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Nunes A, Azevedo P, Carreira LM. The phenomenon of skin contraction in CO 2 LASER surgical incisions using superpulse and continuous emission mode - preliminary study. Lasers Med Sci 2024; 39:117. [PMID: 38678503 DOI: 10.1007/s10103-024-04065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024]
Abstract
The skin contraction phenomenon occurs due to the energy emitted by the surgical CO2 LASER affecting the collagen architecture and intracellular water content in tissues. The study aimed to assess how gender, age, breed, body-weight, CO2 LASER emission mode, and potency influence skin contraction following the incision. The study involved 80 dogs (N = 80) of both genders, multiple breeds, undergoing major surgery with CO2 LASER. Subjects were grouped based on LASER potency (12 or 15 Watts) and emission mode (Superpulse-SP or Continuous-CT): GSP12, GSP15, GCT12, and GCT15. A 10 mm incision was performed using the surgical CO2 LASER beam, consistently employing a focal point of 0.4 mm, positioned at a distance of 1 mm from the skin surface, and always maintained perpendicular to it, and resulting lengths measured with a digital caliper. Results were considered significant for p-value < 0.05. GSP12 showed minimal contraction, while GCT15 exhibited the most significant. Male subjects in GCT12, GCT15, and GSP12 experienced less contraction than females. Purebred dogs had greater contraction than mixed breeds. GSP12 individuals showed age-related contraction decrease (p < 0.01), with skin contracting by 0.09 mm per year. Weight and skin contraction trended towards significance (p = 0.06), with a 0.02 mm increase per unit weight. For a constant power of 12 W, the analysis of the relationship between the emission mode of the LASER beam and the final skin contraction (GSP12 vs. GCT12) revealed statistically significant differences (p < 0.01). This study suggests that the use of the Continuous mode of LASER emission, regardless of the power used, is associated with a higher level of final skin contraction. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: Project approval registration number by the Research and Teaching Ethics Committee (CEIE),Faculty of Veterinary Medicine-University of Lisbon (FMV_ULisboa), Lisboa-Portugal, N/Refª 015/2022.
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Affiliation(s)
- A Nunes
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
| | - P Azevedo
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal
| | - L Miguel Carreira
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal.
- Department of Clinics, Surgery Faculty of Veterinary Medicine, University of Lisbon (FMV_ULisboa), 1300, Lisbon, Portugal.
- Centre for Interdisciplinary Research in Animal Health, FMV-ULisboa, Lisbon, Portugal.
- Laboratório Associado Para a Ciência Animal E Veterinária (AL4AnimalS), Lisbon, Portugal.
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal.
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2
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Carreira LM, Azevedo P. Advantages of the co 2 laser use in the rare condition of nasal mucosa squamous cell carcinoma surgery in dogs-a clinical prospective study. Lasers Med Sci 2024; 39:114. [PMID: 38662131 DOI: 10.1007/s10103-024-04059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
Nasal mucosa tumors are an uncommon process and very dificult to work on with surgery. Radiotherapy associated or not with chemotherapy is the standard method to treat the disease. However, its access it is in the majority of the case not possible, making the surgery the best choice to try to achieve the patient's control. The anatomy of the region makes the complete surgical resection very difficult to achieve using the common and conventional blade scalpel surgery. The study features the advantages of using a CO2 laser to perform nasal mucosa carcinoma surgery in 6 dogs (N = 6). For the work we used an Aesculigth CO2 surgical laser model -Vetscalpel®, with the settings of 12Watts in a Superpulse mode, and a 0.25-0.4 mm focus to dissect the nasal mucosa, and a 1.5 mm focus for vaporization of the area. All the masses were histopathologically characterized as squamous cells carcinoma. The CO2 surgical laser allow us to work in a bloodless region promoting a more accurate dissection of the nasal mucosa sparing therefore the underlying and adjacent tissues and being less invasive. Also, it was possible to do the vaporization of the entire surgical area interviened. None of the patients presented relapse of clinical signs. Only 2 individuals were alive at the end of the study, presenting a survival rate of 420 and 514 days, which is in the same line of literature results of the treatment with radiotherapy combined with chemotherapy wich shows a median of 474-580 days. The study demonstrates successful outcomes with CO2 laser surgery in treating nasal mucosa SCC in dogs, with patients experiencing improved survival rates compared to traditional treatment methods. This highlights the efficacy and potential of CO2 laser surgery as a valuable tool in managing aggressive nasal tumors in veterinary oncology.
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Affiliation(s)
- L Miguel Carreira
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal.
- Department of Clinics, Surgery, Faculty of Veterinary Medicine University of Lisbon (FMV_ULisboa), 1300, Lisbon, Portugal.
- Centre for Interdisciplinary Research in Animal Health, FMV-ULisboa, Lisbon, Portugal.
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal.
- Faculty of American LASER Study Club, ALSC, San Diego, USA.
| | - P Azevedo
- Anjos of Assis Veterinary Medicine Centre (CMVAA), Barreiro, Portugal
- Faculty of American LASER Study Club, ALSC, San Diego, USA
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3
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Carreira LM, Alves J, Inacio F, Pires G, Azevedo P. Sex diferences in serum and synovial fluid C-reactive protein concentration in healthy dogs. Vet Res Commun 2024:10.1007/s11259-024-10386-0. [PMID: 38662317 DOI: 10.1007/s11259-024-10386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
Differences between serum C-reactive protein (SCRP) and synovial fluid C-reactive protein (SFCRP) concentrations in healthy animals may be influenced by the sex of the individual and associated with various factors. The objective of this study was to evaluate the disparities in SCRP and SFCRP concentrations between females and males, as well as within each sex. Sixty healthy dogs (N = 60), comprising both sexes, were enrolled in the study. Peripheral blood and knee synovial fluid samples were collected for SCRP and SFCRP analysis, respectively. Serum C-reactive protein (SCRP) and SFCRP concentrations were measured, with mean of 9.61 ± 4.96 mg/L for SCRP and 1.28 ± 3.05 mg/L for SFCRP. Notably, SFCRP concentrations were consistently lower than SCRP concentrations in both sexes. Statistically significant differences were observed between sexes for both SCRP (P = 0.021) and SFCRP (P = 0.007). Further analysis within females revealed statistically significant differences between SCRP and SFCRP concentrations (P = 0.002), whereas in males, such differences were not significant (P = 0.175). Additionally, weak correlations were found between SCRP and SFCRP concentrations for both sexes (females r = 0.07; males r = 0.29). Joint capsule thickness was assessed using ultrasonography, revealing thicker joint capsules in males. A robust positive association was noted between joint capsule thickness and the SFCRP concentration in both sexes. These findings offer valuable insights into the dynamics of CRP in the context of joint health in male and female patients, elucidating the underlying pathological mechanisms of joint disease and inflammation. Overall, this underscores the importance of considering sex-specific factors in the assessment and management of joint health, as well as in the design and interpretation of studies involving SFCRP concentrations.
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Affiliation(s)
- L Miguel Carreira
- Anjos of Assis Veterinary Medicine Centre - CMVAA, Rua D.ª Francisca da Azambuja Nº9 -9A, 2830-077, Barreiro, Portugal.
- Department of Clinics - Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV-ULisboa), Av. da Universidade Técnica de Lisboa, Polo Universitário Alto da Ajuda, 1300-477, Lisbon, Portugal.
- Interdisciplinary Centre for Research in Animal Health (CIISA) - University of Lisbon, (FMV/ULisboa) Av. da Universidade Técnica, 1300-477, Lisbon, Portugal.
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300, Lisbon, Portugal.
- Faculty of Amercian, LASER Study Club - ALSC, Altamonte Springs, FL, 32714, USA.
- Privat Human Dentistry (PHD), 1200, Lisbon, Portugal.
| | - J Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - F Inacio
- Department of Clinics - Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV-ULisboa), Av. da Universidade Técnica de Lisboa, Polo Universitário Alto da Ajuda, 1300-477, Lisbon, Portugal
| | - G Pires
- Department of Clinics - Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV-ULisboa), Av. da Universidade Técnica de Lisboa, Polo Universitário Alto da Ajuda, 1300-477, Lisbon, Portugal
- Interdisciplinary Centre for Research in Animal Health (CIISA) - University of Lisbon, (FMV/ULisboa) Av. da Universidade Técnica, 1300-477, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300, Lisbon, Portugal
| | - P Azevedo
- Anjos of Assis Veterinary Medicine Centre - CMVAA, Rua D.ª Francisca da Azambuja Nº9 -9A, 2830-077, Barreiro, Portugal
- Faculty of Amercian, LASER Study Club - ALSC, Altamonte Springs, FL, 32714, USA
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Rodrigues HC, Martins C, Fragoso E, Lopes C, Azevedo P. Mepolizumab in severe asthma exacerbation in a respiratory ICU-a successful off-label use. Pulmonology 2023; 29:438-440. [PMID: 37031002 DOI: 10.1016/j.pulmoe.2023.03.002] [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: 06/27/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- H C Rodrigues
- Unidade de Cuidados Intensivos Respiratórios, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Portugal; Unidade Multidisciplinar de Asma Grave, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - C Martins
- Unidade de Cuidados Intensivos Respiratórios, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - E Fragoso
- Unidade de Cuidados Intensivos Respiratórios, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - C Lopes
- Unidade de Cuidados Intensivos Respiratórios, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Portugal; Unidade Multidisciplinar de Asma Grave, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - P Azevedo
- Unidade de Cuidados Intensivos Respiratórios, Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Portugal
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Butolo NP, Azevedo P, Alencar LD, Malaspina O, Nocelli RCF. Impact of low temperatures on the immune system of honeybees. J Therm Biol 2021; 101:103082. [PMID: 34879910 DOI: 10.1016/j.jtherbio.2021.103082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
Changes in temperature resulting from climate change can impact the distribution and survival of species, including bees, where temperature may also affect their immune system. Evaluation of immune system activity is often performed by the total count of circulating hemocytes in the hemolymph. However, there are few studies on bees examining the relationship between the amount of circulating hemocytes and temperature. This study evaluated changes of circulating hemocytes in Apis mellifera hemolymph at different temperatures and development stages. Total hemocytes of bees were determined at - 8, 16, 24, and 32 °C - and at different development stages - in vivo larvae, in vitro larvae, newly emerged, and forager bees. A. mellifera larvae had a greater number of circulating hemocytes compared to the other development stages (newly emerged and foragers). Additionally, temperature was an important factor explaining variation of circulating hemocytes in the hemolymph, according to principal component analyses (PCA), as the number of circulating hemocytes was greater at higher temperatures. Therefore, extreme events arising from climate change, such as variation in temperature, can directly impact the immune system of bees, both individually and at the colony level, threatening the distribution and survival of several species.
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Affiliation(s)
- N P Butolo
- Centro de Estudos de Insetos Sociais - CEIS, Instituto de Biociências - Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Estadual Paulista 'Júlio de Mesquita Filho' (UNESP-SP), Rio Claro, SP, Brazil
| | - P Azevedo
- Grupo de Genética e Genômica da Conservação, Instituto de Biologia - Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Estadual de Campinas (UNICAMP-SP), Campinas, SP, Brazil.
| | - L D Alencar
- Grupo de Genética e Genômica da Conservação, Instituto de Biologia - Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Estadual de Campinas (UNICAMP-SP), Campinas, SP, Brazil
| | - O Malaspina
- Centro de Estudos de Insetos Sociais - CEIS, Instituto de Biociências - Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Estadual Paulista 'Júlio de Mesquita Filho' (UNESP-SP), Rio Claro, SP, Brazil
| | - R C F Nocelli
- Departamento de Ciências da Natureza, Matemática e Educação, Centro de Ciências Agrárias, Universidade Federal de São Carlos (UFSCar-SP), Araras, SP, Brazil
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Marques Pires C, Medeiros P, Oliveira C, Flores R, Mane F, Silva R, Campos I, Azevedo P, Gaspar A, Pereira MA, Galvao CB, Antunes N, Marques J. Impact of Atrial Fibrillation type in Acute Coronary Syndrome and the antithrombotic strategy. Europace 2021. [DOI: 10.1093/europace/euab116.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
Atrial fibrillation (AF) is an adverse prognostic factor during acute coronary syndrome (ACS). Current evidence recommends dual antithrombotic therapy (DAT), 1 antiplatelet drug and 1 anticoagulant drug, as the default strategy after nonST elevation ACS.
AIM
To identify the clinical differences and prognosis of AF type-new onset (nAF) or pre-existing (pFA)- during ACS, to evaluate antithrombotic strategy at hospital discharge (HD) and its impact on haemorrhagic and ischemic events.
METHODS
We performed a retrospective observational cohort study including 3241 patients (pts) with ACS (mean age 64 years, 77.5% male) admitted to a single center over a 6-year period, with 12-months follow-up.
RESULTS
AF rhythm was identified in 11.2% pts, of whom 63.2% presented nAF and 36.8% pAF.
When AF types where compared, pts with pAF had a higher prevalence of cardiovascular (Cv) comorbidities, including hypertension (p < 0.001), previous ACS (p = 0.03), valvular disease (p = 0.01) or stroke (p = 0.05), had greater left atrial diameter (p < 0.001) and were less likely to have significant coronary lesions (p = 0.05). Pts with nAF more frequently presented with STelevation ACS (p < 0.001) and had a lower Hemoglobin nadir (p < 0.001). The independent predictors of nAF in ACS were age (OR 1.1, p< =0.001), LVEF ≤ 40% (OR 2.2, p = 0.001), STelevation ACS (OR 2.6, p< =0.001) and previous valvular disease (OR 3.5, p< =0.01). Compared with the population without AF, nAF was a predictor of in-hospital death (OR 2.9, p = 0.027) and in-hospital composite endpoint (death, stroke, reinfarction and cardiogenic shock) (OR 2.5, p = 0.001) in multivariate analysis, but pAF wasn’t. During 12-months follow-up of pts with ACS and AF, there was no difference regarding death or follow-up composite endpoint (death, stroke and ACS) between the AF types.Regarding antithrombotic therapy, nAF pts were less often anticoagulated (p < 0.001) and pAF pts where more often treated with triple antithrombotic therapy (TAT) at HD (<0.001). Most of the pts with TAT stopped the second antiplatelet at agent 6-months (43.8%) or 12 months (25.5%) after HD. During 12-months follow-up, pts discharged with TAT had trend towards more haemorrhagic events (TAT 6.2% vs DAT2.7%,p = 0.69) and both groups had similar ischaemic events (death, ACS, stroke) (TAT 20.9% vs DAT23.7%,p = 0.714). In multivariate analysis the choice of TAT or DAT wasn’t a predictor of ischaemic events.
CONCLUSIONS
In ACS, pts with nAF had worst in-hospital outcomes than pts with pAF. Regarding antithrombotic strategy at HD pts with nFA were less often anticoagulated and less often treated with TAT. In our study the choice between DAT or TAT had no statistical impact on follow-up outcomes.
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Affiliation(s)
| | | | | | | | - F Mane
- Braga Hospital, Braga, Portugal
| | - R Silva
- Braga Hospital, Braga, Portugal
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of in-hospital management in ST Segment Elevation Myocardial Infarction in Portuguese hospitals over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To assess the evolution of in-hospital management of ST Segment Elevation Myocardial Infarction (STEMI) over the years in Portuguese hospitals and its impact on in-hospital complications and mortality
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of acute coronary syndrome since 2002 until 2019 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical data, revascularization strategy, medication during hospitalization. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess tendencies in categorical variables, and Kruskal-Wallis tests were used to assess tendencies in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 24425 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive increase in patients treated with aspirin, P2Y12 inhibitors (from 22.2% to 97.6% – p<0.001), beta blockers 62.% to 72.4% – p<0.001), ACE inhibitors (68.9% to 78.2% – p<0.001) and statins (72.1% to 88.4% – p<0.001), a progressive decrease in GP 2a3b inhibitors (20.9 to 14.6% – p<0.001), enoxaparin (55.2% to 29.9% – p<0.001), nitrates (82.7% to 16.1% – p<0.001), calcium channel blockers (5.0% to 3.1% – p<0.001) and inotropes (12.0% to 5.6% – p<0.001).
There was an increase of the use primary coronary angioplasty (36.4% to 73.2% – p<0.001), and of drug eluting stents (0% to 70.1% – p<0.001) a decrease in the use of fibrinolysis (75.7% to 1.6% – p<0.001), bare metal stents (88.1% to 0.3% – p<0.001) and intra-aortic balloon pump (1.8% to 0% – p=0.009), but not in invasive mechanical ventilation (2.5% to 1.9% – p=0.142).
Less patients had moderate to severely impaired left ventricle ejection fraction (28.8% to 14.9% – p<0.001), and there was a significant reduction in almost all in-hospital complications: re-infarction (2.0% to 1.0% – p<0.001); heart failure (36.2% to 9.9% – p<0.001); cardiogenic shock (10.8% to 3.9% – p<0.001); AV block (5.8% to 2.5% – p<0.001); mechanical complications (2.8% to 0.4% – p<0.001); stroke (1.3% to 0.4% – p<0.001); in-hospital mortality (9.9% to 3.8% – p<0.001); as well as length of stay ([4–10] days to [3–6] days – p<0.001). Exceptions were and increase in major bleeding (0.9% to 1.8% – p<0.001) and resuscitated cardiac arrest (3.9% to 4.5%, p=0.001).
Conclusion
In 17 years, we report a progressive evolution of the in-hospital treatment of STEMI patients in Portuguese hospitals, with a higher prescription of guideline recommended medications, use of invasive reperfusion techniques and last generation stents, resulting in a lower rate of in-hospital complications and mortality.
In-hospital outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Registo Nacional de Síndromes Coronárias Agudas - Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Sousa J, Lopes P, Azevedo P, Baptista R, Gavina C, Monteiro S. Parenteral anticoagulation in non-ST segment elevation acute coronary syndromes: which option to pick? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
According to the 2015 European Society of Cardiology's non-ST segment elevation acute coronary syndrome (NSTE-ACS) clinical practice guideline, fondaparinux is the parenteral anticoagulant with the most favorable efficacy/safety profile. Thus, it is recommended over enoxaparin, for instance, in that setting. However, its use and performance in a contemporary portuguese cohort has not been fully described.
Purpose
To assess fondaparinux utilization degree and to compare its in-hospital efficacy and safety profiles with those of enoxaparin, in a contemporary portuguese cohort of NSTE-ACS patients.
Methods
Patients consecutively admitted with NSTE-ACS, between October 2010 and January 2019, were retrospectively identified from a national registry of acute coronary syndromes and were further divided in two groups, as per parenteral anticoagulation strategy (fondaparinux vs. enoxaparin). Key exclusion criteria were specific contraindications to both agents, recent hemorrhagic stroke and indications for anticoagulation other than ACS. The primary efficacy endpoint was a composite of in-hospital reinfarction and mortality, whereas the primary safety endpoint was moderate-to-severe bleeding, as defined by the GUSTO criteria.
Results
A total of 5843 NSTE-ACS patients (mean age 65±13 years, 72.4% males) were included. Of these, 89.2% had a myocardial infarction, while the remaining 10.8% were diagnosed with unstable angina. The most frequent cardiovascular comorbidities were hypertension (71.3%), dyslipidemia (63.0%) and diabetes mellitus (31.7%). Fondaparinux was the anticoagulant of choice in 27.5% of patients, whereas the remainder were treated with enoxaparin. Compared with patients receiving enoxaparin, those in the fondaparinux group were younger, had less hypertension or diabetes mellitus and exhibited a less severe presentation; nonetheless, they had more often a previous history of coronary artery disease or hemorrhagic events. An invasive approach in terms of revascularization was adopted in 87.7% of the cohort (79.1% in the fondaparinux group vs. 90.9% in the enoxaparin group, p<0.001). The primary efficacy and safety endpoints occurred in 2.4% and 4.7% of patients, respectively. After adjustment for relevant covariates, the use of fondaparinux was independently associated with a lower rate of both the primary efficacy (OR 0.56 [0.32–0.95], p=0.034) and the primary safety endpoints (OR 0.37 [0.23–0.59], p<0.001).
Conclusion
In a contemporary portuguese cohort of NSTE-ACS patients, fondaparinux was underused but still independently associated with a lower risk of both a composite of in-hospital reinfarction or mortality event and major hemorrhage.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - P Lopes
- Centro Hospitalar de Lisboa Ocidental, Cardiology, Lisbon, Portugal
| | - P Azevedo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Gavina
- Hospital Pedro Hispano, Medicine, Matosinhos, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
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9
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De Sousa Bispo J, Azevedo P, Freitas P, Marques N, Reis C, Horta E, Trabulo M, Abecasis J, Canada M, Ribeiras R, Andrade M. Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation.
Objectives
To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI
Methods
Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint.
Results
377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF <40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102)
Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint.
We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001.
Conclusion
PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge.
Kaplan-Meier Survival Curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Freitas
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - C Reis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - E Horta
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Trabulo
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - J Abecasis
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M Canada
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
| | - M.J Andrade
- Hospital de Santa Cruz, Cardiology, Lisbon, Portugal
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10
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal.
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001).
At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001).
Conclusion
Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality.
6 Month Outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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11
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Menezes Fernandes R, Mota T, Bispo J, Costa H, Azevedo P, Bento D, Marques N, Jesus I. Recurrent syncope, which patient should we follow more closely. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The importance of education is well recognized in patients presenting with syncope, in order to reduce the recurrence rate.
Purpose
To determine a predictive score of recurrent syncopal episodes after the first medical assessment.
Methods
We conducted a retrospective study enrolling patients followed in our Syncope Consultation from January 2015 to November 2019. Clinical and episodes characteristics, as well as diagnostic studies were analysed. Correlation between variables was performed by the Chi-square and T-Student tests, with a significance level of 95%. Independent predictors of recurrent syncope were identified through a binary logistic regression analysis, considering p=0.05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analysed groups. SPSS 24.0 was used for statistical analysis.
Results
A total of 694 patients were included, and 420 (60.5%) had recurrent syncope at the first evaluation. After educational approach, 97 (14%) maintained recurrent episodes. In this subgroup, the mean age was 63.7±22.8 years-old and 88.7% already had previous recurrent syncope (vs 56.1%; p<0.001). The prodrome of malaise was common (40.2% vs 26.8%; p=0.008), but 32% of these patients had syncope without prodromes (vs 21.8%; p=0.032). They also had frequently first-degree atrioventricular (AV) block (22.5% vs 6.8%; p<0.001) and 51.7% had a final diagnosis of reflex syncope. No previous medication with calcium channel blockers (CCB) (p<0.001), malaise (p=0.011), not having Q-waves in the electrocardiogram (p=0.022) and the presence of first-degree AV block (p<0.001) were independent predictors of recurrent syncope. A predictive score of recurrence was determined using the formula: 0.108 − 1.556 x (medication with CCB) + 0.989 x (malaise) − 1.031 x (Q-waves) + 2.406 x (first degree AV block). Variables should be replaced by 1 or 0, depending on whether the condition is present or not. A cut-off of 0.283 was obtained with a specificity of 96.1% and a discriminative power of 81.2%.
Conclusion
In our patients presenting with syncope, recurrence rate reduced from 60,5% to 14% just with educational measures. To help identify patients who maintain recurrence, we determined a predictive score using clinical data from the first visit, with a good discriminative power and excellent specificity. It could be used to strengthen education, to direct diagnostic studies and to shorten follow-up visits, but it still needs validation to be used in clinical practice.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - T.F Mota
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - J.S Bispo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - H Costa
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - P Azevedo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - D Bento
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - N Marques
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - I Jesus
- Algarve University Hospital Center, Cardiology, Faro, Portugal
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Guimarães R, Ramalho L, Campos B, Azevedo P, Piovesana L, Cendes F. Tractography of the corticospinal tract in Parkinson's Disease. How does diffusion values vary along tract segments? Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Monteiro F, Azevedo P, Monteiro L, Machado C, França G, Norton A, Reis A. Antipsychotics in first-episode psychosis: Patterns of prescription in an inpatient unit. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.1650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionThe treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.Objectives/aimsTo know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.MethodsWe retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.ResultsA total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.ConclusionsSecond-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Campos I, Azevedo P, Pereia VH, Costeira-Pereira A, Salome N, Vieira C, Costa-Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Marques J. P1308 A peculiar case of an acute pulmonary embolism. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
Cardiac tumors represent a challenging diagnosis, since the heart is an unusual site of metastasis from any malignancy.Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas but cardiac metastization from bladder urothelial carcinoma is an extremely rare event. Here, we report the case of an 82-year-old man in whom right ventricular extension of cardiac metastization was diagnosed after a pulmonary thromboembolism.
CASE REPORT DESCRIPTION
An 82-year-old male was admitted to our hospital with a history of cough with streaky hemoptysis, fever and anorexia for 2 weeks, and breathlessness on exertion for 2 day. He had a history of bladder urothelial carcinoma 3 months ago, with extensive areas of epidermoid differentiation, treated only surgically with cystectomy. On physical examination, he was afebrile with a blood pressure of 135/70, tachycardic at 115beats/min, and his respiratory rate was 26breaths/min. The room air oxygen saturation was 90%, and arterial blood gas analysis revealed hypoxemia with an elevated alveolo-arterial oxygen gradient. The blood test revealed a normocytic normochromic anemia and an elevated levels of D-dimer. The echocardiogram revealed a pediculated and mobile mass attached to the apex of the right ventricle. A CT pulmonary angiography was performed and found an acute and bilateral pulmonary thromboembolism, being the patient immediately hypocoagulated. It was also performed a cardiac MRI (with and without contrast) that showed a large mass in the RV. It was arising from the RV free wall and was occupying almost half of the RV (mid and apical cavity). It had irregular edges with intermediate enhancement on T1 images and is hyperintense on T2 stir images. There was some evidence of contrast uptake on T1 weighted contrast images. It did not seem to have a significant fatty component on T1 weighted images with fat saturation. The cardiac MRI features were consistent with tumorous involvement of the RV. As part of the work for primary cancer, a colonoscopy was performed which also showed the presence of metastases in the proximal sigmoid colon from the bladder urothelial carcinoma. During hospitalization, the echocardiogram was repeated, showing an increase in the mass previously described, extending to the trunk of the pulmonary artery. Soon after, our patient died suddenly after an episode of sudden dyspnea and hemodynamic instability.
CONCLUSION
We experienced a very uncommon case of a metastatic cardiac tumor from urothelial carcinoma. To the best of our knowledge, only a small number of cases were reported and the reason for the rarity of cardiac metastasis from urothelial carcinoma is unclear. Although the echocardiography has become the gold standard for the diagnosis of intracardiac masses, cardiac MRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, allowing a comprehensive characterization of such lesions.
Abstract P1308 Figure. pediculated and mobile mass (20x56mm) at
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - P Azevedo
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereia
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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15
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Menezes Fernandes R, Mota T, Azevedo P, Bispo J, Guedes J, Costa H, Cunha S, Bento D, Cordeiro P, Bettencourt N, Marques N, Pereira S, Nobre A, Jesus I. P871 Giant left ventricular (pseudo?)aneurysm complicating anterior myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Clinical approach of cardiac aneurysms and pseudoaneurysms is significantly distinct. Therefore, it is crucial to accurately differentiate these two entities, which could be a real challenge.
Case report
We describe a case of a 55-year-old woman, with hypertension and previous smoking habits. She was admitted in our Cardiology Department with the diagnosis of anterior acute myocardial infarction, and was submitted to emergent coronariography, unveiling an occlusion of the middle segment of the anterior descending artery. She underwent successful primary percutaneous coronary intervention (PCI) 1h45 after the chest pain onset. Transthoracic echocardiogram (TTE) revealed depressed left ventricle ejection fraction (LVEF 30%), with akinesia of anterior and septal walls and all apical segments. She evolved in Killip-Kimbal class 2 and was discharged clinically stable. One week later, the patient performed a control TTE that showed an apical thrombus, with a small pericardial effusion, and she initiated warfarin. Three weeks later, a reevaluation TTE demonstrated a severe increase of the left ventricle dimensions, with LVEF 32%, and a small pericardial effusion. In apical 4-chambers incidence, it was visualized a linear structure (42 mm x 5 mm) attached to the endocardial border of the anterolateral apical segment and to the apical segment of the interventricular septum, of undefined nature. The apical segments were dyskinetic and had a very thin wall, which could correspond to aneurysm versus pseudoaneurysm. To clarify these findings, the patient performed a cardiac magnetic resonance revealing a large anterior myocardial infarction complicated with extensive myocardial necrosis, severe depression of LV systolic function (LVEF 25%) and septum rupture distal to the right ventricle apex (without connecting with it), compatible with a large apical pseudoaneurysm. The clinical case was discussed in the Heart Team and it was decided to perform cardiac surgery. However, surgical findings showed integrity of septal and free walls, and she underwent an aneurysmectomy, without further complications. Histological examination confirmed the presence of a thin myocardial wall with marked fibrosis and, consequently, the diagnosis of ventricular aneurysm. She was discharged clinically stable and maintains follow-up in Cardiology consultation of our Hospital.
Conclusion
In this patient, initially admitted with an anterior myocardial infarction submitted to primary PCI, follow-up with advanced imaging modalities pointed to the diagnosis of pseudoaneurysm. Despite the preoperative diagnosis, surgical findings were compatible with a giant left ventricular aneurysm. Even with high spatial resolution exams, postoperative evaluation of tissue layers remains the gold standard for this differential diagnosis.
Abstract P871 Figure. Apical pseudoaneurysm vs aneurysm
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - H Costa
- Faro Hospital, Cardiology, Faro, Portugal
| | - S Cunha
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Cordeiro
- Hospital Particular do Algarve, Cardiology, Faro, Portugal
| | - N Bettencourt
- Hospital Particular do Algarve, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - S Pereira
- Faro Hospital, Cardiology, Faro, Portugal
| | - A Nobre
- Hospital de Santa Maria, Cardiothoracic Surgery, Lisbon, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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16
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Menezes Fernandes R, Mota T, Bispo J, Azevedo P, Guedes J, Costa H, Bento D, Cafe H, Shamasna M, Fidalgo AP, Jesus I. P918 Screening protocol of patent foramen ovale in cryptogenic stroke. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cryptogenic stroke reaches a prevalence of 30% and entails a significant risk of recurrence. Transesophageal echocardiography is the gold standard in identifying potential proximal embolic sources, including patent foramen ovale (PFO). Based on recent evidence, PFO percutaneous closure is recommended in selected cases of cryptogenic stroke, especially if associated with high risk features. Since PFO is present in up to 27% of the general population, the real challenge is to define which patients have a pathogenic PFO.
Purpose
To develop a pathogenic PFO screening protocol in patients with cryptogenic stroke, aimed at secondary prevention.
Methods
We revised the literature, analysing published articles in PubMed in the last 5 years, with the keywords "patent foramen ovale and cryptogenic stroke". Subsequently, we produced a screening algorithm based on cryptogenic stroke definition, on RoPE (Risk of Paradoxical Embolism) Score and on the inclusion and exclusion criteria of the CLOSE, REDUCE and RESPECT studies, which showed promising results of PFO closure in this context.
Results
Our protocol establishes that patients who present with ischemic stroke should be evaluated for risk factors and undergo a detailed etiological study. When the study is inconclusive, the RoPE score is applied to determine the probability of finding a pathogenic or an incidental PFO. If equal or greater than 7 points, in the absence of predefined exclusion criteria, a transesophageal echocardiogram is performed. If the screening is positive, the patient will be referred to the Cardiology Department for therapeutic guidance. If negative, alternative complementary diagnostic methods may be considered.
Conclusion
Through the application of this protocol, patients with high probability of having a pathogenic PFO and, consequently, those who may benefit from percutaneous closure, will be selected to undergo a screening transesophageal echocardiogram. The implementation of a PFO screening protocol in patients who present with cryptogenic stroke is relevant, by proposing to reduce its recurrence rate through the early referral of young patients with indication for an invasive strategy.
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - H Costa
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - H Cafe
- Faro Hospital, Cardiology, Faro, Portugal
| | - M Shamasna
- Faro Hospital, Stroke Unit, Faro, Portugal
| | | | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Campos I, Azevedo P, Costeira Pereira A, Salome N, Vieira C, Pereira VH, Costa Oliveira C, Marques Pires C, Medeiros P, Flores R, Mane F, Mare R, Marques J. P1314 A singular explanation of stroke in young adults. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Although primary cardiac tumors are rare, papillary fibroelastoma (PFE) is the most common benign neoplasm of cardiac valvular structures. Because patients are often asymptomatic the true prevalence is unknown, being most commonly recognized given the evolution of higher-resolution imaging technology. The clinical presentation of PFEs can diverge between being asymptomatic to symptomatic based on the serious complications that can occur, such as acute valve dysfunction or embolization, giving rise to a wide variety of presenting features including neurologic events, acute coronary syndrome, and distal embolic events. The location on the mitral valve does not occur frequently, with rare cases reported in the literature. Here, we present an unusual case of a 32-year-old male with an acute stroke secondary to a PFE in the mitral valve.
CASE REPORT DESCRIPTION
A 32-year-old male patient with a history of crohn"s disease was admitted to our emergency department with a transient sudden-onset aphasia associated with a right hemiparesis. At admission, these symptoms had completely resolved. On further questioning, the patient described another episode of transient right hemiparesis in the last year. On physical examination, the patient"s vital signs were stable. The patient was awake, alert, and oriented with full Glasgow Coma Scale. There was no focal neurological deficit on neurological examination and his cardiovascular examination was normal with no murmurs, added sounds or carotid bruit. A cranial CT showed no signs of acute intracranial disease. Head MRI showed multiple areas of restricted diffusion in the left frontal lobe consistent with acute stroke. As part of the workup to determine the cause of his embolic stroke, a transthoracic echocardiogram and transoesophageal echocardiography were performed, showing a spherical and highly mobilemass attached on the downstream side of the anterior mitral valve leaflet of approximately 1.1 cm in diameter, suggesting the diagnosis of PFE. A bubble study was negative which out ruled patent foramen ovale. After completing the rest of the workup, it was determined that PFE was likely the cause of his stroke. Cardiothoracic surgery was consulted and the patient underwent surgical resection. Histology confirmed the diagnosis of PFE. After 5 years the patient remains asymptomatic, without new embolic events.
DISCUSSION AND CONCLUSIONS
We present a special case that illustrates the importance of diagnosing primary cardiac tumours in a young patient presenting with acute stroke with minimal or no risk factors.Although primary cardiac tumours are rare, diagnosis and treatment at an early stage may prevent serious complications and reduce the morbidity and mortality of embolic stroke.
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Affiliation(s)
- I Campos
- Hospital de Braga, Cardiology, Braga, Portugal
| | - P Azevedo
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | - N Salome
- Hospital de Braga, Cardiology, Braga, Portugal
| | - C Vieira
- Hospital de Braga, Cardiology, Braga, Portugal
| | - V H Pereira
- Hospital de Braga, Cardiology, Braga, Portugal
| | | | | | - P Medeiros
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Flores
- Hospital de Braga, Cardiology, Braga, Portugal
| | - F Mane
- Hospital de Braga, Cardiology, Braga, Portugal
| | - R Mare
- Hospital de Braga, Neurology, Braga, Portugal
| | - J Marques
- Hospital de Braga, Cardiology, Braga, Portugal
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18
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Garcia M, Azevedo P, Guerra-Junior A, Barbosa M. PNS24 GASTOS COM MEDICAMENTOS E SEU IMPACTO NA RENDA DAS FAMÍLIAS BRASILEIRAS. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.372] [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: 10/25/2022]
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19
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Menezes Fernandes R, Mota T, Bispo J, Azevedo P, Guedes J, Silva D, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P1721Determination of a predictive score of cardiogenic shock in acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiogenic shock is one of the leading causes of death in patients with acute coronary syndrome (ACS), reaching in-hospital mortality rates of 50%.
Purpose
To identify a predictive score of cardiogenic shock in patients with ACS.
Methods
We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of cardiogenic shock were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. Statistical analysis was conducted with SPSS 24.0.
Results
During this period, 4458 patients were admitted with ACS and 74 (1,7%) developed cardiogenic shock. In this subgroup, 59,5% were over 65 years of age, 63,5% were male and 93,2% presented with acute myocardial infarction with ST segment elevation. Also, 83,8% were in sinus rhythm at admission, 22,7% had creatinine>1,5 mg/dL and 17,9% had left ventricular ejection fraction (LVEF) <30%. The in-hospital mortality rate was 51,4%. LVEF <30% (p=0,018), creatinine>1,5 mg/dL (p=0,044) and absence of sinus rhythm at admission (p=0,041) were independent predictors of cardiogenic shock. A predictive score of this complication in patients with ACS was determined using the formula: 1,723 + 1,505 x (creatinine>1,5) + 4,483 x (LVEF <30%) – 2,094 x (sinus rhythm at admission). A cutoff of 0,58 was obtained with 44,4% sensitivity, 85,2% specificity and 85% discriminative power.
Conclusion
Cardiogenic shock occurred in 1,7% of patients admitted with ACS and was associated with a high mortality rate. We determined a predictive score of this complication with a good discriminative power, which included LVEF <30%, creatinine >1,5 mg/dL and the rhythm on admission's electrocardiogram. By taking into account clinical variables, this score can be used at a very early stage of admission, allowing risk stratification of developing cardiogenic shock in each patient. However, it needs validation to be applied in clinical practice.
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Affiliation(s)
| | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Silva
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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20
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Faria Da Mota T, Sousa Bispo J, Azevedo P, Fernandes R, Guedes JP, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P844NAS2H score, a novel predictive score of 1-year all cause mortality in Acute Coronary Syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients admitted for Acute Coronary Syndromes (ACS), mortality is influenced by several clinical and therapeutical factors, and management of these patients should be guided by an estimate of individual risk.
Objective
To develop a simple predictive model of 1-year mortality in patients admitted for ACS.
Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for ACS in a Cardiology department between the 1st of October 2010 and the 1st of October 2017. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Patients with 1y mortality (1yM) events were studied regarding baseline demographic and clinical characteristics, risk factors and hospitalization data, and a correlational analysis with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%) was performed. Independent predictors of 1yM were identified through binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.
Results
A total of 3251 patients were included, 826 (25,4%) of which were female, with a mean age of 65,5±13,4 years. In the studied sample, 268 patients (8,2%) died in the year following hospital discharge; this group had a mean age of 65,6±13,2 years, and 80 (29,9%) were female patients. There was a significant association between 1yM and multiple clinical, therapeutical and laboratorial variables, but after multivariate analysis only age greater than 65 years old (yo) [p=0,001], previous stroke [p=0,005], haemoglobin (Hb) <10mg/dL [p<0,001], brain natriuretic peptide (BNP) >100pg/mL [p=0,001], and left ventricular ejection fraction (LVEF) <50% [p <0,001] proved to be independent predictors of the studied outcome. Using these variables, the authors developed a scoring model to predict 1yM in patients admitted for ACS with the following formula = 0,002 + (0,736 x Age >65yo) + (0,91 x previous stroke) + (2,562 x Hb <10) + (0,63 x BNP >100) - (1,207 x FEVE >50%). In this function, variables should be substituted by 1 or 0, depending on wheter they are present or not. The discrimination cutoff was 0,57, with a 70,6% sensibility and 75,9% specificity, and a discriminant power of 75,4%.
Conclusion
Defining the mortality risk of ACS patients after discharge represents a real challenge and demands a careful evaluation of multiple factors in an attempt to achieve an accurate estimation of risk. The authors developed a predicting model for 1yM in ACS patients, with a good discriminant power, based on simple variables. The present score will require validation in a larger cohort of ACS patients before it can be applied in a clinical context.
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Affiliation(s)
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J P Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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21
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Faria Da Mota T, Azevedo P, Fernandes R, S J, Guedes J, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P4579Prediction of CABG indication in patients admitted for NSTEMI with the new CABG DAPE2S score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
A significant number of patients admitted for Non-ST Elevation Myocardial Infarction (NSTEMI) have multivessel complex coronary artery disease (CAD) and benefit from Coronary Artery Bypass Graft surgery (CABG). These patients frequently present high-risk surgical profiles, constituting a challenging group when it comes to balancing ischemic and haemorrhagic risk.
Objective
To develop a simple predictive risk model of referral to CABG in patients admitted for NSTEMI.
Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for NSTEMI in a Cardiology department between the 1st of October 2010 and the 1st of October 2018. Demographic profile, clinical characteristics, risk factors and hospitalization data of NSTEMI patients referred to CABG were studied, and a correlational analysis was performed with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%). Independent predictors of CABG in patients with NSTEMI were identified through Binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was subsequently applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.
Results
A total of 2476 patients were included, 668 (27%) of which were female, with a mean age of 68,5±13,4 years. In the studied sample, 273 patients (11%) were proposed to CABG. The authors found a significant association between CABG and multiple clinical, laboratorial and therapeutical variables, but after multivariate analysis only male sex, previous Diabetes Mellitus, previous angina, previous Percutaneous coronary intervention, absence of a normal EKG, ST segment depression at admission, sinus rythm and brain natriuretic peptide (BNP) >100pg/mL proved to be independent predictors of referral. Using these variables, the authors developed a risk model to predict CABG referral in NSTEMI patients: −0,614 − (0,756 x female sex) + (0,305 x diabetes) + (0,631 x angina) − (1,513 x previous PCI) + (1,216 x sinus rythm) + (0,672 x ST depression) − (0,806 x normal EKG) + (0,562 x BNP>100). In this function, variables should be substituted by 1 or 0, depending on wheter the condition they specify is present or absent. The optimal discrimination cutoff was 0,23, with a 64% sensibility and 59% specificity, and a discriminant power of 60%.
Conclusion
Being able to predict referral to surgical revascularization in NSTEMI may help physicians to optimize a specific approach in each patient, in particular with regard to anti-thrombotic strategies. The authors developed a risk predicting model for CABG in NSTEMI patients based on simple clinical and laboratory variables, which will require validation in a larger cohort, before it can be applied in a clinical context.
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Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J S
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Martins T, Vaz A, Asseiceira I, Mexia S, Pereira L, Lopes C, Azevedo P, Barreto C, Sampaio D. P317 Nutritional status and body composition in a cystic fibrosis population: comparison with a healthy population. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cunha C, Fernandes M, Santos M, Ferreira M, Caiado A, Miranda P, Azevedo P, Manso M, Oliveira J, Barreira S, Féria L, Maio R. ERAS® program in the “elderly” - can we still improve even in the extremes? Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Faria Da Mota T, Azevedo P, Bispo J, Fernandes R, Guedes JP, Silva D, Bento D, Amado J, Mimoso J, Santos W, Jesus I. P6418Modified shock index - an independent predictor of acute heart failure and in-hospital mortality in patients with ST-segment elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J P Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Silva
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Amado
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Quina-Rodrigues C, Gaspar A, Oliveira C, Campos I, Abreu G, Arantes C, Martins J, Braga CG, Vieira C, Salgado A, Azevedo P, Pereira MA, Marques J. P4615Pulse pressure: an independent predictor of in-hospital cardiovascular mortality in acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4615] [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: 11/13/2022] Open
Affiliation(s)
| | - A Gaspar
- Hospital de Braga, Braga, Portugal
| | | | - I Campos
- Hospital de Braga, Braga, Portugal
| | - G Abreu
- Hospital de Braga, Braga, Portugal
| | | | | | | | - C Vieira
- Hospital de Braga, Braga, Portugal
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Rodrigues T, Azevedo P, Pereira L, Celeste B. P256 Clinical and genetic characteristics of patients in a Lisbon CF Centre - importance in the face of CFTR targeted therapies. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30551-4] [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: 10/14/2022]
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Martins T, Vaz A, Asseiceira I, Mexia S, Pereira L, Lopes C, Almeida Nunes P, Azevedo P, Barreto C, Sampaio D. P199 Nutritional status and eating behaviour in a CF population. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30494-6] [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: 10/14/2022]
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Gaspar A, Lourenco A, Pereira M, Azevedo P, Marques J, Leite-Moreira A. P5561Remote ischaemic conditioning in ST elevation myocardial infarction as adjuvant to primary angioplasty: preliminary results of a randomized clinical trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Quina-Rodrigues C, Gaspar A, Abreu G, Arantes C, Campos I, Martins J, Braga C, Vieira C, Salgado A, Azevedo P, Pereira M, Marques J. P5552Protective effect of obesity in acute myocardial infarction: evidence of the “obesity paradox”. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moura Guedes J, Azevedo P, Bento D, Carvalho D, Bispo J, Amado J, Marques N, Santos W, Mimoso J, Brandao V, De Jesus I. P5594ST elevation myocardial infarction network still faster saves still more lives. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Faria B, Azevedo P, Santos P, Reis L, Almeida R, Craveiro N, Antunes H, Ruivo C, Marreiro A, Azevedo O, Oliveira M, Von Hafe P, Calvo L. P4519Long QT: Is it a predictor of prognosis in patients with Takotsubo cardiomyopathy? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4519] [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: 11/13/2022] Open
Affiliation(s)
- B. Faria
- Hospital Guimaraes, Guimaraes, Portugal
| | - P. Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - P. Santos
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | - L. Reis
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R. Almeida
- Hospital Garcia de Orta, Almada, Portugal
| | - N. Craveiro
- Hospital of Santarem, Cardiology, Santarem, Portugal
| | | | - C. Ruivo
- Hospital Santo Andre, Leiria, Portugal
| | | | | | | | | | - L. Calvo
- Hospital Guimaraes, Guimaraes, Portugal
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Santos V, Cardoso AV, Lopes C, Azevedo P, Gamboa F, Amorim A. Cystic fibrosis - Comparison between patients in paediatric and adult age. Rev Port Pneumol (2006) 2016; 23:17-21. [PMID: 27743767 DOI: 10.1016/j.rppnen.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 06/28/2016] [Accepted: 07/22/2016] [Indexed: 10/20/2022] Open
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. Although most cases are diagnosed in childhood, diagnosis in adults is apparently increasing. OBJECTIVE Evaluate the adult population with CF, comparing patients who were diagnosed before and after 18 years of age. METHODS Retrospective analysis of patients followed in three main medical centres in Portugal in 2012. Comparison of two groups: G1 - patients diagnosed at <18 years and G2 - patients diagnosed at ≥18 years. RESULTS 89 adults were identified: 61.8% in G1, 38.2% in G2. Gender distribution was similar in both groups. Average age in G2 was higher (38.3±8.4 vs. 26.8±6.1 years, p<0.001). Respiratory symptoms most frequently led to CF diagnosis in all patients, mainly in adulthood. There was a greater percentage of patients homozygous for the mutation delF508 in G1 (43.6 vs. 8.8%, p=0.02). Respiratory and pancreatic function, and body mass index (BMI) showed a higher severity in G1 (G1 vs. G2: FEV1: 54.6±27.3 vs. 29.9±64.6%, p=0.177; pancreatic insufficiency 72.7 vs. 26.5%, p<0.001; BMI 20.2±3.4 vs. 22.2±4.8, p=0.018). Pseudomonas aeruginosa and methicillin-sensitive Staphylococcus aureus were the most frequently isolated microorganisms. Lung transplantation rate was higher in G2 (20.6 vs. 10.9%, p=0.231) while mortality rate was higher in G1 (0 vs. 3.6%, p=0.261). Hospital admission rate was higher in G1 as well as mortality rate. CONCLUSION The results suggest that patients with CF diagnosed in childhood have characteristics that distinguish them from those diagnosed in adulthood, and these differences may have implications for diagnosis, prognosis and life expectancy.
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Affiliation(s)
- V Santos
- Pulmonology Department, Centro Hospitalar de São João, EPE, Portugal.
| | - A V Cardoso
- Pulmonology Department, Centro Hospitalar de São João, EPE, Portugal
| | - C Lopes
- Pulmonology Department, Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal
| | - P Azevedo
- Pulmonology Department, Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal
| | - F Gamboa
- Pulmonology Department, Hospitais da Universidade de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Amorim
- Pulmonology Department, Centro Hospitalar de São João, EPE, Portugal; Faculty of Medicine of Porto University, Portugal
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Li S, Moossavi S, Azevedo P, Schurmann B, Gorka P, Penner GB, Plaizier JC, Khafipour E. 1459 Effects of duration of moderate increases in grain on bacterial diversity in the digestive tract of Holstein calves. J Anim Sci 2016. [DOI: 10.2527/jam2016-1459] [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: 11/13/2022] Open
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Meale SJ, Li S, Azevedo P, Derakhshani H, Plaizier JC, Steele M, Khafipour E. 1614 Does weaning age affect the development of ruminal and fecal microbiomes in dairy calves? J Anim Sci 2016. [DOI: 10.2527/jam2016-1614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Azevedo O, Marques N, Antunes H, Azevedo P, Oliveira M, Bento D, Guedes J, Marmelo B, Faria R, Correia E. Screening of lysosomal acid lipase deficiency in patients with severe dyslipidemia and premature coronary heart disease. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amorim A, Gamboa F, Sucena M, Cunha K, Anciães M, Lopes S, Pereira S, Ferreira R, Azevedo P, Costeira J, Monteiro R, da Costa J, Pires S, Nunes C. Recommendations for aetiological diagnosis of bronchiectasis. Rev Port Pneumol (2006) 2016; 22:222-235. [PMID: 27134122 DOI: 10.1016/j.rppnen.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023] Open
Abstract
The number of bronchiectasis diagnoses has increased in the last two decades due to several factors. Research carried out over the last years showed that an aetiological diagnosis could change the approach and treatment of a relevant percentage of patients and consequently the prognosis. Currently, systematic investigation into aetiology, particularly of those disorders that can be subject to specific treatment, is recommended. Given the complexity of the aetiological diagnosis, the Pulmonology Portuguese Society Bronchiectasis Study Group assembled a working group which prepared a document to guide and standardize the aetiologic investigation based on available literature and its own expertise. The goal is to facilitate the investigation, rationalize resources and improve the delivery of care, quality of life and prognosis of patients with bronchiectasis.
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Ferro F, Freitas F, Lopes C, Costa R, Pinto A, Azevedo P, Bárbara C. 260 Predictors of lung function decline in cystic fibrosis. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30498-2] [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: 10/21/2022]
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Azevedo P, Vitória J, Norton A. Mental health and suicidal risk in lesbian, gay and bisexual population. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionNowadays, the lesbian, gay and bisexual (LGB) community still suffers from prejudice and social stigma, including from medical professionals.Thus, it is urgent to draw attention to this population since these individuals have an increased risk of mental disorders, substance abuse and dependence, suicidal ideation and suicide attempt or complete suicide.AimsTo underline the prevalence of mental disorders and increased suicide risk in the LGB population.ObjectivesTo summarize the latest literature about this field.MethodsA brief review of the latest literature was performed on PubMed using the keywords “mental health”, “suicidal risk”, “LGB population”.ResultsLGB individuals appear to be at increased risk of mental disorders and suicidal behavior than heterosexuals. According to Meyer, they are exposed to what is called the minority stress: proximal, depending on the subject and related to fear of rejection and internalized homophobia and distal, regardless of the individual including prejudice, social stress, social exclusion (including their own families) and violence.The odds of attempting suicide are approximately 2 to 7 times higher for lesbians, gay men and bisexuals (LGBs) than for heterosexuals.ConclusionsMinority stress related to prejudice and stigma against LGB people has a significant risk that can be related to suicide ideation and attempt.The higher rate of many psychiatric conditions noted in this community underscores the need for clinicians to provide nonjudgmental care and approachable environment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Silva J, Mota J, Azevedo P. California rocket fuel: And what about being a first line treatment? Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThe association venlafaxine-mirtazapine is currently known as California Rocket Fuel (CRF). Studies show advantage in terms of efficacy and rapid control of depressive symptoms compared to other associations. Venlafaxine is a selective serotonin-noradrenalin reuptake inhibitor and mirtazapine is a noradrenergic-specific serotonergic antidepressant: the result is a potent noradrenergic and serotonergic effect. Studies say that CRF should be performed only for drug-resistant depression; however, there are case reports of its use as a first line treatment, in selected patients.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and critically review the controversies of venlafaxine-mirtazapine association as a first line antidepressants strategy.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “venlafaxine-mirtazapine association”. A case report about a depressed woman is presented.ResultsDespite most studies are referent to its utility in drug-resistant depression, there are recent pilot studies that recommend CRF as a first line option.M., a 64-year-old woman, had her first psychiatric consultation. She had been depressed for 2 years, she lost 10 kg, had total insomnia and suicidal thoughts. CRF was started up to 150/15 mg, daily. An improvement was noticed after two weeks of treatment and the stabilization of depressive symptoms were achieved by the fourth month.ConclusionsCRF seems to be effective and useful. Patients with insomnia and weight loss may benefit from CRF as a first line option. However, more studies are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Silva J, Mota J, Azevedo P. Chronic psychiatric changes in a severe post-traumatic brain injury patient. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionSevere traumatic brain injury (TBI) causes neuropsychiatric disturbances. Emotional and personality disturbances seem to cause much more seriously handicap than residual cognitive or physical disabilities. The prognosis may be poor associated with marked social impairment, so a multidisciplinary approach team is required in order to improve patient's quality of life and reintegration in family and society.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and learn more about chronic psychiatric changes in severe post-traumatic brain injury and share with the scientific community how challenging the approach of this entity can be.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “traumatic brain injury” and “psychiatric changes”. A case report is presented.ResultsAlthough SSRI, benzodiazepines, mood stabilizers and antipsychotics are commonly used, new options are reported such as methylphenidate and cholinesterase inhibitors. The presented patient, a 27-year-old male, began with neuropsychiatric disturbances after a work-related fall from 9 meters high: convulsions and alcohol compulsive drinking. Three years have passed and his changes are still difficult to approach. Besides other medication, such as benzodiazepines and mood stabilizers, flufenazine injections and naltrexone seemed to be determinant in his behaviour and mood stabilization. He is also on a long-term alcoholism programme.ConclusionsAlthough the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed, such as randomized-controlled studies to study new pharmacological and non-pharmacological approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Azevedo P, Monteiro F, Correia A, Norton A, Moreira A. Isolated Psychiatric Presentation of Anti N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1939] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionAnti N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an autoimmune disorder with a presentation that includes acute behavioral changes, psychosis, cognitive impairment and autonomic instability. In some cases, there are isolated psychiatric symptoms without neurological involvement.AimsTo raise awareness of the disorder among psychiatrists, considering it a differential diagnosis in a first psychotic episode since a prompt diagnosis and treatment can dramatically affect the outcome.ObjectivesTo summarize the latest literature about this field and to present a case report.MethodsA brief review of the latest literature was performed on PubMed using the keywords “anti N-methyl-D-aspartate receptor encephalitis”, “anti-NMDA encephalitis”, “psychiatric symptoms”.ResultsA 20-year-old male was admitted to our inpatient unit with bizarre delusions of grandious and religious content, somatic hallucinations, sleep cycle inversion and strange behaviour. These symptoms had been present for 1 week and remitted after 10 days of treatment with risperidone. On follow-up, he developed anhedonia, apathy and blunt affect. Brain MRI showed multiple hyperintense changes in T2 and T2-FLAIR, highly suggestive of demyelinating lesions. The cerebrospinal fluid showed mild lymphocytic pleocytosis, mildly increased proteins, oligoclonal bands and anti-NMDAR antibodies of intrathecal production. He was treated with corticoids and the antipsychotic was discontinued. No neurologic symptoms were ever present.ConclusionThis is an atypical case of anti-NMDAR encephalitis because of its isolated psychiatric presentation. Most patients develop neurological symptoms 2 to 3 weeks after onset of psychiatric symptoms. Monosymptomatic syndromes arise in less than 5% of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Silva J, Mota J, Azevedo P. Electroconvulsive therapy in schizophrenia – where do we stand? Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionElectroconvulsive therapy is currently used in the management of severe depression, long-term mania and catatonia. Regarding schizophrenia-related psychosis ECT is also an option, but the indication is restrictive to severe cases, drug intolerance or resistant ones. Lack of evidence of cost-effectiveness compared to clozapine, and side effects of ECT techniques before 2003, influenced NICE guidance to not recommend ECT in schizophrenia, but modern ECT machines and procedures are subsequent to 2003. ECT is often performed when clozapine fails to respond in monotherapy or if there is intolerance to antipsychotic side effects. ECT in combination with clozapine seems to have significant results allowing the patients to achieve rapid control of psychotic symptoms with fewer side effects, comparing with antipsychotics-association strategies.ObjectivesTo summarized the latest literature about this field and to present recent data from the Electrovulsivetherapy Unit, in Hospital de Magalhães Lemos, Portugal.AimTo explore and critically review the controversies of electroconvulsive therapy in the management of drug-resistant schizophrenia.MethodsRetrospective data of an Electroconvulsive Therapy Unit during 2006–2015 was review.Results198 ECT treatments in schizophrenic patients were performed in our unit, during 2006–2007, in a total of 647 ECT (30,6%). In 2014–2015, 945 schizophrenic patients received ECT treatment, in a total of 2149 performed ECT (43,9%).ConclusionsAlthough guidelines are crucial for the uniform practice of medicine, sometimes is important to be critical about them. The use of ECT in schizophrenia is safe and effective and further research is needed to continue to support this treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Silva A, Amorim A, Azevedo P, Lopes C, Gamboa F. Cystic fibrosis - characterization of the adult population in Portugal. Rev Port Pneumol (2006) 2016; 22:141-5. [PMID: 26898888 DOI: 10.1016/j.rppnen.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The incidence of cystic fibrosis (CF) in Portugal is estimated at 1:8000 live births, although there is a lack of accurate statistics. The average life expectancy has been steadily increasing and CF is no longer an exclusively pediatric disease. OBJECTIVES Characterize the Portuguese adult population with the diagnosis of CF. METHODS Retrospective study based on clinical data of adult CF follow-up patients in the three specialized centers in Portugal where all of CF patients are seen, during 2012. RESULTS In 2012, there were 89 follow-up patients, 48 (54%) female and 15 (17%) lung transplanted. The average age was 31.3±9 years. The median age at diagnosis was 13 years and 34 (38%) were diagnosed in adulthood. The most frequent mutation was F508del (54.9%). Of the 89 patients, 49 patients (56%) had pancreatic insufficiency, 7 (9%) were diabetic and 42 patients (47.7%) had a body mass index (BMI) <20kg/m(2). As to ventilatory function, the average value of the forced expiratory volume in 1s (FEV1) was 58.45±28.59%. Only one of 77 patients did not have chronic airway infection. The most commonly isolated germ was methicillin-sensitive Staphylococcus aureus in 49 patients (55%). During 2012, two patients (2.2%) died at the ages of 21 and 36 years. DISCUSSION This study is the first description of the Portuguese adult CF population, which is particularly important since it can give us a better understanding of the real situation. A significant percentage of these patients were diagnosed in adulthood, which highlights the need for diagnostic suspicion in a patient with chronic lung disease and atypical manifestations.
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Affiliation(s)
- A Silva
- Department of Respiratory Medicine, Centro Hospital e Universitário de Coimbra, Coimbra, Portugal.
| | - A Amorim
- Department of Respiratory Medicine, Centro Hospitalar de São João, Porto, Portugal
| | - P Azevedo
- Department of Respiratory Medicine, Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria, Lisbon, Portugal
| | - C Lopes
- Department of Respiratory Medicine, Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria, Lisbon, Portugal
| | - F Gamboa
- Department of Respiratory Medicine, Centro Hospital e Universitário de Coimbra, Coimbra, Portugal
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Domingues M, Amaral R, Fonseca JA, Azevedo P, Correia-de-Sousa J. Assessment of asthma control using CARAT in patients with and without Allergic Rhinitis: A pilot study in primary care. Rev Port Pneumol (2006) 2016; 22:163-6. [PMID: 26767726 DOI: 10.1016/j.rppnen.2015.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Asthma and Allergic Rhinitis (AR) are two chronic inflammatory diseases that are often concomitant. The Control of Allergic Rhinitis and Asthma Test (CARAT) was developed to evaluate the control of these diseases from the patients' perspective. Its performance in asthma patients without AR has not been previously studied. AIM To test the hypothesis that CARAT can be used to assess asthma control in patients with asthma and without AR. METHODS A cross-sectional study was conducted in 3 primary healthcare centres in Northern Portugal. Adult patients identified in the Electronic Patient Record with a diagnosis of asthma were invited to participate. CARAT was used to assess asthma control and Asthma Control Test (ACT) as a comparator. The associations between asthma patients without AR (AsAR) and with AR (AwAR) were analyzed with Spearman correlation. Additionally, Receiver Operating Characteristic (ROC) curve analysis, summarized by Area Under the Curve (AUC), was used to assess performance of CARAT for screening asthma that was not well-controlled. RESULTS A total of 103 asthma patients completed the study, 64 (62%) had AwAR and in 87 (85%) asthma was not well-controlled. We observed a strong correlation between CARAT and ACT scores (r=0.734) in all asthma patients and in both groups: AsAR (r=0.737) and AwAR (r=0.843). ROC curve demonstrated CARAT as having a good discriminative power for both AsAR and AwAR groups (AUC=0.894 and 0.946, respectively). CONCLUSION These initial results suggest that CARAT has a good discriminative performance, similar to other asthma control assessment tools, for asthma patients with and without AR.
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Affiliation(s)
- M Domingues
- São Pedro da Cova Family Health Unit, Gondomar, Porto, Portugal
| | - R Amaral
- CINTESIS - Centre for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Fonseca
- CINTESIS - Centre for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal; Allergy Unit, CUF Porto Institute & Hospital, Porto, Portugal; Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal.
| | - P Azevedo
- La Salette Family Health Unit, Oliveira de Azeméis, Aveiro, Portugal
| | - J Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Horizonte Family Health Unit, Matosinhos, Porto, Portugal
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Guimarães R, Dagher A, Piovesana L, Larcher K, Campos L, Azevedo P, Zeighami Y, D'Abreu A, Cendes F. Cortical thinning pattern in Parkinson's disease stages. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.221] [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: 10/22/2022]
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Freire G, Lopes C, Freitas F, Azevedo P. ePS02.2 Fungal colonization in a cystic fibrosis adult population. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Viegas LP, Silva SP, Silva SL, Campos Melo A, Serra-Caetano A, Branco-Ferreira M, Azevedo P, Pereira-Santos MC, Pereira-Barbosa M. Severe bronchiectasis in a patient with common variable immunodeficiency. Eur Ann Allergy Clin Immunol 2015; 47:95-98. [PMID: 25951148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Bronchiectasis are common in Common Variable Immunodeficiency. These patients are prone to infection, leading to progressive lung destruction and accelerated FEV1 decline. CLINICAL CASE 40 year-old man, with recurrent respiratory infections, autoimmunity and diarrhea since age 7. At 17 CVID was diagnosed and IVIgG was started. During the following years, respiratory symptoms progressively worsened and bronchiectasis was found on thoracic computed tomography. Bronchoscopy revealed Pseudomonas aeruginosa in bronchoalveolar lavage and bronchial secretions cultures. Eradication therapy led to clinical improvement. DISCUSSION This case report stresses the importance of regular microbiological screening and appropriate antibiotherapy. Early/aggressive treatment may significantly impact on patients' evolution.
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Affiliation(s)
- L Paulos Viegas
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte CHLN, Lisboa, Portugal. Av. Professor Egas Moniz 1649-035 Lisbon, Portugal. E-mail: Phone: +351 918 65 11 06
| | - S P Silva
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte CHLN, Lisboa, Portugal. Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - S L Silva
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte CHLN, Lisboa, Portugal. Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - A Campos Melo
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - A Serra-Caetano
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - M Branco-Ferreira
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte CHLN, Lisboa, Portugal. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - P Azevedo
- Serviço de Pneumologia, Hospital Santa Maria, CHLN, Lisboa, Portugal
| | - M C Pereira-Santos
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - M Pereira-Barbosa
- Immunoallergology Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte CHLN, Lisboa, Portugal. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Zuffada F, Airoldi F, Pappalettera M, Salerno-Uriarte JA, Cameli M, Casini S, Fineschi M, Lunghetti S, Geyer A, D'ascenzi F, Pierli C, Mondillo S, Lee CH, Son JW, Park KH, Choi YJ, Lee SH, Kim U, Park JS, Shin DG, Kim YJ, Kim HJ, Abreu G, Azevedo P, Braga C, Arantes C, Martins J, Vieira C, Salgado A, Correia A, Nabais S, Dingli P, Reichmuth L, Yamagata K, Felice H, Prisecaru R, Riahi L, Bolatti M, Van Den Heuvel P, De Greef Y, Stockman D, Schwagten B. Case-based session Club 35: Friday 5 December 2014, 10:00-11:00 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nascimento R, Lopes C, Freitas F, Azevedo P, Bárbara C. 144 The impact of Pseudomonas aeruginosa colonization in CF. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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