. Mean age was 66.4±13.1. ST-elevation myocardial infarction (STEMI) occurred in 45.5%, non-ST segment elevation myocardial infarction in 42.6% and unstable angina in 11 9% of the studied population. Moderate to severe systolic dysfunction was present in 23.5% of the cases. Regarding comorbidities and past medical history, 76% had hypertension (HTN), 30.3% diabetes, 16.4% chronic kidney disease (CKD), 62.2% dyslipidaemia and 10.5% heart failure (HF). Mean HB at admission was 13.8±1.8 g/dL, mean HB after PCI was 12.9±1.9 g/dL and mean ΔHB was 0.9±1.1 g/dL. The mean follow-up was 51.6±30.6 months. In univariate analysis, ΔHB was significantly associated with all-cause mortality (HR 1.15 per 1 g/dL loss, 95% CI 1.01–1.30, p=0.04), as was HB at admission, HB after PCI, age, sex, diabetes, HTN, dyslipidaemia, CKD and moderate to severe systolic dysfunction. In multivariate analysis, ΔHB remained significantly associated with the endpoint and gained even more statistical power (HR 1.25, 95% CI 1.10–1.43, p&lt;0.01). HB at admission and after PCI, age, CKD and moderate to severe systolic dysfunction were also independent predictors of this outcome.

Conclusions

In our study, irrespective of the admission and discharge HB, ΔHB was associated with more adverse outcomes in patients submitted to PCI. Hence, even patients with a normal HB after PCI have a worse long-term prognosis if a negative variation of HB occurs. This highlights the importance of identifying and optimising all the correctable factors that might lead to an increased bleeding risk.

Funding Acknowledgement

Type of funding sources: None.

Effect of a supervised exercise program on overweight and obese adolescents: a quasi-experimental study

Background

Obesity and overweight are a worldwide public health problem, and physical exercise is an important intervention to reduce these high rates. Supervised exercise programs have significant impacts on the prevalence of obesity in adolescentes and the nurses should guide on the importance of physical activity.

Purpose

To evaluate the effect of an exercise program on the profile of obesity and overweight in adolescents.

Methods

Quasi-experimental study based on TREND guidelines. Performed with 72 adolescents, who underwent a physical activity program supervised (aerobic and resistance physical exercises) by a health professional 5 times a week, each session lasting from 50 to 60 minutes. The population consisted of all obese and overweight adolescents, aged between 14 and 18 years, who were authorized by the doctor to perform physical activity, and who did not have physical mobility problems and/or cognitive alterations. Adolescents with an anthropometric index greater than or equal to the z +1 score, and waist circumference greater than the 90th percentile, and/or skinfolds greater than the 90th percentile were considered obese or overweight. Adolescents who did not perform outcome assessments before and after the intervention, or those who did not attend physical exercise sessions for a week were excluded. The primary outcomes were anthropometric measurements (body mass index, tricipital and subscapular skinfolds, estimated body fat percentage, brachial perimeter, arm fat area, waist and neck circumference measurement), while secondary outcomes were lipid profile, capillary glycemia and blood pressure. Outcomes were assessed before and the day after the program ended. The effect of the program in relation to the outcomes was analyzed using appropriate statistical tests, with p&lt;0.05 being considered significant.

Results

A total 520 adolescents were assessed for eligibility; of these, 129 were considered eligible and 124 agreed to participate in the study, but 20 gave up participating. Therefore, 104 started the intervention and 32 adolescents were excluded over time, as they did not show up for a week in the exercise program, which totaled 72 adolescents for analysis. A significant improvement was observed in all primary outcomes analyzed (p&lt;0.001) and in most secondary outcomes (capillary blood glucose, p=0.0001; triglycerides, p=0.0001; systolic blood pressure, p=0.005) after 12 weeks of the supervised physical exercise program.

Conclusion

The supervised physical exercise program showed a significant reduction in anthropometric measurements, as well as in glycemic, triglyceride and blood pressure levels. To prove the effect of physical exercise on adolescents may impact public and educational policy measures and the incorporation of this practice in adolescents' school life.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPq)

Subsegmental pulmonary embolism: yet another case for being a medical conservative

Background

The advent of multi-detector computed tomographic pulmonary angiography has allowed better assessment of the peripheral pulmonary arteries, thereby increasing the incidence of pulmonary embolism (PE). Even though most patients with PE are treated with anticoagulation, its value in the subsegmental setting (SSPE) has not yet been confirmed.

Purpose

To perform a meta-analysis aimed at ascertaining the extent to which anticoagulation results in a net positive effect in patients with SSPE.

Methods

We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to March 2021, for controlled studies addressing the effect of anticoagulation on SSPE patients. Specifically, venous thromboembolism (VTE) recurrence served as the primary efficacy endpoint, whereas clinically significant bleeding represented the primary safety outcome. Furthermore, major bleeding, PE-related and all-cause mortality were also studied, as secondary endpoints. All anticoagulation strategies, namely oral or parenteral, met inclusion criteria. Study-specific odds ratios (ORs) were pooled, under a random-effects model.

Results

1 cross-sectional, 8 retrospective and 4 prospective non-randomized studies, encompassing 82, 641 and 157 patients, respectively, were regarded as eligible for quantitative evaluation. 667 patients (75.8%) were allocated to the anticoagulation arm. The absolute number of events for each outcome may be reported as follows: primary efficacy endpoint, 5; primary safety endpoint, 60; major bleeding, 38; PE-related mortality, 0; all-cause mortality, 25. 7 studies reported their respective outcomes under a prespecified 3-month follow-up period, while only 1 featured cancer patients as its entire sample. As for the primary efficacy endpoint, and despite the surprising adjudication of all its 5 events to the anticoagulated patients, their relative overrepresentation (371 vs. 143 patients) stemmed a non-significant tendency towards a decrease in VTE recurrence in this arm (OR 0.59, 95% CI 0.09–3.81, P 0.58, i2 0%). On the other hand, anticoagulation was associated with a significant increase in clinically significant hemorrhages (OR 2.89, 95% CI 1.07–7.80, P 0.04, i2 0%) and a non-significant propensity towards an increment in major bleeding (OR 2.44, 95% CI 0.79–7.59, P 0.12, i2 0%). Lastly, and even though no events of PE-related mortality were reported, anticoagulation was linked with a meaningful reduction in all-cause mortality (OR 0.31, 95% CI 0.11–0.82, P 0.02, i2 0%).

Conclusion

Currently available evidence underpins marginal efficacy and safety concerns regarding the use of anticoagulation in SSPE patients, who are expected to experience very low to none PE-related mortality. The association of anticoagulation with lower all-cause death may be attributable to selection bias. Randomized controlled trials are, however, still needed to fully validate this hypothesis.

Funding Acknowledgement

Type of funding sources: None.

Impacto do Confinamento em Doentes com Esquizofrenia Durante a Pandemia de COVID-19

INTRODUÇÃO: A pandemia de COVID-19 e as medidas de saúde pública implementadas para a controlar podem causar ou acentuar sintomas de ansiedade e depressão, especialmente em pessoas vulneráveis, como os doentes com esquizofrenia.MÉTODOS: O presente estudo procurou avaliar o impacto do confinamento de março e abril de 2020 numa amostra de 40 doentes com esquizofrenia acompanhados na consulta externa do Hospital de Vila Franca de Xira.RESULTADOS: Destes doentes, 65% respeitaram o confinamento, 32,5% sentiram maior ansiedade, 97,5% mantiveram a medicação e 15% aumentaram as suas doses. Os consumos de álcool aumentaram em 42,8% dos doentes e os de tabaco em 30,7%, mas não houve aumento nos consumos de cannabis. Houve um aumento na procura de ajuda psiquiátrica em 10% dos doentes e psicológica em 15% dos casos.CONCLUSÃO: Não houve redução da adesão à terapêutica e a maioria dos doentes cumpriu as regras de confinamento impostas.

Digital pathology in the immunohistochemical evaluation of biomarkers in breast cancer

Background

Currently, the evaluation of biomarkers HER-2 and ER is critical for targeting therapy for breast cancer and is performed by experienced pathologists, which takes time and causes a certain interobserver variability. The use of histological slide scanners coupled with the application of software for immunoexpression quantification can be profitable in pathological laboratories routine. This study aims to compare the quantification of HER-2 and ER immunoexpression employing automatic algorithms, using as standard the evaluation performed by a pathologist.

Methods

From the archive since 2016 to 2018 were retrieved 75 immunostained slides for HER-2 and 76 immunostained slides for ER with invasive breast carcinoma diagnosis. The slides were scanned in Aperio CS2 and the immunostaining signal was quantified in Aperio Imagescope using a membrane and nuclear algorithm, respectively. The concordance between the scores obtained and the previous assessment was calculated by Cohen’s Kappa coefficient as well as the sensitivity and specificity for each algorithm.

Results

Both algorithms showed an almost perfect concordance with the conventional method (k = 0.94 for HER-2; k = 0.92 for ER). Digital evaluations presented a sensitivity of 100% for both biomarkers, and a specificity of 100% for HER-2 and 80% for ER.

Conclusions

This assay showed that applying signal quantification software for HER-2 and ER in digitized slides is accurate, as these tools have potential to be implemented in laboratory routine. However, it will be necessary to increase the sample to obtain more reliable values and extend this study to the PR and Ki67 biomarkers since both carry prognostic and predictive information as well.

Validity of the association between periodontitis and female infertility conditions: a concise review

Hormones and inflammatory mechanisms are implicated with female reproductive function, including follicle maturation, ovulation, embryo implantation, and pregnancy. Periodontitis is a chronic inflammatory disease due to a polymicrobial disruption of the homeostasis and may be considered as a potential risk factor that affect female fertility. The role of periodontitis is becoming meaningful, with significant associations with polycystic ovary syndrome, endometriosis and bacterial vaginosis. Further, periodontitis is linked with known risk factors towards female infertility, such as age, obesity, and chronic kidney disease. This review aims to summarize the available evidence on the association between periodontitis and female infertility-associated conditions, and to discuss warranting steps in future research.

Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy

OBJECTIVES

To determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion.

MATERIALS AND METHODS

Retrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings.

RESULTS

We included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152-39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806).

CONCLUSION

TCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO.

Portuguese version of Parent-reported Drug Hypersensitivity Quality of Life Questionnaire (P-DrHy-Q): assessment of reliability and validity

Summary

Background. Drug hypersensitivity in children impacts the quality of life of the patients and their caregivers. The parent-reported drug hypersensitivity quality of life questionnaire (P-DrHy-Q), the first disease-specific quality-of-life questionnaire for caregivers who have children with drug hypersensitivity, was recently developed. The aim of this study was to assess the validity and reliability of the portuguese version of the P-DrHy-Q. Methods. A translation of the Parent-reported Drug Hypersensitivity Quality of Life Questionnaire (P-DrHy-Q) to the Portuguese population was performed, assessing its applicability in 74 caregivers from two allergy departments. The analyses included internal consistency (Cronbach's alpha) and test-retest reliability: 14 caregivers completed the P-DrHy-Q without any intervention one week after answering the first questionnaire. Results. The 12-item scale assessed the mental health and social activity. The internal consistency of the scale was good (Cronbach's alpha = 0.884) and the test-retest associations were excelent (Intra-class correlation coefficient = 0.985; p less than 0.001). The mean value of the questionnaire was (37.01 SD; 18.57) with Mental Health being more affected than Social Activity. Employed caregivers had a significant higher score (p less than 0.001). No other factor was statistically significant. Conclusions. The Portuguese version of the P-DrHy-Q is valid for evaluating quality of life impairment in Portuguese caregivers of children with drug hypersensitivity. Its application might be relevant for future research and provide clinicians and researchers with a tool to define which psychosocial support is required to provide more comprehensive care in drug hypersensitivity.

Acute urticaria in children: from pediatric emergency department to allergology consultation at a central hospital

Summary

Background. Acute urticaria is a common condition in the pediatric emergency department (ED) and no data is available in Portugal. Objective. We aimed to characterize the prevalence, etiology and management of acute urticaria in children presenting at an ED of a portuguese central hospital and report the follow-up investigation when drug or food allergy was suspected.Methods. Retrospective study of clinical records from children admitted to the ED with acute urticaria during one year period. Results. 250 children were included, mean age of 7.4 ± 4.9 years (0-17 years). The most frequently suspected etiological factors were infections (22%), foods (12%), insect bites (9%) and drugs (8%), of which, upper respiratory tract infections, seafood and β-lactam antibiotics were the most frequent. In 44% of cases, the etiology of urticaria was not determined. After ED discharge, of the 50 patients with suggestive drug or food allergy, only 48% were sent to allergological workup and the allergy confirmed in 6 of them (2.4% of the 250 children). Conclusions. These data suggest that allergy is not the main trigger of acute urticaria in ED children, but when suspected, reference to an allergy department to complete allergological workup was insufficient.

Prevalence of Tobacco Smoking in Patients with Schizophrenia and Bipolar Disorder in a Portuguese Hospital

N/a.