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Magro F, Fernandes S, Patita M, Arroja B, Lago P, Rosa I, de Sousa HT, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Sousa P, Portela F, Correia L, Moreira P, Dias S, Afonso J, Danese S, Peyrin-Biroulet L, Vucicevic KM, Santiago M. The influence of subclinical active inflammation on IFX pharmacokinetic modeling and disease progression assessment: findings from a prospective real-world study in inflammatory bowel disease patients. J Crohns Colitis 2024:jjae014. [PMID: 38243908 DOI: 10.1093/ecco-jcc/jjae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND AIMS Effective management of inflammatory bowel disease (IBD) relies on a comprehensive understanding of infliximab (IFX) pharmacokinetics (PK). This study's primary goal was to develop a robust PK model, identifying key covariates influencing IFX clearance (CL), while concurrently evaluating the risk of disease progression during the maintenance phase of IBD treatment. METHODS The multicenter, prospective, real-world DIRECT study was conducted in several care centers, which included 369 IBD patients in the maintenance phase of IFX therapy. A two-compartment population PK model was used to determine IFX CL and covariates. Logistic and Cox regressions were applied to elucidate the associations between disease progression and covariates embedded in the PK model. RESULTS The PK model included the contributions of weight, albumin, antidrug antibody (ADA), and fecal calprotectin (FC). On average, higher ADA, FC concentration and weight, and lower albumin concentration resulted in higher IFX CL. In the multivariate regression analyses, FC levels influenced the odds of disease progression in all its different definitions, when adjusted for several confounding factors. Additionally, alongside FC, both IFX and CL demonstrated a significant impact on the temporal aspect of disease progression. CONCLUSION In this 2-year real-world study, readily available clinical covariates, notably FC, significantly impacted IFX availability in IBD patients. We demonstrated that subclinical active inflammation, as mirrored by FC or CRP, substantially influenced IFX clearance. Importantly, FC emerged as a pivotal determinant, not only of IFX pharmacokinetics but also of disease progression. These findings underscore the need to integrate FC into forthcoming IFX pharmacokinetic models, amplifying its clinical significance.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal
- Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Portugal
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Samuel Fernandes
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
- Clinica Universitária de Gastrenterologia da Universidade de Medicina de Lisboa, Lisbon, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
- ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irina Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
- ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Eugénia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luís Correia
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Paula Moreira
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Sandra Dias
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Joana Afonso
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IBD Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Katarina M Vucicevic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Serbia
| | - Mafalda Santiago
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
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Sousa P, Patita M, Arroja B, Lago P, Rosa I, de Sousa HT, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Portela F, Correia L, Santiago M, Dias S, Alves C, Afonso J, Dias CC, Magro F. Thiopurines have no impact on outcomes of Crohn's disease patients beyond 12 months of maintenance treatment with infliximab. Dig Liver Dis 2023:S1590-8658(23)01016-2. [PMID: 37980274 DOI: 10.1016/j.dld.2023.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The emergence of new treatments the inflammatory bowel diseases (IBD) raised questions regarding the role of older agents, namely thiopurines. AIMS To clarify the benefits of combination treatment with thiopurines on Crohn's disease (CD) patients in the maintenance phase of infliximab. METHODS In this analysis of the 2-year prospective multicentric DIRECT study, patients were assessed in terms of clinical activity, faecal calprotectin (FC), C-reactive protein (CRP), and infliximab pharmacokinetics. A composite outcome based on clinical- and drug-related items was used to define treatment failure. RESULTS The study included 172 patients; of these, 35.5 % were treated with combination treatment. Overall, 18 % of patients achieved the composite outcome, without statistically significant differences between patients on monotherapy and on combination treatment (21.6% vs 11.5 %, p = 0.098). Median CRP, FC, and infliximab pharmacokinetic parameters were similar in both groups. However, in the sub-analysis by infliximab treatment duration, in patients treated for less than 12 months, the composite outcome was reached in fewer patients in the combination group than in the monotherapy group (7.1% vs 47.1 %, p = 0.021). CONCLUSION In CD patients in maintenance treatment with infliximab, combination treatment does not seem to have benefits over infliximab monotherapy beyond 12 months of treatment duration.
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Affiliation(s)
- Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal; ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irina Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal; ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Eugenia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luis Correia
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Sandra Dias
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Catarina Alves
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Claudia Camila Dias
- Knowledge Management Unit, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal; Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal.
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Gomes SF, Melo FJ, Silva R, Santiago M, Estevinho MM, Dias S, Dias CC, Magro F. Dipeptidyl peptidase 4 (DPP4) in fecal samples: validation of the extraction methodology and stability in short-term storage conditions. Clin Chem Lab Med 2023; 61:1636-1642. [PMID: 37098041 DOI: 10.1515/cclm-2023-0139] [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: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES This study assesses the clinical relevance of dipeptidyl peptidase 4 (DPP4) membrane exopeptidase as a biomarker of inflammatory bowel disease (IBD). A spike-and-recovery approach of DPP4 in fecal samples was used to compare two different methods for protein extraction, followed by a stability assessment. METHODS Fecal samples of healthy volunteers spiked with known concentrations of recombinant DPP4 were processed using a standard manual extraction protocol and the CALEX® protocol. The two methods were compared by quantification of fecal DPP4 by ELISA, followed by Bland-Altman analysis. For the stability assays DPP4 was extracted from fecal samples and stored under different conditions of temperature and time after collection. RESULTS In general, the levels of spiked DPP4 in stool samples were lower with the manual protocol than in those obtained with the CALEX® method; this trend was corroborated by Bland-Altman analysis. Nonetheless, variability was within the acceptable limits for both protocols. In the stability assessment, no statistically significant differences were found between the results obtained under the different storage conditions. CONCLUSIONS Both manual and CALEX® protocols provided equal extraction ability of DPP4 from stool samples. In addition, DPP4 provided flexibility in terms of sample storage enabling the accurate assessment of samples delivered up to a week before analysis.
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Affiliation(s)
- Sandra F Gomes
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Porto, Portugal
| | - Francisco Jorge Melo
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Porto, Portugal
| | - Rita Silva
- Portuguese Study Group of Inflammatory Bowel Disease (GEDII), Porto, Portugal
| | - Mafalda Santiago
- Portuguese Study Group of Inflammatory Bowel Disease (GEDII), Porto, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Porto, Portugal
- Department of Gastroenterology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Sandra Dias
- Portuguese Study Group of Inflammatory Bowel Disease (GEDII), Porto, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Portuguese Study Group of Inflammatory Bowel Disease (GEDII), Porto, Portugal
- RISE - Health Research Network, Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, Porto, Portugal
- Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal
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Magro F, Estevinho MM, Catalano G, Patita M, Arroja B, Lago P, Rosa I, Tavares de Sousa H, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Sousa P, Portela F, Correia L, Moreira P, Santiago M, Dias S, Afonso J, Danese S, Peyrin-Biroulet L, Dias CC. How many biomarker measurements are needed to predict prognosis in Crohn's disease patients under infliximab?-A prospective study. United European Gastroenterol J 2023. [PMID: 37318072 DOI: 10.1002/ueg2.12420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/07/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Timely stratification of Crohn's disease (CD) is essential for patients' management. The use of noninvasive accurate biomarkers is key to monitor treatment and to pursue mucosal healing, the ultimate treatment endpoint in CD. OBJECTIVE We aimed to evaluate the performance of readily available biomarkers and develop risk matrices to predict CD progression. METHODS Data from 289 CD patients receiving infliximab (IFX) maintenance therapy for 2 years was collected; those patients were included in DIRECT, a prospective multicenter observational study. Disease progression was evaluated using two composite outcomes incorporating clinical and drug-related factors, the first including IFX dose and/or frequency adjustments. Univariate and multivariable logistic regressions were used to calculate the odds ratios (OR) and to develop risk matrices. RESULTS The isolated presence of anemia at least once during follow-up was a significant predictor of disease progression (OR 2.436 and 3.396 [p ≤ 0.001] for composite outcomes 1 and 2, respectively) regardless of confounding factors. Isolated highly elevated C-reactive protein (CRP; >10.0 mg/L) and fecal calprotectin (FC; >500.0 μg/g) in at least one visit were also significant predictors, while milder elevations (3.1-10.0 mg/L and 250.1-500.0 μg/g) were only relevant when detected in at least two visits (consecutive or not). The combination of biomarkers in risk matrices had good ability to predict progression; patients simultaneously presenting anemia, highly elevated CRP and FC at least once had 42%-63% probability of achieving the composite outcomes. CONCLUSION The combined evaluation of hemoglobin, CRP, and FC in at least one time point and their incorporation into risk matrices seems to be the optimal strategy for CD management, as data from additional visits did not meaningfully influence the predictions and may delay decision-making.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Gaia Catalano
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
- ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irina Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, IPOLFG, EPE, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
| | - Eugénia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luís Correia
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Paula Moreira
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Sandra Dias
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IBD Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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Estevinho MM, Cabeda J, Santiago M, Machado E, Silva R, Duro M, Pita I, Morais R, Macedo G, Bull TJ, Magro F, Sarmento A. Viable Mycobacterium avium subsp. paratuberculosis Colonizes Peripheral Blood of Inflammatory Bowel Disease Patients. Microorganisms 2023; 11:1520. [PMID: 37375022 DOI: 10.3390/microorganisms11061520] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Pathobionts, particularly Mycobacterium avium subsp. paratuberculosis (MAP) and Escherichia coli isolates with adherence/invasive ability (AIEC) have been associated with inflammatory bowel disease (IBD), particularly Crohn's disease (CD). This study aimed to evaluate the frequency of viable MAP and AIEC in a cohort of IBD patients. As such, MAP and E. coli cultures were established from faecal and blood samples (with a total n = 62 for each) of patients with CD (n = 18), ulcerative colitis (UC, n = 15), or liver cirrhosis (n = 7), as well as from healthy controls (HC, n = 22). Presumptive positive cultures were tested by polymerase chain reaction (PCR), for a positive confirmation of MAP or E. coli identity. E. coli-confirmed isolates were then tested for AIEC identity using adherence and invasion assays in the epithelial cell line of Caco-2 and survival and replication assays in the macrophage cell line of J774. MAP sub-culture and genome sequencing were also performed. MAP was more frequently cultured from the blood and faecal samples of patients with CD and cirrhosis. E. coli presumptive colonies were isolated from the faecal samples of most individuals, in contrast to what was registered for the blood samples. Additionally, from the confirmed E. coli isolates, only three had an AIEC-like phenotype (i.e., one CD patient and two UC patients). This study confirmed the association between MAP and CD; however, it did not find a strong association between the presence of AIEC and CD. It may be hypothesized that the presence of viable MAP in the bloodstream of CD patients contributes to disease reactivation.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia/Espinho Hospital Center, 4434-502 Vila Nova de Gaia, Portugal
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - José Cabeda
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
- Centro Interdisciplinar de Investigação Marinha e Ambiental (CIIMAR, CIMAR), 4450-208 Matosinhos, Portugal
| | - Mafalda Santiago
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - Elisabete Machado
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
| | - Ricardo Silva
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
| | - Mary Duro
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Escola Superior de Saúde Fernando Pessoa, 4200-253 Porto, Portugal
- LAQV@REQUIMTE, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Inês Pita
- Department of Gastroenterology, Entre Douro e Vouga Hospital Center, 4520-211 Santa Maria da Feira, Portugal
| | - Rui Morais
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Tim J Bull
- Institute of Infection and Immunity, St George's University of London, London SW17 ORE, UK
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
| | - Amélia Sarmento
- FP-I3ID, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-150 Porto, Portugal
- I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-150 Porto, Portugal
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Magro F, Moreira PL, Catalano G, Alves C, Roseira J, Estevinho MM, Silva I, Dignass A, Peyrin-Biroulet L, Danese S, Jairath V, Dias CC, Santiago M. Has the therapeutical ceiling been reached in Crohn's disease randomized controlled trials? A systematic review and meta-analysis. United European Gastroenterol J 2023; 11:202-217. [PMID: 36876515 PMCID: PMC10039796 DOI: 10.1002/ueg2.12366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/25/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND AND AIMS The availability of biological agents for inflammatory bowel disease has increased over the past years. In this systematic review and meta-analysis, we aimed to explore time trends in clinical response and clinical remission rates in Crohn's disease (CD) patients treated with biologics while discussing the need for new strategies. METHODS MEDLINE, Cochrane, and ISI Web of Science databases were searched for randomized placebo-controlled trials with biological agents in moderate-to-severe CD patients. Sub-group and meta-regression analyses compared treatment and placebo by calculating the pooled odds ratios of clinical remission and clinical response, across time categories and publication year. We also estimated the proportion of patients achieving clinical remission and clinical response by comparing both groups according to the publication year. RESULTS Twenty-five trials were included in the systematic review, which enrolled 8879 patients between 1997 and 2022. The clinical remission and clinical response odds, in induction and maintenance, have been constant over time, as no statistically significant differences were found between time categories (interaction p-values: clinical remission [induction, p = 0.19; maintenance, p = 0.24]; clinical response [induction, p = 0.43; maintenance, p = 0.59]). In meta-regression analyses, publication year did not influence these outcomes (clinical remission [induction, OR 1.01{95% CI 0.97-1.05}, p = 0.72; clinical response [induction, OR 1.01{95% CI 0.97-1.04]; p = 0.63; maintenance, OR 1.03{95% CI 0.98-1.07}; p = 0.21]), with the exception of clinical remission in maintenance studies, which presented a decreased effect (odds ratio 0.97{95% CI 0.94-1.00}, p = 0.03]). CONCLUSIONS Our review highlights that the odds of clinical outcomes in CD patients receiving biological treatment relative to placebo have been stable in the last decades.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, São João University Hospital Center, Porto, Portugal
- Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- RISE-Health Research Network, Porto, Portugal
- GEDII-Portuguese Inflammatory Bowel Disease Study Group, Porto, Portugal
| | - Paula Leão Moreira
- Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal
| | | | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Roseira
- Gastroenterology Department, Algarve University Hospital Center, Faro, Portugal
- ABC-Algarve Biomedical Center, Loulé, Portugal
| | - Maria Manuela Estevinho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | - Isabel Silva
- Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt Am Main, Germany
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Claudia Camila Dias
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Santiago
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- GEDII-Portuguese Inflammatory Bowel Disease Study Group, Porto, Portugal
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Estevinho MM, Leão Moreira P, Silva I, Laranjeira Correia J, Santiago M, Magro F. A scoping review on early inflammatory bowel disease: definitions, pathogenesis, and impact on clinical outcomes. Therap Adv Gastroenterol 2022; 15:17562848221142673. [PMID: 36569381 PMCID: PMC9772959 DOI: 10.1177/17562848221142673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC) arise from a dysregulation of the balance between commensal microbiota and mucosal-associated immune system, in patients with genetic and environmental predisposition. Different pathophysiological mechanisms have been reported to influence disease history, with impact on disease phenotype and risk of complications. OBJECTIVES This review aims to summarize the definitions of early CD and UC, analyze the underlying immunological mechanisms, and evaluate the impact of recognizing and treating early inflammatory bowel disease (IBD) on patients' prognosis (short- and long-term outcomes). DESIGN To address this issue, we have performed a scoping review. DATA SOURCES AND METHODS Three online databases (MEDLINE, Web of Science, and ScienceDirect) were searched and the results were independently screened by two reviewers. RESULTS From 683 records identified, 42 manuscripts evaluating early IBD in adult patients were included. The 'early CD' concept was first described in 2008. Four years later, an international consensus proposed the definition of diagnosis up to 18 months, in patients without previous or current need for disease-modifying therapies. Several other definitions have been proposed; the '2 years since diagnosis' is the most used, regardless of disease characteristics or medication. The amount of evidence on early UC is lower and more recent. Regarding early disease pathogenesis, most theories emphasize the prominent role of innate immunity, followed by early-Th1 adaptive response. CONCLUSION The treatment of early CD seems to be crucial for the management of CD patients, impacting short-, medium-, and long-term outcomes. On the other hand, the early treatment of UC appears to be less advantageous, yet evidence comes from only a few retrospective studies.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Leão Moreira
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Isabel Silva
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - João Laranjeira Correia
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Mafalda Santiago
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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Roseira J, Santiago M, Estevinho MM, Moreira P, Alves C, Danese S, Peyrin-Biroulet L, Dignass A, Feakins R, Magro F. Impact of Crohn's Disease Therapies on Histology in Randomized Controlled Trials: Systematic Review With Meta-analysis. Inflamm Bowel Dis 2022:6762046. [PMID: 36250778 DOI: 10.1093/ibd/izac203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND The effectiveness of Crohn's disease treatments for inducing histological outcomes has not been addressed systematically. We performed a systematic review and meta-analysis of randomized controlled trials in Crohn's disease to assess the impact of therapies on mucosal histopathology. METHODS Databases (MEDLINE, CENTRAL, Web of Science, EMBASE) were searched for randomized controlled trials including adult patients and evaluating histological outcomes. Risk of bias was evaluated using the Critical Appraisal Skills Programme. Histological outcomes, pooled frequencies, pooled odds ratios, and standard mean differences of the histological scores were compared between the intervention and placebo groups using a random-effects model. RESULTS Out of 2070 records, 10 studies were included. The quality of the studies ranged from moderate to high, but they were clinically and methodologically diverse. All interventions were superior to placebo. Histological response was achieved by 68% of patients, and 38% achieved remission. Pooled odds ratio for histological remission in patients receiving intervention vs placebo was 4.14 (95% CI, 2.28-7.50; I2 0%; P < .01). Heterogeneity in histological response estimates was significant, and subgroup analysis of the odds ratio results was limited by the low number of studies per group. The standard mean difference of histological scores was higher for patients receiving intervention in both induction and maintenance studies (-2.95; 95% CI, -4.17 to -1.74; I2 83% P < .00; and -2.58; 95% CI, -3.89 to -1.27; I2 56% P < .00). CONCLUSIONS Crohn's disease therapies are effective for achieving histological outcomes. Adherence to recently published consensus on histopathology harmonization assessment in Crohn's disease would facilitate adequate comparison between studies in the future.
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Affiliation(s)
- Joana Roseira
- Gastroenterology Department, Algarve University Hospital Center, Faro, Portugal.,ABC (Algarve Biomedical Center), Loulé, Portugal
| | - Mafalda Santiago
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde), Porto, Portugal
| | - Maria Manuela Estevinho
- Gastroenterology Department, Gaia/Espinho Hospital Center, Gaia/Espinho, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Moreira
- Clinical Pharmacology Unit, São João Hospital University Center, Porto, Portugal
| | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Roger Feakins
- Department of Cellular Pathology, Royal Free Hospital, London, and University College London, UK
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Gastroenterology, São João Hospital Center, Porto, Portugal.,MedInUP, Center for Drug Discovery and Innovative Medicines, Porto, Portugal
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Santiago M, Dias CC, Alves C, Ministro P, Gonçalves R, Carvalho D, Portela F, Correia L, Lago P, Magro F. The Magnitude of Crohn's Disease Direct Costs in Health Care Systems (from Different Perspectives): A Systematic Review. Inflamm Bowel Dis 2022; 28:1527-1536. [PMID: 35179190 DOI: 10.1093/ibd/izab334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of inflammatory bowel disease (IBD) has been increasing worldwide, causing high impact on the quality of life of patients and an increasing burden for health care systems. In this systematic review, we reviewed the literature concerning the direct costs of Crohn's disease (CD) for health care systems from different perspectives: regional, economic, and temporal. METHODS We searched for original real-world studies examining direct medical health care costs in Crohn's disease. The primary outcome measure was the mean value per patient per year (PPY) of total direct health care costs for CD. Secondary outcomes comprised hospitalization, surgery, CD-related medication (including biologics), and biologics mean costs PPY. RESULTS A total of 19 articles were selected for inclusion in the systematic review. The studies enrolled 179 056 CD patients in the period between 1997 and 2016. The pooled mean total cost PPY was €6295.28 (95% CI, €4660.55-€8503.41). The pooled mean hospitalization cost PPY for CD patients was €2004.83 (95% CI, €1351.68-€2973.59). The major contributors for the total health expenditure were biologics (€5554.58) and medications (€3096.53), followed by hospitalization (€2004.83) and surgery (€1883.67). No differences were found between regional or economic perspectives, as confidence intervals overlapped. However, total costs were significantly higher after 2010. CONCLUSIONS Our review highlighted the burden of CD for health care systems from different perspectives (regional, economic, and temporal) and analyzed the impact of the change of IBD treatment paradigm on total costs. Reducing the overall burden can depend on the increase of remission rates to further decrease hospitalizations and surgeries.
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Affiliation(s)
- Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal
| | - Catarina Alves
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Ministro
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Tondela-Viseu Hospital Center, Viseu, Portugal
| | - Raquel Gonçalves
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Diana Carvalho
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Central Lisbon Hospital Center, Lisbon, Portugal
| | - Francisco Portela
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Luís Correia
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology and Hepatology, Northern Lisbon Hospital Center, Lisbon, Portugal
| | - Paula Lago
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Gastroenterology, Porto University Hospital Center, Porto, Portugal
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Portuguese Inflammatory Bowel Disease Study Group (GEDII), Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Gastroenterology, São João University Hospital Center, Porto, Portugal.,Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal
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Magro F, Magalhães D, Patita M, Arroja B, Lago P, Rosa I, Tavares de Sousa H, Ministro P, Mocanu I, Vieira A, Castela J, Moleiro J, Roseira J, Cancela E, Sousa P, Portela F, Correia L, Santiago M, Dias S, Alves C, Afonso J, Danese S, Peyrin-Biroulet L, Dias CC. Subclinical Persistent Inflammation as Risk Factor for Crohn's Disease Progression: Findings From a Prospective Real-World Study of 2 Years. Clin Gastroenterol Hepatol 2022; 20:2059-2073.e7. [PMID: 34896644 DOI: 10.1016/j.cgh.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Subclinical intestinal inflammation is common in Crohn's disease (CD). We aimed to explore its impact in the disease progression of infliximab-treated patients and the usefulness of fecal calprotectin (FC) and C-reactive protein (CRP) as surrogate minimally invasive biomarkers. METHODS The registry-based, prospective, observational, multicenter DIRECT (study to investigate the correlation of fecal calprotectin with serum Drug levels and development of an antI-dRug antibodiEs among adult patients with inflammatory bowel disease reCeiving anti-TNF-alfa treatment or vedoluzimab treatment) study followed infliximab-treated CD patients for 2 years in a tertiary care setting. Persistent inflammation definition was based on FC (>150 μg/g, >250 μg/g, or >350 μg/g) or serum CRP (>3 μg/mL) concentrations over 2 consecutive or at least 3 visits. Patients were categorized according to a composite outcome reflecting disease progression that incorporated surgery; hospitalizations; new fistulae, abscess, or stricture; and treatment escalation. RESULTS Of 322 DIRECT study patients, 180 asymptomatic, infliximab treated on maintenance regimen were included in the analysis. Patients developing the composite endpoint (n = 96) presented higher median levels of FC (205 [interquartile range, 98-515] μg/g; P = .045) but not of CRP (2.50 [interquartile range, 0.80-6.00] μg/mL; P = .895). Biomarker-defined persistent subclinical inflammation prevalence ranged from 24% to 81%. Considering FC >250 μg/g in 2 consecutive visits, prevalence was 50%, odds of achieving the endpoint were increased 3-fold (odds ratio, 2.996 [95% confidence interval, 1.557-5.776]), and time-to-outcome occurrence was significantly lower among subjects with persistent inflammation (median time: 11 months). Both clinical-related and treatment-related components were significantly associated with persistent inflammation. Definitions based on CRP >3 μg/mL, FC >150 μg/g, FC >350 μg/g, double biomarkers (FC >250 μg/g and/or CRP >3 μg/mL), or more visits did not improve predictive ability. CONCLUSIONS Persistent inflammation, defined simply and readily by FC >250 μg/g over 2 consecutive visits, was associated with a significantly higher risk and shorter time to occurrence of a composite outcome reflecting disease progression in asymptomatic infliximab-treated CD patients.
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Affiliation(s)
- Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Gastroenterology, São João Hospital University Centre, Porto, Portugal; Center for Health Technology and Services Research, Porto, Portugal; Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal; Portuguese Inflammatory Bowel Disease Group, Porto, Portugal.
| | - Diogo Magalhães
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Patita
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Paula Lago
- Department of Gastroenterology, Porto Hospital University Centre, Porto, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Entidade Pública Empresarial, Lisbon, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal; Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Irinia Mocanu
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia da Orta Hospital, Almada, Portugal
| | - Joana Castela
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Entidade Pública Empresarial, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Entidade Pública Empresarial, Lisbon, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve Hospital University Centre - Portimão Unit, Portimão, Portugal
| | - Eugénia Cancela
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Viseu-Tondela Hospital Centre, Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Coimbra Hospital University Centre, Coimbra, Portugal
| | - Luís Correia
- Department of Gastroenterology, Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research, Porto, Portugal; Portuguese Inflammatory Bowel Disease Group, Porto, Portugal
| | - Sandra Dias
- Portuguese Inflammatory Bowel Disease Group, Porto, Portugal
| | - Catarina Alves
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Afonso
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; IBD Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Claudia Camila Dias
- Center for Health Technology and Services Research, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Carones Esteves A, Freitas P, Brites L, Santiago T, Santiago M, Rovisco J, Da Silva JAP. AB1357 THE BEST CUT-OFF POINT FOR MEDIAN NERVE CROSS SECTIONAL AREA AT THE LEVEL OF PISIFORM BONE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCarpal tunnel syndrome (CTS) is a focal neuropathy caused by compression of the median nerve (MN) at the wrist. Electromyography (EMG) is the gold standard for the diagnosis of CTS. Currently, the ultrasound (US) is frequently used as an initial screening exam by measuring the cross-sectional area (CSA) of the MN. The cut-off point of the CSA at the pisiform bone level to define CTS remains controversial with previous studies reporting values between 6.5mm2 and 15mm2 (1).ObjectivesThe aim of this study is to determine the best cut-off point of the CSA for the diagnosis of CTS.MethodsCross-sectional study at a Tertiary Rheumatology Department including patients aged ≥ 18 years with symptoms compatible with CTS. Sociodemographic and clinical data, visual analogue scale for pain (VAS), Boston Questionnaire (BQ), and the results of EMG and US performed in each patient were collected. The EMG was performed according to the standardized protocol (sensory conduction velocity, sensory amplitude, distal sensory and motor latency), and the patients were categorized in 4 groups: normal, mild, moderate, and severe. A rheumatologist with expertise in imaging performed all the US evaluations by means of a 6–18-MHz (Siemens ACUSON S 2000) linear array transducer. The largest CSA of the MN was measured at the level of the pisiform bone. Receiver operating characteristic (ROC) curve was used to determine optimal cut-off values of the CSA taking the EMG result as the gold-standard. One-way ANOVA test was used to compare CSA between the 4 EMG groups.ResultsFifty patients were included, 90% were female, mean age was 52.1 ± 10.8 years and median duration of symptoms was 28.0 (IQR 23.0-31.0) months. The mean VAS was 4.2 ± 2.9. In the BQ there was a mean symptom severity score of 2.4 ± 0.6 and a mean functional status score of 2.0 ± 0.9. One-way ANOVA showed that mean CSA values were significantly different in the 4 groups of patients. The Ryan-Einot-Gabriel-Welsch post hoc analysis showed that only the mean CSA of patients with severe STC is different from the remaining groups defined by EMG results. The best cut-off point for CSA at the pisiforme bone level for CTS diagnosis was 6.6 mm2 with a sensitivity and specificity of 92.9% and 75.0% (AUC=0.9, P<0.001). The positive and negative predictive values were 95.1% and 66.7%, respectively. For severe CTS diagnosis the best cut-off point for CSA was 12.3mm2 with a sensitivity of 82.4% and a specificity of 72.7% (AUC=0.8, P<0.001). The positive and negative predictive values were 60.9% and 88.9%, respectively.ConclusionIn our study we found that the best cut-off point of the CSA was 6.6mm2 for distinguishing patients with/without CTS based on EMG alterations, with a high sensitivity and moderate specificity. This is a lower cut-off value than usually used in clinical practice and could be explained by small sample and the greater number of patients with mild and moderate STC on EMG.References[1]McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: A new paradigm. Rheumatology (Oxford, England). 2014;54.Disclosure of InterestsNone declared
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Magro F, Sottomayor C, Alves C, Santiago M, Ministro P, Lago P, Correia L, Gonçalves R, Carvalho D, Portela F, Dias CC, Dignass A, Danese S, Peyrin-Biroulet L, Estevinho MM, Leão Moreira P. Composite outcomes in observational studies of Crohn's disease: a systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848221092754. [PMID: 35601803 PMCID: PMC9118904 DOI: 10.1177/17562848221092754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to assess composite and aggregate outcomes of observational studies in Crohn's disease and to evaluate whether the number and type of variables included affect the frequency of the outcome. METHODS MEDLINE [via PubMed], Scopus and Web of Science were searched to identify observational studies that enrolled patients with Crohn's disease and evaluated a composite or aggregate outcome. The proportion of patients achieving the outcome was determined and a random-effects meta-analysis was performed to evaluate how the frequency of each outcome varies according to the reporting of predefined variables. RESULTS From 10,257 identified records, 46 were included in the qualitative analysis and 38 in the meta-analysis. The frequency for composite and aggregate outcomes was 0.445 [95% confidence interval (CI): 0.389-0.501] and 0.140 (95% CI: 0.000-0.211), respectively. When comparing composite outcomes by number of included variables, the frequency was 0.271 (95% CI: 0.000-0.405) and 0.698 (95% CI: 0.651-0.746), for one and six variables, respectively. The frequency of the composite outcome varied according to the identity of the variables being reported. Specific pairs of predefined variables had a significant effect in the frequency of composite outcomes. CONCLUSION Composite outcomes with increasing number of predefined variables show an increase in frequency. Outcomes including variables such as 'Surgery' and 'Steroids' had higher frequencies when compared with the ones that did not include these variables. These results show that the frequency of composite outcomes is dependent on the number and type of variables being reported.
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Affiliation(s)
| | | | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Paula Lago
- Department of Gastroenterology, Santo António University Hospital Center (CHUPorto), Porto, Portugal
| | - Luís Correia
- Department of Gastroenterology, Lisbon North Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Santo António dos Capuchos Hospital at Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Francisco Portela
- Department of Gastroenterology, University Hospital Centre of Coimbra, Coimbra, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Leão Moreira
- Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
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Santiago M, Stocker F, Ministro P, Gonçalves R, Carvalho D, Portela F, Correia L, Lago P, Trindade E, Dias CC, Magro F. Incidence Trends of Inflammatory Bowel Disease in a Southern European Country: A Mirror of the Western World? Clin Transl Gastroenterol 2022; 13:e00481. [PMID: 35347090 PMCID: PMC9132531 DOI: 10.14309/ctg.0000000000000481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/09/2022] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) affects people from all age categories worldwide. Although the incidence of the disease is stabilizing or decreasing in most Western world countries, its prevalence is still increasing because of the rise in life expectancy and better disease management. This work intends to identify the trends related to IBD incidence nationwide, analyzing regional, sex, and age distributions. METHODS Data were provided by the Portuguese Shared Services of the Ministry of Health. This study consisted of a retrospective analysis of all first consultations coded for "Chronic enteritis/ulcerative colitis" (D94) in a primary healthcare setting, between 2017 and 2020, in Portugal. The primary outcome measure was the IBD incidence rate per 100,000 inhabitants. We also calculated the incidence rate per person-year and forecasted incidence until 2024. RESULTS Between 2017 and 2019, the incidence rate of IBD in Portugal decreased from 54.9 to 48.6 per 100,000 inhabitants. The average incidence was 20 new cases of IBD per 1,000 person-year. It was predicted that, in December 2023, IBD incidence would reach 305.4 new cases (95% Prediction Interval 156.6-454.3), a similar result to the values forecasted for December 2021 (305.4, 95% Prediction Interval 197.3-413.6). DISCUSSION The incidence of IBD slightly declined from 2017 to 2019, and it is posed to stabilize in the future. The presented data are of the utmost importance for the characterization of IBD in Southern European countries and the establishment of future health policies in the setting of compounding prevalence in the Western world.
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Affiliation(s)
- Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
| | - Francisco Stocker
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal;
| | - Paula Ministro
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Tondela-Viseu Hospital Center, Viseu, Portugal;
| | - Raquel Gonçalves
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Braga Hospital, Braga, Portugal;
| | - Diana Carvalho
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Central Lisbon Hospital Center, Lisbon, Portugal;
| | - Francisco Portela
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Coimbra University Hospital Center, Coimbra, Portugal;
| | - Luís Correia
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology and Hepatology, Northern Lisbon Hospital Center, Lisbon, Portugal;
| | - Paula Lago
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Gastroenterology, Porto University Hospital Center, Porto, Portugal;
| | - Eunice Trindade
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Pediatrics, São João University Hospital Center, Porto, Portugal;
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal;
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;
- Portuguese Inflammatory Bowel Disease Study Group (GEDII), Porto, Portugal;
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal;
- Department of Gastroenterology, São João University Hospital Center, Porto, Portugal;
- Clinical Pharmacology Unit, São João University Hospital Center, Porto, Portugal.
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14
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Magro F, Alves C, Santiago M, Ministro P, Lago P, Correia L, Gonçalves R, Carvalho D, Portela F, Dias CC, Dignass A, Danese S, Peyrin-Biroulet L, Estevinho MM, Moreira P. Composite outcomes in observational studies of ulcerative colitis: A systematic review and meta-analysis. United European Gastroenterol J 2021; 10:54-72. [PMID: 34907660 PMCID: PMC8830283 DOI: 10.1002/ueg2.12183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Ulcerative colitis (UC) has been the focus of numerous observational studies over the years and a common strategy employed in their design is the use of composite and aggregate outcomes. Objective This systematic review and meta‐analysis aims to identify composite and aggregate outcomes of observational studies in UC and to evaluate how the number and type of variables included and the length of follow‐up affect the frequency of patients that achieve these outcomes. Methods A systematic literature search was carried out using MEDLINE [via PubMed], Scopus, and Web of Science online databases. Observational studies that included UC patients and reported composite or aggregate outcomes were identified. A set of variables considered to be representative of progressive or disabling UC was defined, the proportion of patients attaining the outcomes was determined and a random‐effects meta‐analysis was performed by dividing the identified studies into subgroups according to different criteria of interest. Results A total of 10,264 records were identified in the systematic search, of which 33 were retained for qualitative analysis and 20 were included in the meta‐analysis. The mean frequency for composite outcomes was 0.363 [95% confidence interval (CI) 0.323‐0.403]. The frequency of composite outcome for the subgroup of studies that included the variable “Biologics” was significantly higher than for those in which this variable was not reported [0.410; 95% CI 0.364‐0.457 versus 0.298; 95% CI 0.232‐0.364; p = 0.006]. Composite outcomes were also more frequent as the follow‐up duration increased. Conclusion The frequency of composite outcomes in observational studies of UC is dependent on the specific identity of the variables being reported. Moreover, longer follow‐up periods are associated with higher frequencies of composite outcomes. The evidence provided here is useful for the design of future observational studies of UC that aim to maximize the frequency of patients that achieve composite outcomes. Summarize the established knowledge on this subject Observational studies have become a valuable source of information but also present a remarkable heterogeneity. The inconsistency on the reported outcomes between individual studies and the potential for reporting biases has led to calls for the development of core outcome sets (COS).
What are the significant and/or new findings of this study? This is the first systematic review and meta‐analysis of outcomes in observational studies of Ulcerative colitis (UC). The frequency of composite outcomes in observational studies of UC is dependent on the specific identity of the variables being reported and on the follow‐up duration. Reporting of the variable “Biologics” significantly increased the frequency of composite outcomes. These findings may be useful for the design of future observational studies of UC.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, São João University Hospital Center (CHUSJ), Porto, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
| | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Paula Lago
- Department of Gastroenterology, Santo António University Hospital Center (CHUPorto), Porto, Portugal
| | - Luís Correia
- Department of Gastroenterology, Lisbon North Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Santo António dos Capuchos Hospital at Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Francisco Portela
- Department of Gastroenterology, University Hospital Centre of Coimbra, Coimbra, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Axel Dignass
- Agaplesion Markus Hospital, Department of Medicine I, Frankfurt, Germany
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Moreira
- Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
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15
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Magro F, Alves C, Lopes J, Lopes S, Tavares de Sousa H, Cotter J, Macedo da Silva V, Lago P, Vieira A, Brito M, Duarte MAM, Portela F, Silva JP, Ministro P, Arroja B, Carvalho L, Torres J, Santiago M, Estevinho MM, Danese S, Peyrin-Biroulet L, Dias CC, Borralho P, Feakins RM, Carneiro F. Histologic Features of Colon Biopsies (Geboes Score) Associated With Progression of Ulcerative Colitis for the First 36 Months After Biopsy. Clin Gastroenterol Hepatol 2021; 19:2567-2576.e9. [PMID: 32920215 DOI: 10.1016/j.cgh.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In addition to findings from endoscopy, histologic features of colon biopsies have been associated with outcomes of patients with ulcerative colitis (UC). We investigated associations between Geboes scores (a system to quantify structural changes and inflammatory activity in colon biopsies) and UC progression, and the time period over which this association is valid. METHODS We analyzed data from 399 asymptomatic patients with UC enrolled in the ACERTIVE study, followed at 13 inflammatory bowel disease (IBD) centers in Portugal through 31 December 2019. Blood and stool samples were collected and analyzed, and all patients underwent sigmoidoscopy within 24 h of sample collection. We assessed baseline endoscopic status (Mayo endoscopic subscore), histologic features of 2 sigmoid and 2 rectal biopsies (Geboes score), and concentration of fecal calprotectin (FC). The primary outcome was UC progression (surgical, pharmacologic, and clinical events). We generated survival curves for 36 months or less and more than 36 months after biopsy according to Geboes score using the Kaplan-Meier method and compared findings with those from a log rank test. Cox regression was adjusted for Mayo endoscopic subscore, Geboes score, and level of FC; results were expressed as adjusted hazard ratios (HR) with 95% CIs. RESULTS Patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 had a higher frequency of, and a shorter time to UC progression, than patients with Geboes scores ≤2B.0, Geboes scores ≤3.0, or Geboes score ≤4.0 (P < .001). Disease progression occurred earlier in patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 compared with patients with Geboes scores ≤2B.0 (HR, 2.021; 95% CI, 1.158-3.526), Geboes scores ≤3.0 (HR, 2.007; 95% CI, 1.139-3.534), or Geboes scores ≤4.0 (HR, 2.349; 95% CI, 1.269-4.349), respectively, in the first 36 months after biopsy. Similar results were found for patients with concentrations of FC below 150 μg/g. CONCLUSIONS We found histologic features of colon biopsies (Geboes score) to be an independent risk factor for progression of UC in the first 36 months after biopsy.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, São João University Hospital Center (CHUSJ), Porto, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal.
| | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, São João University Hospital Center (CHUSJ), Porto, Portugal
| | - Susana Lopes
- Department of Gastroenterology, São João University Hospital Center (CHUSJ), Porto, Portugal
| | - Helena Tavares de Sousa
- Department of Gastroenterology, Algarve Hospital University Center-Portimão Unit, Portimão, Portugal; ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine - University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Paula Lago
- Department of Gastroenterology, Porto Hospital Center, Hospital de Santo António, Porto, Portugal
| | - Ana Vieira
- Department of Gastroenterology, Garcia de Orta Hospital, Almada, Portugal
| | - Mariana Brito
- Department of Gastroenterology, Garcia de Orta Hospital, Almada, Portugal
| | - Maria A M Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Francisco Portela
- Gastroenterology Department, University Hospital Center of Coimbra, Coimbra, Portugal
| | - João P Silva
- Gastroenterology Department, Portuguese Institute of Oncology of Lisbon, Lisboa, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Tondela-Viseu Hospital Center, Viseu, Portugal
| | - Bruno Arroja
- Department of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Liliana Carvalho
- Department of Gastroenterology, Lisbon Ocidental Hospital Center, Lisboa, Portugal
| | - Joana Torres
- Department of Gastroenterology, Beatriz Ângelo Hospital, Loures, Portugal
| | - Mafalda Santiago
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Cláudia Camila Dias
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Roger M Feakins
- Department of Histopathology, Royal Free Hospital, London, United Kingdom
| | - Fátima Carneiro
- Department of Pathology, São João University Hospital Center (CHUSJ), Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), University of Porto, Porto, Portugal
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Camargo L, Pérez Cruz L, Cruz-Zaragoza E, Chávez García ML, Santiago M, Marcazzó J. Synthesis, RL and OSL characterization of thulium doped NaMgF 3 neighborite. Appl Radiat Isot 2020; 168:109516. [PMID: 33229198 DOI: 10.1016/j.apradiso.2020.109516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
The aim of this work is to study the dosimetric properties of tissue-equivalent thulium doped NaMgF3 neighborites and to determine their possible application as dosimeters in personal dosimetry. In this aspect, radioluminescence (RL) and optically stimulated luminescence (OSL) dosimetric properties of undoped and Tm3+ -doped NaMgF3 have been investigated for the first time. Samples were synthesized by solid state reaction and by considering a stoichiometric mixture of pure NaF and MgF2 reagents. Two emission peaks centered at 460 and 360 nm have been found in the RL emission spectrum of the doped samples, which can be ascribed to the 1D2 - 3F4 and 1D2 - 3H6 transitions of Tm3+ cations, respectively. Maximum OSL emission under blue light stimulation has been found for samples doped with 0.2 mol % of thulium. Furthermore, the OSL signal of this compound depends linearly on dose within the range 0.05-100 Gy. Besides, its OSL signal features satisfactory repeatability and a minimum detectable dose of 0.04 Gy. Finally, it has been found a low fading of the OSL signal of approximately 13% after the first 60 h, after which the OSL response remains constant. The obtained results suggest the feasibility of using this compound as an OSL detector in personal dosimetry.
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Affiliation(s)
- L Camargo
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina
| | - L Pérez Cruz
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, A.P. 70543, 04510 Ciudad de México, Mexico
| | - E Cruz-Zaragoza
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, A.P. 70543, 04510 Ciudad de México, Mexico
| | - M L Chávez García
- Facultad de Química, Universidad Nacional Autónoma de México, 04510 Ciudad de México, Mexico
| | - M Santiago
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina
| | - J Marcazzó
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina.
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Magro F, Lopes J, Borralho P, Dias CC, Afonso J, Ministro P, Santiago M, Geboes K, Carneiro F. Comparison of the Nancy Index With Continuous Geboes Score: Histological Remission and Response in Ulcerative Colitis. J Crohns Colitis 2020; 14:1021-1025. [PMID: 31965158 DOI: 10.1093/ecco-jcc/jjaa010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Evidence has been supporting that histological activity of ulcerative colitis [UC] has relevance for the prediction of clinical outcomes in UC patients, such as clinical relapse. In this study, we aimed to compare two histological indexes-the continuous Geboes score [GS] and the Nancy index [NI] -regarding their definitions of histological remission and response, and to determine the ability of faecal calprotectin [FC] levels to discriminate between these histological statuses according to the NI. METHODS A large cohort of UC patients [N = 422] who were previously enrolled in other studies was analysed. RESULTS GS and NI were shown to be strongly correlated [correlation coefficient: 0.882, p <0.001], indicating high accordance in the classification of patients as having/not having histological remission and response. FC levels moderately correlated with NI regarding these histological statuses [correlation coefficient: 0.481, p <0.001], moderately predicted the absence of remission defined by NI >0 {area under the curve (AUC) 0.667 (95% confidence interval [CI] 0.609-0.724)}, and were good predictors of the absence of histological response defined by NI >1 (AUC 0.825 [95% CI 0.777-0.872]). The optimal FC cut-offs determined to predict the NI-defined histological remission and response were 91 μg/g and 106 μg/g, when maximising the negative predictive value [NPV]. CONCLUSIONS Due to the higher applicability of the NI, this study encourages the systematic use of this histological index to assess histological remission and response in UC patients.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Mafalda Santiago
- CINTESIS - Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Ghent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal.,Institute of Research and Innovation in Health [i3S], University of Porto, Porto, Portugal
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Hevia Palacios M, Fraile A, Rodríguez-Patrón R, Santiago M, Hevia V, Burgos Revilla J. Does aetiology of urethral stricture influence the survival of the buccal mucosa graft? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32798-1] [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: 10/23/2022] Open
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Furie R, Rovin BH, Houssiau F, Amoura Z, Santiago M, Contreras G, Malvar A, Mok CC, Saxena A, Yu X, Teng YKO, Barnett C, Burriss S, Green Y, Ji B, Kleoudis C, Roth D. OP0164 BLISS-LN: A RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 3 TRIAL OF INTRAVENOUS BELIMUMAB IN PATIENTS WITH ACTIVE LUPUS NEPHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lupus nephritis (LN), a serious manifestation of systemic lupus erythematosus (SLE), affects nearly 70% of patients (pts) in high-risk groups. To preserve renal function, LN requires fast and effective treatment. Despite medical advances, progression rates at 15 years to end-stage renal disease (ESRD) remain >40% for pts with diffuse proliferative LN. Belimumab (BEL), approved in pts aged ≥5 years with active SLE, improved renal parameters in pts with baseline renal involvement in apost hocanalysis of Phase 3 trials data.Objectives:To assess efficacy and safety of intravenous (IV) BEL vs placebo (PBO), plus standard therapy (ST), in pts with active LN.Methods:BLISS-LN is a Phase 3, randomised, double-blind, PBO-controlled, 104-week study (GSK Study BEL114054,NCT01639339). Adults with SLE and biopsy-proven LN (class III, IV, and/or V) were randomised (1:1) to monthly BEL 10 mg/kg IV or PBO, plus ST. Primary endpoint: Primary Efficacy Renal Response (PERR); defined as urine protein creatinine ratio [uPCR] ≤0.7; estimated glomerular filtration rate [eGFR] within 20% of the pre-flare value or ≥60 ml/min/1.73m2; no rescue therapy) at Week (Wk) 104. Key secondary endpoints: Complete Renal Response (CRR; defined as uPCR <0.5; eGFR within 10% of the pre-flare value or ≥90 ml/min/1.73m2; no rescue therapy) at Wk 104; PERR at Wk 52; time to renal-related event (defined as ESRD/doubling of serum creatinine/renal worsening/renal disease-related treatment failure) or death. Other endpoints: time to PERR/CRR sustained through Wk 104; SLEDAI-S2K score <4 points at Wk 104; safety.Results:Overall, 448 pts were randomised (efficacy: 223/group; safety: 224/group). Significantly more BEL (43%) than PBO (32.3%) pts achieved PERR at Wk 104 (OR 1.55, 95% CI 1.04, 2.32; p=0.0311). More BEL than PBO pts achieved key secondary and other efficacy endpoints (Table).Overall, 214 (95.5%) BEL and 211 (94.2%) PBO pts had ≥1 adverse event (AE); 58 (25.9%) BEL and 67 (29.9%) PBO pts had ≥1 serious AE; 29 (12.9%) pts in each group had ≥1 AE resulting in study treatment discontinuation; 4 (1.8%) BEL and 3 (1.3%) PBO pts developed on-treatment fatal AEs.Conclusion:In the largest LN study to date, data from BLISS-LN demonstrate that BEL plus ST significantly improves LN renal responses compared with ST alone with a favourable safety profile.Study funding: GSK.Table.Endpoint, n (%)PBO(n=223)BEL(n=223)OR/HR (95% CI) vs PBOp-valueCRR at Wk 104*44 (19.7)67 (30.0)OR 1.74(1.11, 2.74)0.0167PERR at Wk 52*79 (35.4)104 (46.6)OR 1.59(1.06, 2.38)0.0245Time to PERR throughWk 104†72 (32.3)96 (43.0)HR 1.46(1.07, 1.98)0.0157Time to CRR throughWk 104†44 (19.7)67 (30.0)HR 1.58(1.08, 2.31)0.0189Time to renal-related event or death†63 (28.3)35 (15.7)HR 0.51(0.34, 0.77)0.0014SLEDAI-S2K score <4 points at Wk 104*41 (18.4)62 (27.8)OR 1.76(1.11, 2.78)0.0164*PBO and BEL columns represent the n (%) responders†Data presented as n (cumulative incidence)Disclosure of Interests:Richard Furie Grant/research support from: GSK, Consultant of: GSK, Brad H Rovin Grant/research support from: GSK, Consultant of: GSK, Frederic Houssiau Grant/research support from: UCB, Consultant of: GSK, Zahir Amoura Grant/research support from: GSK, Roche, Consultant of: GSK, Astra Zeneca, Amgen, Mittermayer Santiago: None declared, Gabriel Contreras Grant/research support from: Genentech, Merck, Consultant of: Genentech, Merck, Ana Malvar Consultant of: GSK and Roche, chi chiu mok: None declared, Amit Saxena Consultant of: GSK, AZ, BMS, Xueqing Yu: None declared, Y.K. Onno Teng Grant/research support from: GSK, Consultant of: GSK, Aurinia Pharmaceuticals, Novartis, Carly Barnett Shareholder of: GSK, Employee of: GSK, Susan Burriss Shareholder of: GSK, Employee of: GSK, Yulia Green Shareholder of: GSK, Employee of: GSK, Beulah Ji Shareholder of: GSK, Employee of: GSK, Christi Kleoudis Shareholder of: GSK, Consultant of: GSK, Employee of: Parexel, David Roth Shareholder of: GSK, Employee of: GSK
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Santiago M, Magro F, Correia L, Portela F, Ministro P, Lago P, Trindade E, Dias CC. Rehospitalization rates, costs, and risk factors for inflammatory bowel disease: a 16-year nationwide study. Therap Adv Gastroenterol 2020; 13:1756284820923836. [PMID: 35154386 PMCID: PMC8832310 DOI: 10.1177/1756284820923836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/09/2020] [Indexed: 02/04/2023] Open
Abstract
AIMS We aimed to describe the burden of rehospitalization in patients with inflammatory bowel disease (IBD), by evaluating rehospitalization rates, charges, and risk factors over 16 years. METHODS We performed a retrospective analysis of all hospital discharges with a primary diagnosis of IBD in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System (ACSS)'s national registry. We collected data on patient, clinical, and healthcare charges. We used survival analysis to estimate the rate and risk factors of IBD-related rehospitalization. RESULTS We found that 33% (n = 15,931) of the IBD-related hospitalizations corresponded to rehospitalizations, which increased by 12% over 16 years. However, IBD rehospitalization rate per 100,000 IBD patients decreased 2.5-fold between 2003 and 2015. Mean IBD-related rehospitalization charges were €14,589/hospitalization-year in 2000 and €17,548 /hospitalization-year in 2015, with total rehospitalization charges reaching €3.1 million/year by 2015. Overall, the 30-day rate of rehospitalization was 24% for Crohn's disease (CD) and 22.4% for ulcerative colitis (UC). Novel risk factors for rehospitalization include penetrating disease in CD patients {hazard ratio (HR) 1.34 [95% confidence interval (CI) 1.20-1.51], p < 0.001} and colostomy in UC patients [HR 2.84 (95% CI 1.06-7.58)]. CONCLUSION IBD-related rehospitalization should be closely monitored, and efforts to reduce its risk factors should be made to improve the quality of care and, consequently, to reduce the burden of IBD.
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Affiliation(s)
| | | | - Luís Correia
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, Hospital Santa
Maria, University Hospital Center of Lisbon North, Lisbon, Portugal
| | - Francisco Portela
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, University
Hospital Center of Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, Tondela-Viseu
Hospital Center, Viseu, Portugal
| | - Paula Lago
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, Hospital Santo
António, University Hospital Center of Porto, Porto, Portugal
| | - Eunice Trindade
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Pediatrics, São João Hospital
Center, Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services
Research (CINTESIS), Porto, Portugal,Department of Community Medicine, Information
and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of
Porto, Portugal
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21
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Roseira J, Magro F, Fernandes S, Simões C, Portela F, Vieira AI, Patita M, Leal C, Lago P, Caldeira P, Gago T, Currais P, Dias CC, Santiago M, Dias S, Tavares de Sousa H. Sexual Quality of Life in Inflammatory Bowel Disease: A Multicenter, National-Level Study. Inflamm Bowel Dis 2020; 26:746-755. [PMID: 31504518 DOI: 10.1093/ibd/izz185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The impact of inflammatory bowel disease (IBD) on sexual health is a leading concern among patients. Most studies focus on sexual dysfunction rather than patient-perceived sexual quality of life (SQoL). We aimed to assess SQoL in IBD patients compared with healthy controls. METHODS This is a multicenter, cross-sectional study of IBD patients (n = 575 with Crohn's disease and n = 294 with ulcerative colitis), compared with healthy controls (n = 398), that used an anonymous self-administered questionnaire. This multimodal questionnaire included sociodemographic data and 4 validated instruments: Short IBD Questionnaire, Social Desirability Scale, Sexual QoL Questionnaire-Male/Female, Nine-item Patient Health Questionnaire. RESULTS Inflammatory bowel disease patients reported lower SQoL (men: 77.29 vs 83.83; P < 0.001; women: 70.40 vs 81.63; P < 0.001) compared with controls. Among IBD patients, SQoL was positively correlated with health-related quality of life (HRQoL) and negatively correlated with depression symptoms. Perianal disease was associated with lower HRQoL and higher incidence of depression, but only impacted SQoL in men. In linear regression analysis for men, SQoL was associated with age, marital status, and depression (β, -2.101; 95% confidence interval [CI], -2.505 to -1.696; P < 0.001). In women, SQoL was associated with depression (β, -1.973; 95% CI, -2.313 to -1.632; P < 0.001) only. CONCLUSIONS Patients with IBD had impaired SQoL compared with healthy controls. Age, widow status, and depression were independent predictors of SQoL in men with IBD, whereas in women depression was the only independent predictor. Emotional and self-esteem issues were the main concerns reported by IBD patients regarding sexual health.
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Affiliation(s)
- Joana Roseira
- Centro Hospitalar Universitário do Algarve, Hospital de Portimão, Portimão, Portugal.,Algarve Biomedical Center, University of Algarve, Algarve, Portugal
| | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Samuel Fernandes
- Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Carolina Simões
- Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | | | | | | | - Carina Leal
- Centro Hospitalar de Leiria, Leiria, Portugal
| | - Paula Lago
- Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - Paulo Caldeira
- Centro Hospitalar Universitário do Algarve, Hospital de Portimão, Portimão, Portugal.,Algarve Biomedical Center, University of Algarve, Algarve, Portugal
| | - Tânia Gago
- Centro Hospitalar Universitário do Algarve, Hospital de Portimão, Portimão, Portugal.,Algarve Biomedical Center, University of Algarve, Algarve, Portugal
| | - Pedro Currais
- Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research, Porto, Portugal
| | - Sandra Dias
- Grupo de Estudos da Doença Inflamatória Intestinal, Porto, Portugal
| | - Helena Tavares de Sousa
- Centro Hospitalar Universitário do Algarve, Hospital de Portimão, Portimão, Portugal.,Algarve Biomedical Center, University of Algarve, Algarve, Portugal
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22
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Santiago T, Santiago M, Coutinho M, Salvador MJ, Da Silva JAP. How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography. Arthritis Res Ther 2020; 22:50. [PMID: 32188488 PMCID: PMC7079468 DOI: 10.1186/s13075-020-02150-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/09/2019] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Measurement of skin involvement is essential for the diagnosis and assessment of prognosis and disease progression in systemic sclerosis (SSc). The modified Rodnan skin score (mRSS) is the gold standard measure of skin thickness, but it has been criticised for the lack of objectivity, poor inter-observer reproducibility and lack of sensitivity to change. Recently, shear-wave elastography (SWE) emerged as a promising tool for the objective and quantitative assessment of the skin in SSc patients. However, no studies have evaluated its sensitivity to change over time. Objective To assess changes in skin stiffness in SSc patients using SWE during a 5-year follow-up. Methods Skin stiffness [i.e. shear-wave velocity values (SWV) in metres per second] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon signed-rank test and the Mann–Whitney U test. Results We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p ≤ 0.001) (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upper arm (p = 0.046) and forearm (p = 0.026). Conclusion This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS and reduce significantly over time in SSc and normal controls.
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Affiliation(s)
- T Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - M Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Coutinho
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M J Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J A P Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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23
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Magro F, Lopes J, Borralho P, Lopes S, Coelho R, Cotter J, Dias de Castro F, Tavares de Sousa H, Salgado M, Andrade P, Vieira AI, Figueiredo P, Caldeira P, Sousa A, Duarte MA, Ávila F, Silva J, Moleiro J, Mendes S, Giestas S, Ministro P, Sousa P, Gonçalves R, Gonçalves B, Oliveira A, Chagas C, Cravo M, Dias CC, Afonso J, Portela F, Santiago M, Geboes K, Carneiro F. Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels. J Crohns Colitis 2020; 14:169-175. [PMID: 31504348 DOI: 10.1093/ecco-jcc/jjz123] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes-the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]-regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. METHODS This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. RESULTS The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. CONCLUSION The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.
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Affiliation(s)
- Fernando Magro
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.,Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joanne Lopes
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Paula Borralho
- Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - José Cotter
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Helena Tavares de Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.,ABC - Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Marta Salgado
- Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal
| | - Patrícia Andrade
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Vieira
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Caldeira
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - A Sousa
- Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
| | - Maria A Duarte
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - Filipa Ávila
- Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
| | - João Silva
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisbon, Portugal
| | - Joana Moleiro
- Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisbon, Portugal
| | - Sofia Mendes
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sílvia Giestas
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Paula Sousa
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Raquel Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital de Braga, Braga, Portugal
| | - Ana Oliveira
- Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Cristina Chagas
- Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marilia Cravo
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Joana Afonso
- Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mafalda Santiago
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), University of Porto, Porto, Portugal
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24
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Santiago M, Antunes C, Guedes M, Iacovino M, Kyba M, Reik W, Sousa N, Pinto L, Branco MR, Marques CJ. Correction to: Tet3 regulates cellular identity and DNA methylation in neural progenitor cells. Cell Mol Life Sci 2020; 77:2885. [PMID: 31919574 PMCID: PMC7326887 DOI: 10.1007/s00018-019-03443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article Tet3 regulates cellular identity and DNA methylation in neural progenitor cells, written by Miguel R. Branco and C. Joana Marques, was originally published electronically on the publisher's internet portal.
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Affiliation(s)
- Mafalda Santiago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Claudia Antunes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Marta Guedes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Michelina Iacovino
- Lillehei Heart Institute and Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55455, USA.,Division of Medical Genetics, Department of Pediatrics, Harbor UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, 90502, USA
| | - Michael Kyba
- Lillehei Heart Institute and Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Wolf Reik
- Epigenetics Programme, The Babraham Institute, Cambridge, CB22 3AT, UK.,The Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Luísa Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal
| | - Miguel R Branco
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK.
| | - C Joana Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal. .,Department of Genetics, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal. .,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.
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25
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Santiago M, Magro F, Correia L, Portela F, Ministro P, Lago P, Dias CC. What forecasting the prevalence of inflammatory bowel disease may tell us about its evolution on a national scale. Therap Adv Gastroenterol 2019; 12:1756284819860044. [PMID: 31467592 PMCID: PMC6704422 DOI: 10.1177/1756284819860044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) is increasingly prevalent within western societies. Its complex and chronic facets in addition to its increasing prevalence place a great economic burden on our healthcare systems. Our aim was to estimate the national prevalence of IBD through predictive models. We used prevalence data which spans the years 2003-2007 to estimate prevalence until 2030 by means of four forecasting methods. Prevalence rates are estimated to be 4-6-times higher in 2030 when compared with 2003 with an average annual percent change of 5%. IBD is poised to have a substantial impact on healthcare systems in the near future, given its rapidly increasing prevalence. Forecasting methods will allow for a proactive stance on the development of health policies that will be needed to provide high quality and cost-effective care to these patients, while ensuring the economic viability of healthcare systems.
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Affiliation(s)
- Mafalda Santiago
- CINTESIS – Center for Health Technology and
Services Research, Porto, Portugal,Grupo de Estudo da Doença Inflamatória
Intestinal (GEDII), Porto, Portugal
| | | | - Luís Correia
- Grupo de Estudo da Doença Inflamatória
Intestinal (GEDII), Porto, Portugal,Centro Hospitalar Lisboa Norte, Hospital Santa
Maria, Gastroenterology Department, Lisboa, Portugal
| | - Francisco Portela
- Grupo de Estudo da Doença Inflamatória
Intestinal (GEDII), Porto, Portugal,Centro Hospitalar Universitário de Coimbra,
Gastroenterology Department, Coimbra, Portugal
| | - Paula Ministro
- Grupo de Estudo da Doença Inflamatória
Intestinal (GEDII), Porto, Portugal,Centro Hospitalar Tondela e Viseu,
Gastroenterology Department, Viseu, Portugal
| | - Paula Lago
- Grupo de Estudo da Doença Inflamatória
Intestinal (GEDII), Porto, Portugal,Centro Hospitalar do Porto, Hospital Geral
Santo António, Gastroenterology Department, Porto, Portugal
| | - Cláudia Camila Dias
- CINTESIS – Center for Health Technology and
Services Research, Porto, Portugal,Department of Community Medicine, Information
and Health Decision Sciences, Faculty of Medicine of the University of
Porto, Portugal
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Dias CC, Santiago M, Correia L, Portela F, Ministro P, Lago P, Trindade E, Freitas A, Magro F. Hospitalization trends of the Inflammatory Bowel Disease landscape: A nationwide overview of 16 years. Dig Liver Dis 2019; 51:952-960. [PMID: 30826276 DOI: 10.1016/j.dld.2019.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/10/2019] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In this study, we aimed to determine the hospitalization rates of Inflammatory Bowel Disease (IBD) in a southern-european country and its associated charges over a period of 16 years. METHODS We identified all discharges with a primary diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between 2000 and 2015 in data provided by the Central Administration of Health Services (ACSS). National estimates of hospitalization rates were assessed and adjusted to gender, age, population, and hospitalizations. Hospitalization charges were also assessed. RESULTS There were an estimated 31 358 and 16 669 discharges for CD and UC, respectively. From 2000 to 2015, hospitalization rates per 100000 habitants increased for CD (8.4-11.2) and remained stable for UC (4.4-4.9). The hospitalization rate for IBD increased slightly over time (12.8 per 100 000 habitants in 2000 and 16.1 in 2015). Annual total hospitalization charges amounted to 4.0M€ in 2000 and 5.7M€ in 2015. This increase was mainly due to a rise in the total expenses of CD-related hospitalizations. CONCLUSION CD hospitalization rates per 100000 inhabitants increased over time while remaining constant for UC. Hospitalization charges for IBD increased approximately 2.0M€ during the study period, representing an important burden in the national healthcare system.
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Affiliation(s)
- Cláudia Camila Dias
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Mafalda Santiago
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; IBD Portuguese Group (GEDII), Porto, Portugal
| | - Luís Correia
- IBD Portuguese Group (GEDII), Porto, Portugal; Santa Maria Hospital, Gastroenterology Department, Lisbon, Portugal
| | - Francisco Portela
- IBD Portuguese Group (GEDII), Porto, Portugal; Coimbra Hospital, Gastroenterology Department, Coimbra, Portugal
| | - Paula Ministro
- IBD Portuguese Group (GEDII), Porto, Portugal; Viseu Tondela Hospital, Gastroenterology Department, Viseu, Portugal
| | - Paula Lago
- IBD Portuguese Group (GEDII), Porto, Portugal; Santo António Hospital, Gastroenterology Department, Porto, Portugal
| | - Eunice Trindade
- IBD Portuguese Group (GEDII), Porto, Portugal; São João Hospital, Gastroenterology Department, Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Fernando Magro
- IBD Portuguese Group (GEDII), Porto, Portugal; São João Hospital, Gastroenterology Department, Porto, Portugal; Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.
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Marcazzó J, Camargo L, Martínez N, Caselli E, Acosta MA, López JG, Roldan AM, Khaidukov NM, Santiago M. Thermo- radio- and optically stimulated luminescence of Ce-doped KYF 4 single crystals. Appl Radiat Isot 2019; 152:1-5. [PMID: 31203094 DOI: 10.1016/j.apradiso.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/11/2018] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
The goals of this work are to determine the luminescence properties of KYF4 single crystals doped with different concentrations of Ce3+ ions and to evaluate their possible application as a detector of beta radiation. In particular, thermoluminiscence, radioluminiscence and optically stimulated luminescence properties of KYF4: Ce3+ exposed to beta radiation have been studied and very good dosimetric properties have been obtained within the dose range 0.02-20 Gy.
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Affiliation(s)
- J Marcazzó
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina.
| | - L Camargo
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina
| | - N Martínez
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina
| | - E Caselli
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina
| | - M A Acosta
- Facultad de Ciencias Exactas (UNCPBA), Pinto 399, 7000, Tandil, Argentina
| | - J G López
- Facultad de Ciencias Exactas (UNCPBA), Pinto 399, 7000, Tandil, Argentina
| | - A Martínez Roldan
- Facultad de Ciencias Exactas (UNCPBA), Pinto 399, 7000, Tandil, Argentina
| | - N M Khaidukov
- Kurnakov Institute of General and Inorganic Chemistry, RAS, Leninskii Prospekt 31, 119991, Moscow, Russia
| | - M Santiago
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000, Tandil, Argentina
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Santiago M, Freiría C, Villalba A, Gómez I, Carpio N, Sanz G, Sanz MÁ, Solves P. Immunohaematological events related to changes in haematic and seric ABO group in patients undergoing haematopoietic stem cell transplantation with major ABO mismatch. Transfus Med 2018; 29:136-137. [PMID: 29732616 DOI: 10.1111/tme.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M Santiago
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - C Freiría
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - A Villalba
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - I Gómez
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - N Carpio
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - G Sanz
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - M Á Sanz
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - P Solves
- Transfusion Service Haematology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain
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Conlon KM, Cunius L, Haase D, Kukis K, Santiago M, Smalley B, Dimler M, Marano MA. 309 Integrating Child Life Services into the Burn Team: How Their Presence Makes a Difference. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- K M Conlon
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - L Cunius
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - D Haase
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - K Kukis
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - M Santiago
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - B Smalley
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - M Dimler
- The Burn Center at Saint Barnabas, West Orange, NJ
| | - M A Marano
- The Burn Center at Saint Barnabas, West Orange, NJ
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Rodrigues AM, Canhão H, Marques A, Ambrósio C, Borges J, Coelho P, Costa L, Fernandes S, Gonçalves I, Gonçalves M, Guerra M, Marques ML, Pimenta S, Pinto P, Sequeira G, Simões E, Teixeira L, Vaz C, Vieira-Sousa E, Vieira R, Alvarenga F, Araújo F, Barcelos A, Barcelos F, Barros R, Bernardes M, Canas da Silva J, Cordeiro A, Costa M, Cunha-Miranda L, Cruz M, Duarte AC, Duarte C, Faustino A, Figueiredo G, Fonseca JE, Furtado C, Gomes J, Lopes C, Mourão AF, Oliveira M, Pimentel-Santos FM, Ribeiro A, Sampaio da Nóvoa T, Santiago M, Silva C, Silva-Dinis A, Sousa S, Tavares-Costa J, Terroso G, Vilar A, Branco JC, Tavares V, Romeu JC, da Silva J. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update. Acta Reumatol Port 2018; 43:10-31. [PMID: 29602163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. METHODS SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. RESULTS The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.
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Martínez N, Rucci A, Marcazzó J, Molina P, Santiago M, Cravero W. Characterization of YVO4:Eu3+ scintillator as detector for Fiber Optic Dosimetry. RADIAT MEAS 2017. [DOI: 10.1016/j.radmeas.2017.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hovey M, Santiago M, Porr C. Funding experiential education in a university agriculture program using alternative sources. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.03.190] [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: 11/24/2022]
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Rodrigues M, Galego O, Costa C, Jesus D, Carvalho P, Santiago M, Malcata A, Inês L. Central nervous system vasculitis in systemic lupus erythematosus: a case series report in a tertiary referral centre. Lupus 2017; 26:1440-1447. [DOI: 10.1177/0961203317694259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Central nervous system (CNS) vasculitis (CNS) in systemic erythematosus lupus (SLE) is a rare and challenging diagnosis. We report four cases of CNS vasculitis that occurred 5 to 16 years after the diagnosis of SLE. Magnetic resonance imaging (MRI) detected different features suggestive of CNS vasculitis: enhancement and thickening of the vascular wall, vascular stenosis, ischemic brain lesions and intracerebral haemorrhage unlikely to correspond to other mimic aetiologies. Three patients received combination therapy with glucocorticoids (GC) and cyclophosphamide (CYC). Intravenous human immunoglobulin (IVIG) was administered when the patient had a past history of serious adverse event to CYC or high infectious risk. All patients showed imagiological improvement, at least partially, 5 to 23 days after starting treatment. We discuss the management of CNS in SLE including the role of magnetic resonance imaging (MRI).
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Affiliation(s)
- M Rodrigues
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - O Galego
- Neuroradiology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - C Costa
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - D Jesus
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - P Carvalho
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - M Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - A Malcata
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - L Inês
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
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Ramírez M, Martínez N, Marcazzó J, Molina P, Feld D, Santiago M. Performance of ZnSe(Te) as fiberoptic dosimetry detector. Appl Radiat Isot 2016; 116:1-7. [PMID: 27472824 DOI: 10.1016/j.apradiso.2016.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/10/2015] [Revised: 06/29/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
Fiberoptic dosimetry (FOD) is an experimental technique suitable for in-vivo, real time dosimetry in radiotherapy treatments. FOD relies on using a small scintillator coupled to one end of a long optical fiber. The scintillator is placed at the point where the dose rate is to be determined whereas a light detector at the other end of the fiber measures the intensity of the radioluminescence emitted by the scintillator. One of the problems hampering the straightforward application of this technique in clinics is the presence of Cherenkov radiation generated in the fiber by the ionizing radiation, which adds to the scintillating light and introduces a bias in the dose measurement. Since Cherenkov radiation is more important in short wavelength range of the visible spectrum, using red-emitting scintillators as FOD detectors permits to reduce the Cherenkov contribution by using optical filters. In this work, the performance of red-emitting tellurium-doped zinc selenide crystal as FOD detector is evaluated and compared to the response of an ion-chamber.
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Affiliation(s)
- M Ramírez
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000 Tandil, Argentina; Facultad de Ciencias Exactas y Aplicadas, Instituto Tecnológico Metropolitano (ITM), Calle 73 No 76 A 354, Medellín, Colombia
| | - N Martínez
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000 Tandil, Argentina
| | - J Marcazzó
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000 Tandil, Argentina
| | - P Molina
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000 Tandil, Argentina
| | - D Feld
- Instituto de Oncología Ángel H. Roffo, Av. San Martín, CABA, 5481 Argentina
| | - M Santiago
- Instituto de Física Arroyo Seco (UNCPBA) and CIFICEN (UNCPBA - CICPBA - CONICET), Pinto 399, 7000 Tandil, Argentina
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Moura CA, Santiago M, Neto J, Gomes de Souza VH, Moura CG. Chronic myelomonocytic leukemia mimicking hematologic systemic lupus erythematosus. Lupus 2016; 26:204-207. [PMID: 27365372 DOI: 10.1177/0961203316657436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The relationship between primary hematologic disease and rheumatologic manifestations is well known, especially acute lymphocytic leukemia, lymphomas, plasma cell dyscrasias and myelodysplastic syndrome (MDS). Currently, more has been described about autoimmune manifestations in chronic myelomonocytic leukemia (CMML). Many different clinical scenarios may lead a patient with MDS/CMML initially to seek a rheumatological unit. Autoimmune features such as polymyalgia rheumatic symptoms, myositis, neutrophilic dermatosis, cutaneous vasculitis and positive antinuclear antibodies (ANA) are some examples of clinical presentation of MDS/CMML. Moreover, peripheral cytopenias are a common initial presentation both for systemic lupus erythematous (SLE) and MDS/CMML. The aim of this study was to describe a case of an elderly woman with thrombocytopenia and positivity of antibodies to anti-extractable nuclear antigens (anti-ENA) as initial manifestation of CMML mimicking SLE, and to present some clues that encourage the clinician to perform a bone marrow study in such a clinical scenario.
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Affiliation(s)
- C A Moura
- 1 Programa de Residência de Clínica Médica do Hospital Santo Antonio, Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil.,2 Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.,3 Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
| | - M Santiago
- 2 Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - J Neto
- 3 Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
| | - V H Gomes de Souza
- 4 Clínica de Assistência Multidisciplinar em Oncologia (AMO), Salvador, Bahia, Brazil
| | - C Geraldo Moura
- 1 Programa de Residência de Clínica Médica do Hospital Santo Antonio, Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil.,2 Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
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Costa C, Santiago M, Ferreira J, Rodrigues M, Carvalho P, Silva J, Malcata A. Septic arthritis caused by Peptostreptococcus asaccharolyticus. Acta Reumatol Port 2016; 41:271-272. [PMID: 27155565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Peptostreptococcus spp are commensal organisms, usually involved in periodontal disease. Peptostreptococcus asaccharolyticus is an anaerobic gram-negative cocci, difficult to isolate due to its slow growth. Septic arthritis by this microorganism is a rare entity, but it can occur by hematogenous dissemination from a distant focus. Colonization and growth are more likely to occur in an already damaged articulation. We report the case of a 57 year-old woman with peripheral spondyloarthritis who developed knee septic arthritis by Peptostreptococcus asaccharolyticus.
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Marques M, Ferreira R, Santiago M, Marques A, Machado P, da Silva J, Ndosi M. AB1069 The Educational Needs of People with Spondyloarthropathies (AS and PSA): A Cross-Sectional Study: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2449] [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: 11/03/2022]
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Stewart K, Chahal N, Kovacs A, Manlhiot C, O'Shea S, Jelen A, Collins T, Santiago M, McCrindle B. CHILDREN AGED 12-15 WITH CONGENITAL HEART DISEASE: TRANSITION TO ADULT HEALTH CARE READINESS AND ASSOCIATED FACTORS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.562] [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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Cruz-Zaragoza E, Roman-Lopez J, Ramos Córdoba D, Furetta C, Santiago M, Marcazzó J. Luminescence detection and dose assessment of irradiated Yerba Mate (Ilex paraguariensis) tea leaves. Appl Radiat Isot 2015; 100:75-8. [DOI: 10.1016/j.apradiso.2014.11.022] [Citation(s) in RCA: 2] [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] [Received: 07/31/2014] [Revised: 10/28/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Arias P, Madinabeitia-Mancebo E, Santiago M, Corral-Bergantiño Y, Robles-García V. Effects of early or late-evening fatiguing physical activity on sleep quality in non-professional sportsmen. J Sports Med Phys Fitness 2015:R40Y9999N00A150070. [PMID: 25784397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS This study aims to understand whether night sleep--quality is distorted by fatiguing physical activity (PA) when conducted early or late in the evening. METHODS Participants and Intervention: 9 males (18--38yrs) performed sessions of fatiguing--PA over 3 consecutive days (Mon--Wed), for 2 weeks. One week the PA was performed at 17h, and in the other week at 21h. A Control--week included no PA (PA ABSENT ). The fatiguing--PA sessions comprised several sets of the 20m Shuttle--Run--Test (20mSRT). Sleep was assessed by actigraphic recordings acquired over 3 nights each week. It included the nights following the PA--sessions and the same days in the week of PA ABSENT . Sleep--quality perception was evaluated by mean of the National Sleep Foundation--Sleep Diary. The heart--rate (HR) and body--temperature (BT) at bed--time and waking--up were also registered. RESULTS Neither the 20mSTR--estimated VO 2max nor the number of maximal 20mSRT sets were different in the PA 17h and PA 21h sessions. Compared to the PA ABSENT , the PA 17h and PA 21h sessions increased the HR at bedtime, which recovered to baseline level after the night of sleep. BT was also reduced when waking--up compared to bed--time, but this was also observed in PA ABSENT . Sleep parameters measured by means of actigraphy were not modified by fatiguing activity when compared to PA ABSENT. Nevertheless, the subjective perception of sleep--quality was negatively altered by fatiguing PA. CONCLUSIONS Fatiguing PA performed early or late at the evening has no impact on objective sleep--quality but, subjectively, a deterioration of sleep--quality is perceived by the subjects.
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Affiliation(s)
- P Arias
- Neuroscience and Motor Control Group (NEUROcom), Faculty of Health Sciences, INEF--Galicia, and Faculty of Physiotherapy, Universidade da Coruña and Institute of Biomedical Research of A Coruña, Spain -
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Marcazzó J, Cruz-Zaragoza E, González P, Santiago M, Caselli E. Analysis of the glow curve of KMgF3:Lu compounds without resorting to the quasi-equilibrium approximation. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Santiago M, Antunes C, Guedes M, Sousa N, Marques CJ. TET enzymes and DNA hydroxymethylation in neural development and function - how critical are they? Genomics 2014; 104:334-40. [PMID: 25200796 DOI: 10.1016/j.ygeno.2014.08.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022]
Abstract
Epigenetic modifications of the genome play important roles in controlling gene transcription thus regulating several molecular and cellular processes. A novel epigenetic modification - 5-hydroxymethylcytosine (5hmC) - has been recently described and attracted a lot of attention due to its possible involvement in the active DNA demethylation mechanism. TET enzymes are dioxygenases capable of oxidizing the methyl group of 5-methylcytosines (5mC) and thus converting 5mC into 5hmC. Although most of the work on TET enzymes and 5hmC has been carried out in embryonic stem (ES) cells, the highest levels of 5hmC occur in the brain and in neurons, pointing to a role for this epigenetic modification in the control of neuronal differentiation, neural plasticity and brain functions. Here we review the most recent advances on the role of TET enzymes and DNA hydroxymethylation in neuronal differentiation and function.
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Affiliation(s)
- Mafalda Santiago
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Claudia Antunes
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Marta Guedes
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - C Joana Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal.
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Rowland T, Wharton M, Masters T, Mozer M, Santiago M, Smith DL. Right ventricular myocardial responses to progressive exercise in young adult males. Int J Sports Med 2014; 35:987-93. [PMID: 24838266 DOI: 10.1055/s-0034-1367047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent attention has been focused on possible unique features of the right ventricular response to exercise. This study investigated a) the responses of right ventricular cardiac dynamics and myocardial function to a standard bout of progressive cycle exercise in healthy young males, and b) the effect of level of aerobic fitness on these responses. 14 athletically-trained males (20.4±1.5 years) and 11 normally-active males (21.1±1.3 years) underwent a progressive upright cycle test to exhaustion with measurement of gas exchange variables and assessment of right ventricular stroke volume, systolic and diastolic myocardial velocities, and tricuspid inflow velocities by standard Doppler echocardiographic techniques at rest, submaximal and peak exercise. Stroke volume rose initially by approximately 27% in each group, followed by stable values to exhaustion. Values of maximal stroke index and maximal oxygen uptake were significantly greater in the trained group than the normally-active males (62±10 ml m(-2), 54.3±4.0 ml kg(-1) min(-1); 49±7 ml m(-2), 40.3±5.6 ml kg(-1) min(-1), respectively). No significant differences were observed in increases in systolic or diastolic myocardial velocities, peak pulmonary outflow velocity, systolic ejection rate, or tricuspid inflow velocity between the 2 groups. The magnitude of change of these variables was similar to those previously described for left ventricular responses to similar exercise. This study revealed no unique features of right ventricular functional responses to an acute exercise challenge in young males.
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Affiliation(s)
- T Rowland
- Baystate Medical Center, Pediatrics, Springfield, United States
| | - M Wharton
- Skidmore College, Department of Health and Exercise Sciences, Saratoga Springs, United States
| | - T Masters
- Skidmore College, Department of Health and Exercise Sciences, Saratoga Springs, United States
| | - M Mozer
- Skidmore College, Department of Health and Exercise Sciences, Saratoga Springs, United States
| | - M Santiago
- Skidmore College, Department of Health and Exercise Sciences, Saratoga Springs, United States
| | - D L Smith
- Skidmore College, Department of Health and Exercise Sciences, Saratoga Springs, United States
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Santiago T, Santiago M, Rovisco J, Ferreira J, Duarte C, Malcata A, Da Silva JAP. Coexisting primary Sjögren’s syndrome and sarcoidosis: coincidence, mutually exclusive conditions or syndrome? Rheumatol Int 2014; 34:1619-22. [DOI: 10.1007/s00296-014-3024-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
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Molina P, Sommer M, Marcazzó J, Santiago M, Henniger J, Caselli E. Thermoluminescent kinetics for negligible retrapping: Its application to the analysis of the glow curve of Y2O3: Eu+3. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2013.11.002] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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47
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Ortega F, Marcazzo J, Santiago M, Spano F, Caselli E. On the validity of the general order kinetics for analyzing phosphorescence curves. RADIAT MEAS 2013. [DOI: 10.1016/j.radmeas.2013.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Santiago T, Rovisco J, Santiago M, Silva J, da Silva J. AB0842 Anti-ku antibodies: Clinical and serological evaluation of 12 patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.842] [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: 11/04/2022]
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Carneiro S, Bortoluzzo A, Gonçalves C, Silva J, Ximenes A, Bértolo M, Ribeiro S, Keiserman M, Menin R, Azevedo V, Vieira W, Albuquerque E, Bianchi W, Bonfiglioli R, Campanholo C, Carvalho M, Costa I, Duarte A, Gavi M, Cohen C, Leite N, Lima S, Meirelles E, Pereira I, Pinheiro M, Polito E, Resende G, Rocha F, Santiago M, Sauma M, Skare T, Sampaio-Barros P. SAT0281 Impact of enthesitis in 1505 brazilian patients with spondyloarthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3228] [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: 11/04/2022]
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50
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Ortega F, Marcazzó J, Molina P, Santiago M, Lester M, Henniger J, Caselli E. Analysis of the main dosimetric peak of Al2O3:C compounds with a model of interacting traps. Appl Radiat Isot 2013; 78:33-7. [PMID: 23665765 DOI: 10.1016/j.apradiso.2013.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/26/2013] [Accepted: 02/28/2013] [Indexed: 11/29/2022]
Abstract
The glow curve of Al2O3:C compounds has been analyzed by employing a model consisting of two active traps, thermally disconnected traps and one recombination centre. The analysis takes into account interaction among traps and the thermal quenching of the thermoluminescent emission.
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Affiliation(s)
- F Ortega
- Universidad Nacional del Centro, 7000 Tandil, Argentina
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