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Dramburg S, Grittner U, Potapova E, Travaglini A, Tripodi S, Arasi S, Pelosi S, Acar Şahin A, Aggelidis X, Barbalace A, Bourgoin A, Bregu B, Brighetti MA, Caeiro E, Caglayan Sozmen S, Caminiti L, Charpin D, Couto M, Delgado L, Di Rienzo Businco A, Dimier C, Dimou MV, Fonseca JA, Goksel O, Hernandez D, Hernandez Toro CJ, Hoffmann TM, Jang DT, Kalpaklioglu F, Lame B, Llusar R, Makris M, Mazon A, Mesonjesi E, Nieto A, Öztürk AB, Pahus L, Pajno G, Panasiti I, Papadopoulos NG, Pellegrini E, Pereira AM, Pereira M, Pinar NM, Priftanji A, Psarros F, Sackesen C, Sfika I, Suarez J, Thibaudon M, Uguz U, Verdier V, Villella V, Xepapadaki P, Yazici D, Matricardi PM. Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study. Allergy 2024; 79:908-923. [PMID: 38311961 DOI: 10.1111/all.16029] [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: 05/15/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach. OBJECTIVE To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach. METHODS Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed. RESULTS Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers. CONCLUSIONS In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.
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Affiliation(s)
- S Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - U Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E Potapova
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Travaglini
- Department of Biology, Tor Vergata University, Rome, Italy
- Italian Aerobiology Monitoring Network - Italian Aerobiology Association, Rome, Italy
| | - S Tripodi
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
- Allergolology Service, Policlinico Casilino, Rome, Italy
| | - S Arasi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital (IRCCS), Rome, Italy
| | | | - A Acar Şahin
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - X Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University Hospital "Attikon", Athens, Greece
| | - A Barbalace
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - A Bourgoin
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - B Bregu
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - M A Brighetti
- Department of Biology, Tor Vergata University, Rome, Italy
| | - E Caeiro
- MED- Mediterranean Institute for Agriculture, Environment and Development, Institute for Advanced Studies and Research, University of Évora, Évora, Portugal
- Portuguese Society of Allergology and Clinical Immunology, Lisbon, Portugal
| | | | - L Caminiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - D Charpin
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - M Couto
- Immunoallergology, Hospital CUF Trindade, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | | | - C Dimier
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - M V Dimou
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - J A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - O Goksel
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma. Faculty of Medicine, Ege University, Izmir, Turkey
| | - D Hernandez
- Department of Allergy, Health Research Institute Hospital La Fe, Valencia, Spain
| | - C J Hernandez Toro
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T M Hoffmann
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - D T Jang
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - F Kalpaklioglu
- Department of Immunology and Allergic Diseases, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - B Lame
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - R Llusar
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - M Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University Hospital "Attikon", Athens, Greece
| | - A Mazon
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - E Mesonjesi
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - A Nieto
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - A B Öztürk
- Division of Allergy and Immunology, Department of Pulmonary Medicine, Arel University, School of Medicine, Istanbul, Turkey
| | - L Pahus
- Aix Marseille Univ, APHM, INSERM CIC 1409, INSERM U1263, INRA 1260 (C2VN), Marseille, France
| | - G Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - I Panasiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - E Pellegrini
- Department of Reggio Calabria, ARPA - Regional Agency for Environmental Protection, Calabria, Italy
| | - A M Pereira
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Pereira
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - N M Pinar
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - A Priftanji
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Tirana, Albania
| | - F Psarros
- Allergy Department, Athens Naval Hospital, Athens, Greece
| | - C Sackesen
- Division of Pediatric Allergy, Koç University School of Medicine, Istanbul, Turkey
| | - I Sfika
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - J Suarez
- Department of Biology of Organisms and Systems, Area of Botany, University of Oviedo, Oviedo, Spain
| | - M Thibaudon
- Réseau National de Surveillance Aérobiologique, Brussieu, France
| | - U Uguz
- Department of Biology, Faculty of Science, Ege University, Izmir, Turkey
| | - V Verdier
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - V Villella
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - P Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - D Yazici
- Cellular and Molecular Medicine, KUTTAM, Graduate School of Health Sciences, Koç University, Istanbul, Turkey
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - P M Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Freitas C, Lima B, Melo N, Mota P, Novais-Bastos H, Alves H, Sokhatska O, Delgado L, Morais A. Distinct TNF-alpha and HLA polymorphisms associate with fibrotic and non-fibrotic subtypes of hypersensitivity pneumonitis. Pulmonology 2023; 29 Suppl 4:S63-S69. [PMID: 34629327 DOI: 10.1016/j.pulmoe.2021.08.013] [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: 05/05/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Since Hypersensitivity Pneumonitis (HP) categorization in fibrotic and nonfibrotic/inflammatory types seems to be more consistent with the distinctive clinical course and outcomes, recent international guidelines recommended the use of this classification. Moreover, fibrotic subtype may share immunogenetic and pathophysiological mechanisms with other fibrotic lung diseases. AIM To investigate HLA -A, -B, -DRB1 and TNF-α -308 gene polymorphisms among fibrotic and nonfibrotic HP patients due to avian exposure, also in comparison with asymptomatic exposed controls. METHODS We prospectively enrolled 40 HP patients, classified as fibrotic or nonfibrotic/inflammatory, and 70 exposed controls. HLA and TNF-α polymorphisms were determined by polymerase chain reaction-sequence specific primer amplification. RESULTS While HLA alleles were not associated to HP susceptibility, fibrotic HP patients showed increased frequencies of HLA A*02 (46.7% vs 25.7%; OR=2.53, p = 0.02) and HLA DRB1*14 (10.0% vs 0.7%; OR=15.44, p=0.02) alleles when compared with exposed controls, although not statistically significant after correction for multiple comparisons. TNF-α G/G genotype (associated with low TNF-α production) frequencies were significantly increased among the non-fibrotic/inflammatory HP patients comparatively to fibrotic presentations (88% vs 60%; RR=0.44; p=0.04) and controls (88% vs 63%, OR 4.33, p=0.037). Also, these patients had a significantly increased frequency of the G allele (94.0% vs 73.3%, RR=0.44, p=0.01), while fibrotic HP patients predominantly presented the A allele (26.7% vs 6.0%, RR=2.28, p=0.01). CONCLUSIONS Our results support the hypothesis that fibrotic and non-fibrotic HP subtypes exhibit a distinct profile of TNF-α and HLA polymorphisms, which may be relevant to predict disease course and better define treatment strategies.
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Affiliation(s)
- C Freitas
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
| | - B Lima
- Oficina de Bioestatística, Ermesinde, Portugal
| | - N Melo
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - P Mota
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - H Novais-Bastos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Institute for Research and Innovation in Health (I3S), University of Porto, Portugal
| | - H Alves
- National Health Institute Doutor Ricardo Jorge, Porto, Portugal
| | - O Sokhatska
- Basic and Clinical Immunology, Department of Pathology, and Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology, Department of Pathology, and Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
| | - A Morais
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
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Baena A, Paolino M, Villarreal-Garza C, Torres G, Delgado L, Ruiz R, Canelo-Aybar C, Song Y, Feliu A, Maza M, Jeronimo J, Espina C, Almonte M. Latin America and the Caribbean Code Against Cancer 1st Edition: Medical interventions including hormone replacement therapy and cancer screening. Cancer Epidemiol 2023; 86 Suppl 1:102446. [PMID: 37852728 DOI: 10.1016/j.canep.2023.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
Prostate, breast, colorectal, cervical, and lung cancers are the leading cause of cancer in Latin America and the Caribbean (LAC) accounting for nearly 50% of cancer cases and cancer deaths in the region. Following the IARC Code Against Cancer methodology, a group of Latin American experts evaluated the evidence on several medical interventions to reduce cancer incidence and mortality considering the cancer burden in the region. A recommendation to limit the use of HRT was issued based on the risk associated to develop breast, endometrial, and ovarian cancer and on growing concerns related to the over-the-counter and without prescription sales, which in turn bias estimations on current use in LAC. In alignment with WHO breast and cervical cancer initiatives, biennial screening by clinical breast examination (performed by trained health professionals) from the age of 40 years and biennial screening by mammography from the age of 50 years to 74, as well as cervical screening by HPV testing (either self-sampling or provider-sampling) every 5-10 years for women aged 30-64 years, were recommended. The steadily increasing rates of colorectal cancer in LAC also led to recommend colorectal screening by occult blood testing every two years or by endoscopic examination of the colorectum every 10 years for both men and women aged 50-74 years. After evaluating the evidence, the experts decided not to issue recommendations for prostate and lung cancer screening; while there was insufficient evidence on prostate cancer mortality reduction by prostate-specific antigen (PSA) testing, there was evidence of mortality reduction by low-dose computed tomography (LDCT) targeting high-risk individuals (mainly heavy and/or long-term smokers) but not individuals with average risk to whom recommendations of this Code are directed. Finally, the group of experts adapted the gathered evidence to develop a competency-based online microlearning program for building cancer prevention capacity of primary care health professionals.
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Affiliation(s)
- Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Cynthia Villarreal-Garza
- Centro de Cáncer de Mama, Hospital Zambrano Hellion - TecSalud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Gabriela Torres
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Lucia Delgado
- Escuela de Graduados, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Yang Song
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Violence, and Injury Prevention, Pan American Health Organization, Washington, DC, USA
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Farraia M, Paciência I, Castro Mendes F, Cavaleiro Rufo J, Delgado L, Moreira A. Cost-effectiveness analysis of grass pollen specific immunotherapy in children with allergic rhinitis compared to the standard of care symptomatic treatment in Portugal. Eur Ann Allergy Clin Immunol 2023; 55:212-228. [PMID: 34927406 DOI: 10.23822/eurannaci.1764-1489.240] [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] [Indexed: 11/17/2022]
Abstract
Summary Background. Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are scarce. We aim to compare the cost-effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) against standard-of-care (SOC) treatment in children with grass pollen allergic rhinitis. Methods. We created a Markov model to compare the three strategies over a 10-year horizon. SOC was the reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis were used to assess models' uncertainty. Results. We obtained an ICER of € 12,605 and € 6,318 for SLIT and SCIT, respectively. In sensitivity analysis, SCIT was more cost-effective than SLIT. Conclusions. AIT is cost-effective in children with grass pollen allergic rhinitis, especially for the subcutaneous route.
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Affiliation(s)
- M Farraia
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - I Paciência
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - F Castro Mendes
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
| | - A Moreira
- EPIUnit - Institute of Public Health, University of Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
- São João University Hospital Center, Porto, Portugal
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Rodrigues M, de Castro Mendes F, Paciência I, Barros R, Padrão P, Cavaleiro Rufo J, Silva D, Delgado L, Moreira A, Moreira P. Diet quality, asthma and airway inflammation in school-aged children. Eur Ann Allergy Clin Immunol 2023. [PMID: 37288989 DOI: 10.23822/eurannaci.1764-1489.301] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Summary Background. Asthma is a major public health problem, with increasing prevalence in most countries, particularly among children. Poor dietary quality is also increasing in children, and evidence of the overall quality of children's food patterns effects on asthma is scarce. Methods. This cross-sectional analysis (660 children: 49.1% females, aged 7-12years) evaluated the association between diet quality and asthma (n = 56) and airway inflammation among school-aged children according to body mass index (BMI). Diet quality was assessed through the Healthy Eating Index (HEI)-2015, and categorized by tertiles. Higher scores represent a healthier diet. A questionnaire was used to enquire about self-reported medical diagnosis of asthma and asthma under medication. Lung function and airway reversibility were measured, and airway inflammation assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/obese (p less than 85th), (n = 491), and overweight/obese (p ≥ than 85th), (n = 169). The associations between diet quality and asthma and airway inflammation were estimated using logistic regression models. Results. Non-overweight/obese children in 2nd tertile of HEI-2015 score had decreased odds of having eNO ≥ 35ppb (OR 0.43, 95%CI 0.19-0.98), medical diagnosis of asthma (OR 0.18; 95%CI 0.04-0.84), and asthma treatment (OR 0.12; 95%CI 0.01-0.95), compared to children in the 1st tertile. Conclusions. Our findings suggest that a higher diet quality associates with lower levels of airway inflammation and reduced prevalence of asthma among non-overweight/obese school-aged children.
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Affiliation(s)
- M Rodrigues
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - F de Castro Mendes
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - I Paciência
- Center for Environmental and Respiratory Health Research (CERH), Population Health, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - R Barros
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - P Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - D Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Immuno-Allergology, Centro Hospitalar São João, Porto, Portugal
| | - A Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
- Department of Immuno-Allergology, Centro Hospitalar São João, Porto, Portugal
| | - P Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
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Boechat JL, Sousa-Pinto B, Delgado L, Silva D. Biologicals in severe chronic rhinosinusitis with nasal polyps: translation to clinical practice while waiting for head-to-head studies. Rhinology 2023:3066. [PMID: 36946510 DOI: 10.4193/rhin22.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1.0-2.6% of the population (1) and results in relevant direct and indirect costs. Recently, several randomized controlled trials (RCTs) with Type 2-targeting biologicals (anti-IL4Rα, anti-IL5R, anti-IL5 and anti-IgE) opened a new treatment field for patients refractory to first-line treatments (2,3).
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Affiliation(s)
- J L Boechat
- Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine, Universidade Federal Fluminense, Niterói/RJ, Brazil
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - B Sousa-Pinto
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar de São João, E.P.E., Porto, Portugal
| | - D Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar de São João, E.P.E., Porto, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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Fucho G, Delgado L, González-Rodríguez A, Guàrdia A, Álvarez A, Crivillés S, Barbero J, Monreal J, Labad J, Palao Vidal D. The impact of sexual hormones on depressive symptoms and alcohol use in a woman with delusional disorder at the perimenopausal stage: case report and review of recent works. Eur Psychiatry 2022. [PMCID: PMC9567285 DOI: 10.1192/j.eurpsy.2022.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
The influence of sexual hormones on mental disorders have been extensively reported. In fact, recent studies suggest that sex hormones may play a relevant role in the pathophysiology of psychosis, may be a precipitant when exogenously administered or even be used as a treatment agent of psychotic disorders.
Objectives
To describe the case of a patient with a recent diagnosis of delusional disorder (DD) with an onset in the perimenopausal period.
Methods
Case report and narrative review focused on the impact of sexual hormones on depressive symptoms and alcohol use comorbidity during perimenopause in DD women by using PubMed database.
Results
Case report: A 48-year-old woman diagnosed with DD. The clinical assessment of climacteric symptoms, as well as the gonadotropins (elevated levels of follicle-stimulating hormone -FSH- and luteinizing hormone -LH-) and estrogen levels monitoring (variations on 17-β-estradiol -E2-) enabled to link the endocrine changes with the onset and course of the psychiatric disorder. During the development of the disease, the patient also presented comorbid depressive symptoms and alcohol use disorder. Review: Estrogen depletion seems to increase the risk of psychosis, while scientific literature is not conclusive in establishing a definitive relationship between depressive symptoms and hormonal imbalance in DD. Alcohol use disorder is a common comorbidity in both perimenopausal women and patients with DD.
Conclusions
Multiaxial management of the case helped clinicians to achieve clinical stabilization. Sex differences as well as hormonal pattern disturbances should receive special attention due to the seminal implications in pharmacotherapy and clinical outcomes.
Disclosure
No significant relationships.
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Castillo C, Artagaveytia N, Brignoni L, Laitman Y, Camejo N, Hernández AL, Krygier G, Cayota A, Delgado L, Friedman E. Population-based screening of Uruguayan Ashkenazi Jews for recurrent BRCA1 and BRCA2 pathogenic sequence variants. Mol Genet Genomic Med 2022; 10:e1928. [PMID: 35332707 PMCID: PMC9184654 DOI: 10.1002/mgg3.1928] [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: 07/26/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
In Ashkenazi Jews (AJ) three recurring pathogenic sequence variants (PSVs) are detected in ~2.5% of the general population in the BRCA1 (c.68_69del = 185delAG, c.5266dup = 5382insC), and BRCA2 (c.5946del = 6174delT). Population‐based screening for these PSVs in AJ women is part of the health basket in Israel. To assess the feasibility and outcome of BRCA genotyping in the Jewish population of Uruguay, AJ in the greater Montevideo area were recruited using ethically approved protocol and without pretest counseling were genotyped for the three predominant AJ PSVs in the BRCA genes. Independently confirmed PSV carriers were counseled, and genetic testing was offered to additional family members. Overall, 327 participants were enrolled: 312 (95%) female, 261 (80%) had all four grandparents AJ, and 14 (4%) women were breast cancer survivors with a mean age ± standard deviation (SD) 50 ± 11.5 years. The BRCA1 c.68_69del PSV was detected in three cancer free participants (0.92%, CI 95% 0.31–2.6), all with a suggestive family history. No carriers of the other two recurrent PSVs were detected. Online oncogenetic counseling was provided for all carriers. In conclusion, the rate of the BRCA1 c.68_69del PSV was similar with the rate in other AJ communities. AJ population BRCA genotyping screens in Uruguay seem feasible and should be promoted.
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Affiliation(s)
- Cecilia Castillo
- Servicio de Oncología Clínica, Hospital de Clínicas "Dr. Manuel Quintela", Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - Nora Artagaveytia
- Departamento Básico de Medicina, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Lucia Brignoni
- Departamento Básico de Medicina, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Yael Laitman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Natalia Camejo
- Servicio de Oncología Clínica, Hospital de Clínicas "Dr. Manuel Quintela", Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - Ana Laura Hernández
- Departamento de Psicología Médica, Hospital de Clínicas "Dr. Manuel Quintela", Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - Gabriel Krygier
- Servicio de Oncología Clínica, Hospital de Clínicas "Dr. Manuel Quintela", Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - Alfonso Cayota
- Departamento Básico de Medicina, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.,Laboratorio de Genómica Funcional, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Lucia Delgado
- Servicio de Oncología Clínica, Hospital de Clínicas "Dr. Manuel Quintela", Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Genetics, Sheba Medical Center, Tel Hashomer, Israel.,The Department of Genetics and biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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de Almeida LM, Cortés S, Vilensky M, Valenzuela O, Cortes-Sanabria L, de Souza M, Barbeito RA, Abdelhay E, Artagaveytia N, Daneri-Navarro A, Llera AS, Müller B, Podhajcer OL, Velazquez C, Alcoba E, Alonso I, Bravo AI, Camejo N, Carraro DM, Castro M, Cataldi S, Cayota A, Cerda M, Colombo A, Crocamo S, Del Toro-Arreola A, Delgadillo-Cristerna R, Delgado L, Breitenbach MD, Fernández E, Fernández J, Fernández W, Franco-Topete RA, Gaete F, Gómez J, Gonzalez-Ramirez LP, Guerrero M, Gutierrez-Rubio SA, Jalfin B, Lopez-Vazquez A, Loria D, Míguez S, Moran-Mendoza ADJ, Morgan-Villela G, Mussetti C, Nagai MA, Oceguera-Villanueva A, Reis RM, Retamales J, Rodriguez R, Rosales C, Salas-Gonzalez E, Segovia L, Sendoya JM, Silva-Garcia AA, Viña S, Zagame L, Jones B, Szklo M. Socioeconomic, Clinical, and Molecular Features of Breast Cancer Influence Overall Survival of Latin American Women. Front Oncol 2022; 12:845527. [PMID: 35530311 PMCID: PMC9071365 DOI: 10.3389/fonc.2022.845527] [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: 12/29/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.
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Affiliation(s)
| | - Sandra Cortés
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marta Vilensky
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | | | | | | | | | | | - Nora Artagaveytia
- Hospital de Clínicas Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | | | - Andrea S Llera
- Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | | | | | | | - Elsa Alcoba
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | - Isabel Alonso
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Alicia I Bravo
- Hospital Regional de Agudos Eva Perón, Buenos Aires, Argentina
| | - Natalia Camejo
- Hospital de Clínicas Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | | | - Mónica Castro
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Lucia Delgado
- Hospital de Clínicas Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | | | - Elmer Fernández
- Universidad Católica de Córdoba, Centro de Investigaciones en Bioquímica Clínica e Inmunologia-CONICET, Córdoba, Argentina
| | | | | | | | | | - Jorge Gómez
- Texas A&M University, Houston, TX, United States
| | | | | | | | - Beatriz Jalfin
- Hospital Regional de Agudos Eva Perón, Buenos Aires, Argentina
| | | | - Dora Loria
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | - Silvia Míguez
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | | | | | | | | | | | - Rui M Reis
- Hospital de Câncer de Barretos, Barretos, Brazil
| | - Javier Retamales
- Grupo Oncológico Cooperativo Chileno de Investigación, Santiago, Chile
| | | | - Cristina Rosales
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | | | | | - Juan M Sendoya
- Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Aida A Silva-Garcia
- OPD Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara, Mexico
| | - Stella Viña
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | - Livia Zagame
- Instituto Jalisciense de Cancerologia, Guadalajara, Mexico
| | - Beth Jones
- Yale School of Public Health, Yale University, New Heaven, CT, United States
| | - Moysés Szklo
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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10
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Sumba A, Centurión D, Lorenzo F, Delgado L. Rabdomiosarcoma orbitario en el adulto jóven: a propósito de un caso clínico. Rev Peru Investig Salud 2022. [DOI: 10.35839/repis.6.1.1017] [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: 11/16/2022] Open
Abstract
Objetivo: Describir el diagnóstico, tratamiento y la evolución de un adulto jóven rabdomiosarcoma alveolar orbitario. Caso Clínico. Hombre de 20 años, consultó por dolor retro-orbitario derecho, proptosis, cefalea, disminución de la visión y fiebre. Valorado por oftalmología se planteó absceso infraorbitario derecho. Se realizó tomografía computarizada donde se observó un tumor orbitario abscedado de 38x25mm. La estadificación fue un T2bN1M0, sitio favorable, Estadio III del IRSG, riesgo intermedio. Se decidió drenaje quirúrgico y biopsia. La anatomía patológica informó rabdomiosarcoma alveolar variante sólida. Se realizó exenteración orbitaria. Se utilizó quimioterapia con esquema: vincristina, adriamicina, ciclofosfamida alternado con irinotecan. Presentó una progresión tumoral local y encefálica por lo que inicia radioterapia con criterio paliativo hemostático, falleciendo luego por complicaciones infecciosas y neurológicas. Conclusión. El rabdomiosarcoma alveolar orbitario en adultos es poco frecuente, agresivo, con alto riesgo de diseminación, y mal pronóstico. Puede simular procesos infecciosos orbitarios, como en nuestro paciente, siendo especialmente importante el diagnóstico precoz, el manejo interdisciplinario, el tratamiento precoz y el soporte de las posibles complicaciones, todo lo cual condiciona la evolución de los pacientes con rabdomiosarcoma.
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11
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Castillo C, Camejo N, Rondan M, Savio F, Herrera G, Krygier G, Delgado L. Survival and Time to Initiation of Adjuvant Chemotherapy Among Breast Cancer Patients in Uruguay. BCTT 2021; 13:651-658. [PMID: 34908875 PMCID: PMC8664648 DOI: 10.2147/bctt.s338276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
Introduction Increases in disease-free survival and overall survival (OS) with the use of adjuvant chemotherapy in early breast cancer (BC) are widely known; however, the optimal time to initiate treatment with adjuvant chemotherapy remains controversial. Objective To evaluate the time elapsed between surgery and the initiation of adjuvant chemotherapy and its possible impact on OS in patients diagnosed with BC stages I–III. Materials and Methods This retrospective study included 112 patients diagnosed with BC stages I–III who received adjuvant chemotherapy at the Mastology Unit of the Hospital de Clínicas in Uruguay from 2009 to 2019. OS was estimated using the Kaplan–Meier method, and a Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals. Results No statistically significant association was found between the time from surgery to the initiation of chemotherapy and the described variables. OS was worse for patients initiating chemotherapy more than 90 days after breast surgery (n = 19) (HR 7.63; p = 0.004) and between 61 and 90 days after surgery (n = 46) (HR 4.58; p = 0.040) compared to those who started before 30 days (n = 23). Controlling by type of surgery and stage, the prognosis of patients who started chemotherapy between 61 and 90 days after surgery was similar to that of patients who underwent chemotherapy within the first 30 days, controlling for surgery (HR 4.10; p = 0.056) and controlling for stage (HR 3.76; p = 0.075). Prognosis was worse for patients with stage III disease (p = 0.022) who underwent a mastectomy and/or axillary lymph node dissection (p = 0.025). Conclusion Patients who started chemotherapy more than 90 days following surgery and those with stage III disease or underwent mastectomy and/or axillary lymph node dissection who initiated it between 61 and 90 days had a worse OS. Multiple factors are involved in the time between surgery and the initiation of chemotherapy, and further studies are needed to evaluate which of these factors influence the delay of chemotherapy in order to design strategies to avoid such delays and their negative impact on survival.
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Affiliation(s)
- Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
- Correspondence: Cecilia Castillo Department of Clinical Oncology, School of Medicine, University of Uruguay, Avenida Italia s/n, Montevideo, 11600, UruguayTel +59824872075 Email
| | - Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Monika Rondan
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Florencia Savio
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Gabriel Krygier
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Lucia Delgado
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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Monteiro L, Silva P, Delgado L, Amaral B, Garcês F, Salazar F, Pacheco JJ, Lopes C, Bousbaa H, Warnakulasuriya S. Expression of spindle assembly checkpoint proteins BubR1 and Mad2 expression as potential biomarkers of malignant transformation of oral leukoplakia: an observational cohort study. Med Oral Patol Oral Cir Bucal 2021; 26:e719-e728. [PMID: 34704983 PMCID: PMC8601638 DOI: 10.4317/medoral.24511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background The Spindle Assembly Checkpoint (SAC) is a surveillance mechanism essential to ensure the accuracy of chromosome segregation during mitosis. Our aim was to evaluate the expression of SAC proteins in oral carcinogenesis, and to assess their potential in predicting malignant transformation of oral leukoplakia. Material and Methods We analysed the immunoexpression of BubR1, Mad2, Bub3, and Spindly proteins in 64 oral biopsies from 52 oral leukoplakias and 12 normal tissues. Univariate and multivariate analysis were performed to evaluate predictive factors for malignant transformation (MT). Results We observed that BubR1 and Mad2 were more highly expressed in high dysplasia grade lesions than in low grade or normal tissues (P<0.05). High expression of Spindly was significantly correlated with a high Ki-67 score (P=0.004). Six (11.5%) oral leukoplakias underwent malignant transformation. In univariate analysis, the binary dysplasia grade (high grade) (P<0.001) was associated with a higher risk of malignant transformation as well as high BubR1 (P<0.001) and high Mad2 (P=0.013) expression. In multivariate analysis, high expression of BubR1 and Mad2 when combined showed an increased risk for malignant transformation (P=0.013; HR of 4.6, 95% CI of 1.4-15.1). Conclusions Our findings reveal that BubR1 and Mad2 were associated with an increased risk for malignant transformation independently of histological grade and could be potential and useful predictive risk markers of malignant transformation in oral leukoplakias. Key words:BubR1, Mad2, Spindly, Bub3, Oral Leukoplakia, epithelial dysplasia, Oral squamous cell carcinoma.
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Affiliation(s)
- L Monteiro
- Rua Central de Gandra, 1317 4585-116 Gandra PRD, Portugal
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14
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Pedrero AA, González-Rodríguez A, Pérez DG, Delgado L, Fucho G, Uribe IP, Acebillo S, Monreal J, Vidal DP, Labad J. Comorbidity and therapeutic response of body dysmorphic disorder (BDD) in autism spectrum disorder (ASD). Eur Psychiatry 2021. [PMCID: PMC9476015 DOI: 10.1192/j.eurpsy.2021.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a biological basis overlapped with obsessive compulsive disorders and body dysmorphic disorder (BDD). The combination of pharmacological treatment and psychological interventions have been considered the gold-standard Objectives Our main objective was to present the case of a patient with ASD and comorbid BDD. As a second objective, we reviewed recent works on the common neurobiological substrate and therapeutic options for both conditions. Methods (1)Clinical case: Patient with ASD and BDD, treated with fluoxetine 60 mg/day and aripiprazole 30 mg/day. (2)Non-systematic narrative review focused on neurobiological substrate and treatment of ASD and BDD. The electronic search was performed by the PubMed database (1990-2020) using the following key terms: “autism spectrum disorder”, “body dysmorphic disorder”, “dysmorphophobia”, “neurobiology”, “pharmacological treatment”, “psychological treatment” and “treatment”. Results Our patient is a 31-year-old single male fulfilling DSM-5 criteria for ASD, diagnosed in childhood, and BDD. He received pharmacological treatment and CBT. He also verbalized having been concerned with his lips and mouth for the last 10 years. This discomfort leads to passive ideas of death. Review: All articles (n=4) supported the use of selective serotonin reuptake inhibitors (SSRIs) and CBT in this comorbidity. None of them reported the use of antipsychotics. Oone article described the use of Repetitive transcranial magnetic stimulation (rTMS) and oxytocin. Conclusions ASD and BDD share the basis of corticostriatal circuits. ISRS and CBT may be effective in treatment. Other options (oxytocin or rTMS) should be further investigated. Examining this comorbidity could be useful for discovering possible endophenotypes.
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15
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Castillo C, Camejo N, Hernandez AL, Artagaveytia N, Alonso R, Delgado L. Prevalence of Known Risk Factors in Uruguayan Women Treated for Breast Cancer at a University Hospital. Breast Cancer (Auckl) 2021; 15:11782234211006667. [PMID: 33911873 PMCID: PMC8047938 DOI: 10.1177/11782234211006667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/02/2021] [Indexed: 11/16/2022]
Abstract
Introduction In Uruguay, breast cancer has the highest incidence and mortality of all cancer in women. Knowledge of the distribution of risk factors related to disease development supports the implementation of prevention strategies in routine clinical practice. This study aimed to determine the epidemiological profile for breast cancer and the frequency of mammographic surveillance in the surveyed population. Materials and Methods A survey was conducted among Uruguayan women diagnosed with breast cancer who were assisted in the mastology unit of the oncology service of the Hospital de Clínicas in Montevideo, Uruguay, from September 1, 2018, to March 1, 2020. Results This study included 398 respondents, with a median (SD) age at diagnosis of 61 (34-86) years. A total of 310 respondents (78.0%) had 1 or more risk factors. Most women aged over 50 years (264 out of a total of 338 [78.1%]) underwent mammographic surveillance at least biennially. Conclusions Consistent with international reports, most respondents had a risk factor. Among the group of respondents aged over 50 years, most underwent mammographic and clinical surveillance at least biennially. Although it is only possible to formulate conclusions about the surveyed women because of the study design, the obtained data further our understanding of the epidemiological profile of the Uruguayan population, which can contribute to prevention practices.
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Affiliation(s)
- Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Ana Laura Hernandez
- Department of Medical Psychology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Nora Artagaveytia
- Department of Basic Medicine, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Rafael Alonso
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Lucia Delgado
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Boechat JL, Chora I, Morais A, Delgado L. The immune response to SARS-CoV-2 and COVID-19 immunopathology - Current perspectives. Pulmonology 2021; 27:423-437. [PMID: 33867315 PMCID: PMC8040543 DOI: 10.1016/j.pulmoe.2021.03.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/26/2021] [Accepted: 03/13/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 is a new beta coronavirus, similar to SARS-CoV-1, that emerged at the end of 2019 in the Hubei province of China. It is responsible for coronavirus disease 2019 (COVID-19), which was declared a pandemic by the World Health Organization on March 11, 2020. The ability to gain quick control of the pandemic has been hampered by a lack of detailed knowledge about SARS-CoV-2-host interactions, mainly in relation to viral biology and host immune response. The rapid clinical course seen in COVID-19 indicates that infection control in asymptomatic patients or patients with mild disease is probably due to the innate immune response, as, considering that SARS-CoV-2 is new to humans, an effective adaptive response would not be expected to occur until approximately 2–3 weeks after contact with the virus. Antiviral innate immunity has humoral components (complement and coagulation-fibrinolysis systems, soluble proteins that recognize glycans on cell surface, interferons, chemokines, and naturally occurring antibodies) and cellular components (natural killer cells and other innate lymphocytes). Failure of this system would pave the way for uncontrolled viral replication in the airways and the mounting of an adaptive immune response, potentially amplified by an inflammatory cascade. Severe COVID-19 appears to be due not only to viral infection but also to a dysregulated immune and inflammatory response. In this paper, the authors review the most recent publications on the immunobiology of SARS-CoV-2, virus interactions with target cells, and host immune responses, and highlight possible associations between deficient innate and acquired immune responses and disease progression and mortality. Immunotherapeutic strategies targeting both the virus and dysfunctional immune responses are also addressed.
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Affiliation(s)
- J L Boechat
- Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | - I Chora
- Internal Medicine Service, Department of Medicine, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - A Morais
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Pulmonology Department, Centro Hospitalar e Universitario de Sao Joao, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal
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González-Rodríguez A, Sanz N, Guàrdia A, Pedrero AA, Pérez DG, Fucho G, Delgado L, Uribe IP, Monreal J, Vidal DP, Labad J. Impact of day hospital care on adherence to psychiatric follow-up appointments and medications in patients with delusional disorder. Eur Psychiatry 2021. [PMCID: PMC9476090 DOI: 10.1192/j.eurpsy.2021.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionDay care programs have been extensively used to treat people with acute psychiatric disorders. Day hospitals (DH) can act as an alternative to admission in patients with acute symptoms, shorten the duration of admission, be useful for rehabilitation and maintenance care or enhance treatment in patients with poor adherence to outpatient care. Few research has been conducted in delusional disorder (DD).ObjectivesTo investigate whether DH care increases adherence with psychiatric appointments in patients with DD. To describe functions of partial hospitalization in DD.MethodsComparative study including DD patients who attended a DH (Group 1:n=12) versus patients who did not receive DH care (Group 2;n=7). Patients attending DH were classified into 3 groups according to the program function at referral. Adherence with outpatient follow-up appointments (primary outcome) and pharmacy refill data (secondary outcome) were assessed after discharge over a 6-month period (DH) and compared with group 2. For statistical analyses, non-parametric tests were performed.ResultsProgram function (DH): alternative to admission (n=4); shortening of admission (n=5) and enhancing outpatient treatment (n=3). Patients receiving DH care were more frequently referred from the inpatient unit or emergency department compared to those who did not attend DH (commonly referred from primary care services). No statistically significant differences were found between both groups in adherence to psychiatric appointments. Patients who attended DH showed higher compliance with antipsychotics (89.29% vs.72.62, p<0.05).ConclusionsDH care may be a useful alternative to increase adherence with antipsychotics in DD patients with poor awareness of illness.Conflict of interestAGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.
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González-Rodríguez A, Guàrdia A, Pedrero AA, Seeman M, Delgado L, Fucho G, Acebillo S, Monreal J, Vidal DP, Labad J. Follow-up of patients with delusional disorder in a specialized outpatient clinic over a 2-year period. Eur Psychiatry 2021. [PMCID: PMC9475817 DOI: 10.1192/j.eurpsy.2021.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction In order to prevent relapse and increase medication adherence, primary care physicians and psychiatric inpatient units should consider referring patients with delusional disorder (DD) to specialized outpatient clinics for treatment and follow-up. Objectives This poster describes a sample of DD patients referred to a specialized unit for DD and documents rates of follow-up care. Methods Over a 2-year period, 29 individuals were consecutively referred to the Parc Tauli -Delusional Syndrome Working Group, which provides treatment and clinical care for patients with delusional disorders for a catchment area of nearly 450.000 inhabitants in Sabadell (Barcelona, Spain). Criteria for inclusion in the program are relatively flexible. Referred patients are evaluated at baseline and at 6 months following their first appointment. Treatment and case management are offered by a multidisciplinary team consisting of psychiatric, nursing, and social work personnel. Psychological interventions are also offered. Results Of the 29 persons initially referred, 27 attended at least one scheduled appointment. Twenty-one out of the 27 patients received a confirmed diagnosis of DD (14 women,7 men), 2 suffered from schizophrenia and 4 were diagnosed with other psychiatric disorders and referred to other programs: primary care (n=2), affective program (n=1) and addictions unit (n=1). A breakdown of DD subtypes follows: persecutory (n=10,47.6%), jealous (n=4,19%), somatic (n=5,23.81%), mixed (n=2,9.5%). Three patients with DD (14.3%) were lost to follow-up. Attendance rates of the 21 DD patients: 80.4% (Women:77.67%, Men:100%). Conclusions For a traditionally difficult-to-engage population, adherence to multidisciplinary clinic appointments was relatively high. Loss to follow-up was lower than would have been expected. Conflict of interest AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.
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Fucho G, González-Rodríguez A, Pedrero AA, Guàrdia A, Delgado L, Cobo J, Acebillo S, Monreal J, Vidal DP, Labad J. Therapeutic implications of structural and functional neuroimaging findings in delusional disorder: A case report and review of literature. Eur Psychiatry 2021. [PMCID: PMC9475827 DOI: 10.1192/j.eurpsy.2021.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionSeveral neuroimaging studies on psychosis spectrum have been published in the last decades, most of them based on schizophrenia. In the context of neuroanatomical dysfunctions, clinical and prognosis implications have been reported. Nevertheless, only a few studies have been focused on delusional disorder (DD).ObjectivesTo present the case of a patient diagnosed with DD who suffered from two cerebrovascular events after the onset of the psychiatric disease. Our aim is to elucidate potential implications of those lesions on the course of DD. We also reviewed the literature to assess evidence for specific changes in DD on brain structures and functions.MethodsCase report and non-systematic narrative review in PubMed (2000-2020).ResultsCase report: A 66-year-old female with DD presenting, during the course of the disease, general atrophy and consecutive ischemic lesions on parietal, occipital and cerebellar areas. Clinical stabilization was achieved 12-16 months after risperidone 1.5mg/day treatment. Review: 19 studies were included: Structural brain data (n=15), Functional data (n=13). Most of the structural neuroimaging studies reported white and gray matter abnormalities, particularly in temporal, parietal and frontal lobes, and in limbic structures. Functional neuroimaging studies pointed to temporal and parietal lobes, as well as basal ganglia and limbic related structures.ConclusionsTemporal, parietal, frontal, basal ganglia and limbic-related structures, as well as dysfunctions in other specific brain regions, may be implicated in the core symptoms of DD. These findings might be further investigated as potential neuroimaging markers of prognosis, such as partial or delayed response to antipsychotic treatment, as presented in our case.
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Pedrero AA, González-Rodríguez A, Guàrdia A, Delgado L, Fucho G, Acebillo S, Monreal J, Labad J, Vidal DP. Are anxiety disorders a prelude to delusional disorder? A systematic review. Eur Psychiatry 2021. [PMCID: PMC9471389 DOI: 10.1192/j.eurpsy.2021.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Prevalence rates of panic attacks have been reported to be around 24-63% in psychotic patients. Common underlying biological substrates for panic and paranoia have been proposed, suggesting that delusional disorder (DD) may be preceded by the development of anxiety disorders. Objectives The main objective of this study was to investigate anxiety comorbidity in DD. As a second objective, we set ourselves to know prescription rates for the use of antidepressants and benzodiazepines in anxiety disorders in the context of DD. Methods A systematic literature search was performed using PubMed (1980- September 2020) according to the PRISMA guidelines. The following search terms were used: (delusional disorder) AND (anxiety OR anxiety disorder OR anxi*). Research studies and case reports were included if they met the following criteria: DD diagnosis (DSM, ICD), publication in peer-review journal and investigations containing information on anxiety comorbidity in DD. Results Four studies fulfilled our criteria, including 155 patients: 65 (42%) women, mean age 42.7 years (SD:14.96). Thirty-three of the 155 patients (21.29%) presented at least one comorbid anxiety disorder: 14 specific phobias, 9 panic attacks, 5 social phobias and 2 agoraphobias. Treatment was not reported for many patients (n= 28). Four patients received fluoxetine and 1 patient benzodiazepines. All of them showed partial improvement of symptoms. Conclusions Less than a third of DD patients showed an anxiety disorder. The effectiveness of antidepressant and benzodiazepine treatment has been poorly described. Future studies may be focused on the investigation of preceding comorbid anxiety disorders in patients with DD.
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21
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Delgado L, González-Rodríguez A, Pedrero AA, Guàrdia A, Fucho G, Seeman M, Acebillo S, Monreal J, Labad J, Vidal DP. Successful treatment of primary delusional parasitosis with paroxetine: A case report and narrative review. Eur Psychiatry 2021. [PMCID: PMC9471771 DOI: 10.1192/j.eurpsy.2021.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Antipsychotics have been classically considered the treatment of choice for delusional disorder (DD) and antidepressant medications have been restricted to patients with comorbid depression. Objectives Our aim is to describe the case of a patient with DD with delusions of parasitosis, who responded to paroxetine as monotherapy. We also aimed to review the recent literature on the potential use of antidepressants as the main treatment for somatic type DD. Methods After the case report, we present a narrative review on the use of antidepressants in DD, somatic type (DSM-criteria) by using PubMed database from inception until 2020. Results Case: 74 year-old woman without previous psychiatric diagnosis who suffered from long-term cutaneous and vulvar pruritus. She was referred to psychiatry from dermatology to assess thought content and sensoperceptive disturbances. In the past, she had received unsuccessful treatment with antihistamines. The patient brought a collection of “the identified parasite” (matchbox sign) to our first appointment. On assessment, she was diagnosed with DD with delusions of parasitosis. Risperidone 1mg/day was poorly tolerated (excessive sedation). She refused further antipsychotic treatment, so we started paroxetine up to 20mg/day. The patient went into total remission of her pruritus and delusions of parasitosis. Review. In line with our case, 6 studies reported on the successful use of antidepressants as monotherapy for DD, somatic type. Most of studies report the successful use of an antipsychotic/antidepressant combination (case-series, case reports). Conclusions Although antipsychotics are the treatment of choice, antidepressant medications may be an effective alternative in somatic type DD when patients refuse antipsychotics.
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Gaspar A, Santos N, Faria E, Câmara R, Rodrigues-Alves R, Carrapatoso I, Gomes E, Pereira AM, Carneiro-Leão L, Morais-Almeida M, Delgado L, Pedro E, Branco-Ferreira M. Anaphylaxis: A Decade of a Nationwide Allergy Society Registry. J Investig Allergol Clin Immunol 2021; 32:23-32. [PMID: 32732188 DOI: 10.18176/jiaci.0515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anaphylaxis is an acute, life-threatening, multiorgan hypersensitivity reaction. Objective: The aim of this study was to identify the causes of anaphylaxis in Portugal in order to improve our knowledge of epidemiology and management. METHODS We implemented a nationwide notification system for anaphylaxis over a 10-year period, with voluntary reporting by allergists. Data on 1783 patients with anaphylaxis were included. Etiopathogenesis, manifestations, and clinical management were characterized in detail for both children and adults. RESULTS The mean age was 32.7 (20.3) years, and 30% were under 18 years of age; 58% were female. The mean age at the first anaphylaxis episode was 27.5 (20.4) years (ranging from 1 month to 88 years). The main culprits of anaphylaxis were foods (48%), drugs (37%) (main trigger in adults, 48%), and hymenoptera venom (7%). The main culprit foods were shellfish (27%), fresh fruit (17%), cow's milk (16%), tree nuts (15%), fish (8%), egg (7%), and peanut (7%). The main drugs were nonsteroidal anti-inflammatory drugs (43%), antibiotics (39%), and anesthetic agents (6%). Other causes included exercise (3%), latex (2%), cold-induced anaphylaxis (2%), and idiopathic anaphylaxis (2%). Most patients (80%) were admitted to the emergency department; only 43% received adrenaline. Anaphylaxis recurred in 41% of patients (21% with ≥3 anaphylactic episodes); 7% used an adrenaline autoinjector device. CONCLUSION Food is the leading cause of anaphylaxis in Portugal, while drugs were the main elicitors in adults. We emphasize undertreatment with adrenaline and recurrent episodes, highlighting the need to improve diagnostic and therapeutic approaches to anaphylaxis.
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Affiliation(s)
- A Gaspar
- Immunoallergy Department, Hospital da Luz Lisboa, Portugal
| | - N Santos
- Immunoallergy Department, Centro Hospitalar Universitário Algarve, Portugal
| | - E Faria
- Immunoallergy Department, Centro Hospitalar Universitário Coimbra, Portugal
| | - R Câmara
- Immunoallergology Unit, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - R Rodrigues-Alves
- Immunoallergology Unit, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - I Carrapatoso
- Immunoallergy Department, Hospital da Luz Lisboa, Portugal
| | - E Gomes
- Immunoallergy Department, Centro Hospitalar Universitário do Porto, Portugal
| | - A M Pereira
- Immunoallergology Unit, Hospital CUF Porto and Instituto CUF Porto, Portugal
| | - L Carneiro-Leão
- Immunoallergy Department, Centro Hospitalar São João, Porto, Portugal
| | - M Morais-Almeida
- Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - L Delgado
- Immunoallergology Unit, Hospital CUF Porto and Instituto CUF Porto, Portugal.,Immunoallergy Department, Centro Hospitalar São João, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - E Pedro
- Immunoallergy Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | - M Branco-Ferreira
- Immunoallergy Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal.,Immunoallergology University Clinic, Faculty of Medicine of the University of Lisbon, Portugal
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Fiani B, El-Farra MH, Dahan A, Endres P, Taka T, Delgado L. Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes. Clin Transl Oncol 2021; 23:1263-1271. [PMID: 33449268 DOI: 10.1007/s12094-020-02549-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type. METHODS The authors performed an extensive review of the published literature (PubMed) focusing on "brachial plexus tumors" that identified invasion of the cervicothoracic spine. RESULTS The search yielded 2774 articles pertaining to "brachial plexus tumors". Articles not in the English language or involving cervicothoracic spinal invasion were excluded. CONCLUSIONS Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.
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Affiliation(s)
- B Fiani
- Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Drive, Palm Springs, CA, 92262, USA.
| | - M H El-Farra
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - A Dahan
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - P Endres
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - T Taka
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
| | - L Delgado
- University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA
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Paciência I, Cavaleiro Rufo J, Ribeiro AI, Mendes FC, Farraia M, Silva D, Delgado L, Moreira A. Association between the density and type of trees around urban schools and exhaled nitric oxide levels in schoolchildren. Eur Ann Allergy Clin Immunol 2021; 53:29-36. [PMID: 32729315 DOI: 10.23822/eurannaci.1764-1489.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Greenspaces in school's neighbourhood represent an important environment to promote healthy development. The aim of this study was to assess the association between the density and type of trees around schools and exhaled Nitric Oxide (NO) levels in schoolchildren. Data on 845 children from 20 primary schools in Porto was analysed. Airway inflammation was assessed by measuring exhaled NO level. The density and type of trees were quantified within a 500 m buffer around schools. Associations were estimated using mixed-effect models. A significant association was observed between non-tree covered areas around schools and exhaled NO levels in schoolchildren (β = - 1.42, 95% CI - 2.84, - 0.001). Our results suggested that the presence of trees in school neighbourhoods may play a role in the biological mechanisms underlying the complex links between environment and airway inflammation.
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Affiliation(s)
- I Paciência
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - A I Ribeiro
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, School of Medicine, University of Porto, Porto, Portugal
| | - F C Mendes
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - M Farraia
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - D Silva
- Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - L Delgado
- Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal
| | - A Moreira
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Service of Basic and Clinic Immunology, Departament of Pathology, School of Medicine, University of Porto, Porto, Portugal.,Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal
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Toca M, Roman-Riechmann E, Vázquez-Frías R, Batista de Morais M, Sosa P, Boggio-Marzet C, Becker D, Delgado L, Marchisone S. A Latin American pediatric gastroenterology group’s understanding of cow’s milk protein allergy diagnosis and treatment: Results of a survey by the Food Allergy Working Group of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica. Revista de Gastroenterología de México (English Edition) 2020. [DOI: 10.1016/j.rgmxen.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Toca MC, Roman-Riechmann E, Vázquez-Frías R, Batista de Morais M, Sosa P, Boggio-Marzet C, Becker D, Delgado L, Marchisone S. A Latin American and Spanish pediatric gastroenterology group's understanding of cow's milk protein allergy diagnosis and treatment: Results of a survey by the Food Allergy Working Group of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica. Rev Gastroenterol Mex (Engl Ed) 2020; 85:382-389. [PMID: 31623948 DOI: 10.1016/j.rgmx.2019.08.002] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/17/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION There are discrepancies in the diagnosis and management of cow's milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. MATERIAL AND METHODS Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. RESULTS The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57, 83 and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. CONCLUSION CMPA management is diverse and there is poor adherence to the clinical practice guidelines.
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Affiliation(s)
- M C Toca
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - E Roman-Riechmann
- Servicio de Pediatría, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - R Vázquez-Frías
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
| | - M Batista de Morais
- Escuela Paulista de Medicina, Universidade Federal de Sáo Paulo, Sao Paulo, Brasil
| | - P Sosa
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - C Boggio-Marzet
- Departamento Materno Infanto Juvenil, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
| | - D Becker
- Ministerio de Salud Pública y Bienestar Social del Paraguay, Asunción, Paraguay
| | - L Delgado
- Centro Hospitalario Pereira Rossel, Montevideo, Uruguay
| | - S Marchisone
- Hospital Infantil de Córdoba, Córdoba, Argentina
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Hoffmann TM, Travaglini A, Brighetti MA, Acar Şahin A, Arasi S, Bregu B, Caeiro E, Caglayan Sozmen S, Charpin D, Delgado L, Dimou M, Fiorilli M, Fonseca JA, Goksel O, Kalpaklioglu F, Lame B, Mazon A, Mesonjesi E, Nieto A, Öztürk A, Pajno G, Papadopoulos NG, Pellegrini E, Pereira AM, Pereira M, Pinar NM, Pinter E, Priftanji A, Sackesen C, Sfika I, Suarez J, Thibaudon M, Tripodi S, Ugus U, Villella V, Matricardi PM, Dramburg S. Cumulative Pollen Concentration Curves for Pollen Allergy Diagnosis. J Investig Allergol Clin Immunol 2020; 31:340-343. [PMID: 32959781 DOI: 10.18176/jiaci.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T M Hoffmann
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - A Travaglini
- Department of Biology, Tor Vergata University, Rome, Italy.,Italian Aerobiology Monitoring Network - Italian Aerobiology Association, Italy
| | - M A Brighetti
- Department of Biology, Tor Vergata University, Rome, Italy
| | - A Acar Şahin
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - S Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children´s research Hospital (IRCCS), Rome, Italy
| | - B Bregu
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - E Caeiro
- Mediterranean Institute for Agriculture, Environmental and Development, University of Évora, Évora, Portugal.,Portuguese Society of Allergology and Clinical Immunology, Lisbon, Portugal
| | - S Caglayan Sozmen
- Department of Pediatric Allergy and Immunology, Okan University Faculty of Medicine, Istanbul, Turkey
| | - D Charpin
- Department of Pneumonology and Allergy, La Timone Hospital, APHM, Aix-Marseille University, Marseille, France
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - M Dimou
- Allergy Department, 2nd Pediatric Clinic, Athens General Children´s Hospital "P&A Kyriakou," University of Athens, Athens, Greece
| | - M Fiorilli
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - J A Fonseca
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal.,MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - O Goksel
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma, Faculty of Medicine, Ege University, Izmir, Turkey
| | - F Kalpaklioglu
- Kırıkkale University School of Medicine, Department of Chest Diseases, Division of Immunology and Allergic Diseases, Turkey
| | - B Lame
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - A Mazon
- Pediatric Allergy and Pneumology Unit, Children´s Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - E Mesonjesi
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - A Nieto
- Pediatric Allergy and Pneumology Unit, Children´s Hospital La Fe; Health Research Institute La Fe, Valencia, Spain
| | - A Öztürk
- Department of Allergy and Immunology, Koç University Hospital, İstanbul, Turkey
| | - G Pajno
- Department of Pediatrics- Allergy Unit, University of Messina, Messina, Italy
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, Athens General Children´s Hospital "P&A Kyriakou," University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children´s Hospital, University of Manchester, Manchester, UK
| | - E Pellegrini
- ARPACal- Regional Agency for Environmental Protection, Department of Reggio Calabria, Italy
| | - A M Pereira
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - M Pereira
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.,Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - N M Pinar
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey
| | - E Pinter
- Allergy Department, 2nd Pediatric Clinic, Athens General Children´s Hospital "P&A Kyriakou," University of Athens, Athens, Greece
| | - A Priftanji
- Department of Allergology and Clinical Immunology, UHC Mother Teresa, Medical University Tirana, Albania
| | - C Sackesen
- Division of Pediatric Allergy, Koç University School of Medicine, Istanbul, Turkey
| | - I Sfika
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - J Suarez
- Department of Biology of Organisms and Systems, Area of Botany, University of Oviedo, Oviedo, Spain
| | - M Thibaudon
- Réseau National de Surveillance Aérobiologique, Brussieu, France
| | - S Tripodi
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - U Ugus
- Department of Biology, Faculty of Science, Ege University, Izmir, Turkey
| | - V Villella
- Pediatric Allergy Unit, Sandro Pertini Hospital, Rome, Italy
| | - P M Matricardi
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - S Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
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Vedham V, Henderson MK, Podhajcer O, Llera A, Breitenbach MD, Abdelhay E, Müller B, Ordenes JF, Navarro AD, Del Toro-Arreola A, Velazquez CA, Delgado L, Artagaveytia N, Gross TG. The US–Latin America Cancer Research Network. JCO Glob Oncol 2020. [DOI: 10.1200/go.20.52000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI) Center for Global Health promotes global oncology research to reduce cancer burden worldwide. In 2009, NCI launched the Latin American Cancer Research Network (LACRN) to support a clinical cancer research network in Latin America. LACRN was started by a coalition of research institutions through bilateral collaborative agreements between the US Department of Health and Human Services and the governments of Argentina, Brazil, Chile, Mexico, and Uruguay. The LACRN is supported through a research contract to a study coordination center and subcontracts to 6 low- and middle-income country sites. The participating countries have a shared goal that meets the specific research needs of the regions. The overarching purpose of this endeavor is to implement high-quality standards for conducting clinical research studies and developing collaborative cancer research projects. METHODS NCI supported a clinical breast cancer project for LACRN, “Molecular profiling of breast cancer (MPBC) in Latin American women with stage II and III breast cancer receiving standard neo-adjuvant chemotherapy.” The molecular profiling of breast cancer study was conducted in 40 hospitals and research institutions across 5 countries with a study population of approximately 1,400 patients. RESULTS AND CONCLUSION Establishing a comprehensive network in Latin America and their research institutions yielded an incredible research resource that can be used in future studies, driven by the network. Throughout the process of developing and implementing studies, LACRN helped identify key elements of the functionality of research networks, such as the pivotal role of institutional and government commitment for sustainability; the importance of building multidisciplinary teams, transparent communications, and training; the ability to combine translational, epidemiology, and clinical research to close research gaps; and the application of new technologies to standard cancer clinical care.
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Affiliation(s)
- Vidya Vedham
- National Cancer Institute, Center for Global Health, Rockville, MD
| | | | | | - Andrea Llera
- Fundación Instituto Leloir, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | - Thomas G. Gross
- National Cancer Institute, Center for Global Health, Rockville, MD
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Leal M, Paciência I, Farraia M, Cavaleiro Rufo J, Castro Mendes F, Delgado L, Viegas C, Moreira A. Airborne food and aeroallergens levels in healthcare settings. An unaccounted but potentially relevant source of exposure? J Investig Allergol Clin Immunol 2020; 31:426-432. [PMID: 32500857 DOI: 10.18176/jiaci.0623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Exposure to airborne allergens of biological origin associates with the development and exacerbation of allergic asthma and rhinitis. Assessment of allergens exposure in healthcare facilities may contribute to monitor hygiene and survey specific allergens which may cause symptoms in sensitized subjects. Objective: To assess concentration of indoor and airborne food allergens across different healthcare settings. METHODS Dust was vacuumed from primary health care centers in Lisbon; and emergency unit, day hospital, internal medicine ward, operating room and the outpatient clinic of a university central hospital in Porto. Samples were sieved, weighed, extracted and concentrations of Nbos d 5, Cor a 9, Gal d 2, Ara h 3, Ara h 6, Der p 1, Fel d 1, Can f 1, Bla g 2, Alt a 1 and Phl p 5 were determined using a multiplex array for allergens (MARIA™). RESULTS All airborne food and aeroallergens were found at least in one sampled area, except for Alt a 1. Levels of Der p 1 and Fel d 1 ranged from 13.0 µg/g to 971.0 µg/g and from 7.0 µg/g to 4618.8 µg/g, respectively. The emergency unit revealed the higher levels of food allergens, namely Nbos d 5 (16034.0 µg/g) and Cor a 9 (10649.5 µg/g). CONCLUSIONS With the exception of the operating room, exposure levels of dust mite, cat and dog allergens in healthcare facilities were above the values associated with sensitization and occurrence of allergic asthma or rhinitis symptoms in sensitized subjects.
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Affiliation(s)
- M Leal
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - I Paciência
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - M Farraia
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - F Castro Mendes
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - L Delgado
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.,NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Portugal
| | - A Moreira
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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30
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Paciência I, Cavaleiro Rufo J, Silva D, Mendes F, Farraia M, Delgado L, Padrão P, Moreira P, Severo M, Moreira A. Effects of Indoor Endocrine-Disrupting Chemicals on Childhood Rhinitis. J Investig Allergol Clin Immunol 2019; 30:195-197. [PMID: 31833476 DOI: 10.18176/jiaci.0471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I Paciência
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal.,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - D Silva
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - F Mendes
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - M Farraia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - P Padrão
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - P Moreira
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - M Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - A Moreira
- Basic and Clinical Immunology Unit, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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31
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Palleiro MR, Perez A, Mareco K, Piñeiro N, Delgado L, Cuello M. P2.09 Access and Outcomes of TKI EGFR in Lung Cancer Treatment from UYan Population. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Pierre R, Vieira M, Vázquez R, Ninomiya I, Messere G, Daza W, Dadan S, Higuera M, Sifontes L, Harris P, Gana J, Rodríguez M, Vasquez M, González M, Rivera J, Gonzales J, Angulo D, Cetraro M, Del Compare M, López K, Navarro D, Calva R, Wagener M, Zablah R, Carias A, Calderón O, Vera-Chamorro J, Toca M, Dewaele M, Iglesias C, Delgado L, León K, Hassan I, Ussher F, Follett F, Bernedo V, Grinblat V, Agüero N, Oviedo C, García A, Salazar A, Coello P, Furnes R, Menchaca M, Fernández M, Khoury A, Rojo C, Fernández S, Morao C. Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Revista de Gastroenterología de México (English Edition) 2019. [DOI: 10.1016/j.rgmxen.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pierre R, Vieira M, Vázquez R, Ninomiya I, Messere G, Daza W, Dadan S, Higuera M, Sifontes L, Harris P, Gana JC, Rodríguez M, Vasquez M, González M, Rivera J, Gonzales J, Angulo D, Cetraro MD, Del Compare M, López K, Navarro D, Calva R, Wagener M, Zablah R, Carias A, Calderón O, Vera-Chamorro JF, Toca MC, Dewaele MR, Iglesias C, Delgado L, León K, Hassan I, Ussher F, Follett F, Bernedo V, Grinblat V, Agüero N, Oviedo C, García AG, Salazar A, Coello P, Furnes R, Menchaca M, Fernández M, Khoury A, Rojo C, Fernández S, Morao C. Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mex (Engl Ed) 2019; 84:427-433. [PMID: 30292584 DOI: 10.1016/j.rgmx.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/02/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVE Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.
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Affiliation(s)
- R Pierre
- Clínica Razetti, Barquisimeto, Venezuela.
| | - M Vieira
- Hospital Pequeño Príncipe, Curitiba, Brasil
| | - R Vázquez
- Hospital Infantil de México Federico Gómez, México DF, México
| | - I Ninomiya
- Hospital Italiano, Buenos Aires, Argentina
| | - G Messere
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - W Daza
- Unidad de Gastroenterología Pediátrica y Nutrición, Gastronutriped, Bogotá, Colombia
| | - S Dadan
- Unidad de Gastroenterología Pediátrica y Nutrición, Gastronutriped, Bogotá, Colombia
| | - M Higuera
- Unidad de Gastroenterología Pediátrica y Nutrición, Gastronutriped, Bogotá, Colombia
| | - L Sifontes
- Centro Médico El Valle, Porlamar, Venezuela
| | - P Harris
- Pontificia Universidad Católica, Santiago, Chile
| | - J C Gana
- Pontificia Universidad Católica, Santiago, Chile
| | - M Rodríguez
- Hospital de Niños Dr. J.M. de Los Ríos, Caracas, Venezuela
| | - M Vasquez
- Hospital Universitario de Pediatría Dr. Agustín Zubillaga, Barquisimeto, Venezuela
| | - M González
- Hospital Dr. Roberto del Río, Santiago, Chile
| | - J Rivera
- Instituto Nacional de Salud del Niño, Lima, Perú; Clínica Ricardo Palma, Lima, Perú
| | - J Gonzales
- Instituto Nacional de Salud del Niño, Lima, Perú; Clínica Ricardo Palma, Lima, Perú
| | - D Angulo
- Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú
| | - M D Cetraro
- Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú
| | | | - K López
- Hospital Dr. Miguel Pérez Carreño, Caracas, Venezuela
| | - D Navarro
- Hospital Dr. Miguel Pérez Carreño, Caracas, Venezuela
| | - R Calva
- Facultad de Medicina BUAP, Puebla, México
| | - M Wagener
- Hospital de Niños Dr. O. Alassia, Santa Fe, Argentina
| | - R Zablah
- Clínica de Gastroenterología, Endoscopia y Nutrición Pediátrica Multipediátrica, San Salvador, El Salvador
| | - A Carias
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - O Calderón
- Clínica Farallones-Gastroped, Cali, Colombia
| | | | - M C Toca
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - M R Dewaele
- Hospital Pereira Rossel, Montevideo, Uruguay
| | - C Iglesias
- Hospital Pereira Rossel, Montevideo, Uruguay
| | - L Delgado
- Hospital Pereira Rossel, Montevideo, Uruguay
| | - K León
- Policlínica Metropolitana, Caracas, Venezuela
| | - I Hassan
- Policlínica Metropolitana, Caracas, Venezuela
| | - F Ussher
- Hospital Universitario Austral, Buenos Aires, Argentina
| | - F Follett
- Hospital Universitario Austral, Buenos Aires, Argentina
| | - V Bernedo
- Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - V Grinblat
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | - N Agüero
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| | - C Oviedo
- Hospital Vozandes, Quito, Ecuador
| | - A G García
- Gastroclínica, San Salvador, El Salvador
| | - A Salazar
- Hospital Central Ignacio Morones Prieto, San Luis Potosí, México
| | - P Coello
- Hospital Civil Juan I. Menchaca, Guadalajara, México
| | - R Furnes
- Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - M Menchaca
- Hospital Universitario UANL, Monterrey, México
| | - M Fernández
- Hospital Dr. Manuel Antonio Narváez, Porlamar, Venezuela
| | - A Khoury
- Centro Policlínico Valencia, Valencia, Venezuela
| | - C Rojo
- Hospital Regional Leonardo Guzmán, Antofagasta, Chile
| | | | - C Morao
- Hospital de Niños Dr. J.M. de Los Ríos, Caracas, Venezuela
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Farraia M, Cavaleiro Rufo J, Paciência I, Castro Mendes F, Delgado L, Laerte Boechat J, Moreira A. Metabolic interactions in asthma. Eur Ann Allergy Clin Immunol 2019; 51:196-205. [PMID: 31287260 DOI: 10.23822/eurannaci.1764-1489.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Metabolomics can be used to explore altered metabolic pathways in asthma, giving insights into its pathophysiology. We aimed to review how metabolomics has been used to understand asthma by describing metabolic pathways under research and discussing clinical implications. The search was performed in PubMed, and studies published since 2000 using a metabolomics approach, were included. A total of 32 studies were analysed. Pathways related with cellular energy homeostasis, lipid metabolism and oxidative stress, immune and inflammatory processes and others were altered. Initial studies focused on biomarker discovery. But, metabolomics can be used to evaluate drug effects on specific pathways, to highlight pathways that can further develop in new targeted treatments and to identify differences according to asthma severity and phenotypes.
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Affiliation(s)
- M Farraia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - I Paciência
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal and Centro Hospitalar Universitário de S. João EPE, Porto, Portugal.,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal
| | - F Castro Mendes
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal and Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - L Delgado
- Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departamento de Imunoalergologia, Centro Hospitalar Universitário de S. João EPE, Porto, Portugal
| | - J Laerte Boechat
- Disciplina de Imunologia Clínica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brasil
| | - A Moreira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal and Centro Hospitalar Universitário de S. João EPE, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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Puente A, Rizo F, Carmen M, Delgado L. PO004 The Added Value of Gated- Spect Myocardial Perfusion Imaging In a Group of Elderly Mexican Patients With Suspected of Ischemic Heart Disease: A Turn For Better Prognosis. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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36
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Puente A, Flores D, Rosales S, Rivera B, Delgado L. PO003 Enhanced Noninvasive Imaging Evaluation Using Positron Emission Tomography In Patients With Suspected Coronary Artery Disease: Relationship Between Coronary Artery Calcium and Myocardial Blood Flow. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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37
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Camejo Mártinez N, Castillo C, Artagaveytia N, Hernández AL, Schiavone A, Milans S, Laviña G, Delgado L. Encuestas sobre prevención del cáncer de mama en una población de mujeres uruguayas. An Facultad Med (Univ Repúb Urug) 2018. [DOI: 10.25184/anfamed2018v5n2a6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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38
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Duarte AF, Sousa-Pinto B, Freitas A, Delgado L, Costa-Pereira A, Correia O. Skin cancer healthcare impact: A nation-wide assessment of an administrative database. Cancer Epidemiol 2018; 56:154-160. [PMID: 30179829 DOI: 10.1016/j.canep.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin cancer is an important health concern, with an increasing incidence worldwide. OBJECTIVE To assess the clinical and economic burden of melanoma (MM) and non-melanoma skin cancer (NMSC) at public hospitals in mainland Portugal. METHODS We used an administrative database containing a registration of all hospitalizations and ambulatory episodes occurred in Portuguese public hospitals between 2011 and 2015. We assessed all episodes with associated diagnoses of MM or NMSC regarding neoplasm location, metastases occurrence, length of stay, in-hospital mortality and hospital costs. RESULTS We assessed 15,913 MM and 72,602 NMSC episodes. 14.3% of MM episodes presented with metastases, compared to 1.9% of NMSC episodes. Patients' median age was lower for MM (66 years) than NMSC (76 years). The trunk was the most common location for MM (32.5%), followed by the lower limbs (26.5%). NMSC presented with higher length of stay than MM (median 5 versus 4 days; p < 0.001), but with lower in-hospital mortality (7.3% versus 11.9%; p < 0.001). MM episodes had higher average hospital costs than NMSC episodes (1197.7 versus 1113.5 €; p < 0.001). Overall, NMSC episodes amounted a total of 80.8 million € in hospital costs versus 19.1 million € for MM episodes. CONCLUSION Skin neoplasms have substantial impact on healthcare services. NMSC is an important contributor to this burden. NMSC underreporting should be tackled and it should not be downplayed in skin cancer preventative strategies.
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Affiliation(s)
- A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - A Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - L Delgado
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - A Costa-Pereira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
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Camejo N, Castillo C, Shiavone A, Alfonso AL, Amarillo D, Xavier F, Krygier G, Delgado L. Características del cáncer de mama masculino en una población uruguaya. An Facultad Med (Univ Repúb Urug) 2018. [DOI: 10.25184/anfamed2018v5n1a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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40
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Couto M, Kurowski M, Moreira A, Bullens DMA, Carlsen K, Delgado L, Kowalski ML, Seys SF. Mechanisms of exercise-induced bronchoconstriction in athletes: Current perspectives and future challenges. Allergy 2018; 73:8-16. [PMID: 28599081 DOI: 10.1111/all.13224] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 06/05/2017] [Indexed: 01/08/2023]
Abstract
The evidence of exercise-induced bronchoconstriction (EIB) without asthma (EIBwA ) occurring in athletes led to speculate about different endotypes inducing respiratory symptoms within athletes. Classical postulated mechanisms for bronchial obstruction in this population include the osmotic and the thermal hypotheses. More recently, the presence of epithelial injury and inflammation in the airways of athletes was demonstrated. In addition, neuronal activation has been suggested as a potential modulator of bronchoconstriction. Investigation of these emerging mechanisms is of major importance as EIB is a significant problem for both recreational and competitive athletes and is the most common chronic condition among Olympic athletes, with obvious implications for their competing performance, health and quality of life. Hereby, we summarize the latest achievements in this area and identify the current gaps of knowledge so that future research heads toward better defining the etiologic factors and mechanisms involved in development of EIB in elite athletes as well as essential aspects to ultimately propose preventive and therapeutic measures.
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Affiliation(s)
- M. Couto
- Allergy Unit Hospital & Instituto CUF Porto Porto Portugal
| | - M. Kurowski
- Department of Immunology, Rheumatology and Allergy Healthy Ageing Research Centre Medical University of Łódź Łódź Poland
| | - A. Moreira
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar São João E.P.E. Porto Portugal
| | - D. M. A. Bullens
- Laboratory of Pediatric Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
- Division of Pediatrics UZ Leuven Leuven Belgium
| | - K.‐H. Carlsen
- Institute for Clinical Medicine University of Oslo Oslo Norway
| | - L. Delgado
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar São João E.P.E. Porto Portugal
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy Healthy Ageing Research Centre Medical University of Łódź Łódź Poland
| | - S. F. Seys
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
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41
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Affiliation(s)
- R Barros
- Faculty of Nutrition, University of Porto, Porto, Portugal
| | - L Delgado
- Immunology Lab, Basic & Clinical Immunology, Faculty of Medicine, University of Porto, Porto, Portugal.
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42
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Leonardi A, Doan S, Fauquert JL, Bozkurt B, Allegri P, Marmouz F, Rondon C, Jedrzejczak M, Hellings P, Delgado L, Calder V. Diagnostic tools in ocular allergy. Allergy 2017; 72:1485-1498. [PMID: 28387947 DOI: 10.1111/all.13178] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 04/04/2017] [Indexed: 12/21/2022]
Abstract
Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.
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Affiliation(s)
- A. Leonardi
- Department of Neuroscience; Ophthalmology Unit; University of Padua; Padua Italy
| | - S. Doan
- Service d'Ophtalmologie; Hôpital Bichat and Fondation A. de Rothschild; Paris France
| | - J. L. Fauquert
- Unité d'Allergologie de l'Enfant CHU Estaing; CHU Estaing; Clermont-Ferrand Cedex1 France
| | - B. Bozkurt
- Faculty of Medicine; Department of Ophthalmology; Selcuk University; Konya Turkey
| | - P. Allegri
- Rapallo Hospital Ophthalmology Department; Allergic Conjunctivitis Unit; Ocular Inflammatory Diseases Referral Center; Genova Italy
| | - F. Marmouz
- Pole sanitaire du Vexin; Pontoise France
| | - C. Rondon
- Allergy Unit; Regional University Hospital of Malaga; IBIMA, UMA; Malaga Spain
| | - M. Jedrzejczak
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | | | - L. Delgado
- Laboratory of Immunology; Faculty of Medicine; Basic and Clinical Immunology Unit, and Center for Research in Health Technologies and Information Systems (CINTESIS); University of Porto; Porto Portugal
| | - V. Calder
- Department of Ocular Biology & Therapeutics; UCL Institute of Ophthalmology; London UK
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43
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Silva D, Pereira AM, Santos N, Amaral L, Delgado L, Oude Elberink JN, Coimbra A. The Vespid Allergy Quality of Life Questionnaire - cultural adaptation and translation to Portuguese. Eur Ann Allergy Clin Immunol 2017; 49:114-121. [PMID: 28497674] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A cross-cultural translation of the Vespid Allergy Quality of Life Questionnaire (VQLQ) to the Portuguese population (VQLQ-P) was performed, assessing its applicability in wasp and in non-beekeeper bee venom allergic patients. Additionally, we evaluated a Visual Analogue Scale (VAS) to estimate hymenoptera allergy interference with daily life. Methods. Cross-cultural translation was performed according to recommendations. The final VQLQ-P version, the Expectation of Outcome questionnaire (EoQ), EQ-5D and VAS were applied to wasp (n = 19) and non-beekeeper bee venom allergic patients (n = 30). Results. VQLQ-P significantly correlated with EoQ, (r = 0.76, p < 0.01), EQ-5D (usual activities and anxiety / depression dimensions) and VAS, with a good internal consistency (Cronbach α = 0.88) in wasp allergic individuals. VQLQ-P and EoQ correlation was also high (r = 0.67, p < 0.01) in bee allergy. Conclusion. The VQLQ-P is a valuable tool to evaluate quality of life impairment in Portuguese hymenoptera venom allergic individuals.
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Affiliation(s)
- D Silva
- Serviço de Imunoalergologia, Centro Hospitalar de São João E.P.E., Porto, Portugal. E-mail: Phone: 919 078 179. Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - A M Pereira
- Allergy Unit, CUF-Porto Hospital and Institute, Porto, Portugal. CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
| | - N Santos
- Serviço de Imunoalergologia, Centro Hospitalar de São João E.P.E., Porto, Portugal
| | - L Amaral
- Serviço de Imunoalergologia, Centro Hospitalar de São João E.P.E., Porto, Portugal
| | - L Delgado
- Serviço de Imunoalergologia, Centro Hospitalar de São João E.P.E., Porto, Portugal. Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal. CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal. Immunology Lab / Clinical Pathology Department, Centro Hospitalar de São João E.P.E., Porto, Portugal
| | - J N Oude Elberink
- Department of Allergology, University of Groningen, University Medical Center of Groningen, Groningen Research Institute Asthma and COPD (GRIAC, Groningen), the Netherlands
| | - A Coimbra
- Serviço de Imunoalergologia, Centro Hospitalar de São João E.P.E., Porto, Portugal
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44
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Fauquert JL, Jedrzejczak-Czechowicz M, Rondon C, Calder V, Silva D, Kvenshagen BK, Callebaut I, Allegri P, Santos N, Doan S, Perez Formigo D, Chiambaretta F, Delgado L, Leonardi A. Conjunctival allergen provocation test : guidelines for daily practice. Allergy 2017; 72:43-54. [PMID: 27430124 DOI: 10.1111/all.12986] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 07/14/2016] [Indexed: 01/15/2023]
Abstract
Conjunctival allergen provocation test (CAPT) reproduces the events occurring by instilling an allergen on the ocular surface. This paper is the compilation of a task force focussed on practical aspects of this technique based on the analysis of 131 papers. Main mechanisms involved are reviewed. Indications are diagnosing the allergen(s)-triggering symptoms in IgE-mediated ocular allergy in seasonal, acute or perennial forms of allergic conjunctivitis, especially when the relevance of the allergen is not obvious or in polysensitized patients. Contraindications are limited to ongoing systemic severe pathology, asthma and eye diseases. CAPT should be delayed if receiving systemic steroids or antihistamines. Local treatment should be interrupted according to the half-life of each drug. Prerequisites are as follows: obtaining informed consent; evidencing of an allergen by skin prick tests and/or serum-specific IgE dosages; being able to deal with an unlikely event such as acute asthma exacerbation, urticaria or anaphylaxis, or an exacerbation of allergic conjunctivitis. Allergen extracts should be diluted locally prior to administration. Positive criteria are based on itching or quoted according to a composite score. An alternative scoring is based on itching. CAPT remains underused in daily practice, although it is a safe and simple procedure which can provide valuable clinical information.
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Affiliation(s)
- J.-L. Fauquert
- Unité d'Allergologie de l'enfant; CHU Estaing; Clermont-Ferrand Cedex 1 France
| | | | - C. Rondon
- Allergy Unit; Regional University Hospital of Malaga; IBIMA; UMA; Malaga Spain
| | - V. Calder
- Department of Ocular Biology & Therapeutics (ORBIT); UCL Institute of Ophthalmology; London UK
| | - D. Silva
- Serviço de Imunoalergologia; Centro Hospitalar São João; E.P.E.; Porto Portugal
| | - B. K. Kvenshagen
- Pediatric Department; Oestfold Hospital Trust; Fredrikstad Norway
| | - I. Callebaut
- Clinical Immunology; Department of Microbiology and Immunology; Catholic University of Leuven; Leuven Belgium
| | - P. Allegri
- Allergic Conjunctivitis Unit; Ocular Inflammatory Diseases Referral Center; Rapallo Hospital Ophthalmological Dep.; Genova Italy
| | - N. Santos
- Serviço de Imunoalergologia; Centro Hospitalar São João; E.P.E.; Porto Portugal
| | - S. Doan
- Service d'Ophtalmologie; Hôpital Bichat and Fondation A. de Rothschild; Paris France
| | - D. Perez Formigo
- Servicio de Oftalmologia; Hospital Universitario de Torrejon; Madrid Spain
| | - F. Chiambaretta
- Service d'Ophtalmologie; CHU Montpied; Clermont-Ferrand Cedex 1 France
| | - L. Delgado
- Department of Immunology; Faculty of Medicine; University of Porto; Porto Portugal
| | - A. Leonardi
- Ophthalmology Unit; Department of Neuroscience; University of Padua; Padua Italy
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45
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Sepúlveda C, Delgado L, García R, Melendrez M, Fierro J, Ghampson I, Escalona N. Effect of phosphorus on the activity of Cu/SiO 2 catalysts in the hydrogenolysis of glycerol. Catal Today 2017. [DOI: 10.1016/j.cattod.2016.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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Delgado L, Silva C, Oliveira J, Pires I, Simões P. Canine Digital Lesions: Retrospective Study of 124 Cases (2010–2015). J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Barros R, Moreira A, Padrão P, Teixeira VH, Carvalho P, Delgado L, Lopes C, Severo M, Moreira P. Dietary patterns and asthma prevalence, incidence and control. Clin Exp Allergy 2016; 45:1673-80. [PMID: 25818037 DOI: 10.1111/cea.12544] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/05/2015] [Accepted: 03/11/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The increased asthma prevalence in westernized societies has been suggested to be related to environment exposures and lifestyle changes, particularly diet. We aimed to explore the association between dietary patterns and asthma prevalence, incidence and control in a nationally representative population. METHODS Data from 32,644 adults, 53% female, from the 4th Portuguese National Health Survey were analysed. Prevalence of asthma was 5.3%; 'current asthma', defined by asthma symptoms within previous year, 3.5%; 'current medicated asthma' defined by use of asthma medication within previous year, 3.0%; 'current severe asthma' defined by emergency visit because of asthma within previous year, 1.4%; and 'incident asthma', 0.2%. Dietary patterns (DP) were identified by latent trait models based on dietary intake. Unconditional logistic regression models were performed to analyse association between DP and asthma. Age, gender, education, family income, proxy reporting information, smoking, body mass index and physical activity level were analysed as confounders. RESULTS Two of the five identified DP were associated with asthma: 'high fat, sugar and salt' DP (positively correlated with pastry, chocolate and sweet desserts, candies, salty snacks, chips, fruit juices, soft drinks and alcoholic beverages consumption at snacks) was associated with asthma prevalence (OR = 1.13, 95% CI = 1.03, 1.24) and current severe asthma (OR = 1.23, 95% CI = 1.03, 1.48), while 'fish, fruit and vegetables' DP (positively correlated with fish, vegetables and fruit intake at meals) was negatively associated with current (OR = 0.84, 95% CI = 0.73, 0.98), and current medicated asthma (OR = 0.84, 95% CI = 0.72, 0.98), after adjustment for confounders. CONCLUSION & CLINICAL RELEVANCE Our results suggest a protective association between 'fish, vegetables and fruit' DP and current asthma and current medicated asthma, and a detrimental association between 'high fat, sugar and salt' DP and severe asthma prevalence, further supporting the rational for diet and lifestyle intervention studies in asthma based on whole dietary patterns and physical activity.
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Affiliation(s)
- R Barros
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - A Moreira
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal
| | - P Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Epiunit - Public Health Institute, University of Porto, Porto, Portugal
| | - V H Teixeira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Research Centre on Physical Activity and Health, University of Porto, Porto, Portugal
| | - P Carvalho
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - L Delgado
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal
| | - C Lopes
- Epiunit - Public Health Institute, University of Porto, Porto, Portugal.,Department Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Severo
- Epiunit - Public Health Institute, University of Porto, Porto, Portugal.,Department Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Medical Education and Simulation Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - P Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Research Centre on Physical Activity and Health, University of Porto, Porto, Portugal
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48
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Barros R, Moreira P, Padrão P, Teixeira VH, Carvalho P, Delgado L, Moreira A. Obesity increases the prevalence and the incidence of asthma and worsens asthma severity. Clin Nutr 2016; 36:1068-1074. [PMID: 27448950 DOI: 10.1016/j.clnu.2016.06.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/20/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS We aimed to explore the association between obesity and asthma prevalence, incidence and severity. METHODS The study included 32,644 adults, 52.6% female, from a representative sample of the 4th Portuguese National Health Survey. The following asthma definitions were used: ever asthma (ever medical doctor asthma diagnosis), current asthma (asthma within the last 12 months), current persistent asthma (required asthma medication within the last 12 months), current severe asthma (attending an emergency department because of asthma within the last 12 months), and incident asthma (asthma diagnosis within the last 12 months). Body mass index was calculated based on self-reported weight and height and categorised according to WHO classification. Logistic regression models adjusted for confounders were performed. RESULTS Prevalence of ever asthma was 5.3%, current asthma 3.5%, current persistent asthma 3.0%, current severe asthma 1.4%, and incident asthma 0.2%. Prevalence of obesity was 16%, overweight 37.6%, normal weight 44.6% and underweight 0.2%. Being overweight, obesity class I and II, and obesity class III were associated with an OR (95% CI) with ever asthma 1.22 (1.21-1.24), 1.39 (1.36-1.41), 3.24 (3.08-3.40) respectively; current asthma 1.16 (1.14-1.18), 1.86 (1.82-1.90), 4.73 (4.49-4.98) respectively; current persistent asthma 1.08 (1.06-1.10), 2.06 (2.01-2.10), 5.24 (4.96-5.53), and current severe asthma 1.36 (1.32-1.40), 1.50 (1.45-1.55) and 3.70 (3.46-3.95), respectively. Considering the incidence of asthma, obesity more than quadrupled the odds (OR = 4.46, 95% CI 4.30, 4.62). CONCLUSION Obesity is associated in a dose dependent way with an increase of prevalent and incident asthma, and it seems to increase the odds of a more persistent and severe asthma phenotype independently of socio-demographic determinants, physical activity, and dietary patterns. Our results provide rational for future lifestyle intervention studies for weight reduction in the obesity-asthma phenotype.
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Affiliation(s)
- R Barros
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
| | - P Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; Research Centre on Physical Activity and Health, University of Porto, Porto, Portugal; EPI Unit, Public Health Institute, University of Porto, Porto, Portugal
| | - P Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; EPI Unit, Public Health Institute, University of Porto, Porto, Portugal
| | - V H Teixeira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; EPI Unit, Public Health Institute, University of Porto, Porto, Portugal
| | - P Carvalho
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - L Delgado
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal
| | - A Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal
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Lopes C, Pinto L, Leite C, Delgado L, Moreira A, Lourinho I. Personality Traits May Influence the Severity of Atopic Dermatitis in Adult Patients: A Pilot Study. J Investig Allergol Clin Immunol 2016; 26:198-9. [DOI: 10.18176/jiaci.0056] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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50
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Delgado-León B, Moreno J, Cacicedo J, Perez M, Moreno A, Núñez F, Delgado L, Pérez S, Praena-Fernandez J, Montero E, Nieto J, Parra C, Ortiz-Gordillo M, López-Guerra J. PO-0687: Machine learning method for biomarkers identification in lung cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31937-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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