1
|
Ferreira J, Longatto-Filho A, Afonso J, Roque S, Carneiro AL, Vila I, Silva C, Cunha C, Mesquita A, Cotter J, Correia-Neves M, Mansilha A, Cunha P. Inflammatory Cells in Adipose Tissue and Skeletal Muscle of Patients with Peripheral Arterial Disease or Chronic Venous Disease: A Prospective, Observational, and Histological Study. J Cardiovasc Dev Dis 2024; 11:121. [PMID: 38667739 PMCID: PMC11050534 DOI: 10.3390/jcdd11040121] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The main goal of this study was to assess whether the presence of peripheral arterial disease (PAD) correlates with increased inflammatory cell infiltration. An observational, single-centre, and prospective study was conducted from January 2018 to July 2022. Clinical characteristics and anthropometric measures were registered. Consecutive PAD patients with surgical indications for a common femoral artery approach and patients with varicose veins with an indication for surgical ligation of the saphenofemoral junction were included. In both groups, samples of sartorius skeletal muscle, subcutaneous adipose tissue (SAT), and perivascular adipose tissue (PVAT) were collected from the femoral region. We analysed the characteristics of adipocytes and the presence of haemorrhage and inflammatory cells in the samples of PVAT and SAT via haematoxylin-eosin staining. We found that patients with PAD had significantly more inflammatory cells in PVAT [16 (43.24%) vs. 0 (0%) p = 0.008]. Analysing SAT histology, we observed that patients with PAD had significantly more CD45+ leucocytes upon immunohistochemical staining [32 (72.73%) vs. 3 (27.27%) p = 0.005]. Upon analysing skeletal muscle histology with haematoxylin-eosin staining, we evaluated skeletal fibre preservation, as well as the presence of trauma, haemorrhage, and inflammatory cells. We registered a significantly higher number of inflammatory cells in patients with PAD [well-preserved skeletal fibres: PAD = 26 (63.41%) vs. varicose veins = 3 (37.50%) p = 0.173; trauma: PAD = 4 (9.76%) vs. varicose veins = 2 (25.00%) p = 0.229; haemorrhage: PAD = 6 (14.63%) vs. varicose veins = 0 (0%) p = 0.248; inflammatory cells: PAD = 18 (43.90%) vs. varicose veins = 0 (0%) p = 0.018]. Patients with PAD had a higher number of inflammatory cells in skeletal muscle and adipose tissue (PVAT and SAT) when compared with those with varicose veins, emphasizing the role of inflammation in this group of patients.
Collapse
Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department–Fisiologia e Cirurgia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo 01246-903, SP, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
| | - Julieta Afonso
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Susana Roque
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | | | - Isabel Vila
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Silva
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Cunha
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Armando Mansilha
- Vascular Surgery Department–Fisiologia e Cirurgia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| |
Collapse
|
2
|
Ferreira J, Longatto-Filho A, Dionísio A, Correia-Neves M, Cunha P, Mansilha A. Peri-Carotid Adipose Tissue and Atherosclerosis at Carotid Bifurcation. J Cardiovasc Dev Dis 2024; 11:58. [PMID: 38392272 PMCID: PMC10889387 DOI: 10.3390/jcdd11020058] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Vulnerable carotid plaques are responsible for 20% of the ischemic strokes. The identification of these asymptomatic carotid plaques that will become symptomatic is essential but remains unclear. Our main goal was to investigate whether the amount of the peri-carotid adipose tissue, estimated by the extra-media thickness (EMT), is associated with the atherosclerotic characteristics at the carotid bifurcation in patients with PAD. An observational, prospective, single-center, longitudinal study was conducted. Overall, 177 patients were subjected to carotid Doppler ultrasound at the study admission. The following data were collected: EMT, intima-media thickness (IMT), the presence of carotid plaques, the area of the highest plaque, the presence of "acute culprit" carotid stenosis, and the grade of internal carotid stenosis. "Acute culprit" carotid stenosis was defined as a significant atherosclerotic plaque that leads to a neurologic event within 15 days. From each carotid bifurcation, a right and a left EMT were determined. We analyzed both the mean EMTs (calculated as the mean between the right and the left EMT) and the EMT ipsilateral to the carotid bifurcation. The presence of carotid plaques was associated with a higher mean EMT [Median = 1.14; IQR = 0.66 versus Median = 0.97; IQR = 0.40; p = 0.001]. A positive correlation was found between the mean EMT and IMT (right: ρ = 0.20; p = 0.010; left: ρ = 0.21; p = 0.007) and between the mean EMT and the area of the largest carotid plaque (right: ρ = 0.17; p = 0.036; left: ρ = 0.22; p = 0.004). Left carotid stenosis ≥ 70% was associated with higher ipsilateral EMT [Median = 1.56; IQR = 0.70 versus Median = 0.94; IQR = 0.42; p = 0.009]. Patients with "acute culprit" carotid stenosis had a higher ipsilateral EMT [left ipsilateral EMT: Median = 1.46; IQR = 0.63; "non-acute": Median = 0.94; IQR = 0.43; p = 0.009; right ipsilateral EMT: Median = 2.25; IQR = 0.62; "non-acute": Median = 1.00; IQR = 0.51; p = 0.015]. This difference was not found in the contra-lateral EMT. Six months after the neurologic event, EMT ipsilateral to an "acute culprit" carotid stenosis decreased (p = 0.036). The amount of peri-carotid adipose tissue, estimated with EMT, was associated with atherosclerosis at the carotid arteries. The mean EMT was associated with the features of chronic atherosclerosis lesions: the presence of carotid plaques, IMT, and the area of the highest plaque. Ipsilateral EMT was linked with "acute culprit" atherosclerotic plaque.
Collapse
Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department, Physiology and Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Academic Centre of Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga, Portugal
- Department of Pathology (LIM-14), Faculty of Medicine of the University of São Paulo, São Paulo 01246 903, Brazil
- Molecular Oncology Research Centre, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
| | - Ana Dionísio
- Porto Vascular Conference Scientific Advising, 4050-430 Porto, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga, Portugal
- Medicine Department of Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Centre for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine, 4835-044 Guimarães, Portugal
| | - Armando Mansilha
- Vascular Surgery Department, Physiology and Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| |
Collapse
|
3
|
Ferreira J, Afonso J, Longatto-Filho A, Roque S, Carneiro A, Vila I, Silva C, Cunha C, Mesquita A, Cotter J, Correia-Neves M, Mansilha A, Cunha P. Inflammation Is a Histological Characteristic of Skeletal Muscle in Chronic Limb Threatening Ischemia. Ann Vasc Surg 2024; 99:10-18. [PMID: 37931803 DOI: 10.1016/j.avsg.2023.09.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The loss of skeletal muscle is a prognostic factor in several diseases including in patients with chronic limb threatening ischemia (CLTI). Patients with CLTI also have a lower skeletal mass and area when compared to those with claudication. However, there are no currently available data regarding the histological characteristics of core muscles in patients with CLTI. This study aims to determine the differences in core skeletal muscles between patients with claudication and those with CLTI. The second aim is to evaluate the differences in myokines, which are molecules secreted by skeletal muscle, between patients with claudication and those with CLTI. METHODS An observational, prospective study was conducted from January 2018 to July 2022 involving consecutive patients with peripheral arterial disease (PAD). The clinical characteristics were registered. In PAD patients with surgical indication for common femoral artery approach, samples of sartorius skeletal muscle (and not from the limb muscles directly involved in the ischemic process) were collected. The samples were submitted to histological characterization on hematoxylin-eosin and to immunohistochemical analysis to detect CD45+ leukocytes and CD163+ macrophages. The extent of the inflammatory cells (leukocytes and macrophages) was semiquantitatively assessed using a 0-to-4 grade scale as follows: absent (0†), mild (†), moderate (††), severe (†††), and very severe (††††). Serum levels of myokines: irisin, myostatin, IL-8, and lL-6 were determined with multiplex bead-based immunoassay. RESULTS 119 patients (mean age: 67.58 ± 9.60 years old, 79.80% males) 64 with claudication and 54 with CLTI were enrolled in the study. No differences were registered between patients with claudication and those with CLTI on age, gender, cardiovascular risk factors, and medication, except on smoking habits. There was a significantly higher prevalence of smokers and a higher smoking load in the claudication group. Samples of sartorius skeletal muscle from 40 patients (14 with claudication and 26 with CLTI) were submitted to histological analysis. No differences were found in skeletal muscle fibers preservation, trauma, or hemorrhage (on hematoxylin-eosin staining). However, in the immunohistochemistry study, we found more inflammatory cells CD45+ leukocytes in patients with CLTI when compared to those with claudication [CD45+ ≥ moderate (††): claudication (n = 14): 4; 28.57%; CLTI (n = 25): 16; 64.00%; P = 0.034]. Patients with CLTI also had higher tissue levels of CD163+ macrophages, but this difference was not significant [CD163+ ≥ moderate (††): claudication (n = 13): 7; 53.85%; CLTI (n = 27): 21; 77.78%; P = 0.122]. The serum levels of the myokines, irisin, and myostatin were below the lower limit of detection, in the majority of patients, so no valid results were obtained. However, patients with CLTI had a higher serum level of Interleukin (IL)-6 and IL-8. CONCLUSIONS CLTI patients exhibit increased quantities of leukocytes in their sartorius muscle, as well as elevated serum levels of myokines IL-8 and IL-6. Inflamed skeletal muscle can contribute to the loss of muscle mass and account for the lower density of skeletal muscle observed in CLTI. Additionally, inflamed skeletal muscle may contribute to the development of systemic inflammation through the secretion of pro-inflammatory cytokines into the systemic circulation. Halting the inflammatory process could eventually improve the prognosis of CLTI patients.
Collapse
Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department - Physiology and Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal; Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal; Clinical Academic Center Hospital de Trás-os-Montes e Alto Douro-Professor Doutor Nuno Grande-CACTMAD, Vila Real, Portugal.
| | - Julieta Afonso
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal; Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Susana Roque
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal
| | - Alexandre Carneiro
- Radiology Department, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Isabel Vila
- Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Silva
- Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Cunha
- Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal; Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal
| | - Armando Mansilha
- Vascular Surgery Department - Physiology and Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associated Laboratory, Braga, Portugal; Academic Center Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| |
Collapse
|
4
|
Yaneva-Sirakova T, Coca A, Sierra C, Cunha P, Hering D. Predictive value of new cardiovascular tools for stroke risk reclassification. Blood Press 2023; 32:2237129. [PMID: 37477278 DOI: 10.1080/08037051.2023.2237129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Pedro Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital Senhora da Oilveira, Life and Health Research Institute, Minho University, Guimarães, Portugal
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
5
|
Almeida CR, Vieira L, Alves B, Sousa G, Cunha P, Antunes P. The ultimate technique for posterior rib fractures: the parascapular sub-iliocostalis plane block - A series of cases. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:477-482. [PMID: 37678457 DOI: 10.1016/j.redare.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/21/2022] [Indexed: 09/09/2023]
Abstract
We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the Erector Spinae Plane block or the Paravertebral block.
Collapse
Affiliation(s)
- C R Almeida
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - L Vieira
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - B Alves
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - G Sousa
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - P Cunha
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - P Antunes
- Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| |
Collapse
|
6
|
Ferreira M, Laranjo S, Cunha P, Geraldes V, Oliveira M, Rocha I. Orthostatic Stress and Baroreflex Sensitivity: A Window into Autonomic Dysfunction in Lone Paroxysmal Atrial Fibrillation. J Clin Med 2023; 12:5857. [PMID: 37762798 PMCID: PMC10532155 DOI: 10.3390/jcm12185857] [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: 07/11/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The abnormal neural control of atria has been considered one of the mechanisms of paroxysmal atrial fibrillation (PAF) pathogenesis. The baroreceptor reflex has an important role in cardiovascular regulation and may serve as an index of autonomic function. This study aimed to analyze the baroreceptor reflex's role in heart rate regulation during upright tilt (HUT) in patients with lone PAF. The study included 68 patients with lone PAF and 34 healthy individuals who underwent baroreflex assessment. Parameters such as baroreflex sensitivity (BRS), number of systolic blood pressure (BP) ramps, and the baroreflex effectiveness index (BEI) were evaluated. The study found that PAF patients had comparable resting BPs and heart rates (HRs) to healthy individuals. However, unlike healthy individuals, PAF patients showed a sustained increase in BP with an upright posture followed by the delayed activation of the baroreceptor function with a blunted HR response and lower BEI values. This indicates a pronounced baroreflex impairment in PAF patients, even at rest. Our data suggest that together with BRS, BEI could be used as a marker of autonomic dysfunction in PAF patients, making it important to further investigate its relationship with AF recurrence after ablation and its involvement in cardiovascular autonomic remodeling.
Collapse
Affiliation(s)
- Mónica Ferreira
- Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa—CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal; (M.F.); (V.G.)
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central—CHULC, 1150-199 Lisbon, Portugal; (S.L.); (P.C.); (M.O.)
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Pedro Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central—CHULC, 1150-199 Lisbon, Portugal; (S.L.); (P.C.); (M.O.)
| | - Vera Geraldes
- Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa—CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal; (M.F.); (V.G.)
| | - Mário Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central—CHULC, 1150-199 Lisbon, Portugal; (S.L.); (P.C.); (M.O.)
| | - Isabel Rocha
- Faculdade de Medicina and Centro Cardiovascular da Universidade de Lisboa—CCUL, Universidade de Lisboa, 1649-004 Lisbon, Portugal; (M.F.); (V.G.)
| |
Collapse
|
7
|
Fernandes A, Pinto J, Cunha P, Duarte C, Estaca A, Pereira T, Bettencourt M, Candelária I, E Silva MR. Complete Distal Rupture of the Rectus Femoris in an Elite Football Player: A Non-operative Treatment. Cureus 2023; 15:e45494. [PMID: 37859921 PMCID: PMC10584386 DOI: 10.7759/cureus.45494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Although muscle injuries represent the most frequent injury in professional football, isolated complete distal ruptures of the rectus femoris (RF) muscle are rare, and there is no consensus on their treatment and return to play (RTP). In this article, we report a clinical case of successful non-surgical management of an RF grade 4c muscle injury in a professional football player, in which the athlete was able to RTP 21 weeks after the injury, had no re-injury >1 year after RTP, and is playing at an elite level in the Portuguese Football First League.
Collapse
Affiliation(s)
- Alexandre Fernandes
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
- Physical Medicine and Rehabilitation, Hospital de Cascais, Lisbon, PRT
| | - Julio Pinto
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Pedro Cunha
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Carlos Duarte
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Alexandre Estaca
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Tiago Pereira
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | | | | | | |
Collapse
|
8
|
Freitas M, Neves C, Sarmento H, Cunha P, Cotter J. Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus. Cureus 2023; 15:e41784. [PMID: 37575811 PMCID: PMC10420332 DOI: 10.7759/cureus.41784] [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] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls, and investigate predictors of PWV in the HIV-infected group. METHODS PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group. RESULTS In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s, p = .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+ T cell count were independent predictors of PWV in the HIV-infected group. Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.
Collapse
Affiliation(s)
- Mariana Freitas
- Nephrology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT
- School of Medicine, University of Minho, Braga, PRT
| | - Clarisse Neves
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Helena Sarmento
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Pedro Cunha
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| |
Collapse
|
9
|
Ferreira J, Afonso J, Carneiro AL, Vila I, Cunha C, Roque S, Silva C, Mesquita A, Cotter J, Correia-Neves M, Mansilha A, Longatto-Filho A, Cunha P. Exploring the Diversity of Visceral, Subcutaneous and Perivascular Adipose Tissue in a Vascular Surgery Population. J Cardiovasc Dev Dis 2023; 10:271. [PMID: 37504527 PMCID: PMC10380901 DOI: 10.3390/jcdd10070271] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/03/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
The prevalence of obesity has doubled, with a concomitant increase in cardiovascular disease. This study aimed to compare the characteristics of visceral, subcutaneous and peri-aortic adipose tissue determined with computed tomography (CT) scans and to correlate them with cardiovascular risk factors, anthropometric measures and medication. An observational and prospective study was conducted, and 177 subjects were included. Peri-aortic adipose tissue had the highest density, while the subcutaneous adipose tissue had the lowest. The density of subcutaneous adipose tissue differs from the density of visceral (p = 0.00) and peri-aortic adipose tissue (p = 0.00). Smokers/ex-smokers had a lower area (p = 0.00) and density (p = 0.02) of subcutaneous adipose tissue. Multiple linear regression analysis showed that sex was a predictor of subcutaneous adipose tissue area (β = -0.27, t = -3.12, p = 0.00) but smoking habits were not. After controlling for sex, we found that the association between smokers/ex-smokers and area of subcutaneous adipose tissue was lost, but the association with density persisted. Patients with hypertension had a higher visceral adipose tissue area, and this relationship was maintained even after adjusting for gender. Peri-aortic adipose tissue is similar to visceral and distinct from subcutaneous adipose tissue. Cardiovascular risk factors have different influences in distinct adipose compartments.
Collapse
Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- Academic Center Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Clinical Academic Center Hospital de Trás-os-Montes e Alto Douro, Professor Doutor Nuno Grande, CACTMAD, 5000-508 Vila Real, Portugal
| | - Julieta Afonso
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Alexandre Lima Carneiro
- Radiology Department, Unidade Local de Saúde Alto Minho, 4904-858 Viana do Castelo, Portugal
| | - Isabel Vila
- Academic Center Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Cunha
- Academic Center Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Susana Roque
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Cristina Silva
- Academic Center Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- Academic Center Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Angiology and Vascular Surgery, Hospital de São João, 4200-319 Porto, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Faculty of Medicine, Department of Pathology, University of São Paulo, São Paulo 05508-900, SP, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-390, SP, Brazil
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- Academic Center Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| |
Collapse
|
10
|
Fernandes A, Cunha P, Pinto J, Duarte C, Estaca A, Pereira T, Bettencourt M, E Silva MR, Fernandes S. Return to Play After the Diagnosis of Reactive Arthritis in a Professional Football Player. Cureus 2023; 15:e41139. [PMID: 37519606 PMCID: PMC10386846 DOI: 10.7759/cureus.41139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
In professional football, most of the injuries are traumatic; however, these athletes may suffer from rheumatologic diseases, that may present as sports-related injuries. Reactive arthritis (ReA) is classified as a sub-group of the spondyloarthritis family and is relatively rare. In this article, we highlight the successful return to play (RTP) process after the ReA diagnosis in an elite football player in the Portuguese first league. The athlete was able to RTP four months and one week after the diagnosis, had no ReA recurrence nor re-injury >8 months after RTP, and is playing at an elite level.
Collapse
Affiliation(s)
- Alexandre Fernandes
- Physical Medicine and Rehabilitation, Hospital de Cascais, Lisbon, Lisbon, PRT
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Pedro Cunha
- Physiotherapy - Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Julio Pinto
- Physiotherapy - Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Carlos Duarte
- Physiotherapy - Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Alexandre Estaca
- Physiotherapy - Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Tiago Pereira
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Mónica Bettencourt
- Physical Medicine and Rehabilitation, Hospital de Cascais, Lisbon, Lisbon, PRT
| | | | | |
Collapse
|
11
|
Vieira I, Cunha P, Pinto M, Ribeiro S, Sacramento S, Silva A, Almeida C, Guedes I. Anaesthetic management of tetraplegic pregnant patients during child delivery: A systematic review. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:224-230. [PMID: 36842688 DOI: 10.1016/j.redare.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/30/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Pregnancy in spinal cord injured patients has specific issues that must be carefully addressed. However, guidelines for their management are scarce. METHODS A systematic review of the literature regarding the anaesthetic management during delivery of pregnant patients with cervical spinal cord injury was performed on the electronic databases of PubMed (Medline) and Cochrane. RESULTS Twenty-two papers were included. A higher incidence of preterm birth and caesarean delivery were seen. Anaesthetic management was diverse, although most pregnant patients received epidural analgesia. Autonomic dysreflexia symptoms were present in 51% of pregnancies. CONCLUSION Timely management of these patients could possibly reduce caesarean and preterm delivery rates, avoid or minimize common complications, as well as reduce costs. An early reference to anaesthesiology consultation and a multidisciplinary approach is recommended.
Collapse
Affiliation(s)
- I Vieira
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - P Cunha
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - M Pinto
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Ribeiro
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Sacramento
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Silva
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Almeida
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - I Guedes
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| |
Collapse
|
12
|
Almeida C, Cunha P, Vieira L, Antunes P, Francisco E. Point-of-care transthoracic echocardiography: An essential management tool for acute massive pulmonary thromboembolism. Saudi J Anaesth 2023; 17:75-76. [PMID: 37032679 PMCID: PMC10077804 DOI: 10.4103/sja.sja_186_22] [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: 02/25/2022] [Revised: 02/26/2022] [Accepted: 02/27/2022] [Indexed: 12/24/2022] Open
Abstract
The pulmonary thromboembolism may be a life-threatening condition. A hip fracture surgery patient aged >90 years old had a sudden post-operative episode of shock, de-saturation, and reverted cardiac arrest. A point-of-care transthoracic echocardiography (TTE) undertaken by an anesthesiologist revealed inferior vena cava dilation/flattening, right cardiac chamber dilation, and McConnell signs (right ventricular apex hyperkinesia and lateral wall hypokinesia); the ventricular septal wall was shifting to the left side, and the left ventricular chamber collapsed at the end-systole, indicating a high ejection fraction in the context of obstructive shock. As such, it revealed signs of pulmonary thromboembolism. Despite the absolute contraindication for thrombolysis and therapeutic hypocoagulation, the treatment was started immediately along with vasopressor support, which was life-saving in this patient. A summary TTE played a pivotal role in our patient's case, helping with the differential diagnosis of the cause of shock.
Collapse
Affiliation(s)
- Carlos Almeida
- Department of Anesthesiology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Pedro Cunha
- Department of Anesthesiology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Lígia Vieira
- Department of Anesthesiology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Pedro Antunes
- Department of Anesthesiology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Emilia Francisco
- Department of Anesthesiology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| |
Collapse
|
13
|
Ferreira J, Carneiro A, Vila I, Silva C, Cunha C, Longatto-Filho A, Mesquita A, Cotter J, Mansilha A, Correia-Neves M, Cunha P. Inflammation and Loss of Skeletal Muscle Mass in Chronic Limb Threatening Ischemia. Ann Vasc Surg 2023; 88:164-173. [PMID: 35926785 DOI: 10.1016/j.avsg.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lower extremity peripheral arterial disease (PAD) is an atherosclerotic disease of the lower extremities. Atherosclerosis, inflammation, and sarcopenia are independently associated and potentiate each other. Inflammation is deeply involved in the formation and progression of atherosclerosis and is also involved in the pathophysiology of sarcopenia. Sarcopenia is defined as low muscle mass, with low muscle strength. This study aims to determine the differences in skeletal muscle characteristics and in inflammatory parameters between patients with claudication and with chronic limb threatening ischemia (CLTI). METHODS An observational, prospective study in patients with PAD was conducted from January 2018 to December 2020. The clinical characteristics and the cardiovascular risk factors were prospectively registered. The inflammatory parameters determined were: positive acute phase proteins (C-reactive Protein- CRP- and fibrinogen) and negative acute phase proteins albumin, total cholesterol and high-density lipoprotein (HDL). The skeletal muscle area and density were quantified with a computed topography (CT) scan. The strength was determined with a Jamar® hydraulic hand dynamometer. RESULTS A total of 116 patients (mean age: 67.65 ± 9.53 years-old) 64% with claudication and 46% with CLTI were enrolled in the study. No differences were registered between patients with claudication and CLTI on age, cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, and smoking habits) and medication. There was a higher prevalence of men in the claudication group (88.89% vs. 71.70%, P = 0.019). Analyzing the inflammatory parameters, we noted that patients with CLTI had increased serum levels of positive acute phase proteins: CRP (37.53 ± 46.61 mg/L vs. 9.18 ± 26.12 mg/L, P = 0.000), and fibrinogen (466.18 ± 208.07 mg/dL vs. 317.37 ± 79.42 mg/dL, P = 0.000). CLTI patients had decreased negative acute phase proteins: albumin (3.53 ± 0.85 g/dL vs. 3.91 ± 0.72 g/dL, P = 0.001), total cholesterol (145.41 ± 38.59 mg/dL vs. 161.84 ± 34.94 mg/dL, P = 0.013) and HDL (38.70 ± 12.19 mg/dL vs. 51.31 ± 15.85 mg/dL, P = 0.000). We noted that patients with CLTI had lower skeletal muscle area and mass (14,349.77 ± 3,036.60 mm2 vs. 15,690.56 ± 3,183.97 mm2P = 0.013; 10.11 ± 17.03HU vs. 18.02 ± 13.63HU P = 0.013). After adjusting for the variable sex, the association between skeletal muscle density and CLTI persisted (r (97) = -0.232, P = 0.021). The groups did not differ in strength (patients with claudication: 25.39 ± 8.23 Kgf vs. CLTI: 25.17 ± 11.95 Kgf P = 0.910). CONCLUSIONS CLTI patients have decreased skeletal muscle mass and a systemic inflammation status. Recognizing the deleterious triad of atherosclerosis, inflammation and loss of skeletal mass patients with CLTI is an opportunity to improve medical therapy and to perform a timely intervention to stop this vicious cycle.
Collapse
Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department - Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal.
| | | | - Isabel Vila
- Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Silva
- Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Cunha
- Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | - Amílcar Mesquita
- Vascular Surgery Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Armando Mansilha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal; ICVS/3B's - PT Government Associated Laboratory, Guimarães, Portugal; Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
| |
Collapse
|
14
|
Almeida CR, Cunha P, Vieira L, Gomes A. Low-dose spinal block for hip surgery: A systematic review. Trends in Anaesthesia and Critical Care 2022. [DOI: 10.1016/j.tacc.2022.06.004] [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: 11/25/2022]
|
15
|
Ferreira J, Cunha P, Carneiro A, Vila I, Cunha C, Silva C, Longatto-Filho A, Mesquita A, Cotter J, Correia-Neves M, Mansilha A. Is Obesity a Risk Factor for Carotid Atherosclerotic Disease?—Opportunistic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9050162. [PMID: 35621873 PMCID: PMC9144226 DOI: 10.3390/jcdd9050162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
Obesity is a risk factor for coronary atherosclerosis. However, the influence of adipose tissue in carotid atherosclerosis is not completely understood. No systematic review/meta-analysis was previously performed to understand if obesity is a risk factor for carotid atherosclerosis. This paper aims to provide an opportunistic review of the association between obesity and carotid atherosclerosis and define the role of the different adipose tissue depots in the characteristics of carotid stenosis. The databases PubMed and Cochrane Library were searched on 15–27 April and 19 May 2021. A total of 1750 articles published between 1985 and 2019 were identified, 64 were preselected, and 38 papers (35,339 subjects) were included in the final review. The most frequent methods used to determine obesity were anthropometric measures. Carotid plaque was mostly characterized by ultrasound. Overall obesity and visceral fat were not associated with the presence of carotid plaque when evaluated separately. Waist-hip ratio, however, was a significant anthropometric measure associated with the prevalence of carotid plaques. As it reflected the ratio of visceral and subcutaneous adipose tissue, the balance between these depots could impact the prevalence of carotid plaques.
Collapse
Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department, Hospital de Trás-os-Montes, 5000-508 Vila Real, Portugal
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Correspondence: ; Tel.: +351-962-958-421
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Alexandre Carneiro
- Radiology Department, Unidade Local de Saúde Alto Minho, 4904-858 Viana do Castelo, Portugal;
| | - Isabel Vila
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Silva
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo 01246-903, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal;
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (P.C.); (I.V.); (C.C.); (C.S.); (A.L.-F.); (J.C.); (M.C.-N.)
| | - Armando Mansilha
- Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal;
- Vascular Surgery Department, Hospital de São João, 4200-319 Porto, Portugal
| |
Collapse
|
16
|
Carneiro M, Maia I, Cunha P, Guerra I, Magina T, Santos T, Schulze P, Pereira H, Malcata F, Navalho J, Silva J, Otero A, Varela J. Effects of LED lighting on Nannochloropsis oceanica grown in outdoor raceway ponds. ALGAL RES 2022. [DOI: 10.1016/j.algal.2022.102685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Couto D, Conde TA, Melo T, Neves B, Costa M, Cunha P, Guerra I, Correia N, Silva JT, Pereira H, Varela J, Silva J, Domingues R, Domingues P. Effects of outdoor and indoor cultivation on the polar lipid composition and antioxidant activity of Nannochloropsis oceanica and Nannochloropsis limnetica: A lipidomics perspective. ALGAL RES 2022. [DOI: 10.1016/j.algal.2022.102718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
18
|
Vieira L, Almeida C, Francisco E, Cunha P, Antunes P. Single continuous erector spinae plane block for multiple rib, clavicle, and scapula fractures: A case report. Saudi J Anaesth 2022; 16:497-499. [PMID: 36337406 PMCID: PMC9630681 DOI: 10.4103/sja.sja_290_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this study is to describe the ability of a continuous erector spinae plane (ESP) block to provide analgesia in an extended territory (brachial plexus and thoracic nerves) with a single catheter. A continuous ESP block at T4 was performed in a 74-year-old man, two days after trauma involving clavicle, scapula, and multiple posterior rib fractures (first to ninth). The technique was maintained for 12 days and provided effective analgesia not only to the thoracic region but also the scapula and clavicle area (C5–T12 dermatomes). Concomitant respiratory insufficiency was ameliorated, which helped to avoid mechanical ventilation and intensive care unit admission. Moreover, this analgesia technique promoted patient's ambulation. ESP block, as an alternative to a thoracic epidural, is a more straightforward and safer procedure than paravertebral block (PVB). To obtain an extensive dermatome block using PVB, more than one paravertebral catheter would be necessary. Extensive cephalad–caudad spread of the PVB is primarily related to analgesia due to the concomitant epidural spread. PVB frequently causes bilateral block and may produce significant motor or sympathetic block. Additionally, proximal extension of the block under the erector spinae muscle fascia can provide a significant extension of the block to the cervical region, which allows brachial plexus block (cervical plexus block was not observed clinically). This is a unique feature of ESP block, as there is no communication between adjacent paravertebral levels in the cervical region that could allow the same pattern of analgesia using PVB.
Collapse
|
19
|
Vieira L, Almeida C, Cunha P, Gomes A. Low-dose spinal block combined with epidural volume extension in a high-risk cardiac patient: A case-based systematic literature review. Saudi J Anaesth 2022; 16:383-389. [PMID: 36337410 PMCID: PMC9630677 DOI: 10.4103/sja.sja_740_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Anesthetic management of patients with severe cardiac disease can be challenging during prolonged surgical procedures. Thus, alternative neuraxial anesthetic techniques have been described to avoid general anesthesia in these patients. Methods: A case-based systematic literature review on low-dose spinal block combined with different methods of epidural block extension in high-risk cardiac patients was performed. Results: We describe the successful management of a patient with poor left ventricular function who underwent excision arthroplasty of an infected hip prosthesis under low-dose spinal block with levobupivacaine 5 mg and fentanyl 15 μg combined with saline epidural volume extension (EVE). Epidural ropivacaine 0.75% was administered as a bolus of 5 ml followed by an infusion at 5 ml/h later during the course of surgery. Conclusions: Although continuous spinal anesthesia (CSA) or epidural anesthesia may limit hemodynamic instability, the possibility of devastating central nervous system infection may prevent CSA use, and epidural block alone may be less reliable than CSA. Epidural block alone may require large volumes of concentrated local anesthetic to obtain sacral block, which may produce hemodynamic instability. The EVE, particularly using saline EVE, has rarely been described in high-risk cardiac patients as an alternative to CSA or epidural block alone, with the intention to avoid general anesthesia, but it has demonstrated efficacy and a low rate of complications. Hemodynamic stability was maintained in most cases.
Collapse
|
20
|
Rodrigues C, Silva M, Cerejo R, Portugal G, Cunha P, Rodrigues R, Oliveira M, Fragata J. SURGICAL ABLATION OF ATRIAL FIBRILLATION AND LEFT ATRIAL APPENDAGE OCCLUSION BY A TOTALLY VIDEOTHORACOSCOPIC APPROACH - NEW PARADIGM? Port J Card Thorac Vasc Surg 2021; 28:21-24. [PMID: 35333473 DOI: 10.48729/pjctvs.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) contributes to increased morbidity and mortality. Pharmacological and percutaneous catheter therapies are unsatisfactory, with potential serious adverse effects. Cox-Maze III/IV surgery, with higher rates of success, has not been widely adopted because of the associated complexity of the procedure. METHODS We performed a retrospective analysis of the first patients submitted to surgical ablation of AF with occlusion of the left atrial appendage with a totally videothoracoscopic (VATS) approach in our institution. We describe the surgical technique and our results, including duration of surgery, hospital stay, complications and maintenance of sinus rhythm after surgery, at 6, 12 and 18 months of follow-up. RESULTS We studied 15 patients (ages ranging from 39 to 75 years old; 54,5% female gender). Mean time since the diagnosis of AF was 5,75 years. All had been submitted to prior catheter ablation (mean of 2 attempts). Mean diameter and volume of the left atrium was 42 mm (M-mode) and 70 ml (43 ml/m2), respectively. Mean duration of surgery was 2 hours and 22 minutes. In one patient we had to convert the surgery to median sternotomy. Mean hospital stay was 4,8 days. Mean time of follow-up was 12 months. During follow-up, 91%, 90% and 80% of the patients were in sinus rhythm at 6, 12 and 18 months, respectively. CONCLUSION This surgical approach represents a real benefit for those patients with multiple attempts of catheter ablation without success. However, a larger sample of patients with a longer period of follow-up is necessary for further conclusions.
Collapse
Affiliation(s)
- Carolina Rodrigues
- Department of Cardiothoracic Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - Manuela Silva
- Department of Cardiothoracic Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - Rui Cerejo
- Department of Cardiothoracic Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - Guilherme Portugal
- Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - Pedro Cunha
- Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - Rui Rodrigues
- Department of Cardiothoracic Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - Mário Oliveira
- Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| | - José Fragata
- Department of Cardiothoracic Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Portugal
| |
Collapse
|
21
|
Oliveira M, Cunha P, Valente B, Portugal G, Lousinha A, Pereira M, Braz M, Delgado A, Ferreira RC. Impact of substrate-based ablation for ventricular tachycardia in patients with frequent appropriate implantable cardioverter-defibrillator therapy and dilated cardiomyopathy: Long-term experience with high-density mapping. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
22
|
Ferreira J, Carneiro A, Vila I, Cunha C, Silva C, Longatto-Filho A, Mesquita A, Cotter J, Mansilha A, Correia-Neves M, Cunha P. Association of skeletal muscle and cardiovascular risk factors in patients with lower extremity arterial disease. Ann Vasc Surg 2021; 80:223-234. [PMID: 34688875 DOI: 10.1016/j.avsg.2021.08.037] [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: 06/12/2021] [Revised: 07/31/2021] [Accepted: 08/05/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sarcopenia is defined as low muscle mass, with low muscle strength or low physical performance. The skeletal muscle mass (or density) and strength are inversely associated with cardiovascular risk factors. We aim to determine the relationship between skeletal muscle characteristics (strength, mass, area), and cardiovascular risk factors in a population with lower extremity artery disease (LEAD) METHODS: : An observational, prospective study including patients with LEAD was conducted from January 2018 to December 2020. The cardiovascular risk factors and anthropometric measurements were prospectively registered. The skeletal muscle characteristics (area, density/mass and strength) were analysed. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer. RESULTS 96 patients with LEAD with 67.70± 10.11 years-old were enrolled in the study. The most prevalent cardiovascular risk factor was hypertension, followed by dyslipidemia and diabetes. Patients with diabetes had a lower handgrip strength and skeletal muscle density, when compared with patients without diabetes (strength: 19.67± 9.98 kgf versus 26.79 ± 11.80 kgf, p=0.002 and skeletal muscle density: 10.58 ± 17.61 HU versus 18.17 ± 15.33 HU, p=0.032). There was a trend for the association between the presence of cardiovascular risk factors (hypertension and dyslipidemia) and a decrease in skeletal muscle density and strength (density: hypertension: 13.46 ± 16.74 HU versus 20.38 ± 11.63 HU p=0.055; dyslipidemia: 13.57 ± 17.16 HU versus 17.74 ± 13.00 HU p=0.315; strength- hypertension: 22.55 ± 10.08 kgf versus 27.58 ± 15.11 p= 0.073; dyslipidemia: 22.80 ± 10.52 kgf versus 25.28 ± 13.14 kgf p=0.315). Interestingly, we found that smokers had a favorable skeletal muscle characteristic, which could be explained by the higher prevalence of diabetes in non-smokers. CONCLUSIONS The indicators of skeletal muscle dysfunction (strength and density) are associated to the presence of diabetes in patients with LEAD. Therapeutic strategies to improve the skeletal muscle characteristics could have a role in improving LEAD risk factors, particularly diabetes.
Collapse
Affiliation(s)
- J Ferreira
- Vascular Surgery Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - A Carneiro
- Radiology Department- ULSAM, Viana do Castelo, Portugal
| | - I Vila
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - C Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - C Silva
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - A Mesquita
- Vascular Surgery Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - J Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal; Vascular Surgery Department Hospital de São João, Porto, Portugal
| | - M Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - P Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal; Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department- Hospital da Senhora da Oliveira, Guimarães, Portugal
| |
Collapse
|
23
|
Rama TA, Paciência I, Cavaleiro Rufo J, Silva D, Cunha P, Severo M, Padrão P, Moreira P, Delgado L, Moreira A. Exhaled breath condensate pH determinants in school-aged children: A population-based study. Pediatr Allergy Immunol 2021; 32:1474-1481. [PMID: 34018256 DOI: 10.1111/pai.13564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exhaled breath condensate (EBC) pH is a promising biomarker of airway inflammation. Lack of method standardization and interstudy variability precludes its use in clinical practice. While endogenous determinants have been described, underlying mechanisms for variability are mostly unknown. Thus, we aimed to assess the association between asthma and EBC pH in children, while studying potential environmental factors for interstudy variability. METHODS A cross-sectional analysis of exhaled breath condensates from 613 children, aged 7-12 years, was conducted. Assessments included lung function and airway reversibility, exhaled nitric oxide, allergic sensitization, and body mass index (BMI). Indoor air quality (IAQ) was assessed in children's classrooms during 5 school days. Post-deaeration EBC pH showed a bimodal distribution, and the sample was split into acidic and alkaline groups. Regression models were constructed to assess the effects of asthma and asthma adjusted to IAQ parameters on EBC pH. RESULTS Following adjustment to gender and BMI, asthma was significantly associated with a lower EBC pH in the acidic group. The effect of asthma on EBC pH was independent of IAQ, in both groups. In the acidic group, EBC pH was significantly affected by temperature [β = -0.09 (-0.15, -0.02)] and PM 2.5 concentration [β = -0.16 (-0.32, -0.01)], and in the alkaline group by relative humidity [β = 0.07 (0.02, 0.13)] and concentration of endotoxins [β = -0.06 (-0.1, -0.01)]. CONCLUSION Our study shows that in addition to individual determinants such as asthma, environmental factors may influence and should be taken into consideration when interpreting EBC pH level in children.
Collapse
Affiliation(s)
- Tiago Azenha Rama
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Paciência
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| | - João Cavaleiro Rufo
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| | - Diana Silva
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Cunha
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Milton Severo
- Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Luís Delgado
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André Moreira
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| |
Collapse
|
24
|
Laurent S, Chatellier G, Azizi M, Calvet D, Choukroun G, Danchin N, Delsart P, Girerd X, Gosse P, Khettab H, London G, Mourad JJ, Pannier B, Pereira H, Stephan D, Valensi P, Cunha P, Narkiewicz K, Bruno RM, Boutouyrie P. SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk. Hypertension 2021; 78:983-995. [PMID: 34455813 PMCID: PMC8415523 DOI: 10.1161/hypertensionaha.121.17579] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P=0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage (P=0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more (P<0.001 and P<0.01, respectively), and PWV increased less (P=0.0003) than in the conventional group. The SPARTE study lacked sufficient statistical power to demonstrate its primary outcome. However, it demonstrated that a PWV-driven treatment for hypertension enables to further reduce office and ambulatory systolic blood pressure and diastolic blood pressure and prevent vascular aging in patients with hypertension at medium-to-very-high risk, compared with strict application of guidelines.
Collapse
Affiliation(s)
- Stephane Laurent
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.)
| | - Gilles Chatellier
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,Clinical Research Unit, INSERM U970, Paris (G. Chatellier, H.P.)
| | - Michel Azizi
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,Hypertension Department and DMU CARTE, Paris, France (M.A.).,INSERM, CIC1418, Paris, France (M.A.)
| | - David Calvet
- Neurology department, GHU Paris Psychiatrie Neurosciences, Sainte-Anne Hospital (D.C.).,INSERM UMR 1266, FHU NeuroVasc, Paris, France (D.C.)
| | - Gabriel Choukroun
- Nephrology Dialysis Transplantation Department, CHU Amiens, France (G. Choukroun).,MP3CV Research Unit, University Picardie Jules Verne, France (G. Choukroun)
| | - Nicolas Danchin
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,Cardiology Department, Georges Pompidou Hospital, Paris, France (N.D.)
| | | | - Xavier Girerd
- ICAN, Sorbonne University, Assistance-Publique Hopitaux de Paris, Paris, France (X.G.)
| | - Philippe Gosse
- Cardiology Department, Saint Andre Hospital, CHU Bordeaux, France (P.G.)
| | - Hakim Khettab
- Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,INSERM U970, Cardiovascular Research Center - PARCC, Paris, France (H.K., R.-M.B., P.B.)
| | - Gerard London
- Department of Nephrology, Manhes Hospital, Fleury Merogis, France(G.L.)
| | | | - Bruno Pannier
- Department of Internal Medicine, Manhes Hospital, Fleury Merogis, France (B.P.)
| | - Helena Pereira
- Clinical Research Unit, INSERM U970, Paris (G. Chatellier, H.P.)
| | - Dominique Stephan
- University of Strasbourg, France (D.S.).,UMR 1260, INSERM-University of Strasbourg, France (D.S.)
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, Assistance-Publique Hopitaux de Paris, Jean Verdier Hospital, University Sorbonne Paris Cite, Bondy, France (P.V.)
| | - Pedro Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Guimaraes, Portugal (P.C.).,Life and Health Research Institute (ICVS/3B's), Minho University, Portugal (P.C.)
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Debinki, Gdansk, Poland (K.N.)
| | - Rosa-Maria Bruno
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,INSERM U970, Cardiovascular Research Center - PARCC, Paris, France (H.K., R.-M.B., P.B.)
| | - Pierre Boutouyrie
- From the Université de Paris, France (S.L., G. Chatellier, M.A., N.D., R.-M.B., P.B.).,Assistance-Publique Hopitaux de Paris, Georges Pompidou European Hospital, Paris, France (S.L., G. Chatellier, M.A., N.D., H.K., R.-M.B., P.B.).,INSERM U970, Cardiovascular Research Center - PARCC, Paris, France (H.K., R.-M.B., P.B.)
| | | |
Collapse
|
25
|
Melo N, Hipólito I, Alves Pereira J, Cunha P, Almeida J. Colon Ischaemia Induced by Amoxicillin-related Anaphylactic Shock. Eur J Case Rep Intern Med 2021; 8:002640. [PMID: 34268268 PMCID: PMC8276922 DOI: 10.12890/2021_002640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022] Open
Abstract
Colon ischaemia is the most frequent type of ischaemia of the digestive tract. It is more common among the elderly, especially patients with haemodynamic disturbance. In young patients, it is associated with particular drugs such as oral contraceptives and ergotamine derivatives. Anaphylaxis is characterized by acute onset and skin and mucosal involvement together with cardiovascular involvement. Gastrointestinal symptoms are common in anaphylaxis, but gastrointestinal bleeding and acute colon ischaemia are rarely described. Here, we present the case of a 52-year-old woman with acute ischaemic colitis associated with an anaphylactic reaction to amoxicillin.
Collapse
Affiliation(s)
- Nuno Melo
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Isabel Hipólito
- Intensive Care Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Joana Alves Pereira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Pedro Cunha
- Intensive Care Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Jorge Almeida
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| |
Collapse
|
26
|
Castelo A, Portugal G, Vaz Ferreira V, Garcia Bras P, Teixeira B, Valente B, Cunha P, Guerra C, Delgado A, Cruz Ferreira R, Oliveira M. Radiofrequency catheter ablation of focal atrial tachycardia: characteristics and results of a series in a tertiary hospital. Europace 2021. [DOI: 10.1093/europace/euab116.090] [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.
Background
Focal atrial tachycardia (AT) is a relatively uncommon arrhythmia with poor response to medical treatment. Radiofrequency (RF) ablation appears to be a good option for treatment of symptomatic patients (P).
Purpose
To describe the clinical characteristics, electrophysiological (EP) findings, safety and short-term efficacy of catheter ablation in P with AT.
Methods
Retrospective analysis of consecutive P submitted to AT ablation using electroanatomical mapping between 2015 and 2020. If the AT was not present spontaneously, pacing maneuvers (atrial drive or burst pacing with up to 3 extra-stimuli) and isoprenaline was employed until reproducible induction of an ectopic atrial rhythm. Radiofrequency (RF) ablation was delivered at the site of earliest activation after validation of local electrograms until non-inducibility.
Results
A total of 46P (61% female) were included, with a mean age of 48 ± 23 years (minimum 8 months, maximum 86 years). Idiopathic AT was observed in 47,8%, while 52.2% had other relevant comorbidities (chronic pulmonary disease 17.4%; previous cardiac surgery 8,7%; congenital heart disease 10.9%; coronary artery disease 6.5%). Despite anti-arrhythmic therapy, daily palpitations were present in 87% of the cases and dizziness or syncope occurred in 22%). Nearly half (47.8%) had previously sought urgent medical care and 30.4% had a hospital admission due to arrhythmia. The clinical arrhythmia was documented in 34P (47.8% by 12-lead electrocardiography and 26.1% in 24h Holter monitoring). During the EP study a focal AT was documented in all P (spontaneously in 54.3% and induced with pacing maneuvers in 45.7%). AT origin after electroanatomical activation mapping is depicted in figure 1. After focal RF ablation, a second AT was induced in 16P (34.8%) and a new ablation was performed in 15 cases (93.8%). Total RF time was 508 ± 386 sec. One P developed right phrenic nerve palsy after ablation on the lateral wall of the right atrium. No other complications were noted. On follow-up (mean 320 ± 92 days), symptoms improved in 88.1% of the P, with a 3-fold decrease in urgent medical care visits and hospital admission for arrhythmia. Three P (8.7%) were submitted to a new EP study, in which an AT was documented and ablated in 2P.
Conclusion
AT is a very symptomatic arrhythmia, associated with increased usage of hospital resources and poor response to antiarrhythmic therapy. Ablation is an efficient treatment option, with a high success rate, low rate of complications and short-term clinical benefits. Abstract Figure. Distribution of focal atrial tachycardia
Collapse
Affiliation(s)
- A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - G Portugal
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - B Valente
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Guerra
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Delgado
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| |
Collapse
|
27
|
Castelo A, Rosa S, Fiarresga A, Marques M, Portugal G, Cunha P, Bras P, Ferreira V, Mendonca T, Oliveira M, Ferreira R. Late gadolinium enhancement as a predictor of arrhythmias in patients with hypertrophic cardiomyopathy. Europace 2021. [DOI: 10.1093/europace/euab116.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of arrhythmias and sudden cardiac death (SCD). The Late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR) has been associated with the occurrence of arrhythmic events.
Purpose
The aim was to analyze the association between LGE burden and location and arrhythmic events in HCM patients (P).
Methods
Retrospective analysis of P with HCM in a single tertiary center. Baseline clinical, echocardiographic and CMR characteristics were collected. On follow up arrhythmias (ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AF) and atrial flutter (AFL)) were identified. LGE on CMR was compared between patients with and without arrhythmias.
Results
61P (59% male) were included, with a mean age of 58 ± 2 years. The HCM risk-SCD score was 3.35 ± 0.28%. On echocardiography mean left ventricle ejection fraction was 62.16 ± 1.36% and maximum wall thickness 20.59 ± 0.596mm. 31.1% had systolic anterior movement of mitral valve and 26.7% had left ventricle outflow tract obstruction. LGE was present in 88.5% P with a median number of 5 ± 7 segments involved. Interventricular septum (IVS) was involved in 78.7% P, anterior wall
in 57.4%, inferior wall in 54.1%, lateral wall in 52.5%, posterior wall in 9.8%, basal segments in 62.3%, median segments in 68.9% and apical segments in 63.9%. On follow up 3.3%P died, 45.8% had hospitalizations (22,2% because of an arrhythmia) and 75% had arrhythmias (1.6% VF, 6.6% SVT, 50% NSVT, 9.8% PSVT, 37.7% AF and 6.6% AFL). The number of segments with LGE correlated with arrhythmias (p = 0.05 for arrhythmias, p = 0.03 for SVT, p = 0.008 for NSVT and p = 0.042 for PSVT). A cut off of 5 segments involved was a good predictor of arrhythmias (p = 0.002), NSVT (p= 0.006), PSVT (p = 0.024) and AF (p = 0.0029). For SVT the best cut off was 9 (p = 0.003). Considering the LGE location, we found an association between the segments involved and the occurrence of different arrhythmias (table 1).
Conclusion
Supraventricular and ventricular Arrhythmias are frequent in patients with HCM, with the most frequents being NSVT and AF. The LGE burden (>5 segments) and location (median inferior IVS, median anterior IVS, median anterior wall, basal anterior IVS, apical anterior wall, median inferior wall, apical anterior wall and basal inferior IVS) were correlated with arrhythmic events. Abstract Figure.
Collapse
Affiliation(s)
- A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Rosa
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Marques
- Hospital de Santa Marta, Lisbon, Portugal
| | - G Portugal
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| |
Collapse
|
28
|
Almeida CR, Cunha P. Bilateral quadratus lumborum block for management of persistent postoperative paralytic ileus: a case report. Braz J Anesthesiol 2021; 71:582-584. [PMID: 33991551 PMCID: PMC9373554 DOI: 10.1016/j.bjane.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/10/2021] [Accepted: 04/25/2021] [Indexed: 11/01/2022] Open
Abstract
We report the case of a 62-year-old female who suffered from a persistent postoperative paralytic ileus following an urgent open cholecystectomy. On the fifth postoperative day we performed a bilateral Quadratus Lumborum Block (QLB) type 1 which resulted in a progressive resolution of the condition. This case report highlights that QLB is not only limited to somatic pain control, but it can also be used to alleviate visceral pain, namely in the context of paralytic ileus management in the postoperative period.
Collapse
Affiliation(s)
| | - Pedro Cunha
- Centro Hospitalar Tondela Viseu, EPE, Viseu, Portugal
| |
Collapse
|
29
|
Yugar-Toledo JC, Cestari EDES, Souza MRD, Rubio TDA, Mello PGD, Gonzales EG, Uyemura JR, Martin LNC, Tacito LHB, J HM, Cunha P, Vilela-Martin JF. RESISTANT HYPERTENSION ON TREATMENT (RESHYPOT) TRIAL: SEQUENTIAL NEPHRON BLOCKADE COMPARED TO DUAL BLOCKADE OF THE RENIN- ANGIOTENSIN-ALDOSTERONE SYSTEM PLUS BISOPROLOL. J Hypertens 2021. [DOI: 10.1097/01.hjh.0000748624.96533.4c] [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: 11/25/2022]
|
30
|
Figueiras M, Cunha P, Simões M. PSYCHOLOGICAL WELL-BEING, SELF-ESTEEM AND HAPPINESS AMONG HIGHER EDUCATION STUDENTS IN PORTUGAL. Psic , Saúde & Doenças 2021. [DOI: 10.15309/21psd220111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
31
|
Almeida CR, Cunha F, Pinto M, Gonçalves J, Cunha P, Antunes P. A lumbar anterior lateral transverse-process (LALaT) block for a patient with multiple traumatic injuries. J Clin Anesth 2021; 71:110252. [PMID: 33765591 DOI: 10.1016/j.jclinane.2021.110252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Carlos R Almeida
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Filipa Cunha
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Maria Pinto
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal.
| | - João Gonçalves
- Anesthesiology Service, Pedro Hispano Hospital, Porto, Portugal
| | - Pedro Cunha
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| | - Pedro Antunes
- Anesthesiology Service, Tondela Viseu Hospital Centre, Viseu, Portugal
| |
Collapse
|
32
|
Ferreira JMM, Cunha P, Carneiro A, Vila I, Cunha C, Silva C, Longatto-Filho A, Mesquita A, Cotter J, Mansilha A, Correia-Neves M. Sarcopenia as a Prognostic Factor in Peripheral Arterial Disease: Descriptive Review. Ann Vasc Surg 2021; 74:460-474. [PMID: 33556522 DOI: 10.1016/j.avsg.2021.01.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Determine the influence of sarcopenia on the prognosis of peripheral arterial disease (PAD). METHODS A systematic search of the PubMed and Cochrane Library databases was performed with the keywords and medical subject heading (MesH): "muscle, skeletal", "sarcopenia", "prognosis", "duration of stay", "death", "mortality", "patient readmission", "length of stay", "peripheral arterial disease", "intermittent claudication" and "critical limb ischemia". Papers published from January 2010 to October 2020 in English, French, Spanish and Portuguese were eligible for inclusion. The primary outcome was overall survival. Secondary outcomes included post-operative complications, amputation, length of hospital stay and hospital readmission. RESULTS Of 1071 papers, 8 articles and 1511 patients were included (68.96% male, mean age 71.83 years). Five papers found an inverse relationship between SM area and mortality. Matsubara (2015) found that the 5-year overall survival rates were lower for patients with sarcopenia (23.5% ± 0.18% vs 77.5% ± 0.09% P = 0.001). Matsubara (2016) registered 3-year cardiovascular event-free survival rates of 43.1% and 91.2% for patients with and without sarcopenia (P < 0.01). Juszczak (2018) found that survival was lower in patients with reduced total psoas area. Taniguchi (2019) found that 3-year overall survival rate was 60% for patients with sarcopenia and 87% for patients without sarcopenia (P < 0.05). Shimazoe (2019) concluded sarcopenia was a significant predictor of overall survival. Distinctly, Nyers (2017) concluded that higher ratio bilateral psoas area to L4 vertebral body was associated with an increased risk of death. Two other studies analyzed other characteristics of the SM (density and strength). McDermott (2012) and found that lower calf muscle density and strength were associated with an increase in mortality. Sugai (2019) concluded that patients with major cardiovascular and limb events had a lower SM density. CONCLUSIONS Lower SM area and mass seem to be associated with a higher mortality in PAD patients.
Collapse
Affiliation(s)
- Joana Margarida Magalhães Ferreira
- Vascular Surgery Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Isabel Vila
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Silva
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Armando Mansilha
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Vascular Surgery Department, Hospital de São João, Porto, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
33
|
Paciência I, Cavaleiro Rufo J, Mendes F, Farraia M, Cunha P, Silva D, Delgado L, Padrão P, Moreira P, Moreira A. A cross-sectional study of the impact of school neighbourhood on children obesity and body composition. Eur J Pediatr 2021; 180:535-545. [PMID: 32910211 DOI: 10.1007/s00431-020-03798-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
Schools' neighbourhoods provide an important environmental context that may influence the risk of obesity among children. The aim of this study was to assess the effect of neighbourhood surrounding schools on obesity and body composition in schoolchildren. Data on 845 children aged 7 to 12 years old from 20 primary schools were considered. Anthropometric measurements and bioelectrical impedance analysis were performed to assess body mass index (BMI) and characterize body composition. Land use characteristics were quantified within a 500-m buffer zone around schools. Mixed-effect models measured the effects of school neighbourhood on obesity and body composition. The results showed a tendency between green urban areas around schools and lower values of BMI and better body composition parameters compared with built areas, being BMI z-scores CDC, and body fat percentage significantly higher in-built than in green urban areas (β = 0.48, 95% CI 0.05; 0.90, and β = 2.56, 95% CI 0.39; 4.73, respectively).Conclusion: Our findings suggest that the school neighbourhood has an effect on BMI and body fat percentage in schoolchildren. These results may contribute to the creation of healthier cities and help reduce health expenses by focusing on prevention programmes towards the expansion of green spaces. What is Known: • Living in greener areas has been associated with healthy weight outcomes and to the lower impact of obesogenic urban environments. • The school environment may be especially important for youth health outcomes. What is New: • Neighbourhoods around schools may affect child health, specifically the development of obesity. • The presence of urban green areas around school may promote a framework of lifestyle or behaviours conducive to achieving a healthy weight.
Collapse
Affiliation(s)
- Inês Paciência
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - João Cavaleiro Rufo
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Francisca Mendes
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Mariana Farraia
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Pedro Cunha
- Faculdade de Ciências da Nutrição e Alimentação, da Universidade do Porto, Porto, Portugal
| | - Diana Silva
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Luís Delgado
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Patrícia Padrão
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, da Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, da Universidade do Porto, Porto, Portugal
| | - André Moreira
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, da Universidade do Porto, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| |
Collapse
|
34
|
Correia R, Cunha P, Agnoletti B, Pereira L, Partelli F, Filgueiras P, Lacerda V, Romão W. INFRAVERMELHO PORTÁTIL NA REGIÃO DO PRÓXIMO (NIR) APLICADO NO CONTROLE DE QUALIDADE DE CAFÉS ADULTERADO POR BORRA. QUIM NOVA 2021. [DOI: 10.21577/0100-4042.20170850] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PORTABLE NEAR INFRARED SPECTROSCOPY APPLIED TO THE QUALITY CONTROL OF COFFEE ADULTERED BY GROUNDS. The objective of this work was to control the purity level of canephora coffees (Conilon coffee) from the state of Espírito Santo (Brazil), as a function of the addition of grounds produced by the coffees themselves using a portable microspectrometer in the infrared region. (microNIR), associated with chemometric tools. The PCA model grouped the coffees according to the level of adulterant in the samples and showed that the presence of moisture and polysaccharides is important for the discrimination between pure and adulterated samples. PLS-DA and SIMCA classification models were built with commercial samples and resulted in the discrimination of authentic and non-authentic samples with accuracy values above 90% and 82% for PLS-DA and SIMCA, respectively. The quantification results presented by the PLS model were satisfactory for all models, reaching the best results at 75 °C with RMSEP values of 6.13 wt%, R2p = 0.9917; and LOD in the range of 5.6-8.9 wt%; LOQ = 17-26.8 wt%, according to IUPAC; relative standard deviation for repeatability of 1.0 and 1.7 wt%; and intermediate precision of 3.4 and 1.1 wt% for low (<10 wt%) and high (≈ 90 wt%) levels of adulterants, respectively. Therefore, this work represents the first exploratory study to analyze adulterations with coffee grounds by portable NIR, demonstrating the potential of the equipment against this type of adulteration.
Collapse
|
35
|
Castelo A, Rosa S, Fiarresga A, Marques H, Portugal G, Cunha P, Ferreira V, Bras P, Goncalves A, Oliveira M, Ferreira R. Predictors of atrial fibrillation occurrence in patients with hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of dysrhythmias, especially atrial fibrillation (AF).
Purpose
The aim of this study was to evaluate the incidence of AF in HCM patients (P) and to determine predictors of AF.
Methods
Retrospective analysis of HCM P at a single tertiary center. Baseline clinical, echocardiographic and cardiovascular magnetic resonance (CMR) characteristics were collected. On follow up AF was identified by electrocardiogram and/or 24 hours Holter monitoring.
Results
61P (59% male) were included, with a mean age of 58±2 years. 27.9% had angina (all of them CCS 2), 34.4% were in NYHA II and 14.8% in NYHA III, 8.2% had syncope and 39.3% had palpitations. A family history of sudden cardiac death (SCD) or cardiomyopathy was present in 40.4% of the cases. The mean HCM risk SCD score was 3.35±0.28%. On echocardiography left atrium (LA) diameter was 44.86±0.87mm, LA volume (LAvol) was 89.97±5.39mL (indexed LAvol 46.05±2.55mL/m2), interventricular septum (IVS) was 16.83±0.663mm, left ventricle (LV) mass was 290.94±13.897g and maximum wall thickness (MWT) was 20.59±0.596mm. 77% P had LA enlargement. 88.5%P had late gadolinium enhancement (LGE) in CMR with a median number of 5±7 segments involved. AF developed in 23P (37.7%), with a mean age of 58±3 years. Predictors of AF development were NYHA III (p=0.007), risk score (p=0.007), LA diameter (p=0.007), LAvol (p=0.005) and indexed LAvol (p=0.002), MWT (p=0.0015), LGE in more than 5 segments (p=0.029) and LGE in the inferior basal and inferior median IVS (p=0.033 and p=0.042). The only independent predictor was LAvol (p=0.0012), with an area under the curve of 0.755 and a cut off of 85.9mL being the best predictor (p=0.004). Combining LAvol >85.9mL with LGE involving >5 segments and LAvol >85.9mL with LGE in inferior basal IVS (IBIVS) a statistically significant difference between groups was achieved (p=0.009 in the combined predictor LAvol + LGE >5 segments and p=0.002 in the combined predictor LAvol + LGE in IBIVS) (figure 1 and figure 2). In a multivariable analysis including these 2 combined predictors and LAvol alone the only independent predictor was the combination of LAvol + IBIVS involvement.
Conclusion
AF is frequent in patients with HCM and develops in younger ages than in general population. NYHA III, risk score, LA diameter, LAvol, MWT, LGE >5 segments and LGE in IBIVS and in IMIVS were predictors of AF, with LAvol being the independent predictor. The combination of LAvol with LGE >5 segments and LAvol with LGE in IBIVS presented stronger predictor value comparing with these characteristics alone.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Rosa
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - H Marques
- Hospital de Santa Marta, Lisbon, Portugal
| | - G Portugal
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| |
Collapse
|
36
|
Castelo A, Laranjo S, Lousinha A, Cunha P, Brandao C, Alves S, Silva A, Ferreira V, Bras P, Mano T, Oliveira M, Ferreira R. Role of tilt-table testing in syncope diagnosis and management: analysis of patients referred to a syncope unit. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0710] [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
Head-up tilt-testing (HUT) enables the reproduction of reflex syncope in a laboratory setting. Despite being used to confirm the diagnosis of this syncope, there is some concerns regarding the best protocol to use and recent studies with implantable loop recorders have called the value of HUT into question.
Aim
To characterize the population undergoing HUT according to the modified Italian protocol, type of response to HUT and subsequent management at our center in the last 4 years.
Methods
Retrospective analysis of consecutive P who underwent HUT between 2015 and 2018. Descriptive analysis of patients (P) demographics and medical history, indication for HUT, type of response to HUT and management.
Results
A total of 419P (55.1% female) were included with a mean age of 62 years. The majority (n=302, 72.1%) had comorbidities (structural heart disease – 55%, cardiac dysrhythmias – 57.6%, hypertension – 48.3%, diabetes – 15.6%, depression – 15.9%, cerebrovascular disease –10.6%) or was under medication (n=220, 52.5%) with a potential hypotensive or bradycardic effect (44.1% ACEI/ARA, 29.1% beta-blocker, 27.7% diuretic, 23.6% antidepressant, 22.7% calcium channel blocker, 19.1% benzodiazepines). Syncope/presyncope episodes accounted for 56.1% of the HUT, with falls and disequilibrium accounting for 52%. In 21 cases (5%) suspected dysautonomia or other non-specified reasons were the indication for HUT. HUT were ordered according to the guidelines in 136P (84.6% – indication level I, 3.6% – level IIa, 11.8% – level IIb). HUT was positive in 292P (69.7%) – 77.1% after nitroglycerin administration (vasodepressor – 170P, cardioinhibitory – 53P, mixed – 62P and dysautonomic – 7P). Cardioinhibitory (CI) response predominated in the younger, and vasodepressor in the older P. Of the P with CI response, 41.5% had asystole (median of 41.4s, minimum 7.5s, maximum 115s). All P were instructed in the need to avoid triggering factors and perform counterpressure maneuvers. A pacemaker was implanted in 24P (5.7% of all population, due to long sinus pauses and asystole). Twenty-four P (5.7%) completed a tilt training program.
Conclusion
Most of the HUT were requested for syncope/presyncope, frequently according to the guidelines. There was a high rate of positive tests, with a predominance of vasodepressive response, particularly in the elderly.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Laranjo
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Lousinha
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Brandao
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Alves
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Silva
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| |
Collapse
|
37
|
Cunha P, Moreira A, Moreira P, Delgado L. Dietary diversity and childhood asthma-Dietary acid load, an additional nutritional variable to consider. Allergy 2020; 75:2418-2420. [PMID: 32929730 DOI: 10.1111/all.14296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Pedro Cunha
- Faculty of Nutrition and Food Science University of Porto Porto Portugal
| | - André Moreira
- Faculty of Nutrition and Food Science University of Porto Porto Portugal
- Basic & Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- EPIUnit – Public Health Institute University of Porto Porto Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Science University of Porto Porto Portugal
- EPIUnit – Public Health Institute University of Porto Porto Portugal
| | - Luis Delgado
- Basic & Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
| |
Collapse
|
38
|
Oliveira S, Abreu A, Cunha P, Carmo MM, Valente B, Ricardo I, Delgado AS, Oliveira L, Pinto F, Oliveira MM. P542Cardiac autonomic dysfunction and inflammatory response in heart failure - markers for cardiac resynchronization therapy response? Europace 2020. [DOI: 10.1093/europace/euaa162.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
FCP
Introduction
Cardiac sympathetic activation and inflammatory response are involved in chronic heart failure (HF) pathophysiology. The severity of autonomic dysfunction and inflammation might be responsible for different responses to HF treatment.
Aim
To evaluate the impact of cardiac autonomic dysfunction, and it´s association with systemic inflammation, on cardiac resynchronization therapy (CRT) response in severe HF patients.
Methods
Single centre, prospective, longitudinal study, including consecutive patients, referred to CRT. Demographic data, HF aetiology and NYHA class were evaluated. Left ventricular (LV) function data (LV ejection fraction - LVEF) by echocardiography, heart to mediastinum early ratio (HMRe) by 123I-MIBG cardiac scintigraphy, and plasmatic TNF-α levels (pg/mL) were determined, at baseline and 4 months after CRT implantation. CRT response was defined by an absolute increase of at least 5% in LVEF at 4 months evaluation after CRT. Patients were divided in 4 groups according to HMRe and TNF-α cut-points: Group I (TNF-α > 2.0 pg/ml + HMRe ≥ 1.6), Group II (TNF-α > 2.0 pg/ml + HMRe < 1.6), Group III (TNF-α ≤ 2.0 pg/ml + HMRe ≥ 1.6) and Group IV (TNF-α ≤ 2.0 pg/ml + HMRe < 1.6). Data was analyzed using descriptive statistics and groups were compared by Fisher"s exact test.
Results
A total of 95 patients were included (age 68.6 ± 10.2 years), 67.4% male and 32.6% female, 40% with diabetes mellitus, 30.5% with ischemic cardiomyopathy, 23.2% in NYHA III/IV, baseline LVEF - 26 ± 7%. At 4 months, LVEF was 40 ± 11%. In total, 73.7% were responders and 26.3% were non-responders to CRT. There were 28 patients (29.5%) with HMRe ≥ 1.6, with 25 responders (89.3%) and 48 patients (50.5%) with TNF-α ≤ 2.0 pg/ml, with 38 responders (79.2%). Group I had 16 patients (16.8%), with 81.2% responders; Group II had 31 patients (32.7%), with 61.3% responders; Group III had 12 patients (12.6%), with 100% responders, and Group IV had 36 patients (37.9%), with 72.2% responders. Conclusion: In patients with severe HF submitted to CRT, combining cardiac autonomic dysfunction and inflammation, associated to high rate of CRT non response. Contrarily, those with preserved cardiac autonomic function and no increased levels of inflammation identified most significantly CRT responders.
CRT response according to HMRe and TNFα HMRe ≥ 1.6 (n = 28) HMRe < 1.6 (n = 67) Responders NO Respondersn (%) Responders NO Respondersn (%) TNF α > 2 pg/mL (n = 47) G I: 13 (81.2%) 3 (18.8%) GII: 19 (61.3%) 12 (38.7%) * TNF α ≤ 2 pg/mL (n = 48) G III: 12 (100%) 0 (0%)* G IV: 26 (72.2%) 10 (27.8%)
Collapse
Affiliation(s)
- S Oliveira
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| | - M M Carmo
- University of Lisbon, Nova Medical School, CEDOC Chronic Diseases, Lisbon, Portugal, Lisbon, Portugal
| | - B Valente
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - A S Delgado
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| | - L Oliveira
- Quadrantes Clinic, Nuclear Medicine Department, Clinic Quadrantes, Lisbon, Portugal, Lisbon, Portugal
| | - F Pinto
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - M M Oliveira
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| |
Collapse
|
39
|
de Castro Mendes F, Paciência I, Cavaleiro Rufo J, Silva D, Cunha P, Farraia M, Delgado L, Garcia-Larsen V, Severo M, Moreira A, Moreira P. The inflammatory potential of diet impacts the association between air pollution and childhood asthma. Pediatr Allergy Immunol 2020; 31:290-296. [PMID: 31816137 DOI: 10.1111/pai.13185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inhalation of fine particulate matter (PM) can cause systematic inflammation and oxidative stress, which may further aggravate the development and progression of asthma. Although nutritional intake of fatty acids and antioxidants may attenuate some effects of fine PM, the role of the inflammatory potential of diet has not been addressed. Therefore, we aimed to investigate possible modulatory effects of dietary inflammatory potential on the association between indoor air pollution and childhood asthma-related outcomes. METHODS In a sample of 501 children (48.1% females, aged 7-12 years) from 20 public schools located in Porto, Portugal, we evaluated airway reversibility, exhaled nitric oxide levels, atopy, and current respiratory symptoms. Dietary inflammatory index was calculated based on information collected through a reported 24-hour recall questionnaire, and participants were categorized as having an anti-inflammatory or pro-inflammatory diet. Concentrations of indoor PM2.5 and PM10 were measured to assess indoor air quality. Generalized linear mixed models were used to investigate the proportion of effects explained by the exposure to PM2.5 and PM10. RESULTS After adjustment, the exposure effect of PM2.5 and PM10 levels on children with asthma was higher for those having a pro-inflammatory diet (OR = 1.44, 95% CI: 1.01-2.21; and OR = 1.29, 95% CI: 1.03-1.68, respectively) compared to those having an anti-inflammatory diet. CONCLUSION These findings suggest that the quality of diet might affect the association between indoor pollution and asthma in children, highlighting the relevance of children's diet as a potential protective factor to pollutant exposure in childhood asthma.
Collapse
Affiliation(s)
- Francisca de Castro Mendes
- The Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Inês Paciência
- The Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,The Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal
| | - João Cavaleiro Rufo
- The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Diana Silva
- The Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,The Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Pedro Cunha
- The Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Mariana Farraia
- The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Luís Delgado
- The Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,The Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal
| | - Vanessa Garcia-Larsen
- The Program in Human Nutrition, Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Milton Severo
- The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,The Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - André Moreira
- The Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,The Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal.,The Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- The EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,The Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| |
Collapse
|
40
|
Barros-Viegas AT, Carmona V, Ferreiro E, Guedes J, Cardoso AM, Cunha P, Pereira de Almeida L, Resende de Oliveira C, Pedro de Magalhães J, Peça J, Cardoso AL. miRNA-31 Improves Cognition and Abolishes Amyloid-β Pathology by Targeting APP and BACE1 in an Animal Model of Alzheimer's Disease. Mol Ther Nucleic Acids 2020; 19:1219-1236. [PMID: 32069773 PMCID: PMC7031139 DOI: 10.1016/j.omtn.2020.01.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/11/2019] [Accepted: 01/06/2020] [Indexed: 01/08/2023]
Abstract
Alzheimer's disease (AD) is the most common form of dementia worldwide, characterized by progressive memory impairment, behavioral changes, and, ultimately, loss of consciousness and death. Recently, microRNA (miRNA) dysfunction has been associated with increased production and impaired clearance of amyloid-β (Aβ) peptides, whose accumulation is one of the most well-known pathophysiological markers of this disease. In this study, we identified several miRNAs capable of targeting key proteins of the amyloidogenic pathway. The expression of one of these miRNAs, miR-31, previously found to be decreased in AD patients, was able to simultaneously reduce the levels of APP and Bace1 mRNA in the hippocampus of 17-month-old AD triple-transgenic (3xTg-AD) female mice, leading to a significant improvement of memory deficits and a reduction in anxiety and cognitive inflexibility. In addition, lentiviral-mediated miR-31 expression significantly ameliorated AD neuropathology in this model, drastically reducing Aβ deposition in both the hippocampus and subiculum. Furthermore, the increase of miR-31 levels was enough to reduce the accumulation of glutamate vesicles in the hippocampus to levels found in non-transgenic age-matched animals. Overall, our results suggest that miR-31-mediated modulation of APP and BACE1 can become a therapeutic option in the treatment of AD.
Collapse
Affiliation(s)
- Ana Teresa Barros-Viegas
- Doctoral Programme in Health Sciences, Faculty of Medicine, University of Coimbra, Coimbra, 3000-548, Portugal; CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Vítor Carmona
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Elisabete Ferreiro
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3030-789 Coimbra, Portugal
| | - Joana Guedes
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3030-789 Coimbra, Portugal
| | - Ana Maria Cardoso
- Doctoral Programme in Health Sciences, Faculty of Medicine, University of Coimbra, Coimbra, 3000-548, Portugal; CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Pedro Cunha
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Luís Pereira de Almeida
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Catarina Resende de Oliveira
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - João Pedro de Magalhães
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - João Peça
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
| | - Ana Luísa Cardoso
- CNC- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3030-789 Coimbra, Portugal.
| |
Collapse
|
41
|
Ferreira J, Carneiro A, Cunha P, Mansilha A, Vila I, Cunha C, Silva C, Longatto-Filho A, Correia-Neves M, Soutinho G, Meira-Machado L, Mesquita A, Cotter J. P.63 Sarcopenia and Atherosclerotic Occlusive Disease: How Much We Know and What We Need to Know About this Association? Artery Res 2020. [DOI: 10.2991/artres.k.201209.072] [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: 11/01/2022] Open
|
42
|
Ferreira J, Cunha P, Carneiro A, Cunha C, Silva C, Vila I, Mesquita A, Cotter J. P13 Role of Adipose Tissue and Skeletal Muscle in Peripheral Arterial Disease. Artery Res 2020. [DOI: 10.2991/artres.k.191224.048] [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: 11/01/2022] Open
|
43
|
Ferreira J, Cunha P, Mansilha A, Cunha C, Silva C, Vila I, Carneiro A, Mesquita A, Cotter J. Role of Adipose Tissue and Skeletal Muscle in Atherosclerosis and in Central Hemodynamics. Artery Res 2020. [DOI: 10.2991/artres.k.200511.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
44
|
Brito P, Bento A, Gouveia N, Sampaio L, Balsa F, Lopes V, São Bento M, Cunha P, Serra A, Porto M. The impact of the Prüm treaty on the Portuguese forensic DNA database—A brief review. Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.10.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
45
|
Rolo M, Sampaio L, Balsa F, Bento A, Gouveia N, Serra A, Brito P, Lopes V, São-Bento M, Bogas V, Cunha P, Porto M, Carneiro de Sousa M. Assessment of individual shedder status and background DNA on objects: Direct or indirect transfer? Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.10.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
46
|
Gouveia N, Brito P, Turner B, Lopes V, Bento A, Balsa F, Serra A, Sampaio L, Bogas V, Cunha P, Bento M, Porto M. Forensic analysis of MPS mtDNA data using QIAGEN biomedical genomics workbench and AQME tool – preliminary results. Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.10.115] [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]
|
47
|
Ferreira J, Silva C, Cunha C, Vila I, Cunha P, Mesquita A, Cotter J. Role of Adipose Tissue and Skeletal Muscle in Atherosclerotic Occlusive Disease (Peripheral Arterial Disease and Carotid Arterial Disease) and in Central Hemodynamics. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.392] [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]
|
48
|
de Castro Mendes F, Paciência I, Rufo JC, Silva D, Cunha P, Farraia M, Delgado L, Moreira P, Moreira A. Asthma and body mass definitions affect estimates of association: evidence from a community-based cross-sectional survey. ERJ Open Res 2019; 5:00076-2019. [PMID: 31720292 PMCID: PMC6826245 DOI: 10.1183/23120541.00076-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/25/2019] [Indexed: 11/10/2022] Open
Abstract
Asthma and obesity have been on the rise for the past few decades, becoming the most prevalent chronic conditions in children [1, 2]. Obesity has been suggested to increase asthma incidence and prevalence, and change asthma towards a more difficult-to-control phenotype [3]. Yet, the impact of heterogeneous asthma and obesity definitions on the suggested association has been poorly explored. As such, we aimed to evaluate the influence of different asthma and obesity definitions on the obesity–asthma relationship. Differing body mass classifications challenge the strength of the epidemiological evidence suggesting asthma and obesity are linked. The relationship between asthma and overweight in children depends on the body mass definitions adopted.http://bit.ly/2lSxhC5
Collapse
Affiliation(s)
- Francisca de Castro Mendes
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
| | - Inês Paciência
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal.,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - João Cavaleiro Rufo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Diana Silva
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
| | - Pedro Cunha
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Mariana Farraia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Luís Delgado
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
| | - Pedro Moreira
- Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - André Moreira
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal.,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| |
Collapse
|
49
|
Branquinho C, Cunha P, Grothaussen T, Matos M. STAKEHOLDERS’ VOICE ABOUT A YOUTH PARTICIPATORY ACTION-RESEARCH PROGRAM. Psic , Saúde & Doenças 2019. [DOI: 10.15309/19psd200321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
50
|
Costa A, Paiva D, Campos A, Gonçalves F, Cunha P, Cotter J. EVALUATING PULSE WAVE VELOCITY AND CENTRAL PRESSURE IN PATIENTS WITH ACUTE ISCHEMIC STROKE IN ACUTE PHASE. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000570540.39892.8e] [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: 11/25/2022]
|