1
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Neto JA, Pereira PF, Reis Melo A, Tavares M. Pasteurella multocida as an agent for osteoarticular infection. BMJ Case Rep 2023; 16:e255347. [PMID: 38050386 PMCID: PMC10693856 DOI: 10.1136/bcr-2023-255347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Joana Afonso Neto
- Pediatrics Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Pediatrics, University of Porto Faculty of Medicine, Porto, Porto, Portugal
| | | | - Ana Reis Melo
- Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Margarida Tavares
- Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
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2
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Salazar L, Rebelo S, Cotrim J, Tavares M. Are all vesicles 'monkey related'? J Paediatr Child Health 2023; 59:1178-1179. [PMID: 36327104 DOI: 10.1111/jpc.16269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Luís Salazar
- Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHU Porto), Porto, Portugal
| | - Sandra Rebelo
- Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
- Department of Clinical Pathology, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Institute for Research and Innovation in Health (i3S Consortium), University of Porto, Porto, Portugal
| | - Joana Cotrim
- Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHU Porto), Porto, Portugal
| | - Margarida Tavares
- Pediatric Infecciology Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
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3
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Pedrosa I, Costa AL, Reis E Melo A, Tavares M. Endocarditis Without Risk Factors: Clinical Awareness Is Key. Cureus 2023; 15:e46988. [PMID: 38021502 PMCID: PMC10640897 DOI: 10.7759/cureus.46988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Infective endocarditis (IE) is a relatively common disease that can manifest as a spectrum of clinical findings. Clinical awareness is key for the diagnosis. We present a case of a 14-year-old adolescent with fever, coughing, skin lesions, lip drooping, and quadrantanopia. Lumbar puncture was unremarkable and a head CT scan showed ischemic lesions. Blood cultures were positive for Staphylococcus aureus. A transesophageal echocardiogram showed a 7 x 7 mm mitral valve vegetation. The diagnosis of IE was made and flucloxacillin was initiated. Clinical suspicion was decisive for diagnosis. This case illustrates a serious and atypical presentation of an already uncommon disease in a patient without known risk factors for IE. While the initial cardiology workup was negative, a high clinical suspicion should always motivate further investigation as the consequences of untreated acute endocarditis are serious and life-threatening.
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Affiliation(s)
- Ines Pedrosa
- Department of Pediatrics, Centro Hospitalar de Leiria, Leiria, PRT
| | - Ana L Costa
- Department of Pediatric Cardiology, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Ana Reis E Melo
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Margarida Tavares
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Centro Hospitalar Universitário de São João, Porto, PRT
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4
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Borges V, Duque MP, Martins JV, Vasconcelos P, Ferreira R, Sobral D, Pelerito A, de Carvalho IL, Núncio MS, Borrego MJ, Roemer C, Neher RA, O'Driscoll M, Rocha R, Lopo S, Neves R, Palminha P, Coelho L, Nunes A, Isidro J, Pinto M, Santos JD, Mixão V, Santos D, Duarte S, Vieira L, Martins F, Machado J, Veríssimo VC, Grau B, Peralta-Santos A, Neves J, Caldeira M, Pestana M, Fernandes C, Caria J, Pinto R, Póvoas D, Maltez F, Sá AI, Salvador MB, Teófilo E, Rocha M, Moneti V, Duque LM, E Silva FF, Baptista T, Vasconcelos J, Casanova S, Mansinho K, Alves JV, Alves J, Silva A, Alpalhão M, Brazão C, Sousa D, Filipe P, Pacheco P, Peruzzu F, de Jesus RP, Ferreira L, Mendez J, Jordão S, Duarte F, Gonçalves MJ, Pena E, Silva CN, Guimarães AR, Tavares M, Freitas G, Cordeiro R, Gomes JP. Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal. Nat Med 2023; 29:2509-2517. [PMID: 37696933 PMCID: PMC10579057 DOI: 10.1038/s41591-023-02542-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023]
Abstract
Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.
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Affiliation(s)
- Vítor Borges
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Mariana Perez Duque
- Epidemiology and Statistics Division, Directorate-General of Health, Lisbon, Portugal
- Pathogen Dynamics Group, Department of Genetics, University of Cambridge, Cambridge, United Kingdom
| | - João Vieira Martins
- Epidemiology and Statistics Division, Directorate-General of Health, Lisbon, Portugal
| | - Paula Vasconcelos
- Public Health Emergency Centre, Directorate-General of Health, Lisbon, Portugal
| | - Rita Ferreira
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Daniel Sobral
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Ana Pelerito
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Isabel Lopes de Carvalho
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Maria Sofia Núncio
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Maria José Borrego
- National Reference Laboratory for Sexually Transmitted Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Cornelius Roemer
- Biozentrum, University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Richard A Neher
- Biozentrum, University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Megan O'Driscoll
- Pathogen Dynamics Group, Department of Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Raquel Rocha
- National Reference Laboratory for Sexually Transmitted Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Sílvia Lopo
- National Reference Laboratory for Sexually Transmitted Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Raquel Neves
- National Reference Laboratory for Sexually Transmitted Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Paula Palminha
- National Reference Laboratory for Sexually Transmitted Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Luís Coelho
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Alexandra Nunes
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
- Veterinary and Animal Research Centre (CECAV), Faculty of Veterinary Medicine, Lusófona University, Lisbon, Portugal
| | - Joana Isidro
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Miguel Pinto
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - João Dourado Santos
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Verónica Mixão
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Daniela Santos
- Technology and Innovation Unit, Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Silvia Duarte
- Technology and Innovation Unit, Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Luís Vieira
- Technology and Innovation Unit, Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Fátima Martins
- Technical Board, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Jorge Machado
- Department Coordination, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Vítor Cabral Veríssimo
- Epidemiology and Statistics Division, Directorate-General of Health, Lisbon, Portugal
- Public Health Unit, ACES Cascais, ARSLVT, Cascais, Portugal
| | - Berta Grau
- Epidemiology and Statistics Division, Directorate-General of Health, Lisbon, Portugal
- Public Health Emergency Centre, Directorate-General of Health, Lisbon, Portugal
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - André Peralta-Santos
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - José Neves
- Serviço de Dermatovenereologia, Consulta de DST, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Caldeira
- Serviço de Dermatovenereologia, Consulta de DST, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mafalda Pestana
- Serviço de Dermatovenereologia, Consulta de DST, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cândida Fernandes
- Serviço de Dermatovenereologia, Consulta de DST, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Caria
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Raquel Pinto
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Diana Póvoas
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Isabel Sá
- Unidade de Doenças Sexualmente Transmissíveis da Lapa, Lisbon, Portugal
| | | | - Eugénio Teófilo
- GAT - Grupo de Ativistas em Tratamentos, Av. Paris, Lisbon, Portugal
| | - Miguel Rocha
- GAT - Grupo de Ativistas em Tratamentos, Av. Paris, Lisbon, Portugal
| | - Virginia Moneti
- GAT - Grupo de Ativistas em Tratamentos, Av. Paris, Lisbon, Portugal
| | - Luis Miguel Duque
- GAT - Grupo de Ativistas em Tratamentos, Av. Paris, Lisbon, Portugal
| | | | - Teresa Baptista
- GAT - Grupo de Ativistas em Tratamentos, Intendente, Lisbon, Portugal
| | - Joana Vasconcelos
- Serviço de Doenças Infeciosas e Medicina Tropical, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Sara Casanova
- Serviço de Doenças Infeciosas e Medicina Tropical, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas e Medicina Tropical, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Vaz Alves
- Serviço de Doenças Infeciosas e Medicina Tropical, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - João Alves
- Serviço de Dermatovenereologia, Hospital Garcia de Orta, Almada, Portugal
| | - António Silva
- Serviço de Dermatovenereologia, Hospital Garcia de Orta, Almada, Portugal
| | - Miguel Alpalhão
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Dermatology Research Unit (PFilipe Lab), Instituto de Medicina Molecular João Lobo Antunes, University of Lisbon, Lisbon, Portugal
- Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Cláudia Brazão
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Diogo Sousa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Dermatology Research Unit (PFilipe Lab), Instituto de Medicina Molecular João Lobo Antunes, University of Lisbon, Lisbon, Portugal
- Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Francesca Peruzzu
- Serviço de Infeciologia, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | | | - Luís Ferreira
- Serviço Infeciologia do CHUP, Largo Professor Abel Salazar, Porto, Portugal
| | - Josefina Mendez
- Serviço Infeciologia do CHUP, Largo Professor Abel Salazar, Porto, Portugal
| | - Sofia Jordão
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano - ULS Matosinhos, Matosinhos, Portugal
| | - Frederico Duarte
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano - ULS Matosinhos, Matosinhos, Portugal
| | - Maria João Gonçalves
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano - ULS Matosinhos, Matosinhos, Portugal
| | - Eduarda Pena
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano - ULS Matosinhos, Matosinhos, Portugal
| | - Claúdio Nunes Silva
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Margarida Tavares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Graça Freitas
- National Health Authority, Directorate-General of Health, Lisbon, Portugal
| | - Rita Cordeiro
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - João Paulo Gomes
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal.
- Veterinary and Animal Research Centre (CECAV), Faculty of Veterinary Medicine, Lusófona University, Lisbon, Portugal.
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Morais CG, Reis-Melo A, Oliveira J, Ribeiro A, Pinto-Carvalho I, Tavares M. Neuroimaging of central nervous system tuberculosis. Acta Neurol Taiwan 2023; 32(2):86-87. [PMID: 37198514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
A 20-month-old female, not immunized with Bacillus Calmette-Guérin (BCG) vaccine, was admitted due to a four-day history of fever and cough. In the past three months, she presented respiratory infections, weight loss and enlarged cervical lymph nodes. On day two of admission, she displayed drowsiness and positive Romberg's sign; cerebrospinal fluid (CSF) workout revealed 107/ul cells, low glucose and high protein levels. Ceftriaxone and acyclovir were initiated, and she was transferred to our tertiary hospital. Brain magnetic resonance imaging showed punctiform focal areas of restricted diffusion in left capsular lenticular region suggestive of vasculitis secondary to infection. Tuberculin skin test and interferon-gamma release assay were positive. She started tuberculostatic therapy, but two days later she presented tonic-clonic seizures and impaired consciousness. Cerebral computed tomography (CT) revealed tetrahydrocephalus (Figure 1), needing external ventricular derivation. She had a slow clinical improvement, requiring several neurosurgical interventions and developing a syndrome of inappropriate antidiuretic secretion alternating with cerebral salt wasting. Positive results for Mycobacterium tuberculosis were obtained by CSF culture and by polymerase chain reaction in CSF, bronchoalveolar lavage and gastric aspirate specimens. Repeated brain CT showed a large-vessel vasculitis with basal meningeal enhancement, typical of central nervous system (CNS) tuberculosis (Figure 2). She completed one month of corticosteroids and maintained antituberculosis treatment. At two years of age, she has spastic paraparesis and no language skills. Portugal had 1836 cases of tuberculosis (17.8 per 100000) in 2016 and was considered a low-incidence country; consequently, BCG vaccination is not universal (1). We present a severe case of CNS tuberculosis with intracranial hypertension, vasculitis and hyponatremia, associated with poorer outcomes (2). A high index of suspicion allowed prompt start of antituberculosis treatment. Diagnosis was corroborated by microbiological positivity and a typical triad in neuroimaging (hydrocephalus, vasculitis and basal meningeal enhancement) (3), which we wish to emphasize.
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Affiliation(s)
| | - Ana Reis-Melo
- Pediatric Infectious Diseases and Immunodeficiency Unit, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Oliveira
- Department of Neurosurgery, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Augusto Ribeiro
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Irene Pinto-Carvalho
- Department of Pediatrics, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Margarida Tavares
- Pediatric Infectious Diseases and Immunodeficiency Unit, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
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Reina-Couto M, Roboredo-Madeira M, Pereira-Terra P, Silva-Pereira C, Martins S, Teixeira-Santos L, Pinho D, Dias A, Cordeiro G, Dias CC, Sarmento A, Tavares M, Guimarães JT, Roncon-Albuquerque R, Paiva JA, Albino-Teixeira A, Sousa T. Evaluation of urinary cysteinyl leukotrienes as biomarkers of severity and putative therapeutic targets in COVID-19 patients. Inflamm Res 2023; 72:475-491. [PMID: 36617343 PMCID: PMC9826622 DOI: 10.1007/s00011-022-01682-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cysteinyl leukotrienes (CysLT) are potent inflammation-promoting mediators, but remain scarcely explored in COVID-19. We evaluated urinary CysLT (U-CysLT) relationship with disease severity and their usefulness for prognostication in hospitalized COVID-19 patients. The impact on U-CysLT of veno-venous extracorporeal membrane oxygenation (VV-ECMO) and of comorbidities such as hypertension and obesity was also assessed. METHODS Blood and spot urine were collected in "severe" (n = 26), "critically ill" (n = 17) and "critically ill on VV-ECMO" (n = 17) patients with COVID-19 at days 1-2 (admission), 3-4, 5-8 and weekly thereafter, and in controls (n = 23) at a single time point. U-CysLT were measured by ELISA. Routine markers, prognostic scores and outcomes were also evaluated. RESULTS U-CysLT did not differ between groups at admission, but significantly increased along hospitalization only in critical groups, being markedly higher in VV-ECMO patients, especially in hypertensives. U-CysLT values during the first week were positively associated with ICU and total hospital length of stay in critical groups and showed acceptable area under curve (AUC) for prediction of 30-day mortality (AUC: 0.734, p = 0.001) among all patients. CONCLUSIONS U-CysLT increase during hospitalization in critical COVID-19 patients, especially in hypertensives on VV-ECMO. U-CysLT association with severe outcomes suggests their usefulness for prognostication and as therapeutic targets.
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Affiliation(s)
- Marta Reina-Couto
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal.
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal.
- Serviço de Farmacologia Clínica, CHUSJ, Porto, Portugal.
| | - Mariana Roboredo-Madeira
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Patrícia Pereira-Terra
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal
| | - Carolina Silva-Pereira
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal
| | | | - Luísa Teixeira-Santos
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal
| | - Dora Pinho
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal
| | - Andreia Dias
- Serviço de Farmacologia Clínica, CHUSJ, Porto, Portugal
| | | | - Cláudia Camila Dias
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, FMUP, Porto, Portugal
- CINTESIS-Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal
| | - António Sarmento
- Serviço de Doenças Infecciosas, CHUSJ, Porto, Portugal
- Departamento de Medicina, FMUP, Porto, Portugal
| | - Margarida Tavares
- Serviço de Doenças Infecciosas, CHUSJ, Porto, Portugal
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - João T Guimarães
- Serviço de Patologia Clínica, CHUSJ, Porto, Portugal
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Biomedicina-Unidade de Bioquímica, FMUP, Porto, Portugal
| | - Roberto Roncon-Albuquerque
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Departamento de Cirurgia e Fisiologia, FMUP, Porto, Portugal
| | - José-Artur Paiva
- Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Departamento de Medicina, FMUP, Porto, Portugal
| | - António Albino-Teixeira
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal
| | - Teresa Sousa
- Departamento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.
- Centro de Investigação Farmacológica e Inovação Medicamentosa da Universidade do Porto (MEDInUP), Porto, Portugal.
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7
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Espinosa-Pereiro J, Ghimire S, Sturkenboom MGG, Alffenaar JWC, Tavares M, Aguirre S, Battaglia A, Molinas G, Tórtola T, Akkerman OW, Sanchez-Montalva A, Magis-Escurra C. Safety of Rifampicin at High Dose for Difficult-to-Treat Tuberculosis: Protocol for RIAlta Phase 2b/c Trial. Pharmaceutics 2022; 15:pharmaceutics15010009. [PMID: 36678638 PMCID: PMC9864493 DOI: 10.3390/pharmaceutics15010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Previous clinical trials for drug-susceptible tuberculosis (DS-TB) have shown that first-line treatment with doses of rifampicin up to 40 mg/kg are safe and increase the early treatment response for young adults with pulmonary tuberculosis. This may lead to a shorter treatment duration for those persons with TB and a good baseline prognosis, or increased treatment success for vulnerable subgroups (age > 60, diabetes, malnutrition, HIV, hepatitis B or hepatitis C coinfection, TB meningitis, stable chronic liver diseases). Here, we describe the design of a phase 2b/c clinical study under the hypothesis that rifampicin at 35 mg/kg is as safe for these vulnerable groups as for the participants included in previous clinical trials. RIAlta is an interventional, open-label, multicenter, prospective clinical study with matched historical controls comparing the standard DS-TB treatment (isoniazid, pyrazinamide, and ethambutol) with rifampicin at 35 mg/kg (HR35ZE group) vs. rifampicin at 10 mg/kg (historical HR10ZE group). The primary outcome is the incidence of grade ≥ 3 Adverse Events or Severe Adverse Events. A total of 134 participants will be prospectively included, and compared with historical matched controls with at least a 1:1 proportion. This will provide a power of 80% to detect non-inferiority with a margin of 8%. This study will provide important information for subgroups of patients that are more vulnerable to TB bad outcomes and/or treatment toxicity. Despite limitations such as non-randomized design and the use of historical controls, the results of this trial may inform the design of future more inclusive clinical trials, and improve the management of tuberculosis in subgroups of patients for whom scientific evidence is still scarce. Trial registration: EudraCT 2020-003146-36, NCT04768231.
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Affiliation(s)
- Juan Espinosa-Pereiro
- International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Samiksha Ghimire
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Marieke G. G. Sturkenboom
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Jan-Willem C. Alffenaar
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Westmead Hospital, Sydney, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margarida Tavares
- Infectious Diseases Service, Centro Hospitalar de São João, 4200-319 Porto, Portugal
| | - Sarita Aguirre
- National Program for Tuberculosis, Ministry of Health, Asunción 1430, Paraguay
| | - Arturo Battaglia
- Instituto Nacional de Enfermedades Respiratorias y Ambientales, Asunción 1430, Paraguay
| | - Gladys Molinas
- Instituto Nacional de Enfermedades Respiratorias y Ambientales, Asunción 1430, Paraguay
| | - Teresa Tórtola
- Microbiology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Onno W. Akkerman
- TB Center Beatrixoord, Haren, University Medical Center Groningen, University of Groningen, 9751 ND Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Adrian Sanchez-Montalva
- International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Grupo de Estudio de Infecciones por Micobacterias, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIM-SEIMC), 28003 Madrid, Spain
- Correspondence:
| | - Cecile Magis-Escurra
- Radboud University Medical Centre, Department of Respiratory Diseases-TB Expert Center Dekkerswald, 6561 KE Nijmegen, The Netherlands
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8
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Abstract
We report a case of monkeypox in a physician after an occupational needlestick injury from a pustule. This case highlights risk for occupational transmission and manifestations of the disease after percutaneous transmission: a short incubation period, followed by a solitary lesion at the injured site and later by systemic symptoms.
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9
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Costa R, Soares C, Vaz C, Bernardes M, Tavares M, Abreu P. Brown-Séquard syndrome in a patient with spondyloarthritis after COVID-19 vaccine: a challenging differential diagnosis. ARP Rheumatol 2022; 1:257-259. [PMID: 35867044] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 41-year-old woman with pre-radiographic axial and peripheric spondyloarthritis, taking adalimumab since 2010, started motor impairment of the right limbs and numbness of the left leg seven days after the administration of COVID-19 mRNA vaccine. Adalimumab was taken 47 days before clinical onset. A comprehensive study for infectious, autoimmune and neoplastic causes were unremarkable. MRI depicted an acute inflammatory lesion at C2 level with gadolinium enhancement. The patient started methylprednisolone with clinical improvement. Three scenarios should be considered: primary CNS inflammatory disorder or a secondary manifestation of the underlying rheumatologic disease; immune-mediated inflammatory lesion triggered by vaccine; demyelinating event due to adalimumab.
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Affiliation(s)
- Rafaela Costa
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Carolina Soares
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Carlos Vaz
- Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine/Rheumatology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Miguel Bernardes
- Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine/Rheumatology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Margarida Tavares
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal; EPI Unit - Instituto de Saúde Pública, University of Porto, Porto, Portugal
| | - Pedro Abreu
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
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10
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Vaughan AM, Cenciarelli O, Colombe S, Alves de Sousa L, Fischer N, Gossner CM, Pires J, Scardina G, Aspelund G, Avercenko M, Bengtsson S, Blomquist P, Caraglia A, Chazelle E, Cohen O, Diaz A, Dillon C, Dontsenko I, Kotkavaara K, Fafangel M, Ferraro F, Firth R, Fonager J, Frank C, Carrasco MG, Gkolfinopoulou K, Grenersen MP, Guzmán Herrador BR, Henczkó J, Hoornenborg E, Igoe D, Ilić M, Jansen K, Janță DG, Johansen TB, Kasradze A, Koch A, Kyncl J, Martins JV, McAuley A, Mellou K, Molnár Z, Mor Z, Mossong J, Novacek A, Orlikova H, Pem Novosel I, Rossi MK, Sadkowska-Todys M, Sawyer C, Schmid D, Sîrbu A, Sondén K, Tarantola A, Tavares M, Thordardottir M, Učakar V, Van Ewijk C, Varjas J, Vergison A, Vivancos R, Zakrzewska K, Pebody R, Haussig JM. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill 2022; 27. [PMID: 36082686 PMCID: PMC9461311 DOI: 10.2807/1560-7917.es.2022.27.36.2200620] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.
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Affiliation(s)
- Aisling M Vaughan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Soledad Colombe
- Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.,Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Natalie Fischer
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Celine M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jeff Pires
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Giuditta Scardina
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Margarita Avercenko
- Infectious Disease Prevention and Control Unit, Department of Infectious Risks Analysis and Prevention, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sara Bengtsson
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Paula Blomquist
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Anna Caraglia
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Emilie Chazelle
- Santé publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Orna Cohen
- Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Asuncion Diaz
- National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Christina Dillon
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Irina Dontsenko
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | - Katja Kotkavaara
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mario Fafangel
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Federica Ferraro
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Jannik Fonager
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Christina Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mireia G Carrasco
- Ministry of Health, Government of Andorra, Andorra la Vella, Andorra
| | - Kassiani Gkolfinopoulou
- Surveillance Coordination Department. Hellenic National Public Health Organization (EODY), Athens, Greece
| | | | - Bernardo R Guzmán Herrador
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Judit Henczkó
- Department of Microbiological Reference Laboratory, National Public Health Center, Budapest, Hungary
| | - Elske Hoornenborg
- Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands
| | - Derval Igoe
- Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Maja Ilić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Denisa-Georgiana Janță
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | | | - Ana Kasradze
- Head of Public Health Emergency Preparedness and Response Division, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Anders Koch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Andrew McAuley
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, Hellenic National Public Health Organization (EODY), Athens, Greece
| | - Zsuzsanna Molnár
- Department of Communicable Disease Epidemiology and Infection Control, National Public Health Center, Budapest, Hungary
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel.,Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Alina Novacek
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Hana Orlikova
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | | | - Maria K Rossi
- Public Health Scotland, Edinburgh, Scotland, United Kingdom
| | | | - Clare Sawyer
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Anca Sîrbu
- National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania
| | - Klara Sondén
- Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden
| | - Arnaud Tarantola
- Santé publique France Regional Office, Saint-Denis, Île-de-France, France
| | - Margarida Tavares
- National Program for Sexually Transmitted Infections and HIV Infection, Directorate-General of Health, Lisbon, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), and EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.,Emerging Infectious Diseases Unit, Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marianna Thordardottir
- Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland
| | - Veronika Učakar
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Catharina Van Ewijk
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Juta Varjas
- Department of Communicable Diseases, Health Board, Tallinn, Estonia
| | | | - Roberto Vivancos
- Field Services, United Kingdom Health Security Agency, London, United Kingdom
| | - Karolina Zakrzewska
- National Institute of Public Health (NIH) - National Research Institute, Warsaw, Poland
| | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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11
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Perez Duque M, Ribeiro S, Martins JV, Casaca P, Leite PP, Tavares M, Mansinho K, Duque LM, Fernandes C, Cordeiro R, Borrego MJ, Pelerito A, de Carvalho IL, Núncio S, Manageiro V, Minetti C, Machado J, Haussig JM, Croci R, Spiteri G, Casal AS, Mendes D, Souto T, Pocinho S, Fernandes T, Firme A, Vasconcelos P, Freitas G. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill 2022; 27:2200424. [PMID: 35656830 PMCID: PMC9164676 DOI: 10.2807/1560-7917.es.2022.27.22.2200424] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Up to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22-51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor linked to travel or had contact with symptomatic persons or with animals, suggesting the possible previously undetected spread of monkeypox.
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Affiliation(s)
- Mariana Perez Duque
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Sofia Ribeiro
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Pedro Casaca
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Pedro Pinto Leite
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Margarida Tavares
- National Plan Sexually Transmitted Infections and HIV, Directorate-General of Health, Lisbon, Portugal
- Department of infections, Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- University of Porto Medical School, Porto, Portugal
| | - Kamal Mansinho
- Infectious Diseases and Tropical Medicine Service, Centro Hospitalar Lisboa Ocidental, EPE/Hospital de Egas Moniz, Lisbon, Portugal
- Hygiene and Tropical Medicine Institute/NOVA University of Lisbon, Lisbon, Portugal
| | - Luís Miguel Duque
- CheckpointLX, Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
- Hospital Garcia de Orta, Almada, Portugal
| | - Cândida Fernandes
- Sexual Transmitted Diseases Clinic, Dermatovenereology Department, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | - Rita Cordeiro
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Maria José Borrego
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Ana Pelerito
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Isabel Lopes de Carvalho
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Sofia Núncio
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Vera Manageiro
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Corrado Minetti
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
- ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jorge Machado
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Roberto Croci
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Ana Sofia Casal
- Directorate of Health Promotion and Disease Prevention, Directorate-General of Health, Lisbon, Portugal
| | - Diana Mendes
- Division for Communication and Public Relations, Directorate-General of Health, Lisbon, Portugal
| | - Tiago Souto
- Support Unit of National Health Authority and the Emergency Management in Public Health, Public Health Emergencies Operations Centre, Directorate-General of Health, Lisbon, Portugal
| | - Sara Pocinho
- Support Unit of National Health Authority and the Emergency Management in Public Health, Public Health Emergencies Operations Centre, Directorate-General of Health, Lisbon, Portugal
| | - Teresa Fernandes
- Directorate of Health Promotion and Disease Prevention, Directorate-General of Health, Lisbon, Portugal
| | - Ana Firme
- Support Unit of National Health Authority and the Emergency Management in Public Health, Public Health Emergencies Operations Centre, Directorate-General of Health, Lisbon, Portugal
| | - Paula Vasconcelos
- Support Unit of National Health Authority and the Emergency Management in Public Health, Public Health Emergencies Operations Centre, Directorate-General of Health, Lisbon, Portugal
| | - Graça Freitas
- National Health Authority, Directorate-General of Health, Lisbon, Portugal
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12
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Nunes-Silva C, Rocha R, Martins A, Ribeiro L, Nuak J, Tavares M, Sarmento A, Ceia F, Abreu C. Recomendações para o Tratamento e Seguimento de Doentes com Febre Q. ACTA MEDICA PORT 2022; 35:494-503. [DOI: 10.20344/amp.18007] [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] [Received: 01/29/2022] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022]
Abstract
Q fever (or query fever) is a zoonotic infectious disease with worldwide distribution transmitted by an intracellular Gram-negative bacterium, Coxiella burnetii. The most common identified sources of human infection are farm animals, such as sheep, goats and cattle. The disease is endemic in mainland Portugal, with most cases notified in the central and southern regions. Q fever is a complex and pleomorphic disease, with those affected presenting with a wide range of manifestations from acute self-limited flu-like symptoms with good prognosis to persistent localized forms that may harbor a poor prognosis. Cases might occur in an isolated fashion or following outbreaks with great public health repercussion, as seen recently in the Netherlands from 2007 to 2010. Given the complexity of this infection, there is no universal consensus to date on the best strategy to manage Q fever patients. These guidelines provide recommendations regarding the treatment and follow-up of these patients, based on studies, on the author’s experience and on the opinion of international experts. The aim is to harmonize the management of these patients taking into account not only the clinical manifestations but also the risk factors of the host in order to reduce disease-associated morbidity and mortality.
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13
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Nunes-Silva C, Vilares AT, Schweitzer V, Castanhinha S, Martins A, Lopes MJ, Ascoli-Bartoli T, Canelas G, Keir HR, Cunha F, Silva-Pinto A, Rebelo S, Cunha RG, Tavares M. Non-COVID-19 respiratory viral infection. Breathe (Sheff) 2022; 18:210151. [PMID: 36338246 PMCID: PMC9584593 DOI: 10.1183/20734735.0151-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
Implemented control measures brought about by the coronavirus disease 2019 (COVID-19) pandemic have changed the prevalence of other respiratory viruses, often relegating them to a secondary plan. However, it must not be forgotten that a diverse group of viruses, including other human coronaviruses, rhinoviruses, respiratory syncytial virus, human metapneumoviruses, parainfluenza and influenza, continue to be responsible for a large burden of disease. In fact, they are among the most common causes of acute upper and lower respiratory tract infections globally. Viral respiratory infections can be categorised in several ways, including by clinical syndrome or aetiological agent. We describe their clinical spectrum. Distinctive imaging features, advances in microbiological diagnosis and treatment of severe forms are also discussed. Non-COVID-19 respiratory viral infections are a major burden of disease. Emerging molecular-based detection methods and knowledge of viral lower respiratory tract infections’ distinctive features improve diagnosis, treatment and outcome of severe forms.https://bit.ly/3qMqk3T
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14
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Magalhães AC, Ricardo S, Moreira AC, Nunes M, Tavares M, Pinto RJ, Gomes MS, Pereira L. InfectionCMA: A Cell MicroArray Approach for Efficient Biomarker Screening in In Vitro Infection Assays. Pathogens 2022; 11:pathogens11030313. [PMID: 35335638 PMCID: PMC8955223 DOI: 10.3390/pathogens11030313] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
The recently emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has forced the scientific community to acquire knowledge in real-time, when total lockdowns and the interruption of flights severely limited access to reagents as the global pandemic became established. This unique reality made researchers aware of the importance of designing efficient in vitro set-ups to evaluate infectious kinetics. Here, we propose a histology-based method to evaluate infection kinetics grounded in cell microarray (CMA) construction, immunocytochemistry and in situ hybridization techniques. We demonstrate that the chip-like organization of the InfectionCMA has several advantages, allowing side-by-side comparisons between diverse cell lines, infection time points, and biomarker expression and cytolocalization evaluation in the same slide. In addition, this methodology has the potential to be easily adapted for drug screening.
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Affiliation(s)
- Ana C. Magalhães
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- Ipatimup–Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Sara Ricardo
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- Ipatimup–Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- TOXRUN, Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), 4585-116 Gandra, Portugal
| | - Ana C. Moreira
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- IBMC–Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-319 Porto, Portugal
| | - Mariana Nunes
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- Ipatimup–Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Margarida Tavares
- Department of Infectious Diseases and Emerging Infectious Disease Unit, CHUSJ–Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal;
- Public Health and Forensic Sciences and Medical Education Department, FMUP–Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - Ricardo J. Pinto
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- Ipatimup–Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria Salomé Gomes
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- IBMC–Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-319 Porto, Portugal
| | - Luisa Pereira
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (A.C.M.); (S.R.); (A.C.M.); (M.N.); (R.J.P.); (M.S.G.)
- Ipatimup–Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- Correspondence:
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15
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Goncalves M, Henriques A, Costa A, Correia D, Severo M, Lucas R, Barros H, Santos AC, Ribeiro AI, Rocha A, Lopes C, Correia D, Ramos E, Gonçalves G, Barros H, Araújo J, Talih M, Tavares M, Severo M, Lunet N, Meireles P, Duarte R, Lucas R, Camacho R, Fraga S, Correia S, Silva S, Leão T. Insomnia and nightmare profiles during the COVID-19 pandemic in Portugal: characterization and associated factors. Sleep Med 2022; 90:44-52. [PMID: 35093683 PMCID: PMC8744402 DOI: 10.1016/j.sleep.2021.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/22/2022]
Abstract
Objective/background To describe and characterize insomnia symptoms and nightmare profiles in Portugal during the first six weeks of a national lockdown due to COVID-19. Patients/methods An open cohort study was conducted to collect information of the general population during the first wave of SARS-CoV-2/COVID-19 pandemic in Portugal. We analyzed data from 5011 participants (≥16 years) who answered a weekly questionnaire about their well-being. Two questions about the frequency of insomnia and nightmares about COVID-19 were consecutively applied during six weeks (March–May 2020). Latent class analysis was conducted and different insomnia and nightmare profiles were identified. Associations between individual characteristics and both profiles were estimated using odds ratios (ORs) and 95% confidence intervals (CI). Results Five insomnia (No insomnia, Stable-mild, Decreasing-moderate, Stable-severe, Increasing-severe) and three nightmares profiles (Stable-mild, Stable-moderate, Stable-severe) were identified. Being female, younger, perceiving their income as insufficient and feelings of fear towards COVID-19 were associated with higher odds of insomnia (Women: OR = 6.98 95%CI: 4.18–11.64; ≥60 years: OR = 0.30 95%CI: 0.18–0.53; Insufficient income: adjusted OR (aOR) = 8.413 95%CI: 3.93–16.84; Often presenting fear of being infected with SARS-CoV-2 infection: aOR = 9.13 95%CI: 6.36–13.11), and nightmares (Women: OR = 2.60 95%CI: 1.74–3.86; ≥60 years: OR = 0.45 95%CI: 0.28–0.74; Insufficient income: aOR = 2.60 95%CI: 1.20–5.20; Often/almost always presenting fear of being infected with SARS-CoV-2 infection: aOR = 6.62 95%CI: 5.01–8.74). Having a diagnosis of SARS-CoV-2 virus infection was associated with worse patterns of nightmares about the pandemic. Conclusions Social and psychological individual factors are important characteristics to consider in the development of therapeutic strategies to support people with sleep problems during the COVID-19 pandemic.
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16
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Marques-Gomes J, Salt MJ, Pereira-Neto R, Barteldes FS, Gouveia-Barros V, Carvalho A, d'Arminio-Monforte A, De-la-Torre-Rosas A, Harris A, Esteves C, Maor C, Mora C, Oliveira C, Sousa C, Richman DD, Martinez E, Cota-Medeiros F, Gramacho F, Behrens GMN, Gonçalves G, Farinha H, Nabais I, Vaz-Pinto I, Sierra-Madero J, Sousa-Gago J, Thornhill J, Vera J, Erceg-Tusek M, Tavares M, Vasconcelos M, Fernandes N, Gianotti N, Langebeek N, Anjos P, Couto R, Fernandes R, Rajasuriar R, Serrão R, Watson S, Branco T, Teixeira T, Soriano V. Development of the HIV360 international core set of outcome measures for adults living with HIV: A consensus process. HIV Med 2021; 23:639-649. [PMID: 34964226 DOI: 10.1111/hiv.13221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES HIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care. METHODS An international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice. RESULTS From 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years. CONCLUSIONS Adoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.
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Affiliation(s)
- João Marques-Gomes
- Nova School of Business and Economics, Carcavelos, Portugal.,Nova Medical School, Nova University Lisbon, Lisbon, Portugal
| | | | | | | | | | - Alexandre Carvalho
- Braga Public Hospital, Braga, Portugal.,School of Medicine, Minho University, Braga, Portugal
| | - Antonella d'Arminio-Monforte
- Institute of Infectious and Tropical Diseases - Department of Health Sciences, ASST Santi Paolo e Carlo University Hospital, Milan, Italy
| | | | - Amy Harris
- Aneurin Bevan University Health Board, NHS Wales, Newport, UK.,Pharmacy Department, Royal Gwent Hospital, Newport, UK
| | - Catarina Esteves
- Portuguese Association for the Clinical Study of AIDS (APECS), Lisbon, Portugal.,HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
| | | | | | - Carla Oliveira
- Santo António Hospital, Porto University Hospital Centre, Porto, Portugal
| | | | - Douglas D Richman
- Center for AIDS Research, University of California San Diego, La Jolla, California, USA
| | | | - Fábio Cota-Medeiros
- Northern Lisbon University Hospital Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Filipa Gramacho
- Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Georg M N Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Graça Gonçalves
- Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Helena Farinha
- Pharmacy Department, Egas Moniz Hospital, Western Lisbon Hospital Centre, Lisbon, Portugal.,Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Isabel Nabais
- Northern Lisbon University Hospital Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Inês Vaz-Pinto
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal.,HIV Disease Study Group, Portuguese Society of Internal Medicine (NEDVIH-SPMI), Lisbon, Portugal
| | - Juan Sierra-Madero
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Joaquim Sousa-Gago
- Nova Medical School, Nova University Lisbon, Lisbon, Portugal.,Oeiras Mental Health Unit, Western Lisbon Hospital Centre, Lisbon, Portugal
| | - John Thornhill
- British HIV Association, London, UK.,Department of Medicine, Imperial College London, London, UK.,Barts Health NHS Trust, London, UK
| | - José Vera
- HIV Disease Study Group, Portuguese Society of Internal Medicine (NEDVIH-SPMI), Lisbon, Portugal.,Barreiro-Montijo Hospital Centre, Barreiro, Portugal
| | - Maja Erceg-Tusek
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | | | - Miguel Vasconcelos
- Division of Intervention in Addictive Behaviours and Dependencies (DICAD), Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
| | | | - Nicola Gianotti
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Raquel Couto
- Vila Nova de Gaia-Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Reena Rajasuriar
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | | | | | - Teresa Branco
- Portuguese Association for the Clinical Study of AIDS (APECS), Lisbon, Portugal.,Fernando Fonseca Hospital, Amadora, Portugal
| | - Tiago Teixeira
- Infectious Diseases Department, Vila Nova de Gaia-Espinho Hospital Centre, Vila Nova de Gaia, Portugal
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17
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Miranda J, Grilo M, Baptista C, Melo ARE, Tavares M, Ribeiro A. Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2—Case Series of a Pediatric Intensive Care Unit in Portugal. J Pediatr Intensive Care 2021. [DOI: 10.1055/s-0041-1740587] [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: 10/19/2022] Open
Abstract
AbstractPediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) is a novel condition with persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to describe the characteristics of children more severely affected and our clinical approach. We retrospectively collected clinical, treatment, and early outcomes data during a 3-month period in a pediatric intensive care unit (PICU) of a tertiary university hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics and Child Health case definition were hospitalized, seven needed PICU admission. Median age was 13 years and three were overweight, with no other comorbidity. All had positive immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia, hypotension, and shock. Other prominent symptoms were abdominal complaints and rash. All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory markers. Cardiac involvement was observed in all patients with elevated levels of troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed left ventricular function was observed in four patients. All patients received broad-spectrum antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and vasoactive medications. Four patients received prophylactic enoxaparin. All patients needed supplementary oxygen; however, high-flow oxygen therapy and noninvasive ventilatory support with positive end-expiratory pressure were required in three and two patients, respectively. Five patients required invasive mechanical ventilation. The mean duration of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9 and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach. Risk factors, best clinical pathway, and long-term complications are still unknown.
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Affiliation(s)
- João Miranda
- Department of Pediatrics, Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Marta Grilo
- Department of Pediatrics, Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carolina Baptista
- Department of Pediatrics, Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Reis e Melo
- Department of Pediatrics, Immunodeficiency and Infectious Diseases Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Margarida Tavares
- Department of Pediatrics, Immunodeficiency and Infectious Diseases Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Augusto Ribeiro
- Department of Pediatrics, Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal
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18
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Fonseca S, Lacerda L, Teixeira C, Reis-Melo A, Tavares M. Sexually transmitted infections in Portuguese adolescents. An Pediatr (Barc) 2021; 96:454-455. [PMID: 34526245 DOI: 10.1016/j.anpede.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sara Fonseca
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal.
| | - Luísa Lacerda
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Cláudia Teixeira
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal; Facultad de Medicina, Universidad de do Porto, Oporto, Portugal; UCIBIO-REQUIMTE, Universidad de do Porto, Oporto, Portugal
| | - Ana Reis-Melo
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Margarida Tavares
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
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19
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Ribeiro T, Marques A, Ferreira G, Castro C, Tavares M, Espírito-Santo A, Moreira C, Mariz J. Semiquantitative analysis of interim 18F-FDG PET is superior in predicting outcome in Hodgkin lymphoma patients compared to visual analysis. Rev Esp Med Nucl Imagen Mol 2021; 40:281-286. [PMID: 34425968 DOI: 10.1016/j.remnie.2020.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the prognostic value of interim PET (PETi) in adult HL patients, comparing visual with semiquantitative analysis. MATERIAL AND METHODS Retrospective analysis of Hodgkin's lymphoma (HL) patients diagnosed between 2012 and 2016 in the Onco-hematology Department of Instituto Português de Oncologia - Porto (median follow-up: 46.5 months [2.6-66.4]). Fifty-eight patients with available PET at diagnosis (PET0) and PETi data were included. PETi scans were analyzed according to Deauville 5-point scale (5-PS), and cut-off values for changes in maximum standardized uptake value [SUVmax], peak SUV [SUVpeak], metabolic tumour volume [MTV] and total lesion glycolysis index [TLG] between PETi and PET0 were computed using ROC analysis. Visual and semiquantitative data were compared with each other in the prediction of patient outcomes. RESULTS Semiquantitative analysis obtained a higher sensitivity for persistent/relapsed disease compared to the 5-PS (70% vs. 10%, respectively), but lower specificity. It also demonstrated better predictive performance for response to first-line therapy (negative predictive value >92%). The positive predictive value was similar for all five measurements. At 60 months of follow-up, there was a significant difference between the progression free survival (PFS) curves of patients with positive and negative PETi according to ΔSUVmax (56.9% vs. 88.0%, p<0.05), ΔSUVpeak (55.9% vs. 88.1%, p<0.05), ΔMTV (35.3% vs. 88.7%, p<0.05), and ΔTLG (42.4% vs. 88.1%, p<0.05). Statistical significance was not reached when considering 5-PS results. DISCUSSION PETi interpretation according to a semiquantitative approach appears to discriminate HL patients better than the visual 5-PS analysis. This could allow better detection of persistent or early relapsed disease, while a negative PETi result could support de-escalating therapy intensity.
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Affiliation(s)
- T Ribeiro
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - A Marques
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - G Ferreira
- Nuclear Medicine Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - C Castro
- Epidemiology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - M Tavares
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - A Espírito-Santo
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - C Moreira
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - J Mariz
- Onco-Hematology Department, Instituto Português de Oncologia do Porto FG, Street Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
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20
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Fonseca S, Lacerda L, Teixeira C, Reis E Melo A, Tavares M. [Sexually transmitted infections in Portuguese adolescents]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00224-1. [PMID: 34304983 DOI: 10.1016/j.anpedi.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sara Fonseca
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal.
| | - Luísa Lacerda
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Cláudia Teixeira
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal; Facultad de Medicina, Universidade do Porto, Oporto, Portugal; UCIBIO-REQUIMTE, Universidade do Porto, Oporto, Portugal
| | - Ana Reis E Melo
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Margarida Tavares
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
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21
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Pedro N, Fernandes V, Cavadas B, Guimarães JT, Barros H, Tavares M, Pereira L. Field and Molecular Epidemiology: How Viral Sequencing Changed Transmission Inferences in the First Portuguese SARS-CoV-2 Infection Cluster. Viruses 2021; 13:1116. [PMID: 34200621 PMCID: PMC8226748 DOI: 10.3390/v13061116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/31/2022] Open
Abstract
Field epidemiology and viral sequencing provide a comprehensive characterization of transmission chains and allow a better identification of superspreading events. However, very few examples have been presented to date during the COVID-19 pandemic. We studied the first COVID-19 cluster detected in Portugal (59 individuals involved amongst extended family and work environments), following the return of four related individuals from work trips to Italy. The first patient to introduce the virus would be misidentified following the traditional field inquiry alone, as shown by the viral sequencing in isolates from 23 individuals. The results also pointed out family, and not work environment, as the primary mode of transmission.
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Affiliation(s)
- Nicole Pedro
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (N.P.); (V.F.); (B.C.)
- Ipatimup, Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Veronica Fernandes
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (N.P.); (V.F.); (B.C.)
- Ipatimup, Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Bruno Cavadas
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (N.P.); (V.F.); (B.C.)
- Ipatimup, Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
| | - João Tiago Guimarães
- CHUSJ, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal; (J.T.G.); (M.T.)
- FMUP, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal;
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - Henrique Barros
- FMUP, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal;
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - Margarida Tavares
- CHUSJ, Centro Hospitalar Universitário S. João, 4200-319 Porto, Portugal; (J.T.G.); (M.T.)
- FMUP, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal;
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal
| | - Luisa Pereira
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (N.P.); (V.F.); (B.C.)
- Ipatimup, Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
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22
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Almeida P, Viana V, Tavares M, Reis-e-Melo A, Faria C. IMMEDIATE EMOTIONAL IMPACT OF COVID-19 ON CHILDREN AND ADOLESCENTS AND THEIR FAMILIES. Psic , Saúde & Doenças 2020. [DOI: 10.15309/20psd210308] [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: 11/05/2022] Open
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23
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Prista-Leão B, Abreu I, Duro R, Silva-Pinto A, Ceia F, Andrade P, Sobrinho-Simões J, Tavares M, Pereira JM, Santos L, Sarmento A. Panton-Valentine Leukocidin-Producing Staphylococcus aureus Infection: A Case Series. Infect Dis Rep 2020; 12:61-69. [PMID: 33153134 PMCID: PMC7768458 DOI: 10.3390/idr12030014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022] Open
Abstract
Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) is associated with relapsing multifocal skin and soft tissue infections (SSTI), necrotizing pneumonia (NP) and severe musculoskeletal infections. Epidemiology is underknown and underdiagnosis is likely. Recent travel abroad, case clustering and relapsing disease are often reported. We reviewed all cases of PVL-SA infection diagnosed at our center, and found 21 cases over a 43-month period. Most patients were adult males, had relevant travel history, reported recurrent disease and presented with SSTI. Etiologic diagnosis took up to five years; meanwhile, 42% of patients had antibiotic treatments. Draining procedures were required in 43% of patients and intensive care support in 19%. All patients recovered. Methicillin-resistance prevalence was 24%. Only 2/13 decolonized patients had posterior relapsing SSTI, both with likely infected contacts. PVL-SA infection’s severity and impact are clear, even in small case series as ours. Physician awareness and active PVL-gene search are crucial for an adequate management.
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Affiliation(s)
- Beatriz Prista-Leão
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-225-512-100
| | - Isabel Abreu
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Raquel Duro
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Prevention and Control of Infection and Antimicrobial Resistance Unit, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - André Silva-Pinto
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Filipa Ceia
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paulo Andrade
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Prevention and Control of Infection and Antimicrobial Resistance Unit, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Joana Sobrinho-Simões
- Molecular Biology Laboratory of the Department of Clinical Pathology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - Margarida Tavares
- Department of Pediatrics, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - José Manuel Pereira
- Department of Intensive Medicine, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - Lurdes Santos
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - António Sarmento
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; (I.A.); (R.D.); (A.S.-P.); (F.C.); (P.A.); (L.S.); (A.S.)
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Polónia-Valente R, Moucho M, Tavares M, Vilan A, Montenegro N, Rodrigues T. Vaginal delivery in a woman infected with SARS-CoV-2 - The first case reported in Portugal. Eur J Obstet Gynecol Reprod Biol 2020; 250:253-254. [PMID: 32439245 PMCID: PMC7211642 DOI: 10.1016/j.ejogrb.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022]
Affiliation(s)
- R Polónia-Valente
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - M Moucho
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M Tavares
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Portugal; Department of Infectious Diseases, Emerging Infectious Diseaes Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - A Vilan
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - N Montenegro
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal; EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - T Rodrigues
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal; EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Filipe R, Caldas JP, Soares N, Sabino R, Veríssimo C, Silva R, Silva-Pinto A, Tavares M, Sarmento A. Schizophyllum commune sphenoidal sinusitis as presentation of a non-Hodgkin Lymphoma. Med Mycol Case Rep 2020; 28:26-28. [PMID: 32322473 PMCID: PMC7162964 DOI: 10.1016/j.mmcr.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/22/2020] [Accepted: 04/03/2020] [Indexed: 12/16/2022] Open
Abstract
Schizophyllum commune is a basidiomycetes worldwide distributed that has emerged as cause of invasive infections in immunosuppressed patients. We present a case of a man who was simultaneously diagnosed with a small cell non-Hodgkin lymphoma and a sphenoid sinusitis by S. commune. Intraoperative observation and histology description were crucial to consider an alternative diagnosis to mucormycosis suggested by the MRI. The diagnosis was made based on PCR identification and sequencing.
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Affiliation(s)
- Rita Filipe
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculty of Medicine of Porto, Centro Hospitalar Universitário São João, Portugal
| | - João Paulo Caldas
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculty of Medicine of Porto, Centro Hospitalar Universitário São João, Portugal
| | - Neuza Soares
- Internal Medicine Department, Centro Hospitalar Universitário São João, Portugal
| | - Raquel Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, 1649-016, Lisbon, Portugal
| | - Cristina Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, 1649-016, Lisbon, Portugal
| | - Roberto Silva
- Pathology Department, Centro Hospitalar Universitário São João, Portugal
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculty of Medicine of Porto, Centro Hospitalar Universitário São João, Portugal
| | - Margarida Tavares
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.,EPI Unit, Public Health Institute of University of Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculty of Medicine of Porto, Centro Hospitalar Universitário São João, Portugal
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Teles-Silva C, Reis-Melo A, Rodrigues Araújo J, Sampaio M, Tavares M. Visual Diagnosis: Sudden-Onset Decreased Vision in a Healthy Teenage Boy. Pediatr Rev 2020; 41:e12-e15. [PMID: 32238554 DOI: 10.1542/pir.2018-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cardinelli C, Torrinhas R, Sala P, Machado N, Ravacci G, Canuto G, Tavares M, Waitzberg D. OR16: Impact of Cholecystectomy on the Fecal Bile Acids Profile Before and After Roux en-Y Gastric Bypass. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guedes M, Filipe R, Costa A, Soares C, Sarmento A, Tavares M. Central nervous system varicella zoster vasculopathy in an immunocompromised patient. IDCases 2018; 15:e00483. [PMID: 30701156 PMCID: PMC6348231 DOI: 10.1016/j.idcr.2018.e00483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022] Open
Abstract
Central nervous system (CNS) vasculopathy associated with Varicella Zoster Virus (VZV) infection, usually manifesting as stroke due to ischemic lesions by involvement of small arteries, is frequently misdiagnosed. Immunocompromised patients have a particularly higher risk of severe disease and also CNS involvement during or following VZV presentations. We report a case of an 84-year-old man, with myelodysplastic syndrome, who presented with herpes zoster ophthalmicus complicated with left periocular cellulitis and an abnormal neurological exam. Intravenous treatment with acyclovir and amoxicillin/clavulanic acid was began. VZV DNA was detected in the cerebrospinal fluid (CSF) and brain magnetic resonance imaging revealed three acute ischemic lesions in the left frontal and both cerebellar lobes. A VZV CNS multifocal vasculopathy was diagnosed and treatment with intravenous acyclovir continued for 21 days. Immunocompromised patients with VZV infection can have a more severe course of disease with disseminated involvement and multifocal vasculopathy. In these patients the CSF detection of anti-VZV IgG as well as VZV DNA can be helpful in the diagnosis of CNS VZV vasculopathy. The antiviral treatment can improve the outcome and should be adjusted taking in consideration the degree of immunosuppression. This clinical case and review of the literature highlights the challenges in the diagnosis and management of VZV CNS vasculopathy in immunocompromised patients.
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Affiliation(s)
- Mariana Guedes
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Oporto, Portugal
| | - Rita Filipe
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Oporto, Portugal
| | - Andreia Costa
- Neurology Department, Centro Hospitalar Universitário São João, Oporto, Portugal
| | - Carolina Soares
- Neurology Department, Centro Hospitalar Universitário São João, Oporto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,Nephrology and Infectious Diseases R&D Group - Health Investigation and Innovation 17 Institutive (I3S), University of Oporto, Oporto, Portugal.,Oporto Medical School, University of Oporto, Oporto, Portugal
| | - Margarida Tavares
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Oporto, Portugal.,EPI Unit - Instituto de Saúde Pública, University of Oporto, Oporto, Portugal
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Tavares M, Carvalho AC, Almeida JP, Andrade P, São-Simão R, Soares P, Alves C, Pinto R, Fontanet A, Watier L. Implementation and impact of an audit and feedback antimicrobial stewardship intervention in the orthopaedics department of a tertiary-care hospital: a controlled interrupted time series study. Int J Antimicrob Agents 2018; 51:925-931. [PMID: 29339298 DOI: 10.1016/j.ijantimicag.2018.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/04/2017] [Accepted: 01/06/2018] [Indexed: 11/29/2022]
Abstract
A prospective audit and feedback antimicrobial stewardship intervention conducted in the Orthopaedics Department of a university hospital in Portugal was evaluated by comparing an interrupted time series in the intervention group with a non-intervention (control) group. Monthly antibiotic use (except cefazolin) was measured as the World Health Organization's Anatomical Therapeutic Chemical defined daily doses (ATC-DDD) from January 2012 to September 2016, excluding the 6-month phase of intervention implementation starting on 1 January 2015. Compared with the control group, the intervention group had a monthly decrease in the use of fluoroquinolones by 2.3 DDD/1000 patient-days [95% confidence interval (CI) -3.97 to -0.63]. An increase in the use of penicillins by 103.3 DDD/1000 patient-days (95% CI 47.42 to 159.10) was associated with intervention implementation, followed by a decrease during the intervention period (slope = -5.2, 95% CI -8.56 to -1.82). In the challenging scenario of treatment of osteoarticular and prosthetic joint infections, an audit and feedback intervention reduced antibiotic exposure and spectrum.
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Affiliation(s)
- Margarida Tavares
- Department of Infectious Diseases, Hospital Centre of São João (Centro Hospitalar de São João), Porto, Portugal.
| | - Ana Cláudia Carvalho
- Department of Infectious Diseases, Hospital Centre of São João (Centro Hospitalar de São João), Porto, Portugal; Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar de São João, Porto, Portugal
| | - José Pedro Almeida
- Department of Business Intelligence and Data Science, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo Andrade
- Department of Infectious Diseases, Hospital Centre of São João (Centro Hospitalar de São João), Porto, Portugal; Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar de São João, Porto, Portugal
| | - Ricardo São-Simão
- Department of Orthopaedics, Centro Hospitalar de São João, Porto, Portugal
| | - Pedro Soares
- Pharmacy Services, Centro Hospitalar de São João, Porto, Portugal
| | - Carlos Alves
- Department of Infectious Diseases, Hospital Centre of São João (Centro Hospitalar de São João), Porto, Portugal; Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar de São João, Porto, Portugal
| | - Rui Pinto
- Department of Orthopaedics, Centro Hospitalar de São João, Porto, Portugal
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France; Conservatoire National des Arts et Métiers, Paris, France; Unité PACRI, Institut Pasteur, Cnam, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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Tavares MV, Domingues AP, Nunes F, Tavares M, Fonseca E, Moura P. Induction of labour vs. spontaneous vaginal delivery in twin pregnancy after 36 weeks of gestation. J OBSTET GYNAECOL 2016; 37:29-32. [DOI: 10.1080/01443615.2016.1205554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mariana Vide Tavares
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | | | - Filipa Nunes
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Margarida Tavares
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Etelvina Fonseca
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Paulo Moura
- Obstetric A Department, Coimbra Hospital and University Center, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Tavares M, de Lima C, Fernandes W, Martinelli V, de Lucena M, Lima F, Telles A, Brandão L, de Melo Júnior M. Tumour necrosis factor-alpha (-308G/A) promoter polymorphism is associated with ulcerative colitis in Brazilian patients. Int J Immunogenet 2016; 43:376-382. [DOI: 10.1111/iji.12289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/13/2016] [Accepted: 07/28/2016] [Indexed: 01/26/2023]
Affiliation(s)
- M. Tavares
- Laboratory of Immunopathology Keizo Asami; Federal University of Pernambuco; Recife Brazil
| | - C. de Lima
- Laboratory of Immunopathology Keizo Asami and Department of Genetics; Federal University of Pernambuco; Recife Brazil
| | - W. Fernandes
- Master in Pathology; Federal University of Pernambuco; Recife Brazil
| | - V. Martinelli
- Department of Gastroenterology; University Hospital; Federal University of Pernambuco; Recife Brazil
| | - M. de Lucena
- Maurílio Toscano de Lucena; Department of Proctology; Barão de Lucena Hospital; Recife Brazil
| | - F. Lima
- Department of Surgery; University Hospital; Federal University of Pernambuco; Recife Brazil
| | - A. Telles
- Department of Pathology; Federal University of Pernambuco; Recife Brazil
| | - L. Brandão
- Department of Pathology; Federal University of Pernambuco; Recife Brazil
| | - M. de Melo Júnior
- Department of Pathology; Federal University of Pernambuco; Recife Brazil
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Abstract
It has been shown that inadequate sleep has deleterious effects on health by suppressing immunity and promoting inflammation. The aim of this study was to investigate the effect of sleep and salivary glucose levels on the development of gingivitis in a prospective longitudinal study of Kuwaiti children. Data were collected from 10-y-old children ( N = 6,316) in 2012 and again in 2014. Children were approximately equally distributed from 138 elementary schools representing the 6 governorates of Kuwait. Calibrated examiners conducted oral examination, self-reported sleep evaluation interviews, anthropomorphic measurements, and unstimulated whole saliva sample collection. Salivary glucose levels were measured by a florescent glucose oxidase method; values of salivary glucose ≥1.13 mg/dL were defined as high glucose levels. A multilevel random intercept and slope analysis was conducted to determine the relationship between sleep duration and gingivitis on 3 levels: within schools, among children, and over time. The outcome was the progression of the extent of gingival inflammation in children over time. The main independent variables were the number of daily sleep hours and salivary glucose levels. Other explanatory variables and confounders assessed were governorate, dental caries and restorations, and obesity by waist circumference (adjusted for snacking and sex). Gingivitis increased over time in children who had shorter sleep duration ( P < 0.05). Salivary glucose levels >1.13 mg/dL predicted gingivitis ( P < 0.05). Children who had more decayed or filled teeth had more gingivitis ( P < 0.05). No significant association was found between gingivitis and obesity. The level of gingivitis was different among the 6 governorates of Kuwait. Additionally, there was a strong clustering effect of the observations within schools and among children across time. Longitudinal analysis of 6,316 Kuwaiti children revealed that shorter sleep duration and higher salivary glucose levels were both associated with increased gingival inflammation.
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Affiliation(s)
- H Alqaderi
- 1 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - M Tavares
- 1 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.,2 Department of Applied Oral Sciences, Forsyth Research Institute, Cambridge, MA, USA
| | - M Hartman
- 2 Department of Applied Oral Sciences, Forsyth Research Institute, Cambridge, MA, USA
| | - J M Goodson
- 2 Department of Applied Oral Sciences, Forsyth Research Institute, Cambridge, MA, USA
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Labbene I, Arrigo M, Tavares M, Hajjej Z, Brandão JL, Tolppanen H, Feliot E, Gayat E, Ferjani M, Mebazaa A. Decongestive effects of levosimendan in cardiogenic shock induced by postpartum cardiomyopathy. Anaesth Crit Care Pain Med 2016; 36:39-42. [PMID: 27436451 DOI: 10.1016/j.accpm.2016.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catecholamines and/or levosimendan have been proposed for haemodynamic restoration during cardiogenic shock (CS). In CS induced by post-partum cardiomyopathy (PPCM), levosimendan might be particularly favourable. The aim of this study was to evaluate the haemodynamic and echocardiographic effects of levosimendan in patients with CS, in particular in patients with PPCM-induced CS. METHODS Twenty-eight patients with refractory CS were retrospectively included in the study. Among them, a cohort of 8 women with PPCM-induced CS was included. All patients were treated with levosimendan (loading dose followed by a continuous infusion for 24 h) and were invasively monitored, including a pulmonary artery catheter, for 48hours. Echocardiographic measurements were performed at baseline and during follow-up. RESULTS Significant improvements in haemodynamic parameters were observed 48 h after starting levosimendan. The cardiac index increased (+1.2±0.6L/min, P<0.001) and filling pressures decreased (pulmonary artery occlusion pressure, PAOP: -11.2±4.3mmHg, P<0.001; right-atrial pressure, RAP: -6.1±4.9mmHg, P<0.001). The left ventricular ejection fraction was significantly higher at 48 h compared to baseline (38% [34-46%] versus 27% [22-30%], P<0.001). Despite similar characteristics at baseline, in the subgroup of patients with PPCM, more profound decongestive effects at 48hours were observed: PAOP (13±2 versus 17±4mmHg, P=0.007) and RAP (12±4 versus 17±4mmHg, P=0.006) were significantly lower in the PPCM subgroup compared to the non-PPCM subgroup. CONCLUSIONS Haemodynamics and left-ventricular ejection fraction rapidly improved after treatment with levosimendan. In patients with PPCM-induced CS, a more profound reduction of congestion was observed.
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Affiliation(s)
- I Labbene
- University of Tunis El Manar, department of anaesthesiology and critical care medicine, military hospital of Tunis, Tunis, Tunisia.
| | - M Arrigo
- Inserm UMR-S 942, Paris, France.
| | - M Tavares
- Serviço de cuidados intensivos, departamento de anestesia cuidados intensivos e emergência, hospital de Santo António, centro hospitalar do Porto, Porto, Portugal.
| | - Z Hajjej
- University of Tunis El Manar, department of anaesthesiology and critical care medicine, military hospital of Tunis, Tunis, Tunisia.
| | - J L Brandão
- Serviço de cuidados intensivos, departamento de anestesia cuidados intensivos e emergência, hospital de Santo António, centro hospitalar do Porto, Porto, Portugal.
| | | | - E Feliot
- Inserm UMR-S 942, Paris, France.
| | - E Gayat
- Inserm UMR-S 942, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, department of anaesthesiology and critical care medicine, AP-HP, Saint-Louis Lariboisière university hospitals, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Ferjani
- University of Tunis El Manar, department of anaesthesiology and critical care medicine, military hospital of Tunis, Tunis, Tunisia.
| | - A Mebazaa
- Inserm UMR-S 942, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, department of anaesthesiology and critical care medicine, AP-HP, Saint-Louis Lariboisière university hospitals, 2, rue Ambroise-Paré, 75010 Paris, France.
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Almeida AF, Trindade E, B Vitor A, Tavares M. Haemophilus influenzae type b meningitis in a vaccinated and immunocompetent child. J Infect Public Health 2016; 10:339-342. [PMID: 27422142 DOI: 10.1016/j.jiph.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/27/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022] Open
Abstract
Invasive Haemophilus influenzae type b (Hib) disease decreased dramatically after the introduction of conjugate vaccine in routine immunization schedules. We report a case of a fifteen-months-old girl, previously healthy and vaccinated, admitted in the emergency room with fever and vomiting. She was irritable and the Brudzinski's sign was positive. The cerebrospinal fluid (CSF) analysis showed pleocytosis and high protein level. Empiric intravenous antibiotics (ceftriaxone and vancomycin) were administered for suspected bacterial meningitis during 10 days. Serotyping of the Haemophilus influenzae strain found in CSF revealed a serotype b. After one year of follow-up no Hib meningitis sequelae were noted. Despite vaccination compliance and absence of risk factors, invasive Hib disease can occur due to vaccine failure. Efforts to keep the low incidence of invasive Hib disease should be directed to the maintenance of high vaccination coverage rates, combined with the notification and surveillance strategies already implemented in each country.
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Affiliation(s)
- Ana F Almeida
- Department of Pediatrics, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Eunice Trindade
- Department of Pediatrics, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Artur B Vitor
- Department of Pediatrics, Infectious Diseases Unit, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Margarida Tavares
- Department of Pediatrics, Infectious Diseases Unit, São João Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
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Keïta A, Huneau-Salaün A, Guillot A, Galliot P, Tavares M, Puterflam J. A multi-pronged approach to the search for an alternative to formaldehyde as an egg disinfectant without affecting worker health, hatching, or broiler production parameters. Poult Sci 2016; 95:1609-1616. [DOI: 10.3382/ps/pew058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/25/2016] [Indexed: 11/20/2022] Open
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Tavares M, Paredes S, Rocha T, Carvalho P, Ramos J, Mendes D, Henriques J, Morais J. Expert knowledge integration in the data mining process with application to cardiovascular risk assessment. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:2538-42. [PMID: 26736809 DOI: 10.1109/embc.2015.7318909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The data mining process, when applied to clinical databases, suffers from critical data problems, from noisy acquisitions to missing or incomplete data points. Expert knowledge, in the form of practitioners' experience and clinical guidelines, is already used to manually correct some of these problems, while enhancing expert's confidence in such systems. In this work, we propose the Knowledge-Biased Tree (KB3), a knowledge biased decision tree inducer that is able to exploit IF THEN rules to guide the tree inducing process. The KB3 approach was tested against its unbiased counterpart, the C5.0 algorithm in the cardiovascular risk assessment task. Using a clinical dataset provided by the hospital of Sta Cruz (Lisbon, Portugal) the performance of the proposed algorithm is compared against the unbiased C5.0 and the state of the art risk score used in clinical practice (GRACE risk score).
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Tavares M, Neves I, Coelho F, Afonso O, Martins A, Faria F. End-of-life decision making for cancer patients in an intensive care unit. Intensive Care Med Exp 2015. [PMCID: PMC4798027 DOI: 10.1186/2197-425x-3-s1-a651] [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: 11/10/2022] Open
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Tendais-Almeida M, Ferreira-Magalhães M, Alves I, Tavares M, Azevedo I. [Streptococcus pneumoniae Vaccination in Children and Adolescents at High Risk of Invasive Pneumococcal Disease]. ACTA MEDICA PORT 2015; 28:583-589. [PMID: 26667861] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND In Portugal, pneumococcal vaccination is free of charge and recommended by the Directorate-General of Health for the pediatric population at high risk of invasive pneumococcal disease. Our main aim was to describe the vaccination uptake in a pediatric population attending a hospital outpatient clinic. MATERIAL AND METHODS Cross-sectional observational survey of a pediatric population attending a referral hospital outpatient clinic, from July to December 2014. Data was collected from clinical records, Individual Health Bulletin or the registry from Plataforma de Dados da Saúde®. RESULTS Of the 122 participants, 95.9% had, at least, one shot of pneumococcal vaccine, but only 64.8% of these completed the age recommended vaccination scheme. Uptake was higher in children < 5 years old. The proportion of complete vaccination schemes was 100% in hemoglobinopathies and human immunodeficiency virus infection groups, 66.7% in prematures, 62.5% in splenectomized and 54.7% in Down syndrome. Children had better complete vaccination schemes when they attended the Pediatric Infectious Disease (100%) and Pulmonology Clinics (88.2%). Children > 5 years old had a higher uptake of 23-valent polysaccharide vaccine than the 2 to 5-years old ones (74.5% vs 40.5%; p < 0.001). DISCUSSION Most of our pediatric population at high risk of IPD was vaccinated; nevertheless, only two-thirds had completed the scheme for their age. The main failure was on the 23-valent polysaccharide vaccine administration. CONCLUSIONS Although these results are better than those reported in other European countries with similar recommendations, it is essential to explore the causes for the observed flaws in order to optimize vaccination rates.
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Affiliation(s)
| | - Manuel Ferreira-Magalhães
- Serviço de Pediatria. Hospital Pediátrico Integrado. Centro Hospitalar de São João. Porto. Portugal. Serviço de Pediatria. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde. Porto. Portugal
| | - Inês Alves
- Serviço de Pediatria. Hospital Pediátrico Integrado. Centro Hospitalar de São João. Porto. Portugal
| | - Margarida Tavares
- Serviço de Pediatria. Hospital Pediátrico Integrado. Centro Hospitalar de São João. Porto. Portugal
| | - Inês Azevedo
- Serviço de Pediatria. Hospital Pediátrico Integrado. Centro Hospitalar de São João. Porto. Portugal. Serviço de Pediatria. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. EpiUnit. Instituto de Saúde Pública. Universidade do Porto. Porto. Portugal
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Tendais-Almeida M, Ferreira-Magalhães M, Alves I, Tavares M, Azevedo I. Vacinação Contra Infeções por Streptococcus pneumoniae em Crianças e Adolescentes de Alto Risco para Doença Invasiva Pneumocócica. ACTA MEDICA PORT 2015. [DOI: 10.20344/amp.6545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><strong>Background:</strong> In Portugal, pneumococcal vaccination is free of charge and recommended by the Directorate-General of Health for the pediatric population at high risk of invasive pneumococcal disease. Our main aim was to describe the vaccination uptake in a pediatric population attending a hospital outpatient clinic.<br /><strong>Material and Methods:</strong> Cross-sectional observational survey of a pediatric population attending a referral hospital outpatient clinic, from July to December 2014. Data was collected from clinical records, Individual Health Bulletin or the registry from Plataforma de Dados da Saúde®.<br /><strong>Results:</strong> Of the 122 participants, 95.9% had, at least, one shot of pneumococcal vaccine, but only 64.8% of these completed the age recommended vaccination scheme. Uptake was higher in children < 5 years old. The proportion of complete vaccination schemes was 100% in hemoglobinopathies and human immunodeficiency virus infection groups, 66.7% in prematures, 62.5% in splenectomized and 54.7% in Down syndrome. Children had better complete vaccination schemes when they attended the Pediatric Infectious Disease (100%) and Pulmonology Clinics (88.2%). Children > 5 years old had a higher uptake of 23-valent polysaccharide vaccine than the 2 to 5-years old ones (74.5% vs 40.5%; p < 0.001).<br /><strong>Discussion: </strong>Most of our pediatric population at high risk of IPD was vaccinated; nevertheless, only two-thirds had completed the scheme for their age. The main failure was on the 23-valent polysaccharide vaccine administration.<br /><strong>Conclusions: </strong>Although these results are better than those reported in other European countries with similar recommendations, it is essential to explore the causes for the observed flaws in order to optimize vaccination rates.</p>
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Garcia C, Pestana J, Martins S, Nogueira P, Barros V, Rohde R, Camargo M, Feltran L, Esmeraldo R, Carvalho R, Schvartsman B, Vaisbich M, Watanabe A, Cunha M, Meneses R, Prates L, Belangero V, Palma L, Carvalho D, Matuk T, Benini V, Laranjo S, Abbud-Filho M, Charpiot I, Ramalho H, Lima E, Penido J, Andrade C, Gesteira M, Tavares M, Penido M, De Souza V, Wagner M. Collaborative Brazilian Pediatric Renal Transplant Registry (CoBrazPed-RTx): A Report From 2004 to 2013. Transplant Proc 2015; 47:950-3. [DOI: 10.1016/j.transproceed.2015.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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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Kording F, Yamamura J, Überle F, Remus C, Tavares M, Adam G, Schönnagel B. Fetale kardiale MRT Bildgebung mit linksventrikulärer Funktionsanalyse mit einem neuen Trigger Verfahren basierend auf Doppler Ultraschall: Erste Erfahrungen. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Body stalk anomaly is a rare malformation. This anomaly in monozygotic twins is extremely unusual. We describe a case of monoamniotic pregnancy discordant for body stalk anomaly diagnosed at 11 weeks. Ultrasound showed a fetus with a large anterior abdominal wall defect, anomaly of the spine and no evidence of lower extremities and other with a normal morphology. As far as our concern, only three monoamniotic pregnancies discordant for this malformation were reported. Our case represents the fourth reported monoamniotic pregnancy discordant for body stalk anomaly with diagnosis made by ultrasound and the second diagnosed in the first trimester.
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Affiliation(s)
- Mariana Vide Tavares
- Obstetric Department A, Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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Tavares M, Ribeiro L, Borges T, Gomes L, Silva E, Guedes M. [Hepatopulmonary syndrome--a rare cause of hypoxaemia]. An Pediatr (Barc) 2014; 80:e27-8. [PMID: 23746742 DOI: 10.1016/j.anpedi.2013.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 01/24/2013] [Accepted: 04/16/2013] [Indexed: 12/19/2022] Open
Affiliation(s)
- M Tavares
- Serviço de Pediatria, Centro Hospitalar do Porto, Porto, Portugal.
| | - L Ribeiro
- Serviço de Pediatria, Centro Hospitalar do Porto, Porto, Portugal
| | - T Borges
- Unidade de Endocrinologia Pediátrica, Centro Hospitalar do Porto, Porto, Portugal
| | - L Gomes
- Serviço de Pediatria, Centro Hospitalar do Porto, Porto, Portugal
| | - E Silva
- Unidade de Gastrenterologia Pediátrica, Centro Hospitalar do Porto, Porto, Portugal
| | - M Guedes
- Serviço de Pediatria, Centro Hospitalar do Porto, Porto, Portugal
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Roseiro LC, Santos C, Gonçalves H, Moniz C, Afonso I, Tavares M, da Ponte DJB. Concentration of antioxidants in two muscles of mature dairy cows from Azores. Meat Sci 2013; 96:870-5. [PMID: 24211545 DOI: 10.1016/j.meatsci.2013.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Abstract
This study evaluated the concentrations of α-tocopherol, β-carotene, creatine, carnosine, anserine and coenzyme Q10 in Longissimus dorsi (Ld) and Gluteus medius (Gm) muscles of culled dairy cows and the impact of age, production status before slaughter (dry-off vs lactating) and carcass weight on them. The effects of applying a finishing feeding regimen before slaughter were also examined. Gm muscle presented higher levels (P<0.001) of α-tocopherol (5.14 vs 3.61 μg · g(-1)) β-carotene (0.36 vs 0.27 μg · g(-1)), anserine (59.24 vs 43.25 mg · 100 g(-1)) and coenzyme Q10 (3.33 vs 1.73 mg · 100 g(-1)), and by contrast lower (P<0.05) creatine concentration (502.40 vs 527.28 mg · 100 g(-1)) than Ld. Dry-off and lactating cows differed significantly in α-tocopherol level (P<0.001) but not in the concentrations of the other compounds (P>0.05). The finishing feeding promoted higher mean concentrations of anserine and creatine but lower carnosine values (P>0.05) than directly slaughtered dry-off cows. The variation between muscles and from animal-to-animal makes it difficult to exactly define the antioxidant status of the dairy cow's meat.
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Affiliation(s)
- L C Roseiro
- Instituto Nacional de Investigação Agrária e Veterinária, I.P., Unidade Estratégica de Investigação e Serviços de Tecnologia e Segurança Alimentar, Campus do IAPMEI, Edifício S, Estrada do Paço do Lumiar, 22, 1649-038 Lisboa, Portugal.
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Flor de Lima B, Tavares M. Risk factors for extensively drug-resistant tuberculosis: a review. Clin Respir J 2013; 8:11-23. [PMID: 23875862 DOI: 10.1111/crj.12044] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 07/09/2013] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Extensively drug-resistant tuberculosis (XDR-TB) is emerging as a global public health problem. Its treatment is more expensive and difficult, and the outcomes much severe. The identification of risk factors for XDR-TB is of paramount importance to design effective TB control strategies. OBJECTIVE To review published articles on risk factors for XDR-TB. METHODS We identified 249 English articles on PubMed, and 182 were excluded by the abstract. The remaining articles were retrieved for full-text detailed evaluation by authors, and 27 relevant articles were selected for final review. RESULTS Some risk factors were consistently present, mainly previous TB treatment and its length. Other conditions often associated were immigration, alcoholism and HIV coinfection. Pre-XDR-TB points to an increased risk of XDR-TB. CONCLUSION The information regarding determinants of XDR-TB is relatively weak. However, special emphasis should be given to minimize the risks of TB retreatment to prevent the emergence of highly resistant TB.
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Affiliation(s)
- Bárbara Flor de Lima
- Master Programme in Medicine, Hospital de São João and University of Porto Medical School, Portugal
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Bernardino Neto M, de Avelar, Jr. E, Arantes T, Jordão I, da Costa Huss J, de Souza T, de Souza Penha V, da Silva S, de Souza P, Tavares M, Penha-Silva N. Bivariate and multivariate analyses of the correlations between stability of the erythrocyte membrane, serum lipids and hematological variables. Biorheology 2013; 50:305-20. [DOI: 10.3233/bir-130641] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Bernardino Neto
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - E.B. de Avelar, Jr.
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - T.S. Arantes
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - I.A. Jordão
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - J.C. da Costa Huss
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - T.M.T. de Souza
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - V.A. de Souza Penha
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - S.C. da Silva
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - P.C.A. de Souza
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - M. Tavares
- Department of Mathematics, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - N. Penha-Silva
- Institute of Genetics and Biochemistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
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Maserejian NN, Hauser R, Tavares M, Trachtenberg FL, Shrader P, McKinlay S. Dental composites and amalgam and physical development in children. J Dent Res 2012; 91:1019-25. [PMID: 22972857 DOI: 10.1177/0022034512458691] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Resin-based composite dental restoration materials may release bisphenol-A, an endocrine-disrupting chemical. Using secondary analysis of a randomized clinical safety trial of amalgam vs. composites, we tested the hypothesis that dental restoration materials affect children's growth. Children (N = 218 boys, N = 256 girls) aged 6 to 10 yrs at baseline with ≥ 2 decayed posterior teeth were randomized to amalgam or composites (bisphenol-A-diglycidyl-dimethacrylate composite for permanent teeth, urethane-dimethacrylate compomer for primary teeth) for treatment of posterior caries throughout follow-up. Primary outcomes for this analysis were 5-year changes in BMI-for-age z-scores, body fat percentage (BF%), and height velocity; exploratory analyses (n = 113) examined age at menarche. Results showed no significant differences between treatment assignment and changes in physical development in boys [(composites vs. amalgam) BF%, 4.9 vs. 5.7, p = 0.49; (BMI-z-score) 0.13 vs. 0.25, p = 0.36] or girls (8.8 vs. 7.7, p = 0.95; 0.36 vs. 0.21, p = 0.49). Children with more treatment on primary teeth had greater increases in BF% regardless of material type. Girls assigned to composites had lower risk of menarche during follow-up (hazard ratio = 0.57, 95% CI 0.35-0.95). Overall, there were no significant differences in physical development over 5 years in children treated with composites or amalgam. Additional studies examining these restoration materials in relation to age at menarche are warranted (clinicaltrials.gov number NCT00065988).
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Affiliation(s)
- N N Maserejian
- New England Research Institutes, 9 Galen Street, Watertown, MA 02472, USA.
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Abstract
OBJECTIVE No clear association between obesity or body fat distribution and prostate cancer has been shown. We investigated the relation between visceral fat accumulation as measured by computed tomography (CT) and the occurrence of prostate cancer. RESEARCH METHODS AND PROCEDURES We compared body fat distribution assessed by a direct method (CT) in 63 prostate cancer cases with 63 age-matched healthy community controls. A CT scan at the level of the fourth lumbar vertebra was performed in all participants. RESULTS Patients presented a significantly higher mean total abdominal fat area (509.2 +/- 226.1 vs. 334.3 +/- 132.9 cm2, p < 0.001), mostly because of a higher mean visceral fat area (VF; 324.7 +/- 145.6 vs. 177.4 +/- 88.4 cm2, p < 0.001) and a significantly higher mean ratio between visceral and subcutaneous fat areas (V/S ratio; 1.8 +/- 0.4 vs. 1.2 +/- 0.4, p < 0.001). A significantly higher risk of prostate cancer was found for participants with higher VF (odds ratio = 4.6; 95% confidence interval = 2.6 to 8.2 per SD increase) and V/S ratio (odds ratio = 6.0; 95% confidence interval = 2.3 to 11.0 per SD increase). DISCUSSION These results suggest a role for visceral obesity, quantified by CT, as a risk factor for prostate cancer. The action of the adipocytokines secreted by visceral fat cells, steroid hormone disturbances, and increased levels of insulin or other hormones noted in visceral obesity may explain this association.
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Affiliation(s)
- Pedro von Hafe
- Department of Medicine, Hospital S. João, Porto, Portugal.
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Santos LC, Abreu CF, Xerinda SM, Tavares M, Lucas R, Sarmento AC. Severe imported malaria in an intensive care unit: a review of 59 cases. Malar J 2012; 11:96. [PMID: 22458840 PMCID: PMC3350412 DOI: 10.1186/1475-2875-11-96] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/29/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU). METHODS Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011) and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS), malaria score for adults (MSA), simplified acute physiology score (SAPSII) and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12. RESULTS Fifty nine patients were included in the study, all but three were adults; 47 (79,6%) were male; parasitaemia on admission, quantified in 48/59 (81.3%) patients, was equal or greater than 2% in 47 of them (97.9%); the most common complications were thrombocytopaenia in 54 (91.5%) patients, associated with disseminated intravascular coagulation (DIC) in seven (11.8%), renal failure in 31 (52.5%) patients, 18 of which (30.5%) oliguric, shock in 29 (49.1%) patients, liver dysfunction in 27 (45.7%) patients, acidaemia in 23 (38.9%) patients, cerebral dysfunction in 22 (37.2%) patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2%) patients, hypoglycaemia in 18 (30.5%) patients; 29 (49.1%) patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were not associated with death in this cohort. CONCLUSION Severe malaria cases should be continued monitored in the ICUs. SAPS II and the WHO score are good predictors of mortality in malaria patients, but other specific scores deserve to be studied prospectively.
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Affiliation(s)
- Lurdes C Santos
- ICU Infectious Disease Unit, Hospital de S, João, Alameda do Professor Hernâni Monteiro, 4202-451 Porto, Portugal.
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