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Sierra A, Correia C, Ortega T, Forja J, Rodrigues M, Cravo A. Dynamics of CO 2, CH 4, and N 2O in Ria Formosa coastal lagoon (southwestern Iberia) and export to the Gulf of Cadiz. Sci Total Environ 2024; 906:167094. [PMID: 37734615 DOI: 10.1016/j.scitotenv.2023.167094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/16/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
A first characterization of greenhouse gases had been carried out to study their role and impact in a productive transitional coastal system of the southern Portugal - Ria Formosa lagoon. To this purpose, the partial pressure of CO2 (pCO2) and the concentration of dissolved CH4 and N2O have been measured. Two surveys were carried out during 2020, at low tide under typical conditions of Spring (March) and end of Summer (October). The samplings sites were distributed along the costal lagoon covering: i) inner areas with strong human impact (influence of different flows of treated wastewater discharges); and ii) main channels in connection with the main inlets to study the exchanges with the ocean. In general, the highest values of the three greenhouse gases were found at the inner studied areas, especially affected by the disposal of treated effluents from wastewater treatment plans, in October. The mean water - atmosphere fluxes of the CO2, CH4 and N2O are positive, showing that the study area acts as a source of these gases to the atmosphere. On the other hand, it was calculated a rough estimation of the three gases globally exported from Ria Formosa to the ocean, through the main six inlets to evaluate the magnitude of the supply of these gases from Ria Formosa to the adjacent ocean. The mean CO2, CH4 and N2O horizontal water fluxes exported from all the inlets of Ria Formosa to the Gulf of Cadiz for both seasons, during low water, are 8.7 ± 3.9 mmol m-2 s-1, 8.0 ± 3.5 μmol m-2 s-1 and 3.2 ± 1.5 μmol m-2 s-1, which corresponds to a mass transport through the inlets section of 0.7 ± 0.7 kg s-1, 0.2 ± 0.2 g s-1 and 0.2 ± 0.3 g s-1 respectively. From these estimates, as expected, the higher mass transport was found at the larger and deeper inlets (Faro-Olhão and Armona).
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Affiliation(s)
- A Sierra
- Dpto. Química-Física, INMAR, Facultad de Ciencias del Mar y Ambientales, Universidad de Cádiz, Campus Universitario Río San Pedro, 11510 Puerto Real, Cádiz, Andalucía, Spain.
| | - C Correia
- FCT, CIMA, Centre of Marine and Environmental Research\ARNET - Infrastructure Network in Aquatic Research, University of Algarve, Campus de Gambelas, 8000-139 Faro, Portugal.
| | - T Ortega
- Dpto. Química-Física, INMAR, Facultad de Ciencias del Mar y Ambientales, Universidad de Cádiz, Campus Universitario Río San Pedro, 11510 Puerto Real, Cádiz, Andalucía, Spain.
| | - J Forja
- Dpto. Química-Física, INMAR, Facultad de Ciencias del Mar y Ambientales, Universidad de Cádiz, Campus Universitario Río San Pedro, 11510 Puerto Real, Cádiz, Andalucía, Spain.
| | - M Rodrigues
- Laboratório Nacional de Engenharia Civil, Avenida do Brasil, 101, 1700-066 Lisboa, Portugal.
| | - A Cravo
- FCT, CIMA, Centre of Marine and Environmental Research\ARNET - Infrastructure Network in Aquatic Research, University of Algarve, Campus de Gambelas, 8000-139 Faro, Portugal.
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Granjo Morais C, Martins A, Ganhão S, Aguiar F, Rodrigues M, Brito I. Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis recurrence temporally associated with allergen-specific immunotherapy in a female adolescent: a case report. Reumatismo 2023; 75. [PMID: 38115774 DOI: 10.4081/reumatismo.2023.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/01/2023] [Indexed: 12/21/2023] Open
Abstract
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in pediatric patients. It is clinically characterized by fever flares lasting 3-7 days, reappearing every 2-8 weeks with a distinctive clockwork regularity. PFAPA generally begins before 5 years of age and usually ceases 3-5 years after onset. Recurrences may be observed in adolescence and adulthood in up to 20% of cases. The authors aim to describe a case of PFAPA recurrence in adolescence temporally associated with allergen-specific immunotherapy (ASIT). A 16-year-old female patient was referred to the rheumatology unit due to recurrent episodes of fever one month after initiating ASIT for allergic rhinitis. These episodes occurred every 4 weeks and lasted 3 days. During these episodes, she also presented with a sore throat, tonsillar exudates, and cervical lymphadenopathy. Abortive treatment with oral prednisolone was attempted in these episodes, with complete resolution of fever after a single dose. After reviewing her medical background, she had previously experienced febrile episodes accompanied by aphthous ulcers and tonsillar exudates occurring every 7-8 weeks from age 2-7. The etiopathogenesis of PFAPA remains uncertain. Environmental triggers, particularly those with immunomodulator effects, may interfere with the immune responses responsible for PFAPA occurrence, but the mechanisms are still unclear. The authors describe the first report of the reappearance of PFAPA flares, possibly due to ASIT. Further studies are needed to fully clarify if ASIT constitutes a true environmental trigger of PFAPA.
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Affiliation(s)
- C Granjo Morais
- Department of Pediatrics, São João University Hospital Center, Porto.
| | - A Martins
- Department of Rheumatology, São João University Hospital Center, Porto.
| | - S Ganhão
- Pediatric and Young Adult Rheumatology Unit, São João University Hospital Center, Porto.
| | - F Aguiar
- Pediatric and Young Adult Rheumatology Unit, São João University Hospital Center, Porto.
| | - M Rodrigues
- Pediatric and Young Adult Rheumatology Unit, São João University Hospital Center, Porto.
| | - I Brito
- Pediatric and Young Adult Rheumatology Unit, São João University Hospital Center, Porto.
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Miller L, Imms C, Cross A, Pozniak K, O'Connor B, Martens R, Cavalieros V, Babic R, Novak-Pavlic M, Rodrigues M, Balram A, Hughes D, Ziviani J, Rosenbaum P. Impact of "early intervention" parent workshops on outcomes for caregivers of children with neurodisabilities: a mixed-methods study. Disabil Rehabil 2023; 45:3900-3911. [PMID: 36404703 DOI: 10.1080/09638288.2022.2143579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This study explored the feasibility, impact and parent experiences of ENVISAGE (ENabling VISions And Growing Expectations)-Families, a parent-researcher co-designed and co-led program for parents/caregivers raising children with early-onset neurodisabilities. METHODS Parents/caregivers of a child with a neurodisability aged ≤6 years, recruited in Australia and Canada, participated in five weekly online workshops with other parents. Self-report measures were collected at baseline, immediately after, and 3 months post-ENVISAGE-Families; interviews were done following program completion. Quantitative data were analyzed with generalized estimating equations and qualitative data using interpretive description methodology. RESULTS Sixty-five parents (86% mothers) were recruited and 60 (92%) completed the program. Strong evidence was found of effects on family empowerment and parent confidence (all p ≤ 0.05 after the program and maintained at 3-month follow-up). The ENVISAGE-Families program was relevant to parents' needs for: information, connection, support, wellbeing, and preparing for the future. Participants experienced opportunities to reflect on and/or validate their perspectives of disability and development, and how these perspectives related to themselves, their children and family, and their service providers. CONCLUSIONS ENVISAGE was feasible and acceptable for parent/caregivers. The program inspired parents to think, feel and do things differently with their child, family and the people who work with them.Implications for rehabilitationENVISAGE (ENabling VISions And Growing Expectations)-Families is a co-designed, validated parent/researcher "early intervention and orientation" program for caregivers raising a child with neurodevelopmental disabilities (NDDs).ENVISAGE-Families empowered parents' strengths-based approaches to their child, family, disability, and parenting.ENVISAGE-Families increased caregivers' confidence in parenting children with NDD's and provided them tools to support connection, collaboration, and wellbeing.Raising children with NDD can have a profound impact on caregivers, who can benefit from strengths-based, future focused supports early in their parenting experience.
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Affiliation(s)
- L Miller
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - C Imms
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - A Cross
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - K Pozniak
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - B O'Connor
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - R Martens
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - V Cavalieros
- Murdoch Children's Research Institute, Melbourne, Australia
| | - R Babic
- Murdoch Children's Research Institute, Melbourne, Australia
| | - M Novak-Pavlic
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - M Rodrigues
- Department of Health Research Methods, Evidence and Impact, Health Research Methodology Graduate Program, McMaster University, Hamilton, Canada
| | - A Balram
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - D Hughes
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - J Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - P Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
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Rodrigues M, de Castro Mendes F, Paciência I, Barros R, Padrão P, Cavaleiro Rufo J, Silva D, Delgado L, Moreira A, Moreira P. Diet quality, asthma and airway inflammation in school-aged children. Eur Ann Allergy Clin Immunol 2023. [PMID: 37288989 DOI: 10.23822/eurannaci.1764-1489.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Summary Background. Asthma is a major public health problem, with increasing prevalence in most countries, particularly among children. Poor dietary quality is also increasing in children, and evidence of the overall quality of children's food patterns effects on asthma is scarce. Methods. This cross-sectional analysis (660 children: 49.1% females, aged 7-12years) evaluated the association between diet quality and asthma (n = 56) and airway inflammation among school-aged children according to body mass index (BMI). Diet quality was assessed through the Healthy Eating Index (HEI)-2015, and categorized by tertiles. Higher scores represent a healthier diet. A questionnaire was used to enquire about self-reported medical diagnosis of asthma and asthma under medication. Lung function and airway reversibility were measured, and airway inflammation assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/obese (p less than 85th), (n = 491), and overweight/obese (p ≥ than 85th), (n = 169). The associations between diet quality and asthma and airway inflammation were estimated using logistic regression models. Results. Non-overweight/obese children in 2nd tertile of HEI-2015 score had decreased odds of having eNO ≥ 35ppb (OR 0.43, 95%CI 0.19-0.98), medical diagnosis of asthma (OR 0.18; 95%CI 0.04-0.84), and asthma treatment (OR 0.12; 95%CI 0.01-0.95), compared to children in the 1st tertile. Conclusions. Our findings suggest that a higher diet quality associates with lower levels of airway inflammation and reduced prevalence of asthma among non-overweight/obese school-aged children.
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Affiliation(s)
- M Rodrigues
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - F de Castro Mendes
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - I Paciência
- Center for Environmental and Respiratory Health Research (CERH), Population Health, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - R Barros
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - P Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - J Cavaleiro Rufo
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - D Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
| | - L Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Immuno-Allergology, Centro Hospitalar São João, Porto, Portugal
| | - A Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
- Department of Immuno-Allergology, Centro Hospitalar São João, Porto, Portugal
| | - P Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit and Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, Porto, Portugal
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Ray-Coquard I, Leary A, Pignata S, Cropet C, González-Martin A, Marth C, Nagao S, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Alia EMG, Bogner G, Yoshida H, Lefeuvre-Plesse C, Buderath P, Mosconi AM, Lortholary A, Burges A, Medioni J, El-Balat A, Rodrigues M, Park-Simon TW, Dubot C, Denschlag D, You B, Pujade-Lauraine E, Harter P. Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial. Ann Oncol 2023:S0923-7534(23)00686-5. [PMID: 37211045 DOI: 10.1016/j.annonc.2023.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [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: 03/09/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND In the PAOLA-1/ENGOT-ov25 primary analysis, maintenance olaparib plus bevacizumab demonstrated a significant progression-free survival (PFS) benefit in newly diagnosed advanced ovarian cancer patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab, irrespective of surgical status. Prespecified, exploratory analyses by molecular biomarker status showed substantial benefit in patients with a BRCA1/BRCA2 mutation (BRCAm) or homologous recombination deficiency (HRD; BRCAm and/or genomic instability). We report the prespecified final overall survival (OS) analysis, including analyses by HRD status. PATIENTS AND METHODS Patients were randomized 2:1 to olaparib (300 mg bid; up to 24 months) plus bevacizumab (15 mg/kg q3w; 15 months total) or placebo plus bevacizumab. Analysis of OS, a key secondary endpoint in hierarchical testing, was planned for ∼60% maturity or 3 years after the primary analysis. RESULTS After median follow-up of 61.7 and 61.9 months in the olaparib and placebo arms, respectively, median OS was 56.5 versus 51.6 months in the ITT (hazard ratio [HR]=0.92, 95% CI 0.76-1.12; P=0.4118). Subsequent poly(ADP-ribose) polymerase (PARP) inhibitor therapy was received by 105 (19.6%) olaparib patients versus 123 (45.7%) placebo patients. In the HRD-positive population, OS was longer with olaparib plus bevacizumab (HR=0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% versus 48.4%); at 5 years, updated PFS also showed a higher proportion of olaparib plus bevacizumab patients without relapse (HR=0.41, 95% CI 0.32-0.54; 5-year PFS rate, 46.1% versus 19.2%). Myelodysplastic syndrome, acute myeloid leukemia, aplastic anemia, and new primary malignancy incidence remained low and balanced between arms. CONCLUSIONS Olaparib plus bevacizumab provided clinically meaningful OS improvement for first-line patients with HRD-positive ovarian cancer. These prespecified exploratory analyses demonstrated improvement despite a high proportion of patients in the placebo arm receiving PARP inhibitors post-progression, confirming the combination as one of the standards of care in this setting with the potential to enhance cure.
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Affiliation(s)
- I Ray-Coquard
- Department of Medical Oncology, Centre Léon BERARD, Lyon, and GINECO, France;.
| | - A Leary
- Gynecological Cancer Unit, Department of Medicine, Institut Gustave Roussy, Villejuif, and GINECO, France
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, and MITO, Italy
| | - C Cropet
- Department of Biostatistics Centre Léon BERARD, Lyon, and GINECO, France
| | - A González-Martin
- Department of Medical Oncology, Clínica Universidad de Navarra, Program in Solid Tumors (CIMA), Pamplona, and GEICO, Spain
| | - C Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, and AGO Austria, Austria
| | - S Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, and GOTIC, Japan
| | - I Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, and BGOG, Belgium, European Union
| | - N Colombo
- University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS Milan, and MANGO, Italy
| | - J Mäenpää
- Department of Obstetrics and Gynecology and Cancer Center, Tampere University and University Hospital, Tampere, and NSGO, Finland
| | - F Selle
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, and GINECO, France
| | - J Sehouli
- Charité - Department of Gynecology with Center of Oncological Surgery, Universitätsmedizin Berlin, Berlin, and AGO, Germany
| | - D Lorusso
- (3)Gynecologic Oncology Unit, Catholic University of Sacred Heart and Fondazione Policlinico Gemelli IRCCS, Rome, and MITO, Italy
| | - E M Guerra Alia
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, and GEICO, Spain
| | - G Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, and AGO Austria, Austria
| | - H Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, and GOTIC, Japan
| | - C Lefeuvre-Plesse
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, and GINECO, France
| | - P Buderath
- Universitätsklinikum Essen, University Hospital Essen, West German Cancer Center, Department of Gynecology and Obstetrics, Essen and AGO, Germany
| | - A M Mosconi
- S.C. di Oncologia Medica Osp. S. Maria della Misericordia - AO di Perugia, and MITO, Italy
| | - A Lortholary
- Centre Catherine de Sienne Hopital privé du Confluent, Nantes, and GINECO, France
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, and AGO, Germany
| | - J Medioni
- Hôpital Européen Georges Pompidou, Universite de Paris Cite, Paris, and GINECO, France
| | - A El-Balat
- Spital Uster, Frauenklinik, Uster, Switzerland, and Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - M Rodrigues
- Department of Medical Oncology, Institut Curie, Hopital Claudius Régaud, PSL Research University, Paris, France, and GINECO, France
| | - T-W Park-Simon
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, and AGO, Germany
| | - C Dubot
- Oncologie Médicale, Institut Curie, Hôpital René Huguenin, Saint Cloud, Paris, and GINECO, France
| | - D Denschlag
- Hochtaunuskliniken, Bad Homburg, and AGO, Germany
| | - B You
- HCL - Hospices Civils de Lyon IC-HCL, CITOHL, Université Claude Bernard Lyon 1, CICLY,Lyon, and GINECO, France
| | | | - P Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, and AGO, Germany
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Lindgren E, Krzywicka K, de Winter MA, Sánchez van Kammen M, Heldner MR, Hiltunen S, Aguiar de Sousa D, Mansour M, Canhão P, Ekizoglu E, Rodrigues M, Silva EM, Garcia-Esperon C, Arnao V, Aridon P, Simaan N, Silvis SM, Zuurbier SM, Scutelnic A, Sezgin M, Alasheev A, Smolkin A, Guisado-Alonso D, Yesilot N, Barboza MA, Ghiasian M, Leker RR, Arauz A, Arnold M, Putaala J, Tatlisumak T, Coutinho JM, Jood K. A scoring tool to predict mortality and dependency after cerebral venous thrombosis. Eur J Neurol 2023. [PMID: 37165521 DOI: 10.1111/ene.15844] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND We developed a prognostic score to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials.. METHODS We used data from the International CVT Consortium. We excluded patients with pre-existent functional dependency. We used logistic regression to predict poor outcome (modified Rankin Scale 3-6) at 6 months and Cox regression to predict 30-day and 1-year all-cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunken using Ridge regression to adjust for optimism in internal validation. RESULTS Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, we derived the SI2 NCAL2 C score utilizing the following components: absence of female Sex-specific risk factor, Intracerebral hemorrhage, Infection of the central nervous system, Neurologic focal deficits, Coma, Age, lower Level of hemoglobin (g/L), higher Level of glucose (mmol/L) at admission, and Cancer. C-statistics were 0.80 (95%CI 0.75-0.84), 0.84 (95%CI 0.80-0.88) and 0.84 (95%CI 0.80-0.88) for the poor outcome, 30 days and 1 year mortality model, respectively. Calibration plots indicated good model fit between predicted and observed values. The SI2 NCAL2 C score calculator is freely available at www.cerebralvenousthrombosis.com. CONCLUSIONS The SI2 NCAL2 C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted.
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Affiliation(s)
- E Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Krzywicka
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A de Winter
- Department of Internal Medicine, UMC, Utrecht, Utrecht, the Netherlands
| | - M Sánchez van Kammen
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - D Aguiar de Sousa
- Stroke Centre, Centro Hospital Universitário Lisboa Central, Lisbon, Portugal
- CEEM and Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - M Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - P Canhão
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHULN; University of Lisbon, Lisbon, Portugal
| | - E Ekizoglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Rodrigues
- Department of Neurology. Hospital Garcia de Orta, Almada, Portugal
| | - E M Silva
- Department of Neurology. Hospital Garcia de Orta, Almada, Portugal
| | - C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - V Arnao
- U.O.C. Neurologia con Stroke Unit A.R.N.A.S. Civico, Palermo, Italy
| | - P Aridon
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D), University of Palermo, Palermo, Italy
| | - N Simaan
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Silvis
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Zuurbier
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Sezgin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Alasheev
- Department of Neurology, Sverdlovsk, Yekaterinburg, Russia
| | - A Smolkin
- Department of Neurology, Sverdlovsk, Yekaterinburg, Russia
| | - D Guisado-Alonso
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - N Yesilot
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M A Barboza
- Neurosciences Department, Hospital Dr. R.A. Calderón Guardia, CCSS, San José, Costa Rica
| | - M Ghiasian
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - R R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Arauz
- Instituto Nacional de Neurologia and Neurocirugia Manuel Velasco Suarez, Mexico-City, Mexico
| | - M Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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7
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Martins A, Ganhão S, Oliveira Pinheiro F, Granjo Morais C, Rodrigues M, Leuzinger-Dias M, Figueira L, Brito I. Uveitis in patients with oligoarticular juvenile idiopathic arthritis and juvenile spondyloarthritis/enthesitis related arthritis: is there any difference? Reumatismo 2023; 75. [PMID: 37154253 DOI: 10.4081/reumatismo.2023.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/07/2023] [Indexed: 05/10/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common systemic disease causing uveitis in childhood and adolescence.
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Affiliation(s)
- A Martins
- Rheumatology Department, University Hospital of São João, Porto; Medicine Department, Faculty of Medicine, University of Porto.
| | - S Ganhão
- Pediatric and Young Adult Rheumatology Unit, University Hospital of São João, Porto.
| | - F Oliveira Pinheiro
- Rheumatology Department, University Hospital of São João, Porto; Medicine Department, Faculty of Medicine, University of Porto.
| | - C Granjo Morais
- Medicine Department, Faculty of Medicine, University of Porto; Pediatrics Department, University Hospital of São João, Porto.
| | - M Rodrigues
- Medicine Department, Faculty of Medicine, University of Porto; Pediatric and Young Adult Rheumatology Unit, University Hospital of São João, Porto.
| | - M Leuzinger-Dias
- Ophthalmology Department, University Hospital of São João, Porto.
| | - L Figueira
- Ophthalmology Department, University Hospital of São João, Porto; Pharmacology and Therapeutics Department, Faculty of Medicine, University of Porto.
| | - I Brito
- Medicine Department, Faculty of Medicine, University of Porto; Pediatric and Young Adult Rheumatology Unit, University Hospital of São João, Porto.
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8
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Assis EM, Rodrigues M, Vieira JC, Pascoaloti MI, Júnior HM, Souto GR, Souza PE, Horta MC. Microvascular density and tumor budding in oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2023; 28:e174-e182. [PMID: 36565216 PMCID: PMC9985932 DOI: 10.4317/medoral.25640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/14/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is the most prevalent malignant head and neck tumor, excluding the nonmelanoma skin cancer. Despite recent advances in the diagnosis and treatment, the disease's mortality rate is nonetheless high. The presence of isolated neoplastic cells or small clusters of up to four cells at the tumor's invasive front, named tumor budding, is associated with a worse prognosis in OSCC. Angiogenesis has also been recognized as a determining factor in the progression of malignancies and in the development of metastases. Several studies have investigated the assessment of microvascular density (MVD) as a potential prognostic factor in OSCC. This study aimed to evaluate, in OSCC, differences in MVD between tumors with high-intensity tumor budding and tumors with low-intensity or no tumor budding. In samples with high-intensity tumor budding, differences in MVD between the budding area and the area outside the budding were also evaluated. Moreover, the study assessed differences in MVD concerning clinicopathological characteristics such as sex, age, tobacco smoking, tumor location and tumor size. MATERIAL AND METHODS One hundred and fifty [150] samples of OSCC were subjected to immunohistochemistry to assess the intensity of tumor budding (by immunostaining for multi-cytokeratin) and MVD (by immunostaining for CD34 and CD105, independently). The data were treated using descriptive and analytical statistics. RESULTS There were no differences in MVD, assessed by immunostaining for CD34 or CD105, concerning clinicopathological characteristics such as sex, age, tobacco smoking, tumor location and tumor size (p > 0.05). Tumors with high-intensity tumor budding did not show differences in MVD, assessed by immunostaining for CD34 or CD105, when compared to tumors with low-intensity or no tumor budding (p > 0.05). However, in samples with high-intensity tumor budding, the MVD assessed by immunostaining for CD34 was higher in the budding area than in the area outside the budding (p < 0.05). This difference was not observed when MVD was assessed by immunostaining for CD105 (p > 0.05). CONCLUSIONS The higher MVD in the budding area may be an additional indication that this is a peculiar region of the tumor, associated with biological phenomena related to tumor progression.
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Affiliation(s)
- E-M Assis
- Departamento de Odontologia - Pontifícia Universidade Católica de Minas Gerais Avenida Dom José Gaspar 500, Prédio 46, Sala 101 CEP: 30535-901. Belo Horizonte, Minas Gerais, Brasil
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9
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Lima J, Rodrigues M, Eulálio M, Rocha A. Intermediate meals and the place of consumption - Which relationship? Int J Gastron Food Sci 2023. [DOI: 10.1016/j.ijgfs.2023.100719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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10
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Sá D, Mendonça MI, Santos M, Temtem M, Sousa AC, Rodrigues M, Henriques E, Freitas S, Borges S, Guerra G, Freitas AI, Ornelas I, Drumond A, Palma Dos Reis R. Poster No. 054 Genetic variation in the TCF21 gene is associated with the severity of coronary artery disease. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In vitro studies demonstrated that targeted deletion of the transcription factor encoding gene TCF21, was associated with vascular smooth muscle cell disruption. Recent research showed that TCF21 expression contribute to fibrous cap formation, preventing heart attacks.
Purpose
Analyse the TCF21 rs12190287 gene and evaluate its association with atherosclerosis severity measured according to the coronary angiogram patients´ data. Methods: Prospective study with 1,639 coronary artery disease (CAD) patients (mean age 53.4 ± 7.8 years). Two age groups (< 55 and > 55 years) were stratified and analyzed. TCF21 rs12190287 G > C was genotyped in all patients. The severity of CAD was graded according to the number of obstructed coronary arteries with at least 70% narrowed lumen. Chi-squared tests and multivariate logistic regression models were analysed.
Results
The CC genotype was associated with > 70% obstructive lesions (vascular disease rate, 48.1%). Contrariwise, the GG wild genotype was associated with less severe obstructive disease (19.5%) (P = 0.003). When we stratified the TCF21 genotypes per age group (55 years), the CC genotype in the younger group had more obstructed disease (47.4%) when compared with GG (18.8%) (P = 0.012), but this effect was not significant in the older group. Multivariate analysis (logistic regression) showed that the CC genotype had a high risk of multivessel coronary disease (OR = 2.88; P = 0.001) than GG.
Conclusion
This work shows that the TCF21 wild genotype protects against CAD severity. In contrast, the CC genotype is associated with an increased risk of CAD severity.
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11
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Temtem M, Mendonca MI, Serrao M, Santos M, Sa D, Soares C, Sousa AC, Henriques E, Rodrigues M, Freitas S, Borges S, Ornelas I, Drumond A, Palma Dos Reis R. Prognostic impact of adding Coronary Calcium Score to European SCORE2 in an asymptomatic Portuguese population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The new European SCORE2 estimates the combined risk of fatal and non-fatal cardiovascular (CV) events, in contrast with SCORE's use for CV mortality only. Although controversial, several studies point out that Coronary Artery Calcification (CAC) scoring could improve CV risk stratification in primary prevention.
Purpose
Assess the impact of including CAC score to the new SCORE2 in MACE prediction and CV risk stratification in an asymptomatic Portuguese population.
Methods
The new SCORE2 was calculated in a population-based cohort of 1,014 individuals (mean age 58.6±8.5 years) without known CV disease and diabetes. Population was stratified into three SCORE2 risk categories (low-, moderate- and high-risk). According to the Hoff's nomogram, CAC score was categorized into: low CAC (0≤CAC<100 or P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). Kaplan-Meier survival curves were estimated and a multivariate regression analysis predicted the MACE risk for both scores. C-statistic methodology evaluated the ability of CAC when added to the SCORE2 model in MACE prediction.
Results
Kaplan-Meier curves showed that the highest categories of both scores presented a worst survival. Cox regression analysis showed that the highest categories of both CAC and SCORE2 remained in the equation with an increased MACE risk (HR) of 3.69 (p=0.008) and 9.87 (p=0.005), respectively, when compared with the lowest categories. C-statistic demonstrated that the predictive value for MACE increased from 0.668 (SCORE2 model) to 0.787 when CAC was included (p=0.012), showing a better predictive and discriminative capacity for MACE.
Conclusions
Our results highlight the importance of adding CAC score to SCORE2 in primary prevention to improve cardiovascular risk stratification and MACE risk prediction. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Serrao
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - C Soares
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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12
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Sa D, Palma Dos Reis R, Santos M, Temtem M, Sousa AC, Henriques E, Rodrigues M, Freitas S, Borges S, Ornelas I, Drumond A, Mendonca MI. Lipoprotein(a) and cardiovascular outcomes in patients with coronary artery disease and impaired glucose metabolism. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Lipoprotein(a) [Lp(a)] is an LDL-like molecule composed of a part of apolipoprotein(a) bounding covalently to apolipoprotein B-100. High plasma Lp(a) levels were associated with MACE in stable CAD patients. Recent research shows contradictory results in stable CAD patients with high Lp(a) plasmatic levels and impaired glucose metabolism in MACE occurrence.
Purpose
Investigate whether high Lp(a) levels were associated with MACE in CAD patients with impaired glucose metabolism, at an extended follow-up.
Methods
A prospective cohort of 1,127 CAD patients with impaired glucose metabolism (pre-diabetes and diabetes) was observed during 4.9±3.4 years. Pre-diabetes was considered when fasting plasma glucose ranged from 5.6 to 6.9 mmol/L, or hemoglobin A1c levels ranging from 5.7 to 6.4%. Lp(a) levels ≥30 mg/dL were considered high. Bivariate and multivariate Cox regression analysis evaluated the risk of Lp(a) ≥30 mg/dL for MACE occurrence. Kaplan-Meier curves estimated the survival probability for high and low Lp(a) levels.
Results
Of the patients with Lp(a) levels ≥30, 44.4% presented MACE and 32.0% had no MACE (p<0.0001). Cox regression analysis with smoking, hypertension, dyslipidemia, physical inactivity and kidney failure (creatinine clearance <60 mL/min) showed that high Lp(a) remained in the equation as an independent risk factor for MACE (HR=1.24; p=0.031). The Kaplan-Meier showed, at 10-year' follow-up, a better survival in the group with lower Lp(a) levels (p=0.023).
Conclusion
Our study demonstrated that high Lp(a) levels were an independent predictor of MACE and cardiovascular mortality in a CAD population with impaired glucose metabolism. Lp(a) measurement may help further risk stratification for diabetes and pre-diabetes patients suffering CAD. With the recent development of drugs that selectively lower Lp(a) levels, this marker can become a clinical target for reducing CVD risk.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
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13
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Sa D, Mendonca MI, Temtem M, Santos M, Serrao M, Sousa AC, Borges S, Freitas S, Rodrigues M, Henriques E, Guerra G, Ornelas I, Drumond A, Palma Dos Reis R. Genetic information or coronary artery calcium score? What is more helpful in today's clinical practice? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Coronary artery calcium (CAC) score has emerged as the most predictive cardiovascular risk marker in asymptomatic individuals, capable of adding prognostic information beyond the traditional risk factors (TRF). Genetic risk score (GRS) significantly improves cardiovascular genetic risk assessment at the individual level providing a more personalized measure of disease risk.
Purpose
We intend to evaluate which tool, added to TRF, is more valuable in predicting and discriminating cardiovascular events and death (MACE) - GRS or CAC score?
Methods
We performed a prospective study with 1153 participants without CAD history at baseline (74.2% male, age 51.7±8.3 years) during a mean follow-up of 5.4±3.4 years. We selected 14 SNPs previously associated with CAD presenting a risk (HR) for cardiovascular events ≥1. A weighted GRS was calculated, as the sum of these 14 risk alleles weighted by the corresponding effect size in prognostic (HR), and subsequently, subdivided into tertiles. CAC (Agatson) score was calculated in all participants and categorized into: low CAC (0≤CAC<100 or P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). Two models were created with TRF baseline (hypertension, smoking, body mass index, dyslipidemia, diabetes, chronic kidney disease, physical inactivity): 1) plus wGRS and 2) plus CAC score categories. Cox Regression Analyses and C-statistic assessed the predictive and discriminative capacity of both models.
Results
For model 1, Cox regression presented an HR of 4.292 for TRF (p=0.007) and 2.713 for 3rd tertile of wGRS (0.036). A modest but statistically significant improvement in MACE discriminative capacity was verified by adding wGRS to TRF, increasing the C-statistic from 0.617 to 0.687 (ΔC=0.070; p=0.013). On the other hand, model 2 better discriminated MACE when the CAC score (C-statistic = 0.765) was added to TRF (ΔC=0.148; p=0.001). Cox regression displayed an HR of 4.42 for TRF (p=0.015) and an HR of 4.55 for high-risk CAC score (p=0.001).
Conclusion
Our results suggest that adding a polygenic risk score to conventional risk factors provides a modest improvement in the discrimination of first-onset MACE. However, the CAC score added to the traditional model allows better discrimination of MACE compared to wGRS. CAC score could be helpful for MACE prediction, at least in individuals belonging to the higher genetic risk group. However, further investigation is required before clinical implementation.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Serrao
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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14
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Temtem M, Palma Dos Reis R, Serrao M, Sa D, Santos M, Soares C, Sousa AC, Rodrigues M, Freitas S, Henriques E, Borges S, Guerra G, Ornelas I, Drumond A, Mendonca MI. Prognostic role of adding a genetic risk score to the new European SCORE2 in a cardiovascular events prediction, in a moderate-risk region. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The new SCORE2 provides risk estimates for the combined outcome of fatal and non-fatal cardiovascular disease (CVD) events, in contrast with SCORE's use for CVD mortality only. Genetic predisposition to CVD is not considered in SCORE2 for prevention and treatment.
Purpose
Evaluate the impact of adding a Genetic Risk Score (GRS) to the new European SCORE2 in MACE prediction and estimate the additional value in cardiovascular risk stratification in an asymptomatic Portuguese population.
Methods
A prospective study was performed in a population-based cohort of 1,100 individuals without known CVD and diabetes (mean age 53.3±6.9 years). For all included participants, SCORE2 was calculated and three risk categories were considered: low-, moderate- and high-risk. A 33-SNP GRS was constructed and two groups were analyzed: lower and higher than the GRS median. Kaplan-Meier survival curves were created and a Cox regression model was performed with the two scores to assess MACE risk. C-statistic methodology compared the model between SCORE2 solely and SCORE2 plus GRS.
Results
After Kaplan-Meier analysis for MACE occurrence, the high categories of SCORE 2 and GRS showed worst survival when compared to the lower categories (p<0.0001). Cox regression presented an HR of 8.528 (p=0.001) for high-risk SCORE2 and an HR of 4.520 (p<0.0001) for GRS higher than the median. C-statistic demonstrated that the SCORE2 predictive value was 0.678, increasing to 0.792 when GRS was included (p=0.0005).
Conclusions
In this work, combining SCORE2 with multiple genetic loci gathered into a GRS, improved the identification of patients with the worst prognosis. This new tool may be of great utility in risk stratification in primary prevention. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
| | - M Serrao
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - C Soares
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
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15
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Santos M, Mendonca MI, Temtem M, Sa D, Sousa AC, Freitas S, Rodrigues M, Henriques E, Borges S, Guerra G, Freitas AI, Ornelas I, Drumond A, Palma Dos Reis R. Transcription factor 21 and prognosis in a coronary population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
TCF21 is a member of the basic helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart. It regulates epicardium-derived cells differentiation into smooth muscle (SMC) and fibroblast lineages. The biological roles of TCF21 in epicardial fate determination and the progression of atherosclerosis remains a controversial issue.
Purpose
Investigate the impact of the TCF21 rs12190287 G>C variant on the prognosis of a coronary artery disease (CAD) cohort.
Methods
A prospective study was performed with 1,713 CAD patients (mean age 53.3±7.8; 78.7% male) surveyed in terms of MACE occurrence in an extended follow-up of 5.0±4.3. TCF21 rs12190287 was genotyped and analysed using the dominant model (GC+CC) and, subsequently, compared with the wild-type GG to evaluate the survival probability by Kaplan-Meier. A Cox regression analysis with all the risk factors and genetic models was performed to assess the independent variables associated with the prognosis of CAD patients.
Results
GG wild genotype was present in 9.5% of the population, GC in 43.2% and the risk genotype CC accounted for 47.3% of the CAD patients. The dominant model GC+CC showed a worse survival throughout the follow-up period. After multivariate Cox regression analysis, this model remained in the equation as an independent risk factor for MACE occurrence with an HR of 1.41 (p=0.033) together with multivessel disease, physical inactivity, chronic kidney disease (CKD) and diabetes.
Conclusion
TCF21 rs12190287 is a risk factor for prognosis in our population. The role of this gene may influence fundamental SMC processes in response to vascular stress, accelerating atherosclerosis progression and may represent a target for future therapies.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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Santos M, Mendonca MI, Sa D, Temtem M, Sousa AC, Henriques E, Rodrigues M, Freitas S, Borges S, Guerra G, Freitas AI, Ornelas I, Drumond A, Palma Dos Reis R. ZNF259 rs964184 variant is associated with dyslipidemia and coronary artery disease in the young population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease (CAD) is a dynamic inflammatory disease caused by atherosclerosis. GWAS showed that ZNF259 rs964184 encoding zinc finger protein (ZPR1) was associated with dyslipidemia and CAD. Recent research found that ZPR1 transcription is up-regulated in the brain of mice fed a high-fat diet, influencing the cell cycle, apoptosis, and RNA metabolism in neurons. This process at the heart vessels may increase oxidative stress and CAD.
Purpose
Study the association between the ZNF259 rs964184 C>G polymorphism with dyslipidemia and CAD susceptibility in a Portuguese population.
Methods
A case-control study was performed with 3,160 individuals, namely 1,723 CAD patients (mean age 53.3±7.9; 78.7% male) and 1,437 controls (mean age 52.8±7.8; 76.3% male). Participants were stratified into two age groups (<45 and >55 years). ZNF259 rs964184 C>G was genotyped and analysed using the dominant model (CG+GG vs CC). Multivariate logistic regression was performed in both age groups to investigate whether rs964184 polymorphism was associated with dyslipidemia and CAD susceptibility.
Results
The dominant model of ZNF259 was associated with dyslipidemia (OR=1.85; 95% CI: 1.22–2.79; p=0.003) and CAD (OR=1.46; 95% CI: 1.02–2.09; p=0.036) in the younger population under 45 years. In the >55 years group, this model was associated with dyslipidemia (OR 1.46; 95% CI: 1.06–2.01; p=0.020) but not with CAD. After multivariate logistic regression, the CG+GG remained an independent risk factor for CAD susceptibility only in the population <45 years (OR=1.60; 95% CI: 1.03–2.50; p=0.037).
Conclusion
ZNF259 rs964184 is a risk factor for dyslipidemia in the whole population. Dyslipidemia may up-regulate ZPR1 transcription, enhancing the vulnerability of coronary endothelial cells to both oxidative stress and inflammatory response, increasing CAD susceptibility. This mechanism seems more relevant at the cellular level in young patients representing a possible prophylactic and therapeutic target, especially in this age group.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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Santos M, Mendonca MI, Sa D, Temtem M, Sousa AC, Freitas S, Rodrigues M, Henriques E, Borges S, Freitas AI, Guerra G, Ornelas I, Drumond A, Palma Dos Reis R. A Genetic Risk Score englobing variants associated with coronary artery disease is a good marker for prognosis in an asymptomatic population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Genome-wide association studies have identified several loci linked to coronary artery disease, and coronary atherosclerosis progression. However, the impact of the genetic contribution to MACE occurrence in sub-clinical atherosclerosis is unknown.
Purpose
This study intended to assess the relationship between a set of single nucleotide popymorphism (SNP) associated with CAD by GWAS and the MACE occurrence in an asymptomatic population. After that evaluate whether a wGRS englobing these variants is useful to estimate the prognostic.
Methods
Prospective study performed in an asymptomatic cohort from GENEMACOR population-based sample of 1114 subjects aged 51.7±8.3, 74.2 male, without prior coronary artery disease. Coronary Artery Calcium (CAC) score was assessed by coronary computed tomography (Agatston method), and two categories were considered 1–99 and >100. 33 SNP were evaluate to assess the significantly associated with prognostic. A weighted (wGRS) was constructed as the sum of the risk alleles weighted by the corresponding effect size (HR). Cox regression analysis adjusted for the main risk factors, calcium score (CAC) and wGRS to assess the risk of MACE during follow-up. Kaplan Meier assessed the survival.
Results
Of the studied 33 SNPs previously associated with CAD (GWAS), only 4 presented the significant association with MACE occurrence: CDKN2B-AS1 rs4977574, HNF4A rs1884613,
APOE rs7412/rs429358A and GJA4A rs 618675. After Cox regression analysis the wGRS remained in the equation (HR=2.834); p=0.012, together with CAC score (HR 3.35); p=0.012; diabetes (HR=2.398); p=0.032 and age (HR=1.056; p=0.049. WGRS above the median presented a worst survival rate (p=0.006).
Conclusion
The wGRS englobing: CDKN2B-AS1 rs4977574, HNF4A rs1884613, APOE rs7412/rs429358A and GJA4A rs 618675 is independently associated with cardiovascular events in an asymptomatic population. CDKN2B-AS1 rs4977574 gene expression modulates the progression and severity of vascular calcification in vascular smooth muscle cells (VSMCs), HNF1α-AS1 is an important regulatory molecule in cancer biology and cardiovascular disease (its expression may regulate VSMCs, and high expression promotes atheroprotection). More research is crucial for understand prognosis in asymptomatic population.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPE
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - D Sa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Temtem
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - E Henriques
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - S Borges
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A I Freitas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - G Guerra
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - I Ornelas
- Funchal Hospital, Research Unit , Funchal , Portugal
| | - A Drumond
- Hospital Funchal , Funchal , Portugal
| | - R Palma Dos Reis
- New University of Lisbon, Faculty of Medical Sciences , Lisbon , Portugal
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Rodrigues M, Giri N, Royant A, Zhang Y, Bolton R, Evans G, Ealick S, Begley T, Tews I. Trapping a novel intermediate of vitamin B6 biosynthesis in PLP synthase, using in crystallo spectroscopy. Acta Cryst Sect A 2022. [DOI: 10.1107/s205327332209355x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Dourado E, Freitas R, Martins P, Saraiva L, Santiago T, Guimarães F, Costa E, Esperança Almeida D, Dinis SP, Pinto AS, Daniel A, Genrinho I, Couto M, Rodrigues M, Salvador MJ, Duarte AC, Cordeiro A, Santos MJ, Fonseca JE, Resende C, Cordeiro I. AB0696 Prevalence and clinical associations of different autoantibodies in the Reuma.pt systemic sclerosis cohort: is it all really set in stone? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3389] [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
BackgroundDifferent autoantibodies (Ab) have been associated with distinct systemic sclerosis (SSc) phenotypes. Most of these associations have not been confirmed in Portuguese patients.ObjectivesTo evaluate SSc immuno-clinical associations in the Rheumatic Diseases Portuguese Register (Reuma.pt) cohort.MethodsMulticentre open cohort study including adult SSc patients registered in Reuma.pt up to February 2021. The associations between Ab expression and clinical data were established using Chi-Square, Fischer’s Exact or Mann-Whitney U tests. The Bonferroni correction for multiple comparisons was applied to get α≤0.05. Definite associations were defined by p≤0.002, and likely associations by p≤0.05.Results1080 patients were included, with a mean age and disease duration of 60.2±14.6 and 12.4±10.0 years, respectively. Most were females (87.5%) and had white European ancestry (WEA, 93.2%). The most common disease subtypes were limited cutaneous (lcSSc, 57.4%), diffuse cutaneous (dcSSc, 17.7%), and very early diagnosis of SSc (VEDOSS, 12.3%). Most patients expressed antinuclear Ab (ANA, 93.4%), and the most frequent were anti-centromere (ACA, 54.6%), anti-topoisomerase I (Scl70, 21.8%), and anti-Pm/Scl Ab (PmScl, 4.7%).ACA had definite positive associations with female sex, older age at diagnosis, lcSSc, lower modified Rodnan skin score (mRSS, median 0 vs 4), and isolated sclerodactyly, and likely associations with a higher diagnosis delay, WEA and VEDOSS. ACA had definite inverse associations with flexion contractures (FC), myositis, digital ulcers (DU), and interstitial lung disease (ILD), and likely inverse associations with pitting scars (PS) and oesophageal involvement (OI).Scl70 had definite positive associations with male sex, dcSSc, higher mRSS, FC, DU, PS, ILD, and OI, and likely associations with younger age at diagnosis, tendon friction rubs, active scleroderma pattern in capillaroscopy, and heart involvement.PmScl had a definite association with myositis and likely associations with male sex, calcinosis, joints involvement, and ILD. Anti-U1RNP Ab had definite associations with younger age at diagnosis, MCTD and myositis, and likely associations with a lower diagnosis delay, African ancestry and joint involvement. Anti-RNA polymerase III Ab (RP3) had likely associations with higher mRSS and renal involvement. Anti-U3RNP Ab had a definite association with dcSSc and likely associations with calcinosis and renal involvement. Anti-Th/To Ab had likely associations with male sex and myositis. Anti-Ku Ab had likely associations with systemic lupus erythematosus and mixed connective tissue disease (MCTD) overlap syndromes.ConclusionThere was a higher prevalence of ACA and PmScl compared to other cohorts, most likely due to the high proportion of WEA patients. Most immuno-clinical associations described in the literature apply, including ACA with lcSSc and Scl70 with dcSSc, DU, PS and ILD. However, Scl70+ patients did not have an increased risk of renal involvement, and ACA+ patients did not have an increased risk for calcinosis, PAH or OI, contrary to what was described in the literature. New findings included the association of PmScl with ILD and Scl70 with an active pattern in capillaroscopy. Also, anti-U3RNP+ and Th/To+ patients did not have an increased risk of ILD or PAH, contrarily to what was previously reported. These nuances may be specific to the Portuguese SSc population or signal previously reported associations as geographically specific.Disclosure of InterestsNone declared
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Dourado E, Melo AT, Martins P, Sousa Bandeira MJ, Fraga V, Ferraro JL, Saraiva A, Sousa M, Parente H, Dantas Soares C, Gomes Correia AM, Esperança Almeida D, Dinis SP, Pinto AS, Oliveira Pinheiro F, Rato M, Beirão T, Samões B, Santos B, Mazeda C, Chícharo A, Faria M, Neto A, Fernandes Lourenco MH, Brites L, Rodrigues M, Silva-Dinis J, Madruga Dias J, Araújo F, Martins NF, Couto M, Valido A, Santos MJ, Barreira SC, Fonseca JE, Campanilho-Marques R. POS0891 REUMA.pt/MYOSITIS – THE PORTUGUESE REGISTRY OF INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3259] [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
BackgroundThe idiopathic inflammatory myopathies (IMM) module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) is a tool used to systematically evaluate IIM patients.ObjectivesTo clinically characterise the Reuma.pt/Myositis cohort.MethodsMulticentre open cohort study, including IIM patients registered in Reuma.pt up to January 2022. Data collected included demographic, clinical, and treatment data and patient-reported outcomes. Data were presented as frequencies and median (interquartile range) for categorical and continuous variables, respectively.Results280 patients were included, 71.4% female, 89.4% Caucasian, with a median age at diagnosis and disease duration of 48.9 (33.6-59.3) and 5.3 (3.0-9.8) years, respectively. Patients were classified as having definite (N=57/118, 48.3%; N=35/224, 15.6%), likely (N=23/118, 19.5%; N=50/224, 22.3%), or possible (N=2/118, 1.7%; N=46/224, 20.5%) IIM by 2017 EULAR/ACR and Bohan-Peter criteria, respectively. Disease subtypes included dermatomyositis (DM, N=122/280, 43.6%), polymyositis (N=59/280, 21.1%), myositis in overlap syndromes (N=41/280, 14.6%), clinically amyopathic DM (N=17/280, 6.1%), nonspecific myositis (N=13/280, 4.6%), mixed connective tissue disease (N=12/280, 4.3%), immune-mediated necrotizing myositis (N=9/280, 3.2%), and inclusion bodies myopathy (N=7/280, 2.5%). Over the course of the disease, the most common symptoms were proximal muscle weakness (N=180/215, 83.7%), arthralgia (N=127/249, 52.9%), erythema (N=63/166, 38.0%), fatigue (N=47/127, 37.0%), Raynaud’s phenomenon (N=76/234, 32.5%), and dysphagia (N=33/121, 27.3%), and the most common clinical signs were Gottron’s sign (N=75/184, 40.8%), heliotrope rash (N=101/252, 40.1%), Gottron’s papules (N=93/237, 39.2%), and arthritis (N=38/98, 38.8%). Organ involvement included lung (N=78/230, 33.9%), oesophageal (N=40/221, 18.1%), and heart (N=11/229, 4.8%) involvements. Most patients expressed myositis-specific (MSA, N=158/242, 65.3%) and/or myositis-associated (MAA, 112/242, 46.3%) antibodies. The most frequent antibodies were anti-SSA/SSB (N=70/231, 30.3%), anti-Jo1 (N=56/236, 23.7%), and anti-Mi2 (N=31/212, 14.6%). Most patients had a myopathic pattern on electromyogram (N=101/138, 73.2%), muscle oedema in magnetic resonance (N=33/62, 53.2%), and high CK (N=154/200, 55.0%) and aldolase levels (N=74/135, 54.8%) at diagnosis, with median highest CK levels of 1308 (518-3172) and aldolase of 42 (12-121) mg/dL. Neoplasia was found in 11/127 patients (8.7%), most commonly breast (N=3/11, 27.3%), non-melanoma skin (N=2/11, 18.2%), and colorectal (N=2/11, 18.2%) cancer (Table 1). Most patients with cancer-associated myositis had DM (N=8/11, 72.7%) and expressed MSA (N=6/11) and/or MAA (N=3/11). The most used drugs over the course of disease were glucocorticoids (N=201/280, 71.8%), methotrexate (N=117/280, 41.8%), hydroxychloroquine (N=87/280, 31.1%), azathioprine (N=85/280, 30.4%), mycophenolate mofetil (N=56/280, 20.0%), intravenous immunoglobulin (N=55/280, 19.6%), and rituximab (N=45/280, 16.1%). At the last follow-up, there was a median MMT8 of 150 (142-150), modified DAS skin of 0 (0-1), global VAS of 10 (0-50) mm, and HAQ of 0.125 (0.000-1.125).Table 1.Autoantibodies in cancer-associated myositisCancerIIMAutoantibodiesBreastDM (3)Mi2, SRP (+ SSA/SSB), Pm/SclSkin (non-melanoma)Clinically amyopathic DM, PMJo1, SAE1 (+SSA/SSB)ColorectalDM (2)Mi2 (2)KidneyDM-LungDM-LymphomaInclusion bodies myopathy-UnknownDM-ConclusionReuma.pt/Myositis adequately captures the main features of inflammatory myopathies’ patients, depicting in this first report a heterogeneous population, with frequent muscle, joint, skin and lung involvements. Of interest, most patients reached low disease activity at the last follow-up appointment.Disclosure of InterestsNone declared
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Sousa M, Martins P, Santos B, Costa E, Cunha Santos F, Freitas R, Faria M, Martins FR, Rodrigues M, Santiago T, Da Silva JAP, Inês L. POS0861 ANTI-Ku ANTIBODY SYNDROME: IS IT A DISTINCT CLINICAL ENTITY? A CLUSTER ANALYSIS OF 75 PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1421] [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
BackgroundAnti-Ku antibodies are rare among patients with Connective Tissue Diseases (CTD) (1). Their potential role as a disease biomarker is not well established.ObjectivesTo identify subgroups of anti-Ku positive patients according to their spectrum of anti-nuclear antibody (ANA) specificities and analyze their clinical and analytical features.MethodsMulticenter, cross-sectional study of anti-Ku positive patients, irrespective of their diagnosis, followed at eight Rheumatology outpatient clinics. Patients were spontaneously identified according to the local work-out for suspected autoimmune diseases. Anti-Ku and other ANA specificities were determined at each hospital’s Immunology lab according to the local methodology and strategy to decide on which auto-antibodies to check when faced with a positive ANA immunofluorescence. Clinical, analytical and treatment cumulative features were identified following a dedicated structured questionnaire. Hierarchical cluster analysis (method: between-groups linkage, squared Euclidian distance) for ANA specificity variables was performed to identify subgroups.ResultsSeventy-five anti-Ku positive patients were included (female: 73.3%, mean age at diagnosis: 50.5±17.9 years, mean disease duration: 4.7±5.4 years). Their clinical diagnosis were undifferentiated connective tissue disease (UCTD) (21.3%), systemic lupus erythematosus (17.3%), Sjögren’s syndrome (16.0%), inflammatory myositis (14.7%), systemic sclerosis (10.7%), overlap CTD syndrome (8.0%), other connective tissue diseases (17.3%), healthy anti-Ku carrier (17.3%).Six autoantibody clusters were identified and included most patients (Figure 1): Cluster 1 - anti-Ku without any other ANA specificities (36.0%); cluster 2 - Anti-nor90 and anti-fibrillarin (8.0%); cluster 3 - anti-Jo1, PL-7, PL-12, and PM-Scl100 (9.3%); cluster 4 - anti-Scl70 (4.0%); cluster 5 - anti-Sm, anti-ribosome, and anti-dsDNA (13.3%); cluster 6 - anti-centromere, Th/To, PM-Scl75 (8.0%). The remaining patients were outliers (21.3%) not fitting in any cluster.Figure 1.Hierarchical cluster analysis of ANA specificities in anti-Ku+ patientsDetailed clinical analysis of patients in cluster 1, the most numerous, presenting anti-Ku antibodies without any other ANA specificities, the most frequent clinical manifestations were: Raynaud’s phenomenon (40.7%), arthritis (25.9%), sicca syndrome (25.9%), myositis (14.8%), and interstitial lung disease (ILD) (14.8%); 25.9% were healthy anti-Ku carriers. Patients from cluster 1 were most frequently treated with low dose glucocorticoids (51.9%), hydroxychloroquine (37.0%), or methotrexate (18.5%).Among the whole study population (n=75), major organ involvement was present in 18.7%, with ILD in 10.7% and renal involvement in 8.0%. None of the patients in cluster 1 presented nephritis.ConclusionAnti-Ku positive patients without any other ANA specificities is the largest subset and may represent a distinct entity among the differentiated CTD (2). Patients with this anti-Ku syndrome may develop ILD. In addition, anti-Ku antibodies can be found in patients with a diversity of other ANA specificities and heterogeneous CTD diagnosis.References[1]Lakota K, et al. International cohort study of 73 anti-Ku-positive patients: association of p70/p80 anti-Ku antibodies with joint/bone features and differentiation of disease populations by using principal-components analysis. Arthritis Res Ther. 2012 Jan 6;14(1):R2. doi: 10.1186/ar3550. PMID: 22226402; PMCID: PMC3392788.[2]Spielmann L, et al. Anti-Ku syndrome with elevated CK and anti-Ku syndrome with anti-dsDNA are two distinct entities with different outcomes. Ann Rheum Dis. 2019 Aug;78(8):1101-1106. doi: 10.1136/annrheumdis-2018-214439. Epub 2019 May 24. PMID: 31126956.Disclosure of InterestsNone declared
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Santos B, Cardoso I, Miranda S, Aguiar F, Rodrigues M, Brito I. POS1282 PEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME TEMPORALLY-ASSOCIATED WITH SARS-CoV-2 – A PORTUGUESE SINGLE CENTRE CASE SERIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5188] [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
BackgroundAcross the globe, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 appears to affect paediatric population in a milder and nonthreatening way, when compared to adults. However, since April 2020 case reports of previously healthy children presenting with unremitting fever, biologic inflammatory syndrome and cardiac dysfunction have been emerging. This syndrome, which has been termed Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMS-TS), represents a rare complication of COVID-19 in children1.ObjectivesTo describe the clinical, laboratory and imaging characteristics, course, management and outcomes of hospitalized children diagnosed with PIMS-TS in a Portuguese tertiary care hospital.MethodsA retrospective study including children (< 18 years) that attended our hospital from April 2020 to December 2021 was performed. All the children included fulfilled the case definition of PIMS-TS published by the Centre for Disease Control and Prevention. Sociodemographic and clinical data, laboratory markers and imaging findings were collected.ResultsA total of 19 children met the criteria for PIMS-TS, 68% male with a mean age at diagnosis of 8 years old (IQR 5.8-15). They were all caucasian, except for a mixed-race patient, and all previously healthy, except one patient who was obese. Twelve had recent infection by SARS-CoV-2 detected by reverse transcriptase (RT) PCR and 18 had positive IgG serology.All had fever at diagnosis, with a median duration of 6 days (IQR 5-6) and 89.5% had mucocutaneous, gastrointestinal and hematological attainment, respectively. Other affected systems were respiratory (73.7%), cardiovascular (63%), lymphoid organs (52.6%), musculoskeletal (47%), genito-urinary (31.6%) and neurological (26.3%). Laboratory findings can be found in Table 1.Thirty-six percent were admitted in intensive care unit for a median duration of 8 days (IQR 4-9). 42.1% needed respiratory support, 87.5% with supplemental oxygen therapy, 62.5% with mechanical ventilation and 12.5% with non-invasive ventilation. All patients received intravenous (IV) immunoglobulin, 52.6% IV corticosteroid (CS) pulses and 78.9% IV and oral CS. Other treatments included acetylsalicylic acid (n=18), heparin (n=8) and antibiotic therapy (n=19) - Table 3. Seventeen fully recovered and 2 had sequalae: one of them with coronary artery aneurysms and other exertional dyspnea.ConclusionIn this case series, there was a broad spectrum of clinical symptoms and disease severity, ranging from fever and systemic inflammation to critical care admission with myocardial injury, shock, and development of coronary artery aneurysms.Despite short-term morbidity, there were no mortality cases, with most of them recovering without sequelae. All physicians providing clinical care to children should consider this rare but severe delayed syndrome in paediatric population.References[1]Ramcharan T, Nolan O, Lai CY et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020 Oct;41(7):1391-1401.Characters from table content including title and footnotes: 710Disclosure of InterestsNone declared
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Klaassen L, Jaarsma-Coes M, Verbist B, Vu K, Klaver Y, Rodrigues M, Ferreira T, Nabarro C, Luyten G, Rasch C, van Herk M, Beenakker J. MO-0211 Inter-observer variability in MR-based target volume delineation of uveal melanoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02313-1] [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: 10/18/2022]
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Hol M, Rodrigues M, Klaver Y, Spruijt K, Kouwenberg J, Astreinidou E, Rasch C. PO-1484 Accuracy of inter-fraction patient positioning in Ocular Proton Therapy (OPT). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03448-x] [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: 11/16/2022]
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Horeweg N, Verbeek E, Vu K, Marinkovic M, Bleeker J, Rodrigues M, Klaver Y, Beenakker J, Luyten G, Rasch C. PO-1429 First results of the Leiden-Holland Proton Therapy Center collaboration for uveal melanoma treatment. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03393-x] [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: 10/18/2022]
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Meira de Carvalho M, Rodrigues M, Ferreira A, Costa A, Nazaré A. 203 Off-label use of femostop® to treat postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.250] [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: 11/16/2022]
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Pereira Amaral P, Rodrigues M, Matos F, Costa A, Nazaré A. 61 Arabin pessary: 5 Years experience of a terciary hospital. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.193] [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: 11/16/2022]
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Arros M, Santos I, Henriques M, Rodrigues M, Nascimento S, Landim E, Costa A, Nazaré A. 320 Intrahepatic cholestasis of pregnancy and associated maternal-fetal morbidity –experience of six years (2015-2020) of a terciary hospital. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.300] [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: 11/26/2022]
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FIGUEIREDO D, Bártolo A, Sousa H, Rodrigues M, Ribeiro O. POS-767 EFFECTIVENESS OF ICT-BASED INTERVENTIONS FOR PROMOTING MEDICATION ADHERENCE IN KIDNEY TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.803] [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: 10/19/2022] Open
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FIGUEIREDO D, Sousa H, Bártolo A, Oliveira J, Rodrigues M, Paúl C, Costa E, Ribeiro F, Ribeiro O. POS-937 “#LOOKING_TO_STAY_CONNECTED”: CHARACTERISTICS OF PATIENTS WITH ESRD AND FAMILY CAREGIVERS WHO SIGNED UP FOR AN ONLINE INTERVENTION DURING THE COVID-19 PANDEMIC. Kidney Int Rep 2022. [PMCID: PMC8854884 DOI: 10.1016/j.ekir.2022.01.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kiernan MD, Rodrigues M, Mann E, Stretesky P, Defeyter MA. The Map of Need: identifying and predicting the spatial distribution of financial hardship in Scotland's veteran community. BMJ Mil Health 2022; 168:57-63. [PMID: 33664091 PMCID: PMC8788048 DOI: 10.1136/bmjmilitary-2020-001718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION During military service, many household costs for both married and single service personnel are subsidised, and transition can leave veterans unprepared for the financial demands of civilian life. Armed Forces organisations such as Sailor, Soldier, Air Force Association (SSAFA) play a central role in understanding the financial challenges that UK veterans face and provide an insight into the financial hardship experienced by veterans. The aim of this study was to use SSAFA beneficiary data as a proxy to identify the nature of financial benefit, the spatial distribution of financial hardship in the Scottish SSAFA beneficiary community and explore factors that might predict where those recipients are located. METHODS Using an anonymised data set of Scottish SSAFA financial beneficiaries between 2014 and 2019, this study used a geographical methodology to identify the geospatial distribution of SSAFA benefit recipients and exploratory regression analysis to explore factors to explain where SSAFA beneficiaries are located. RESULTS Over half of benefit applicants (n=10 735) were concentrated in only 50 postcode districts, showing evidence of a clustered pattern, and modelling demonstrates association with area-level deprivation. The findings highlight strong association between older injured veterans and need for SSAFA beneficiary assistance. CONCLUSION The findings demonstrate that beneficiaries were statistically clustered into areas of high deprivation, experiencing similar challenges to that of the wider population in these areas. Military service injury or disability was strongly associated with areas of high SSAFA benefit use and in those areas high unemployment was also a significant factor to consider.
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Affiliation(s)
- Matthew D Kiernan
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - M Rodrigues
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - E Mann
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - P Stretesky
- Department of Social Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - M A Defeyter
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
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Barbirato DS, Fogacci M, Rodrigues M, Vasconcelos BE, de Barros M, Pires F. Lateral periodontal cyst: A rare clinicopathological presentation mimicking a residual cyst. J Clin Exp Dent 2022; 14:e95-e99. [PMID: 35070130 PMCID: PMC8760967 DOI: 10.4317/jced.58668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022] Open
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Rocha M, Serronha A, Rodrigues M, Alves PC, Monterroso P. Comfort over safety: thermoregulation overshadows predation risk effects in the activity of a keystone prey. J Zool (1987) 2021. [DOI: 10.1111/jzo.12947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. Rocha
- Escola de Ciências Universidade do Minho Braga Portugal
| | - A. Serronha
- Centro de Investigação em Biodiversidade e Recursos Genéticos InBIO Laboratório Associado Universidade do Porto CIBIO Vairão Portugal
- BIOPOLIS Program in Genomics Biodiversity and Land Planning CIBIO Vairão Portugal
| | - M. Rodrigues
- Centro de Investigação em Biodiversidade e Recursos Genéticos InBIO Laboratório Associado Universidade do Porto CIBIO Vairão Portugal
- BIOPOLIS Program in Genomics Biodiversity and Land Planning CIBIO Vairão Portugal
- Estação Biológica de Mértola (EBM) Mértola Portugal
| | - P. C. Alves
- Centro de Investigação em Biodiversidade e Recursos Genéticos InBIO Laboratório Associado Universidade do Porto CIBIO Vairão Portugal
- BIOPOLIS Program in Genomics Biodiversity and Land Planning CIBIO Vairão Portugal
- Estação Biológica de Mértola (EBM) Mértola Portugal
- Departamento de Biologia Faculdade de Ciências Universidade do Porto Porto Portugal
- Wildlife Biology Program Department of Ecosystem and Conservation Sciences W.A. Franke College of Forestry and Conservation University of Montana Missoula MT USA
| | - P. Monterroso
- Centro de Investigação em Biodiversidade e Recursos Genéticos InBIO Laboratório Associado Universidade do Porto CIBIO Vairão Portugal
- BIOPOLIS Program in Genomics Biodiversity and Land Planning CIBIO Vairão Portugal
- Estação Biológica de Mértola (EBM) Mértola Portugal
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Rodrigues M, Teles P, Pirraco R, Oliveira D, Costa P. Evaluation of fractionation schemes in breast cancer radiotherapy and dosimetric study of the main organs at risk. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Loap P, Loirat D, Berger F, Rodrigues M, Bazire L, Pierga J, Ricci F, Cao K, Vincent-Salomon A, Laki F, Ezzili C, Raizonville L, Mosseri V, Neffati S, Ezzalfani M, Fourquet A, Kirova Y. One-Year Toxicity Report of the RADIOPARP Phase I Trial Evaluating Olaparib With Radiotherapy for Triple Negative Breast Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bezerra I, Rodrigues M, Sousa EM, Malicia J, Prestes R, Rêgo RC, Mendes A, Sousa A, Nassar Junior AP, Pereira AJ. Patient-level costs in intensive care: a case report of a standardized and scalable approach. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Intensive care units (ICU) costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs (Value-Based Healthcare).
Methods
Case report of a costing methodology implementation, in a 15-bed ICU, in a public, teaching hospital at Teresina/Piauí-Brazil (as part of a broader initiative, with 10 hospitals from all Brazilian regions). All costs incurred during ICU stay were measured from the hospital perspective, applying absorption costing method, by using a standardized approach and a specific central IT system. The study was carried out from Oct/19-Sep/20, including 613 patients, and a team of 10 researchers working with 4 teams of the local hospital (costs, IT, ICU and managers).
Results
ICU fixed costs (personnel, overheads, energy/water, depreciation, non-tracked drugs/medical materials), were divided by service capacity (total bed-hours) for calculation of the costs/minute. Costs were then allocated in the patient level multiplying costs/minute by the ICU length of stay. Variable costs (lab/image tests, transfusions, hemodialysis, and traceable medical materials/drugs) were directly allocated, multiplying the unit cost by the volume consumed per patient. A mini-survey applied 1-year after showed that both cost researchers and hospital staff agreed on the main challenges in measuring patient-level costs (fragmented process; fixed costs available only at the hospital level; lack of control on cost-drivers; indirect costs not considered; any reference for lab/image costs) and that the approach was sufficient to overcome them. The local team also reported increased awareness about the importance of patient-level costs after the experience.
Conclusions
The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
Key messages
ICU costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs. The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
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Affiliation(s)
- I Bezerra
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M Rodrigues
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - EM Sousa
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - J Malicia
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - R Prestes
- Hospital of the Federal University of Piauí, Teresina, Brazil
| | - RC Rêgo
- Hospital of the Federal University of Piauí, Teresina, Brazil
| | - A Mendes
- Hospital of the Federal University of Piauí, Teresina, Brazil
| | - A Sousa
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - AP Nassar Junior
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - AJ Pereira
- Impacto-MR Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Temtem M, Serrao M, Mendonca MI, Santos M, Sousa JA, Mendonca F, Sousa AC, Freitas S, Henriques E, Rodrigues M, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Is there a different impact of traditional risk factors on calcium score, in an asymptomatic population? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The coronary calcium score has been increasingly used to stratify and predict cardiovascular risk, particularly in low and intermediate-risk persons. Understanding which determinants have more impact on coronary calcium score level, could lead to the development of new stricter preventive measures for reducing coronary artery calcification (CAC) and, consequently, cardiovascular risk.
Purpose
Our study aimed to investigate the impact of the traditional risk factors (TRFs) on the CAC score level and if there is a different association between this TRFs and CAC score degrees, in an asymptomatic population.
Methods
The study cohort comprised 1,122 consecutive asymptomatic individuals without known coronary artery disease (CAD) belonging to the healthy controls of GENEMACOR study and referred for computed tomography for CAC scoring assessment. The traditional risk factors considered were (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary artery disease. According to the Hoff's nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). We evaluated the association of the different TRFs with these levels of CAC score (Chi-square test). Finally, we performed a logistic regression model adjusted for all significant TRFs selected in the bivariate analyses.
Results
Smoking was significantly associated with high levels of CAC score, 28.4% vs 21.7%; p=0.038 as well as hypertension, 58.8% vs 45.6%; p=0.001, type 2 diabetes 21.1% vs 9.6%; p<0.0001, dyslipidemia, 73.0% vs 66.1%; p=0.057. Family history did not show a significant association with CAC (p=0.717). Then, we constructed a logistic regression model adjusted the significant risk factors in previous analysis. The final multivariate analysis, selected as independent predictors of high CAC: Type 2 diabetes; OR=2.309; 95% CI 1.533–3.479; p<0.0001, hypertension; OR=1.627; 95% CI 1.185–2.233; p=0.003, and smoking, OR=1.565; 95% CI 1.102–2.222; p=0.012.
Conclusions
In this study, well-known and modifiable cardiovascular risk factors are associated with high calcium score levels. However, hypertension and diabetes seem to be preferentially associated with higher CAC scores, while tobacco, although it has a significant association, seems to be not so strong as diabetes and hypertension. This concept may mean that smoking has its primary role in plaque instability and not so much in the growing and calcification of plaques.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Serrao
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Temtem M, Serrao M, Mendonca MI, Santos M, Sousa A, Mendonca F, Sousa AC, Henriques E, Freitas S, Rodrigues M, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Is HNF4A gene, a risk factor or protection against coronary artery disease? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Hepatocyte nuclear factor4 A (HNF4A) gene was considered by GWAS associated with atherosclerosis and CAD susceptibility. Loss-of-function mutations in human hepatocyte nuclear factor 4α (HNF4α), a transcriptor factor encoded by the HNF4A gene, are associated with maturity-onset diabetes of the young and lipid disorders. However, the mechanisms underlying the lipid disorders are poorly understood.
Aim
We propose identifying the genetic predisposition to atherosclerosis progression and events occurrence or regression and better prognosis, through a cohort study from GENEMACOR population.
Methods
We investigated a cohort of 1,712 patients who underwent coronary angiography with more than 70% stenosis of at least one main coronary vessel. 33 SNPs associated with the risk of CAD in previous GWAS were genotyped by TaqMan assays methodology. We evaluated the best genetic model associated with CAD prognosis (events) with a 95% CI in bivariate analysis. The hazard function was performed by a Cox survival regression model adjusted for age, sex, type 2 diabetes, hypertension, and hypercholesterolemia, to evaluate their relationship with the event's incidence. Finally, we constructed Kaplan–Meier cumulative-event curves for the significant genetic variants.
Results
Our evaluation revealed a SNP paradoxically associated with protection from atherosclerosis progression and events occurrence: rs1884613 C>G in the HNF4A gene on chromosome 20 dominant model [OR=0.653; 95% CI (0.522–0.817); p=0.0002]. Cox survival regression model showed a CAD protective effect of HNF4A with a Hazard ratio (HR) of 0.771; p=0.007. The Kaplan-Meier cumulative event analysis disclosed that the CG+GG vs CC genotype of rs1884613 HNF4α was associated with a better prognosis (Breslow test, p=0.004) at the end of the follow-up.
Conclusion
We identified, in this study, one SNPs paradoxically associated with a better CAD prognosis rs1884613 in HNF4A. The HNF4A gene variants could induce loss of HNF4α function, modifying and modulating hepatic lipase and lipid metabolism conferring a beneficial effect on atherosclerosis progression and events occurrence.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Serrao
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Sousa JA, Mendonca MI, Santos M, Temtem M, Mendonca F, Sousa AC, Rodrigues M, Freitas S, Henriques E, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Epicardial adipose tissue volume improves cardiovascular risk reclassification: the Framingham Risk Score example. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Epicardial adipose tissue (EAT) volume can be noninvasively detected by CT and has been suggested to predict major adverse cardiovascular events (MACE). Framingham Risk Score is one of a number of scoring systems used to determine an individual's chances of developing cardiovascular disease, hence identifying who is most likely to benefit from prevention.
Objectives
The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on EAT volume, in comparison to a traditionally known cardiovascular risk score, such as the Framingham.
Methods
895 asymptomatic volunteers were prospectively enrolled in a single Portuguese center (mean age 51.9±7.7, 78.5% male) and underwent a median follow-up time of 3.7 years (IQR 5.0). EAT volume was measured by Cardiac Computed Tomography (CCT) using a modified simplified method. For NRI assessment, EAT volume as a continuous variable was added to the Framingham Risk Score.
Results
After 3.7 median years of follow-up, 27 patients developed a MACE. Using NRI, the net proportion of events (netNRIe) that assigned a higher risk was 33.3% (better reclassified), and the net ratio of non-events (netNRIne) was 24.7%, resulting in a net reclassification index (netNRI) of 58.0%. When the new marker was included in the model, 58.0% of patients were better reclassified. In our work, a total of 33.3% of patients who suffered events (n=27) were correctly reclassified and assigned a higher risk.
Conclusion
EAT volume results in a high reclassification rate in an asymptomatic, low-risk population, demonstrating the benefit of this marker beyond traditional risk assessment models. Our study supports its application, especially in carefully selected individuals.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Temtem M, Serrao M, Mendonca MI, Santos M, Sousa JA, Mendonca F, Sousa AC, Rodrigues M, Freitas S, Henriques E, Borges S, Guerra G, Drumond A, Palma Dos Reis R. The significant role of coronary artery calcification score in asymptomatic patients with metabolic syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Metabolic syndrome (MetS) is a clinical condition composed of metabolic and cardiovascular risk factors, such as abdominal obesity, hyperglycemia, dyslipidemia and hypertension. Many patients with MetS suffer major adverse cardiovascular events (MACE) that are not adequately identified by traditional risk assessment, suggesting the need for early detection of subclinical coronary heart disease to identify those at high-risk. Coronary artery calcification (CAC) screening has added utility in categorizing patients with low, intermediate and high cardiovascular risk.
Purpose
Evaluate the prognostic role of CAC score in asymptomatic population patients with metabolic syndrome in cardiovascular events risk prediction.
Methods
A total of 1,122 asymptomatic individuals without known coronary heart disease, enrolled from GENEMACOR study, were followed for a mean of 5.3±3.4 years for the primary endpoint of all-cause of cardiovascular events. All were referred for computed tomography for the CAC scoring assessment. According to the Hoff's nomogram, 3 categories were created: low CAC (0≤CAC<100 or P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). In a subgroup of 507 individuals with MetS and 615 controls, CAC values were compared by T-student and association of CAC severity with events occurrence was evaluated. Finally, a logistic regression model adjusted for CAC severity was performed in patients with MetS.
Results
Among our population, the extent of CAC differs significantly between men and women in the same age group. Patients with Mets (23.2%, n=115) had higher CAC scores than controls (219.0±486.0 vs 115.8±370.8, p<0.0001). In this cohort, with higher CAC scores, 46.7% vs 22.5% had MACEs (p=0.049) during the follow-up. The logistic regression analysis revealed that CAC≥400 is a MACE predictor (OR=4.326, CI 95% 1.241–15.080, p=0.021) in patients with MetS.
Conclusion
Our results point to the importance of the inclusion of CAC screening in patients with MetS to further stratify those patients that, despite tight control of cardiovascular risk factors, may benefit from more intensive therapies. This tool is a useful and straightforward method that could have a significant impact on the prognosis of future cardiovascular disease in patients with MetS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Serrao
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Sousa A, Mendonca MI, Santos M, Temtem M, Mendonca F, Sousa AC, Rodrigues M, Freitas S, Henriques E, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Epicardial adipose tissue (EAT) volume is related to subclinical atherosclerosis and major adverse cardiovascular events (MACE) in asymptomatic subjects. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Epicardial adipose tissue (EAT) is an emerging cardiovascular risk marker. It has been suggested to be an inflammatory mediator with a role in subclinical atherosclerosis and coronary artery disease. However, its prognostic relevance in hard clinical outcomes remains thoroughly unexplored in the literature.
Purpose
Evaluate the prognostic relevance of EAT, regarding the occurrence of major adverse cardiovascular events (MACE) in an asymptomatic population.
Methods
895 asymptomatic volunteers were prospectively enrolled in a single Portuguese center (mean age 51.9±7.7, 78.5% male) and underwent a median follow-up time of 3.7 years (IQR 5.0). EAT volume was measured by Cardiac Computed Tomography (CCT) using a modified simplified method. Participants were distributed into two groups, above and below the EAT-volume median. We compared both groups regarding the occurrence of MACE through univariate analysis, Kaplan-Meier Survival curves and log-rank test. Association to subclinical atherosclerosis was addressed using correlation between EAT volume and calcium score (Agatson).
Results
There is a strong correlation between EAT volume and calcium score (r=0.205, p<0.0001), sustaining that it may play an important role in mediating coronary artery disease and subclinical atherosclerosis. Patients with higher EAT volume, were exposed to higher occurrence of MACE on follow-up [70.4% (19 of 27) vs 49.4% (429 of 868), p=0.032] with a clearer separation of the curves after 5.7 years.
Conclusion
In an asymptomatic population, EAT volume seems to be related to subclinical atherosclerosis and to the occurrence of adverse cardiovascular events on long-term follow-up. Our study addresses some unanswered questions, such as the prognostic relevance of EAT as an emerging cardiovascular risk marker.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Temtem M, Mendonca MI, Soares C, Serrao M, Rodrigues R, Santos M, Sousa JA, Mendonca F, Sousa AC, Rodrigues M, Henriques E, Freitas S, Drumond A, Palma Dos Reis R. Does coronary calcium score add value to European SCORE in an asymptomatic population? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction in the asymptomatic population. Adding CAC score to European SCORE (Systematic Coronary Risk Evaluation) may improve the prediction of MACE (Major Adverse Cardiovascular Events), providing better cardiovascular risk stratification.
Purpose
Our study aims to evaluate the impact of CAC severity in MACE prediction compared with SCORE and estimate the additional value of CAC score in cardiovascular risk stratification in a low- risk region and asymptomatic population.
Methods and results
The study consisted of a prospective registry of 1110 asymptomatic individuals free of known coronary heart disease, enrolled from the GENEMACOR study and referred for computed tomography for the CAC scoring assessment. The mean age was 51.6±8.2 years, and 74.1% were male. This population was followed for a mean of 5.2±3.3 years for the primary endpoint of all-cause of cardiovascular events. The extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done using Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high CAC (CAC≥400 or P>75). Through a Cox regression for MACE occurrence, SCORE does not remain in the equation, and the higher severity level of CAC presented a significant risk of MACE occurrence with an HR of 7.943 (95% CI 2.948 – 21.401; p<0.0001). Using the C-index, CAC was superior to SCORE (0.729 vs 0.615; p<0.0001). Adding CAC score to SCORE increased MACE prediction compared to SCORE alone (AUC 0.77 vs 0.615; p=0.003).
Conclusion
Our results point to the importance of the CAC score inclusion in primary prevention to improve cardiovascular risk stratification. CAC score in clinical practice could have a prognostic impact on MACE prediction. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - C Soares
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M Serrao
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - R Rodrigues
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Santos M, Mendonca MI, Temtem M, Sousa JA, Mendonca F, Sousa AC, Freitas S, Henriques E, Rodrigues M, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Assessing the clinical utility of a genetic risk score associated with type 2 diabetes in a southern European population. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The development of personalized susceptibility profiles based on genetic information to aid prediction, early detection and prevention of type 2 diabetes (T2D) with potential clinical application, begins to awaken interest in the scientific community. However, its clinical translation is controversial.
Objective
Evaluate the clinical utility of a genetic risk score (GRS) created with the GWAS-derived genetic variants associated to T2D to predict and discriminate the susceptibility to Type 2 diabetes, in a Southern European population with and without T2D.
Methods and results
We studied through a case-control with 3,139 subjects (772 with T2D and 2,367 without) the usefulness of implementing a GRS in clinical practice. We constructed a multiplicative GRS (mGRS) calculated using 10 SNPs of genetic loci robustly associated to T2D (HNF4A rs1884613, IGF2BP2 rs4402960, PPARG rs1801282, TCF7L2 rs7903146, SLC30A8 rs1326634, MC4R rs17782313, ADIPOQ rs266729, FTO rs8050136, TAS2R50 rs1376251 and APO E rs7412 and rs429358), to evaluate the prediction and discrimination of T2D. Two logistic regression models were performed the first with age, sex and BMI. The second with these three risk factors plus hypertension, LDL >130mg/dl and physical inactivity. Logistic regression models, receiver operating characteristic analyses (ROC curve) were used. Each model was analysed individually and added with mGRS to calculate the area under the ROC curve (AUC), which may be considered a global estimate of each model's predictive power. The inclusion of GRS in the first model increased the discriminative power of T2D (AUC=0.669 to 0.692; p<0.0001. In the second model, the increase was AUC=0.712 to 0.729; p<0.0001.
Conclusions
Adding genomic information to traditional models improves the ability to predict and discriminate type 2 Diabetes slightly, compared to traditional models alone. Nevertheless, this increase is not sufficiently robust for translation in clinical practice. However, clinicians should be conscious that T2D genetic research is experiencing a dramatic revolution and stay optimistic that these innovative studies translate into improved care for diabetic patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Mendonca F, Mendonca MI, Santos M, Temtem M, Sousa JA, Sousa AC, Henriques E, Freitas S, Rodrigues M, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Genomic prediction of cardiovascular events in a coronary Southern European population. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Traditional and clinical risk factors are indicators of atherosclerosis over time and strong independent predictors of cardiovascular events, but it is unknown whether other genetic markers could provide information about the evolution of atherosclerotic coronary artery disease (CAD).
Objective
We propose identifying the genetic predisposition to atherosclerotic plaque progression and events occurrence, through a study cohort from GENEMACOR study population.
Methods
We performed a study with a cohort of 1,712 patients who underwent coronary angiography with more than 70% stenosis of at least one main coronary vessel, during a mean follow-up of 5 years (amplitude range 20 years). 33 SNPs associated with risk of CAD in previous GWAS, were genotyped by TaqMan assays methodology. The best model in the bivariate analysis at 95% CI with all genetic variants was generated, to investigate their association with prognostic and events occurrence. The hazard function at a set of confounding-variables was determined to evaluate their relationship with the event's incidence by the Cox survival analysis regression model. Finally, we constructed Kaplan–Meier cumulative-event curves for the significant variants.
Results
The analysis revealed two SNPs associated with the progression of atherosclerosis and events occurrence: rs12190287 G>C in the TCF21 gene on chromosome 10 (dominant model; OR=1.542; 95% CI 1.069 – 2.224; p=0.020) and the rs1333049 G>C in the CDKN2-AS1 gene on chromosome 9 (recessive model; OR=1.228; 95% CI 1.001 – 1.518; p=0.050). The Kaplan-Meier cumulative event curves in the TCF21 variant rs12190287 G> C showed that the GC+CC vs GG genotype was associated with a worse prognosis (log-rank test, p=0.016) and the CDKN2B-AS1 rs1333049 G> C revealed that the CC vs GG+GC genotype also presented severe prognosis and more events at the end of the follow-up period (log-rank test, p=0.046).
Conclusion
We have identified two SNPs associated with the prognosis of CAD, rs12190287 of TCF21 gene and rs1333049 of CDKN2-AS1 gene. Both are in non-coding enhancer regions and regulate transcriptional mechanisms shared among multiple CAD risk loci and could provide new insights into CAD's pathophysiology identifying core mechanisms for therapeutic intervention modulating the disease risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Mendonca F, Mendonca MI, Temtem M, Santos M, Sousa JA, Sousa AC, Henriques E, Freitas S, Rodrigues M, Borges S, Guerra G, Drumond A, Palma Dos Reis R. A genetic risk score predicts recurrent events after myocardial infarction in young patients with a low level of traditional risk factors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary Heart Disease (CAD) is a multifactorial disease, including environmental and genetic risk factors. Current smoking, dyslipidemia and diabetes have a significant impact in long- term mortality and morbidity. However, several genetic variants associated with CAD but not with traditional risk factors (TRFs) has been reported to improve prediction of events and extended mortality, in younger CAD people.
Aim
To evaluate the clinical utility of a GRS composed by variants from GWAS associated to CAD but not with TRF to predict life-long residual risk in patients under 55 years old and a low level of TRFs.
Methods
We conducted a prospective study with 573 consecutive patients aged <55 years presenting with AMI and a low level of TRFs (without diabetes and with LDL cholesterol >150 mg/ml). We analysed several biochemical markers and performed a GRS with variants not associated with TRFs (TCF21 rs12190287, CDKN2B-AS1 rs1333049, CDKN2B rs4977574, PHACTR1 rs1332844, MIA3 rs17465637, ADAMTS7 rs3825807, ZC3HC1 rs11556924, SMAD3 rs17228212 and GJA4 rs618675). We studied the GRS association with a primary composite endpoint of all-cause vascular morbidity and mortality including recurrent acute coronary syndrome (myocardial infarct and unstable angina), coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), re-hospitalization for heart failure, ischemic stroke and cardiovascular dead.
Results
A total of 573 patients were studied and followed up for a mean of 4.7±4.0 years. There were 169 recurrent cardiovascular events. The GRS was sub-divided into terciles, verifying that patients in the third tercile (high risk) had a higher number of risk alleles. Compared with the low-risk GRS tercile, the multivariate-adjusted HR for recurrences was 1.520 (95% CI 1.011–2.286); p=0.044 for the intermediate-risk group and was 2.051 (95% CI 1.382–3.044); p<0.0001 for the high-risk group. Inclusion of the GRS in the model with TRFs alone (low risk) improved the C-statistic analysis (C-statistic = 0.030; p=0.004), cNRI (continuous net reclassification improvement) (30.8%), and the IDI (integrated discrimination improvement index) (0.022).
Conclusions
A multilocus GRS may identify young coronary disease patients with a low level of TRFs but at significant risk of long-term events recurrence. The genetic information may improve prediction discrimination, and reclassification over the conventional risk factors alone, providing better cost-effective therapeutic strategies.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- F Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Soares C, Temtem M, Mendonca MI, Sousa JA, Santos M, Sousa AC, Rodrigues M, Henriques E, Freitas S, Borges S, Guerra G, Drumond A, Palma Dos Reis R. Comparison between a genetic risk score and the European SCORE in cardiovascular events prediction in a primary prevention population. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The risk for Coronary Artery Disease (CAD) can be estimated using different scores, such as the European SCORE (Systematic Coronary Risk Evaluation) scale or genetic risk score (GRS). The addition of GRS to the European SCORE may increase the precision of predicting MACE (Major Adverse Cardiovascular Events).
Purpose
This study aims to compare the European SCORE and the multiplicative genetic risk score (mGRS) in predicting MACE.
Methods and results
The study included 1110 asymptomatic individuals without known CAD from GENEMACOR prospective registry. We defined the primary endpoint of all-cause cardiovascular events.
The study population had mean age of 51.6 years, 74.1% male and had risk factors of diabetes (11.6%), dyslipidemia (67.5%), hypertension (48.1%) and smoking (22.9%). Using C-index methodology, mGRS score was superior to SCORE in predicting MACE (mGRS = 0.832 Vs SCORE = 0.615; p=0.014).
Conclusions
The mGRS score was superior to SCORE in predicting MACE in an asymptomatic and free of CAD population. Genetic information may improve cardiovascular risk stratification in primary prevention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Soares
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
| | - M Temtem
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M I Mendonca
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - J A Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Santos
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A C Sousa
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - M Rodrigues
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - E Henriques
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Freitas
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - S Borges
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - G Guerra
- Funchal Hospital, Research Unit, Funchal, Portugal
| | - A Drumond
- Hospital Dr. Nelio Mendonca, Funchal, Portugal
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Das J, Hodgkinson V, Rodrigues M, Bullivant J, Walker H, Straub V, Campbell C, Guglieri M, Ambrosini A. SMA – OUTCOME MEASURES AND REGISTRIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.288] [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: 11/30/2022]
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Duarte S, Cruz Martins R, Rodrigues M, Lourenço E, Moreira I, Alonso I, Magalhães M. Association between cerebral folate deficiency and hereditary spastic paraplegia. Neurología (English Edition) 2021; 36:550-552. [DOI: 10.1016/j.nrleng.2020.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
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Rodrigues M, Joly F, Ray-Coquard I, Costaz H, Classe JM, Floquet A, De La Motte Rouge T, Colombo PE, Gross MP, Leblanc E, Pomel C, Marchal F, Barranger E, Savoye A, Guillemet C, Petit T, Pautier P, Rouzier R, Courtinard C, Gladieff L. 746P Real-world clinical outcomes of patients with de novo advanced high-grade epithelial ovarian cancer eligible to niraparib maintenance in France. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Santos-Ribeiro S, Rodrigues M, Bellver J, Jorge C, Navarro A, Garrido N, Garcia-Velasco JA, Rei. Soares S. P–787 Impact of delaying ART to promote weight loss: a large multicentre study accounting for the combined effect of female/male age and body mass index (BMI). Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is postponing the start of ART (to promote a reduction in female BMI) beneficial for cumulative live birth rates (CLBR) when accounting for the female/male ageing this delay will cause?
Summary answer
Postponing ART treatment in one year to promote female weight loss could be detrimental in women of advanced maternal age (AMA, >35 years-old).
What is known already
Overweight/obese couples are frequently encouraged to lose weight prior to infertility treatment to enhance ART outcomes. However, a meaningful weight loss is often difficult to achieve for these couples, frequently taking at least one year to accomplish. Given that both female and male ageing are also important for ART success, we were interested in understanding the combined impact on CLBR of BMI reduction and ageing following a one-year delay.
Study design, size, duration
A retrospective study including patients performing their first ART cycle using autologous gametes between 2013–2018 in one of 39 participating ART centres. Only GnRH antagonist cycles were included (n = 14260). CLBR was the primary outcome. Secondary outcomes included time-to-pregnancy, birthweight and gestational age.
Participants/materials, setting, methods
Patients were subdivided according to female BMI (Kg/m2) in either underweight (<18.5), normal-weight (18.5–24.9), overweight (BMI 25.0–29.9 kg/m2) and obese (≥30 kg/m2). Meaningful and extreme weight loss were defined as a reduction from obesity to either overweight or normal-weight, respectively. We performed multivariable regression analysis to account for potential confounding.
Main results and the role of chance
Overweight (36.8%) and obese (33.0%) women had significantly lower CLBR when compared to the underweight (42.6%) and normal-weight (41.4%). When assessing the confounder-adjusted net-effect of male/female age and BMI, the predicted benefit of promoting a meaningful BMI reduction was lower than the estimated hindrance due to male/female ageing as soon as women reached AMA (n = 8365, 58.6%). This absence of benefit was especially important in women >38 years-old, in which even extreme weight-loss did not compensate for the age-related reduction in CLBR caused by the one-year delay. Moreover, male weight-loss failed to provide any additional benefit when accounted for in the regression models. Finally, obesity was also associated with a modest but statistically significant one-month delay in time-to-pregnancy and a 96.1 g (95% confidence interval: 39.9–152.4) increase in birth weight. The diagram of predicted outcomes presented in this study may serve as a useful tool to counsel patients before treatment, namely when recommending treatment postponement to promote short-term (i.e. 3–6 months) or long-term (i.e. 1 year) weight loss.
Limitations, reasons for caution
Caution is recommended when extrapolating these results into everyday practice owing to the retrospective nature of the study and the fact that only GnRH antagonist cycles were included.
Wider implications of the findings: Patients are frequently confronted with the dilemma to either postpone treatment (and promote weight loss) or start treatment immediately (to avoid further ageing). Our results seem to show that women in AMA may have hindered CLBR if recommended to delay treatment even if the desired weight loss is ultimately achieved.
Trial registration number
Not applicable
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Affiliation(s)
| | - M Rodrigues
- University of Lisbon, Faculty of Medicine, Lisboa, Portugal
| | - J Bellver
- IVI-RMA Valencia, Human Reproduction Department, Valencia, Spain
| | - C Jorge
- IVI-RMA Lisboa, Reproductive Medicine, Lisboa, Portugal
| | - A Navarro
- IVI-RMA, IVI Foundation, Valencia, Spain
| | - N Garrido
- IVI-RMA, IVI Foundation, Valencia, Spain
| | | | - S Rei. Soares
- IVI-RMA Lisboa, Reproductive Medicine, Lisboa, Portugal
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