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Smithers R, Miller ARV, Fernandes R. North Central Asia isotopic database for archaeological samples. Data Brief 2024; 53:110032. [PMID: 38348325 PMCID: PMC10859260 DOI: 10.1016/j.dib.2024.110032] [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] [Received: 11/19/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
The North Central Asia Isotopic Database (NCAID) is an open-access dataset of stable isotope measurements from archaeological remains, spanning from the Early Neolithic until present-day in North Central Asia. With 3,143 individual entries corresponding to data accumulated over more than 20 years of research, this comprehensive dataset encompasses measurements of stable carbon and nitrogen isotopes in organic fractions from archaeological humans, animals, and plants. NCAID incorporates diverse supporting information, providing geographical information, archaeological context descriptions, and chronology. This resource facilitates research into past human lifeways, paleo-environments/climates, and animal management practices throughout North Central Asia and will be continually updated as more novel data is released.
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Affiliation(s)
- R. Smithers
- Department of Archaeology, University of York, Kings Manor, York, UK
| | - A. R. Ventresca Miller
- Department of Anthropology, University of Michigan, Ann Arbor 48109, MI, United States
- Museum of Anthropological Archaeology, University of Michigan, Ann Arbor 48109, MI, United States
- Department of Archaeology, Max Planck Institute of Geoanthropology, Kahlaische Strasse 10, 07745 Jena, Germany
| | - R. Fernandes
- Department of Archaeology, Max Planck Institute of Geoanthropology, Kahlaische Strasse 10, 07745 Jena, Germany
- Department of Bioarchaeology, Faculty of Archaeology, University of Warsaw, ul. Krakowskie Przedmieście 26/28, 00-927 Warszawa, Poland
- Masaryk University, Arne Faculty of Arts, Nováka 1, 602 00, Brno-střed, Czech Republic
- Princeton University, Climate Change and History Research Initiative, Princeton, USA
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Pucci R, Cassoni A, Weyh A, Mangini N, Della Monaca M, Battisti A, Fernandes R, Valentini V. Transoral versus transfacial surgical approach to maxillary tumors: evaluation of outcomes and perspectives. Int J Oral Maxillofac Surg 2024; 53:101-108. [PMID: 37271627 DOI: 10.1016/j.ijom.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
Neoplasms of the maxilla have multiple different origins and histology, and often extend towards the infratemporal fossa, orbit, or skull base. Extensive resection may be required, often leading to poor esthetic and functional results. Usually, these lesions are removed via a transfacial approach. The aim of this study was to compare the outcomes of the transoral versus transfacial approach for maxillary tumors. A single-institution retrospective study was conducted on patients with maxillary-midface tumors, treated between January 2009 and December 2019. The patients were divided into two groups according to the surgical approach, transfacial or transoral, and the following outcomes were assessed: extent of the resection based on Brown's classification; postoperative pathology margin assessment; reconstruction technique; esthetic/functional results. A total of 178 patients were included. A satisfactory resection was obtained in both groups, with the transoral cohort achieving a higher rate of clear oncological margins (positive margins: transoral group 3.7% versus transfacial group 6.8%, P = 0.389) and a significantly higher University of Washington Quality of Life score (mean 72.2 versus 67.8, P < 0.001). Even large and invasive tumors can be treated successfully with the transoral approach, avoiding unesthetic facial scars while still providing complete resection of the tumor.
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Affiliation(s)
- R Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - A Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.
| | - A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Health, Jacksonville, FL, USA
| | - N Mangini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - M Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - A Battisti
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Health, Jacksonville, FL, USA
| | - V Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Pacheco M, Sá P, Santos G, Boa-Sorte N, Domingues K, Assis L, Silva M, Oliveira A, Santos D, Ferreira J, Fernandes R, Fortes F, Rocha R, Santana G. Impact of an intervention program on drug adherence in patients with ulcerative colitis: Randomized clinical trial. PLoS One 2023; 18:e0295832. [PMID: 38150452 PMCID: PMC10752503 DOI: 10.1371/journal.pone.0295832] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
AIMS Evaluate the impact of an intervention program in non-adherent patients with ulcerative colitis. METHODS Parallel controlled randomized clinical trial (1:1), approved by the ethics committee (No. 3.068.511/2018) and registered at The Brazilian Clinical Trials Registry (No. RBR-79dn4k). Non-adherent ulcerative colitis patients according to the Morisky-Green-Levine-test were included. Recruitment began in August 2019 until August 2020, with 6-month follow-up. All participants received standard usual care, and additionally the intervention group received educational (video, educational leaflet, verbal guidance) and behavioral interventions (therapeutic scheme, motivational and reminder type short message services). Researchers were blinded for allocation prior to data collection at Visits 1 and 2 (0 and 6 months). Primary outcome: 180-day adherence rate, with relative risk 95%CI. Secondary outcome: 180-day quality of life according to SF-36 domains, using Student's t test. Variables with p<0.20 were selected for regression. Analysis included data from August/2019 to May/2021. RESULTS Forty-six and 49 participants were allocated in control and intervention groups, respectively. Two were excluded due to intervention refusal, and 4 and 6 were lost to follow-up in control and intervention groups. There was no post-intervention adherence rate difference, even after adjustment for type of non-adherence (unintentional/both/intentional) as confounder, or if considered as adherent the intervention group participants lost in follow-up. Interventions promoted better quality of life scores even after multivariate analysis for "Pain", when adjusted for ulcerative colitis severity, sex, and marital status (β = 18.352, p = 0.004), "Vitality", when adjusted for ulcerative colitis severity (β = 10.568, p = 0.015) and "Emotional Aspects", when adjusted for disease severity, income, and education (β = 24.907, p = 0.041). CONCLUSIONS The intervention program was not able to produce a significant medication adherence rate difference between comparative groups, however, there was a significant improvement in quality of life. Study limitations may include: sample size calculated to identify differences of 30%, leading to a possible insufficient power; non blinded participants, exposing the results to the risk of performance bias; outcomes based on self-reported data.
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Affiliation(s)
- Mila Pacheco
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Pedro Sá
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Gláucia Santos
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Ney Boa-Sorte
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Kilma Domingues
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Larissa Assis
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Marina Silva
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Ana Oliveira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Daniel Santos
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Jamile Ferreira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Rosemeire Fernandes
- Centro de Infusões e Medicamentos Especializados da Bahia (CIMEB), Salvador, Bahia, Brazil
| | - Flora Fortes
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Raquel Rocha
- Universidade Federal da Bahia (UFBA), Canela, Salvador, BA–Brazil
| | - Genoile Santana
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
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Augustin E, Holtzman AL, Dagan R, Bryant CM, Indelicato DJ, Morris CG, Deraniyagala RL, Fernandes R, Bunnell AM, Nedrud SM, Mendenhall WM. Challenging the Role of Subtotal Resection Following Proton Radiotherapy for Adenoid Cystic Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2023; 117:e563-e564. [PMID: 37785726 DOI: 10.1016/j.ijrobp.2023.06.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report long-term outcomes of patients with adenoid cystic carcinoma (ACC) of the head and neck treated with proton radiotherapy. MATERIALS/METHODS On this IRB-approved, single institutional prospective outcomes registry, 56 patients were included with de novo, nonmetastatic adenoid carcinoma of the head and neck treated with primary (n = 9) or adjuvant proton therapy from June 2007 to December 2021. The cohort had 30 women and 26 men with a median age of 57 years (range, 10-81 years). Twenty-nine percent (n = 16) had intracranial extension, 23% (n = 13) had orbital extension, and 55% (n = 31) had clinical cranial nerve involvement at the time of radiotherapy. Thirty patients underwent gross total resection (GTR), 26 had gross disease at the time of treatment undergoing a subtotal resection (STR) (n = 17) or biopsy alone (n = 9). The median dose to the primary site was 72.6 GyRBE (range, 64-74.4 GyRBE) delivered in either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received either elective nodal irradiation (ENI) in a node negative neck or concurrent chemotherapy. RESULTS With a median follow-up of 6.2 years (range, 0.9 - 14.7 years), the 5-year local-regional control (LRC), disease free survival (DFS), cause-specific survival (CCS) and overall survival (OS) were 88%, 85%, 89%, and 89%, respectively. Cranial extension (p = 0.003) and gross residual tumor (p = 0.0388) were factors associated with decreased LRC. While LRC for those with a GTR was 96%, those with STR or biopsy alone were 81% and 76%, respectively. T-stage (p = 0.0154), cranial extension (p = 0.0056), extent of resection (p = 0.0355), and gross residual tumor (p = 0.0094) were associated with decreased DFS. T-stage (p = 0.0099), extent of surgery (p = 0.029) and gross residual tumor (p.0071) were associated with decreased CCS. The 5-year cumulative incidence of clinically significant late grade ³3 toxicity was 15% and the crude incidence at most recent follow-up was 23% (n = 13). There was no LRC benefit with ENI (p = 0.94). CONCLUSION Proton therapy provides excellent disease control for head and neck ACC with acceptable toxicity. Gross residual disease at the time of treatment and intracranial involvement were significant prognostic features for worse outcomes. STR did not confer benefit over biopsy only at 5-years and may question the role of extensive and morbid operations if GTR is not technically feasible.
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Affiliation(s)
- E Augustin
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - A L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - R Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - C M Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - D J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - C G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - R L Deraniyagala
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - A M Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - S M Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - W M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
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Vancappel A, Raysseguier C, Révellière C, Penverne T, Fernandes R, El-Hage W. Inhibition, Attentional Control and Binding Abilities in Relation to Dissociative Symptoms Among PTSD Patients. J Trauma Dissociation 2023; 24:609-623. [PMID: 36992662 DOI: 10.1080/15299732.2023.2195397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/03/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION The relationship between dissociation and cognitive abilities remains controversial. Empirical studies have reported positive, negative and non-existent associations between dissociation and cognition. These inconsistent results may be due to the fact that the studies focused mainly on trait dissociation, while dissociation is not stable but transient. After validating the French version of the Clinician Administered Dissociative States Scale (CADSS), the aim of the present study was to evaluate the relationship between state dissociation and cognitive abilities. METHOD We recruited 83 patients suffering from post-traumatic stress disorder (PTSD) and assessed them twice. At T1, they performed a neutral Stroop task and a neutral binding task. At T2 (one to three weeks later), after a script-driven dissociative induction, they performed an emotional Stroop task and an emotional binding task. Between the two sessions, they completed questionnaires at home evaluating PTSD severity, trait dissociation and cognitive difficulties. State dissociation was assessed at T1 and T2 using the Clinician-Administered Dissociative States Scale (CADSS). RESULTS We found good psychometric properties of the French version of the CADSS. After inducing dissociation, significantly lower attentional performance was found among patients with than without dissociative reactions. We found a significant positive correlation between state dissociation and increased attention and memory difficulties after induction. CONCLUSION The French version of the CADSS is a reliable and valid tool to assess state dissociation, which is correlated with attentional difficulties. Attentional training is recommended to help patients control dissociative symptoms.
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Affiliation(s)
- A Vancappel
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
- Département de Psychologie, EE 1901 QualiPsy, Qualité de vie et santé psychologique, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - C Raysseguier
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
| | - C Révellière
- Département de Psychologie, EE 1901 QualiPsy, Qualité de vie et santé psychologique, Tours, France
| | - T Penverne
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
| | - R Fernandes
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
| | - W El-Hage
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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Branco AC, Silva R, Santos T, Jorge H, Rodrigues AR, Fernandes R, Bandarra S, Barahona I, Matos APA, Lorenz K, Polido M, Colaço R, Serro AP, Figueiredo-Pina CG. Corrigendum to "Suitability of 3D printed nanostructured zirconia pieces for dental applications" [Dent Mater 36 (2020) 442-455]. Dent Mater 2023; 39:861. [PMID: 37544861 DOI: 10.1016/j.dental.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- A C Branco
- CQE, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; CDP2T, Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - R Silva
- CQE, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | | | - H Jorge
- Centro Tecnológico da Cerâmica e do Vidro (CTCV), Coimbra, Portugal
| | - A R Rodrigues
- CDP2T, Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - R Fernandes
- CDP2T, Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - S Bandarra
- CiiEM, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - I Barahona
- CiiEM, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - A P A Matos
- CiiEM, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - K Lorenz
- INESC-MN, IPFN, Instituto Superior Técnico, Universidade de Lisboa, Bobadela, Portugal
| | - M Polido
- CiiEM, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - R Colaço
- IDMEC e Departamento de Engenharia Mecânica, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - A P Serro
- CQE, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; CiiEM, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal.
| | - C G Figueiredo-Pina
- CDP2T, Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, Setúbal, Portugal; CiiEM, Instituto Universitário Egas Moniz, Monte de Caparica, Portugal; CeFEMA, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
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Habib N, Centini G, Klebanoff JS, Fernandes R, Giorgi M, Moawad GN, Bakar J. Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression. Facts Views Vis Obgyn 2023; 15:181-187. [PMID: 37436058 PMCID: PMC10410660 DOI: 10.52054/fvvo.15.2.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs. The diagnosis is made using Nantes Criteria, in conjunction with the patient's clinical history and physical findings. Clinical examination with an accurate assessment of the territory of the neuropathic pain is mandatory to set the therapeutic strategy. The aim of the treatment is to control the symptoms and it usually starts with conservative approaches which include analgesics, anticonvulsants, and muscle relaxants. Surgical nerve decompression can be proposed after failure of conservative management. The laparoscopic approach is a feasible and appropriate technique to explore and decompress the pudendal nerve, and to rule out other pelvic conditions that can cause similar symptomatology. In this paper, the clinical history of two patients affected by compressive PN is reported. Both patients underwent laparoscopic pudendal neurolysis suggesting that the treatment for PN should be individualised and carried out by a multidisciplinary team. When conservative treatment fails, laparoscopic nerve exploration and decompression is an adequate option to propose and should be performed by a trained surgeon.
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Weyh A, Gomez J, Kashat K, Fernandes R, Bunnell A. Self-inflicted craniomaxillofacial gunshot wounds: management, reconstruction, and outcomes. Int J Oral Maxillofac Surg 2023; 52:334-342. [PMID: 35773056 DOI: 10.1016/j.ijom.2022.06.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
Suicide by firearm remains one of the leading causes of violence-related injury death in the United States each year. The mortality rate from these injuries is high, resulting in a paucity of outcome data in the literature regarding injuries to the maxillofacial region. This has largely been attributed to a lack of funding for research in this area compared to other leading causes of mortality in the United States. The aim of this study was to detail the authors' experience and approach to complex maxillofacial reconstruction using both local reconstructive methods and microvascular free tissue transfer. A retrospective cohort study was designed, including patients who sustained self-inflicted gunshot wounds to the maxillofacial region between January 1, 2012 and May 1, 2020. Forty-one patients met the inclusion criteria. The majority of the patients were male (87.8%). Mean patient age was 44.2 ± 16.6 years. Alcohol or drugs, and a psychiatric history were present in a majority of the cases. The most involved anatomical region was the midface (75.6% of cases). Seven patients required free tissue transfer for reconstruction, with many needing multiple flaps. Self-inflicted gunshot wounds represent challenging reconstruction scenarios, often in the setting of severe psychological trauma, and require a multidisciplinary team to ensure the optimal outcome.
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Affiliation(s)
- A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - J Gomez
- Department of Oral and Maxillofacial Surgery, Ascension Macomb-Oakland Hospital, Detroit, MI, USA.
| | - K Kashat
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Rodrigues J, Sá A, Fontes R, Barbosa A, Barbosa-Martins J, Oliveira C, Peixoto M, Santos S, Rocha J, Almeida M, Carvalho C, Queiroz L, Fernandes R, Faustino I, Portela C, Coutinho C, Nabiço R. Anxiety and depression screening during neoadjuvant chemotherapy treatment in early breast cancer patients: a multicenter longitudinal observational study. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Costa H, Silva M, Santo ME, Mota T, Fernandes R, Palmeiro H, Marto S, Franco P, Carvalho D, Bispo J, Guedes J, Mimoso J, Marreiros A, Vinhas H, Jesus I. Contrast-induced nephropathy following PCI: can we calculate a safe contrast volume? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Acute kidney injury (AKI) due to contrast induced nephropathy (CIN) is a common complication after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), and is associated with prolonged hospitalizations and elevated cardio and renovascular morbidity. Scientific evidence demonstrates that the mean volume of contrast (VolC) and ratio with creatinine clearance (CrCl) (VolC/CrCl) are independent predictors of CIN, but the accepted optimal value remains controversial.
Objective
Population characterization. To evaluate whether the calculation of VolC using the VolC/ClCr ratio <3.7 used in our Cath lab during PCI of ACS allows preventing the development of AKI by CIN, and whether the development of early vs late AKI influences outcomes.
Methods
Retrospective study between 2017/2020, composed of n=378 patients who suffered ACS. Descriptve analysis was carried out regarding the demographic and clinical characteristics of the patients. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%.
Results
A total of 378 patients were identified, with a mean age of 64.5±11.2 years, 78.6% were male. 60.1% had hypertension, 48.4% dyslipidemia, 24.3% diabetes, 2.6% chronic renal failure (CRF) and 1.6% heart failure. Of these, 12.7% developed AKI (<24h in 1.9% vs ≥24h in 10,8%). Indepedent prognostic factors for development of AKI were smokers (AKI ≥24h 7 (4.8%) vs AKI<24h 2 (1.4%), p=0.001), diabetes (AKI≥24h 17 (19%) vs AKI <24h 2 (2.2%), p=0.007), CRF (AKI ≥24h 6 (60%) vs AKI <24h 1 (10%), p=0.001), CrCl (AKI ≥24h 65.8±27.1, p=0.001), ratio VolC/CrCl (AKI ≥24h 3.3±2.5, p=0.001) and LVEF (AKI ≥24h 51.4±9.7, p=0.001). Mortality afected 4.2% of the patients, and was more frequente in AKI subjects (AKI ≥24h 7 (70%) vs AKI <24h 1 (10%), p=0.001). Using a ratio <3.7 allowed to prevent AK <24h but not AKI ≥24h (AKI <24h ratio <3.7 = 3 (1%) vs ratio ≥3.7 = 9 (4.1%), p=0.001) (AKI ≥24 ratio <3.7 = 30 (25%) vs ratio ≥3.7 = 11 (9.7%), p=0.001). A ratio <2.0 allowed to prevent both early and late AKI (AKI <24h ratio <2.0 = 0 (0%) vs ratio ≥2.0 = 7 (4.5%), p=0.001) (AKI ≥24 ratio <2.0 = 11 (5.6%) vs ratio ≥2.0 = 30 (19.1%), p=0.001).
Conclusion
In patients submitted to ACS PCI, the development of AKI increases mortality, especial if AKI emerge after 24h. We report a more suitable ratio VolC/ClCr <2.0, that allow us to calculate a safe VolC that will help to prevent both early and late AKI in selected patients wtih ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Costa
- Algarve University Hospital Center , Faro , Portugal
| | - M Silva
- Algarve University Hospital Center , Faro , Portugal
| | - M E Santo
- Algarve University Hospital Center , Faro , Portugal
| | - T Mota
- Algarve University Hospital Center , Faro , Portugal
| | - R Fernandes
- Algarve University Hospital Center , Faro , Portugal
| | - H Palmeiro
- Algarve University Hospital Center , Faro , Portugal
| | - S Marto
- Algarve University Hospital Center , Faro , Portugal
| | - P Franco
- Algarve University Hospital Center , Faro , Portugal
| | - D Carvalho
- Algarve University Hospital Center , Faro , Portugal
| | - J Bispo
- Algarve University Hospital Center , Faro , Portugal
| | - J Guedes
- Algarve University Hospital Center , Faro , Portugal
| | - J Mimoso
- Algarve University Hospital Center , Faro , Portugal
| | - A Marreiros
- Algarve University Hospital Center , Faro , Portugal
| | - H Vinhas
- Algarve University Hospital Center , Faro , Portugal
| | - I Jesus
- Algarve University Hospital Center , Faro , Portugal
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Fernandes R, Silva JD, Ferreira JM, Goncalves L. Can carotid angioplasty stenting be better than endarterectomy or best medical treatment for patients with carotid stenosis? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Carotid stenosis is responsible for a considerable amount of strokes and related deaths. Carotid angioplasty stenting (CAS), endarterectomy (CEA) and best medical treatment (BMT) are important in preventing major cardiovascular (CV) events.
Methods
We conducted a systematic review and meta-analysis, with randomized controlled trials (RCT), to compare CAS with CEA and BMT regarding the short and long-term major periprocedural and follow-up CV events (stroke, myocardial infarction, and death) in symptomatic and asymptomatic carotid stenosis. We searched for RCT published from 2008 to 2021 in databases such as Pubmed/MEDLINE, B-On, Embase, Clinical Trials from U.S. National Library of Medicine and International Clinical Trials Registry Platform, between July of 2018 and January of 2019, and in October of 2021.
Results
Nine RCT were included, with a total of 9162 participants for CAS versus (vs) CEA, and 513 participants for CAS vs TMO. Compared with CEA, CAS is associated with periprocedural stroke and death in symptomatic patients (HR=1.65, 95% CI: 1.29–2.11, p=0.05, I2=62%), due to higher stroke events than deaths. That association does not occur in asymptomatic patients in which CAS is not associated with periprocedural stroke or death (CAS=8.55%, CEA=7.05%, p=0.09). During follow-up there were no significant differences between CAS and CEA in symptomatic patients regarding stroke (HR=1.51, 95% CI: 1.23–1.84, p=0.57, I2=0%) and death (HR=1.10, 95% CI: 0.93–1.30, p=0.69, I2=0%). Periprocedural myocardial infarction (MI) incidence is higher in CEA (CAS=1.1%; CEA=2.3%; p=0.03), without influence of symptomatic status. CAS is not inferior to CEA, in both symptomatic and asymptomatic patients with high surgery risk, as for periprocedural and one year CV major events (CAS=12.2%, CEA=20.1%, absolute difference = −7.9, 95% CI: −16.4–0.7, p=0.004). BMT had no significant findings vs CAS in asymptomatic patients (HR=3.5, 95% CI: 0.42–29.11, p=0.246).
Conclusion
CAS is not inferior to CEA as for the periprocedural and one-year major CV events in patients with normal surgery risk. However, there is a higher risk of periprocedural stroke in CAS for symptomatic patients, and of periprocedural MI in CEA with no influence of symptomatic status. CAS seams to prevent middle and long-term ipsilateral stroke in symptomatic patients. BMT has yet to prove not to be inferior to CAS in asymptomatic patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J D Silva
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J M Ferreira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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Farah M, Rizvi I, Fernandes R, Patel A. 571 Evaluating the Effectiveness of Extracorporeal Shockwave Lithotripsy (ESWL) for Ureteric Stones During COVID-19 Pandemic - A Single Centre Experience. Br J Surg 2022. [PMCID: PMC9452093 DOI: 10.1093/bjs/znac269.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aim Reliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results. Method A retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining). Results A total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones <10mm had a SFR of 67%, compared to 58% for stone >10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks. Conclusion Our overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.
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Affiliation(s)
- M Farah
- Sunderland Royal Hospital, Sunderland, United Kingdom
| | - I Rizvi
- Sunderland Royal Hospital, Sunderland, United Kingdom
| | - R Fernandes
- Sunderland Royal Hospital, Sunderland, United Kingdom
| | - A Patel
- Sunderland Royal Hospital, Sunderland, United Kingdom
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Weyh AM, Pucci R, Busby E, Kansal L, Joy R, Bunnell A, Valentini V, Dyalram D, Pattatheyill A, Figari M, Boccalatte L, Larrañaga J, Cassoni A, Fernandes R. Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study. Int J Oral Maxillofac Surg 2022; 51:1412-1419. [PMID: 35599083 DOI: 10.1016/j.ijom.2022.04.016] [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: 10/05/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.
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Affiliation(s)
- A M Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Pucci
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - E Busby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - L Kansal
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India.
| | - R Joy
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - V Valentini
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - D Dyalram
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
| | - A Pattatheyill
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India.
| | - M Figari
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - L Boccalatte
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - J Larrañaga
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - A Cassoni
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Bonan N, Chen J, Ghofrani J, Medina J, Bollard C, Yvon E, Fernandes R. Gene Editing/Gene Therapies: HUMAN ALLOGENEIC NK CELLS MODIFIED TO EXPRESS A TGF-β DOMINANT NEGATIVE RECEPTOR AND IL-15 DISPLAY A STRONG ANTI-TUMOR ACTIVITY IN AN NSG MOUSE MODEL OF HUMAN MESOTHELIOMA. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schmid P, Jung K, Wysocki P, Jassem J, Ma C, Fernandes R, Huisden R, Stewart R, Vukovic P, Tablante Nunes A, Nowecki Z. 166MO Datopotamab deruxtecan (Dato-DXd) + durvalumab (D) as first-line (1L) treatment for unresectable locally advanced/metastatic triple-negative breast cancer (a/mTNBC): Initial results from BEGONIA, a phase Ib/II study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.185] [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: 11/01/2022] Open
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Fernandes R, Pina M, Fava Gaspar C, Teixeira A, Oliveira C, Rodrigues A, Azevedo I. 190P COVID-19 pandemic impact on lung cancer patient’s performance status and access to treatment: A comparative study pre and during COVID-19 era. Ann Oncol 2022. [PMCID: PMC8976191 DOI: 10.1016/j.annonc.2022.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cantero M, Guedes M, Fernandes R, Lollo PCB. Trimethylamine N-oxide reduction is related to probiotic strain specificity: a systematic review. Nutr Res 2022; 104:29-35. [DOI: 10.1016/j.nutres.2022.04.001] [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] [Received: 10/31/2021] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022]
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Fernandes R, Lukito AA, Chandra S, Hutabarat H. C56. Isolated Right Ventricular Non-Compaction Cardiomyopathy (IRVNC) in Adolescence: A Case Report. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab124.055] [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: 03/06/2023]
Abstract
Abstract
Background
Non-compaction ventricular myocardium (NCVM) is a rare genetic cause of cardiomyopathy which mostly affects the left ventricle. A limited case of IRVNC was reported which render a limited knowledge for clinician.
Case Summary
A 16-y.o male presented to our emergency unit with recurrent syncope, chest discomfort, palpitation which exaggerated by strenuous exercise. There was no familial history of sudden death. On admission, BP of 102/64 mmHg and bradycardia of 49 bpm were remarkable. Electrocardiography revealed sinus arrhythmia, 49 bpm with early repolarization on precordial leads and LVH. Laboratory tests were in normal limits. Echocardiography revealed hyper-trabeculated RV with no LV-dysfunction. CMR was performed and showed normal LV dimension and function. Right atrium and RV were dilated with RV-dysfunction. RV trabeculae were indicative for IRVNC (NC/C ratio of 4.3). Holter ECG monitoring was done and remarkable for sinus arrhythmia without sinus pause nor ventricular arrhythmia.
Anticoagulant was given for embolic prevention in the non-compacted area. ACEi, β-blockers, and diuretic were not given due to hypotension, bradycardia and no signs of congestion. The patient showed clinical improvement and discharged after 5 days of hospitalization.
Discussions
Recently, there has been no specific criteria and cut off for IRNVC. Earlier studies mentioned that ILVNC criteria could be used for diagnosing IRNVC, as we used in our case. In the future, it’s necessary to determine new cut off points dedicated for IRVNC. Furthermore, close follow-up is needed as complications such as arrhythmia, embolic events and heart failure might occurred.
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Affiliation(s)
- R Fernandes
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
| | - A A Lukito
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
| | - S Chandra
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
| | - H Hutabarat
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
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20
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Fernandes R, Lukito AA, Chandra S, Hutabarat H. C56. Isolated Right Ventricular Non-Compaction Cardiomyopathy (IRVNC) in Adolescence: A Case Report. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab125.055] [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]
Abstract
Abstract
Background
Non-compaction ventricular myocardium (NCVM) is a rare genetic cause of cardiomyopathy which mostly affects the left ventricle. A limited case of IRVNC was reported which render a limited knowledge for clinician.
Case Summary
A 16-y.o male presented to our emergency unit with recurrent syncope, chest discomfort, palpitation which exaggerated by strenuous exercise. There was no familial history of sudden death. On admission, BP of 102/64 mmHg and bradycardia of 49 bpm were remarkable. Electrocardiography revealed sinus arrhythmia, 49 bpm with early repolarization on precordial leads and LVH. Laboratory tests were in normal limits. Echocardiography revealed hyper-trabeculated RV with no LV-dysfunction. CMR was performed and showed normal LV dimension and function. Right atrium and RV were dilated with RV-dysfunction. RV trabeculae were indicative for IRVNC (NC/C ratio of 4.3). Holter ECG monitoring was done and remarkable for sinus arrhythmia without sinus pause nor ventricular arrhythmia.
Anticoagulant was given for embolic prevention in the non-compacted area. ACEi, β-blockers, and diuretic were not given due to hypotension, bradycardia and no signs of congestion. The patient showed clinical improvement and discharged after 5 days of hospitalization.
Discussions
Recently, there has been no specific criteria and cut off for IRNVC. Earlier studies mentioned that ILVNC criteria could be used for diagnosing IRNVC, as we used in our case. In the future, it’s necessary to determine new cut off points dedicated for IRVNC. Furthermore, close follow-up is needed as complications such as arrhythmia, embolic events and heart failure might occurred.
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Affiliation(s)
- R Fernandes
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
| | - A A Lukito
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
| | - S Chandra
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
| | - H Hutabarat
- Department of Cardiology Faculty of Medicine Pelita Harapan University, Siloam Hospital Lippo Village , Tangerang, Indonesia
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21
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Shaladi A, Marshall K, Fernandes R. 1248 “Passing the Surgical Torch”- A Review of Appropriate Surgical Handover Protocol on The Acute Surgical Take. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.139] [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]
Abstract
Abstract
Aim
Effective handover between shifts is vital to protect patient safety. The Royal College of Surgeons has detailed the necessary information needed for each patient at handover. We aimed to assess compliance with this handover protocol.
Method
Weekday surgical handover was reviewed over an 8-week period of time. Data was collected on documentation of diagnosis, up to investigations/bloods, clinical state of patient, management plan and resuscitation status/ceiling of care and COVID status.
Results
210 patients were reviewed. Of these, a clear diagnosis was documented for 152 patients. Up to date imaging results if applicable was documented in 111 of 153 patients. Up to date bloods were included in 140 of 210 patients. COVID status was only noted in 31 of 210 patients and DNAR status in only 24. After re-audit of 197 a clear diagnosis was seen in 183 patients, COVID status was documented in 170 patients and DNAR status in 169.
Conclusions
Surgical handover is hugely crucial for provision of patient care. Following clear guidance from the royal college of surgeons, better compliance with handover was noted, including a critical improvement in COVID and DNAR status.
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Affiliation(s)
- A Shaladi
- William Harvey Hospital, London, United Kingdom
| | - K Marshall
- William Harvey Hospital, London, United Kingdom
| | - R Fernandes
- William Harvey Hospital, London, United Kingdom
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22
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Ezeife D, Spackman E, Juergens R, Laskin J, Agulnik J, Hao D, Laurie S, Law J, Le L, Kiedrowski L, Melosky B, Shepherd F, Cohen V, Wheatley-Price P, Vandermeer R, Li J, Fernandes R, Shokoohi A, Lanman R, Leighl N. OA16.02 The Economic Value of Liquid Biopsy for Genomic Profiling in Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Nunes S, Viana S, Preguiça I, Alves A, Fernandes R, Jarak I, Carvalho R, Cavadas C, Rolo A, Palmeira C, Pintado M, Reis F. Unraveling the hepatoprotective effects of blueberries in a hypercaloric diet-induced rat model of prediabetes by metabolomic and transcriptomic approaches. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab120.106] [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: 11/12/2022] Open
Abstract
Abstract
Background
We previously described protective effects of blueberry juice (BJ) against hepatic steatosis evolution in a hypercaloric diet-induced rat model of prediabetes; however, the underlying mechanisms, are still scarcely explored. Herein, we aim to elucidate the molecular pathways underpinning BJ hepatoprotection on the dysmetabolism evolution in a rat model of prediabetes.
Methods
A rat model of evolutive prediabetes [Male Wistar rats, 8 weeks old] was developed by ingestion of a high-sucrose (HSu, 35%) diet for 9 weeks (W9), supplemented with a high-fat diet (HF, 60%) for further 14 weeks (HSuHF, W23), vs control with standard diet. Half of the animals (n = 10/group) daily received BJ (25g/Kg BW, orally) between W9 and W23. Along with metabolic characterization, BJ effects on serum and hepatic metabolic surrogates were elucidated using a 1H NMR based metabolomic approach. Moreover, the liver expression of genes (RT-PCR) involved in insulin signaling, lipid metabolism, inflammatory response and mitochondrial respiration was also explored. Values are means ± S.E.M (ANOVA followed by post-hoc tests).
Results
HSuHF+BJ rats restored hepatic levels of betaine and tend to recover the depletion of glutathione content found in HSuHF animals’ livers. Moreover, BJ positively affected the hepatic mRNA expression of key enzymes and mediators involved in fatty acid oxidation, insulin signalling, inflammatory response, as well as mitochondrial respiratory chain-related genes, which were all downregulated (P < 0.05) in HSuHF animals’ livers.
Conclusions
Altogether, these molecular findings contribute to explain the mechanisms by which BJ elicits protection against hepatic steatosis and mitochondrial dysfunction induced by hypercaloric diets in the frame of prediabetes evolution.
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Affiliation(s)
- S Nunes
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine from University of Coimbra (FMUC)
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
| | - S Viana
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine from University of Coimbra (FMUC)
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
- Polytechnic Institute of Coimbra, ESTESC-Coimbra Health School, Pharmacy
| | - I Preguiça
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine from University of Coimbra (FMUC)
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
| | - A Alves
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine from University of Coimbra (FMUC)
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
| | - R Fernandes
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine from University of Coimbra (FMUC)
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
| | - I Jarak
- Dep. Microscopy, Lab. Cell Biology and Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto (UP)
| | - R Carvalho
- Dep. Life Sciences, Faculty of Science and Technology, UC
- Associated Lab. for Green Chemistry-Clean Technologies and Processes, REQUIMTE, UP
| | - C Cavadas
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
- Faculty of Pharmacy, UC
- Center for Neurosciences and Cell Biology, UC
| | - A Rolo
- Dep. Microscopy, Lab. Cell Biology and Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto (UP)
- Center for Neurosciences and Cell Biology, UC
| | - C Palmeira
- Dep. Microscopy, Lab. Cell Biology and Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto (UP)
- Center for Neurosciences and Cell Biology, UC
| | - M Pintado
- CBQF - Center for Biotechnology and Fine Chemistry, Associated Lab., School of Biotechnology, Catholic University, Porto, Portugal
| | - F Reis
- Institute of Pharmacology & Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine from University of Coimbra (FMUC)
- Center for Innovative Biomedicine and Biotechnology, UC
- Clinical Academic Center of Coimbra
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24
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Graça R, Fernandes R, Alves A, Menezes J, Romão L, Bourbon M. Characterisation of LDLR variants in the initiation codon. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Caldeira Da Rocha R, Picarra B, Santos AR, Carias M, Claudio F, Pais J, Carrington M, Fernandes R, Trinca M. Cardiac magnetic resonance evaluation of takotsubo cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.112] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Takotsubo Cardiomyopathy(TCM)is a reversible pathology with clinical features practically indistinguishable from AMI.Cardiac magnetic resonance(CMR)is uniquely suited in differentiating TCM from other forms of acute ventricular dysfunction.CMR can also identify potential complications.
Purpose
The aim of this study was to characterize TCM features,as well as to evaluate diagnostic and prognostic impact of CMR in these patients.
Methods
A 7-years prospective study,which included patients of our center proposed to CMR with presumptive diagnosis of MINOCA based on acute chest pain,troponin raise and absence of angiographically significant coronary disease (luminal stenosis <50%).We analysed clinical characteristics, electrocardiograms, echo and coronariography.A presumptive diagnosis was elaborated and comparison was made with the TCM definitive one after CMR.We applied a protocol to evaluate TCM patients’ left and right ventricles(LV;RV)both anatomically and functionally, and search for late gadolinium enhancement(LGE).
Results
A total of 93 patients were evaluated,of which 16 had the final diagnosis of TCM.Takotsubo-cardiomyopathy patients were all female,with a mean age of 69 ± 14years old.At admission,75% had ST segment elevation, so emergent coronariography was performed. The median highest troponin I was 2,235[1,30-4,27]ng/mL.CMR confirmed 25%(n = 4) of presumptive diagnosis of TCM. On the other 75%initial diagnosis was changed to TCM after CMR:50%(n = 6) and 17%(n = 2)of patients had an initial presumptive diagnoses of reperfunded STEMI and NSTEMI,respectively. In 33% the initial diagnosis was myocarditis.From CMR evaluation of TCM patients, left atrial dilation was found in 31%(mean indexed area 18 ± 1,5cm2/m2).A majority (81%) presented with preserved ejection fraction(EF)(mean LV EF 59 ± 10%).Regional contractility abnormalities were described in 19%,being hypokinesia in all mid and apical segments in 2 cases, and diffuse in one.LV dysfunction was present in 13%(mean LV EF 32 ± 2%) and RV"s in 2cases (mean RV EF 42%),with only one with biventricular EF depression.Mean LV end diastolic indexed volume(EDIV)was 72 ± 23mL/m2,with only 2 with LV dilation(LV EDIV 120 ± 7mL/m2),non had dilated RV.Mild pericardial effusion was found in 38%,mild mitral regurgitation in 8patients and moderate in 1.A complication was registered:LV outflow tract protomesossystolic acceleration with mild anterior leaflet prolapse,without SAM.No LV thrombus was identified.LGE was observed in 2(13%)of patients:in one it was found on the apex,on the other one the pattern was linear intramyocardial on mid segment of inferior septum.
Conclusion
CMR provides a noninvasive and multidimensional assessment for evaluation of Takotsubo cardiomyopathy.In our population,performing CMR allowed an initial diagnosis modification in 3/4 of the cases and identification of one complication,both with therapeutic and prognostic implications.
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - AR Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carias
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - F Claudio
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Trinca
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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26
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Caldeira Da Rocha R, Picarra B, Pais J, Santos AR, Carrington M, Dias Claudio F, Fernandes R, Trinca M. Cardiac Magnetic Resonance as a diagnostic tool in arrhythmias. Europace 2021. [DOI: 10.1093/europace/euab116.033] [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
Etiology of cardiac arrhythmias is often difficult to determine.As the gold standard to anatomical and functional cardiac evaluation,Cardiac Magnetic Resonance(CMR)can be a fundamental technique for accurate assessment of myocardial arrhythmic substrates or for arrhythmias management.
Purpose
The aim of this study is to determine diagnostic and arrhythmic risk stratification impact of CMR performed in patients with suspected or confirmed arrhythmias.
Methods
We performed a six-years prospective study of patients with suspected or confirmed arrhythmias which evaluation with other techniques did not provide a definitive diagnosis.These patients underwent CMR for diagnostic and risk stratification assessment.We applied a protocol to evaluate both ventricles’ morphology and functional and late gadolinium enhancement (LGE) presence.
Results
A total of 93 patients were included,of which 66% were male, with a mean age of 45 ± 17 years old. The indications for patients with suspected or confirmed arrhythmias performing CMR evaluation were the following: 33% (n = 31) of the patients had very frequent premature ventricular complexes, 23% (n = 21) had sustained ventricular tachycardia (VT), 5%(n = 5) non-sustained VT, 17%(n = 16) suspected structural heart disease with high arrhythmic potential,10%(n = 9) unexplained recurrent syncope,9 %(n = 8) supraventricular tachycardia and 3% (n = 3) aborted sudden cardiac death. Depressed ejection fraction (EF)(<50%) was present in 10% (n = 9) for LV(mean EF 38 ± 9%) and 15%(n = 14) for RV (mean EF 42 ± 7%). Dilation of LV was found in 25% of patients (n = 23, mean LV volume: 115 ± 7ml/m²), with RV dilation being present in only 1 patient, who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m²). In total, 16%had interventricular septum hypertrophy (mean 15 ± 4mm/m2).We found slight anterior leaflet prolapse of mitral valve in 10% (n = 9) of the cases and mild mitral regurgitation in 15% (n = 14). Left atrium dilation was observed in 17% (n = 16) of patients (mean area of 18 ± 2cm2/m2), as right atrium was dilated in only two. In 20% of the patients, CMR contributed to establish a previously unknown diagnosis: 6% (n = 5) have hypertrophic cardiomyopathy,4%(n = 4)a myocarditis sequelae and 2%(n = 2)had RVAD. LV non-compaction,a silent myocardial infarction scar and non-ischemic dilated cardiomyopathy were diagnosed in 3%of the cases each. In 15%(n = 14)we found nonspecific variations, which deserve follow-up. On the remaining patients, CMR was considered normal.
Conclusion
As a high reproducible, accurate and versatile technique, CMR allowed an increase on diagnosis in 20% of the patients with suspected or confirmed arrhythmias. Consequently, it contributed to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - AR Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - F Dias Claudio
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Trinca
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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27
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Rai O, Fernandes R. COVID-19 and the reintroduction of surgical training. Br J Surg 2021; 108:e6. [PMID: 33640942 PMCID: PMC7799349 DOI: 10.1093/bjs/znaa003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022]
Affiliation(s)
- O Rai
- General Surgery, William Harvey Hospital, Ashford, UK
| | - R Fernandes
- Department of General Surgery, William Harvey Hospital, Ashford, UK
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28
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Jácome C, Almeida R, Pereira AM, Araújo L, Correia MA, Pereira M, Couto M, Lopes C, Chaves Loureiro C, Catarata MJ, Santos LM, Ramos B, Mendes A, Pedro E, Cidrais Rodrigues JC, Oliveira G, Aguiar AP, Arrobas AM, Costa J, Dias J, Todo Bom A, Azevedo J, Ribeiro C, Alves M, Pinto PL, Neuparth N, Palhinha A, Marques JG, Martins P, Trincão D, Neves A, Todo Bom F, Santos MA, Branco J, Loyoza C, Costa A, Silva Neto A, Silva D, Vasconcelos MJ, Teixeira MF, Ferreira-Magalhães M, Taborda Barata L, Carvalhal C, Santos N, Sofia Pinto C, Rodrigues Alves R, Moreira AS, Morais Silva P, Fernandes R, Ferreira R, Alves C, Câmara R, Ferraz de Oliveira J, Bordalo D, Calix MJ, Marques A, Nunes C, Menezes F, Gomes R, Almeida Fonseca J. Asthma App Use and Interest Among Patients With Asthma: A Multicenter Study. J Investig Allergol Clin Immunol 2021; 30:137-140. [PMID: 32327403 DOI: 10.18176/jiaci.0456] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - R Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - A M Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - L Araújo
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - M A Correia
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - M Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - M Couto
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - C Lopes
- Unidade de Imunoalergologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - C Chaves Loureiro
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M J Catarata
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L M Santos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Ramos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - E Pedro
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - J C Cidrais Rodrigues
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - G Oliveira
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A P Aguiar
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - A M Arrobas
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Costa
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Dias
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Azevedo
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Ribeiro
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Alves
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - P L Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - N Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - A Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - J G Marques
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - P Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - D Trincão
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - A Neves
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - F Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - M A Santos
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - J Branco
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - C Loyoza
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - A Costa
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - A Silva Neto
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - D Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M J Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M F Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M Ferreira-Magalhães
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - L Taborda Barata
- Serviço de Imunoalergologia, Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - C Carvalhal
- Serviço de Imunoalergologia, Hospital Pêro da Covilhã, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - N Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - C Sofia Pinto
- Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Rodrigues Alves
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - A S Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | | | - R Fernandes
- Serviço de Pediatria, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - R Ferreira
- Serviço de Pediatria, Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - C Alves
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - R Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | | | - D Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - M J Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - A Marques
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - C Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - F Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - R Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - J Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of in-hospital management in ST Segment Elevation Myocardial Infarction in Portuguese hospitals over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To assess the evolution of in-hospital management of ST Segment Elevation Myocardial Infarction (STEMI) over the years in Portuguese hospitals and its impact on in-hospital complications and mortality
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of acute coronary syndrome since 2002 until 2019 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical data, revascularization strategy, medication during hospitalization. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess tendencies in categorical variables, and Kruskal-Wallis tests were used to assess tendencies in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 24425 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive increase in patients treated with aspirin, P2Y12 inhibitors (from 22.2% to 97.6% – p<0.001), beta blockers 62.% to 72.4% – p<0.001), ACE inhibitors (68.9% to 78.2% – p<0.001) and statins (72.1% to 88.4% – p<0.001), a progressive decrease in GP 2a3b inhibitors (20.9 to 14.6% – p<0.001), enoxaparin (55.2% to 29.9% – p<0.001), nitrates (82.7% to 16.1% – p<0.001), calcium channel blockers (5.0% to 3.1% – p<0.001) and inotropes (12.0% to 5.6% – p<0.001).
There was an increase of the use primary coronary angioplasty (36.4% to 73.2% – p<0.001), and of drug eluting stents (0% to 70.1% – p<0.001) a decrease in the use of fibrinolysis (75.7% to 1.6% – p<0.001), bare metal stents (88.1% to 0.3% – p<0.001) and intra-aortic balloon pump (1.8% to 0% – p=0.009), but not in invasive mechanical ventilation (2.5% to 1.9% – p=0.142).
Less patients had moderate to severely impaired left ventricle ejection fraction (28.8% to 14.9% – p<0.001), and there was a significant reduction in almost all in-hospital complications: re-infarction (2.0% to 1.0% – p<0.001); heart failure (36.2% to 9.9% – p<0.001); cardiogenic shock (10.8% to 3.9% – p<0.001); AV block (5.8% to 2.5% – p<0.001); mechanical complications (2.8% to 0.4% – p<0.001); stroke (1.3% to 0.4% – p<0.001); in-hospital mortality (9.9% to 3.8% – p<0.001); as well as length of stay ([4–10] days to [3–6] days – p<0.001). Exceptions were and increase in major bleeding (0.9% to 1.8% – p<0.001) and resuscitated cardiac arrest (3.9% to 4.5%, p=0.001).
Conclusion
In 17 years, we report a progressive evolution of the in-hospital treatment of STEMI patients in Portuguese hospitals, with a higher prescription of guideline recommended medications, use of invasive reperfusion techniques and last generation stents, resulting in a lower rate of in-hospital complications and mortality.
In-hospital outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Registo Nacional de Síndromes Coronárias Agudas - Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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30
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Caldeira Da Rocha R, Picarra B, Santos A, Pais J, Carrington M, Bras D, Guerreiro R, Fernandes R, Aguiar J. Searching for the final diagnosis using cardiac magnetic resonance in MINOCA patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with clinical evidence of acute myocardial infarction (AMI), absence of obstructive coronary disease does not imply absence of acute thrombotic process. Thereafter, it can be designated as Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). In these cases, performing Cardiac Magnetic Resonance (CMR) can be essential for establishing a final diagnosis, due to evaluation of the presence and pattern of late enhancement.
Purpose
The aim of this study is to evaluate the diagnostic and prognostic impact of cardiac magnetic resonance in patients with a possible diagnosis of MINOCA.
Methods
A 7-years prospective study in our centre, which included all patients proposed to CMR with a presumptive diagnosis of MINOCA due to acute chest pain, troponin raise and absence of angiographically significant coronary disease (luminal stenosis of <50%). All patients performed functional, anatomical evaluation, as so late gadolinium enhancement search. We analysed clinical characteristics, electrocardiographic presentation, echocardiographic and coronariography results. A presumptive diagnosis was elaborated after coronariography and comparison was made with the definitive one after CMR.
Results
A total of 85 patients were included, 53% were male, with a mean age of 49±20 years old. Clinical history of hypertension was observed in 52% patients, 34% had dyslipidaemia, 8% with diabetes, obesity was present in 21% of patients and smoking habits in 33%. At admission, 47% had ST segment elevation, so emergent coronariography was performed. The mean highest troponin I was 7,54±9,39ng/mL. Late gadolinium enhancement was observed in 50 (59%) of patients. After CMR realization a final diagnosis of MINOCA was made in only 13 patients (15%) and in 51 patients (60%) CMR evaluation allowed a diagnosis modification, with impact on patients' management and prognosis. Of these 51 patients, a definitive diagnosis of myocarditis was seen in 65% of cases, of Takotsubo's myocardiopathy in 27%, and hypertrophic cardiomyopathy in 8%. In 21 (25%) of patients, late gadolinium enhancement was not found. However its absence could exclude type 1 AMI as definitive diagnosis.
Conclusion
CMR is a fundamental technique on MINOCA patients' management. In our population, performing CMR allowed initial diagnosis modification in about two thirds of the cases, with important therapeutic and prognostic implications.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A.R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R.A Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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31
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Stamatiou D, Dakin A, Khalil H, Raju T, Fernandes R, Bowley D, Karandikar S. Perineal hernia repair using a bone fixation anchoring system for the mesh - a video vignette. Colorectal Dis 2020; 22:1806-1807. [PMID: 32644253 DOI: 10.1111/codi.15243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/14/2020] [Indexed: 02/08/2023]
Affiliation(s)
- D Stamatiou
- Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
| | - A Dakin
- Medical Illustration, University Hospitals Birmingham, Birmingham, UK
| | - H Khalil
- Plastic and Reconstructive Surgery, University Hospitals Birmingham, Birmingham, UK
| | - T Raju
- Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
| | - R Fernandes
- T&O Surgery, University Hospitals Birmingham, Birmingham, UK
| | - D Bowley
- Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
| | - S Karandikar
- Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
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De Sousa Bispo J, Mota T, Fernandes R, Azevedo P, Carvalho D, Bento D, Marques N, Mimoso J, Jesus I. Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal.
Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant.
Results
During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001).
At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001).
Conclusion
Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality.
6 Month Outcomes over the years
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia
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Affiliation(s)
| | - T.F Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Blanchette P, Lam M, Le B, Richard L, Shariff S, Pritchard K, Raphael J, Vandenberg T, Fernandes R, Desautels D, Chan K, Earle C. 192P The association between endocrine therapy use and osteoporotic fracture among post-menopausal women treated for early-stage breast cancer in Ontario, Canada. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pucci R, Weyh A, Smotherman C, Valentini V, Bunnell A, Fernandes R. Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps. Int J Oral Maxillofac Surg 2020; 49:1153-1161. [DOI: 10.1016/j.ijom.2020.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/13/2020] [Accepted: 02/27/2020] [Indexed: 01/08/2023]
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Southcott D, Awan A, Ghate K, Clemons M, Fernandes R. Practical update for the use of bone-targeted agents in patients with bone metastases from metastatic breast cancer or castration-resistant prostate cancer. Curr Oncol 2020; 27:220-224. [PMID: 32905286 PMCID: PMC7467800 DOI: 10.3747/co.27.6631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Bone metastases are a significant source of morbidity and mortality for patients with breast and prostate cancer. In this review, we discuss key practical themes regarding the use of bone-targeted agents (btas) such as bisphosphonates and denosumab for managing bony metastatic disease. The btas both delay the onset and reduce the incidence of skeletal-related events (sres), defined as any or all of a need for radiation therapy or surgery to bone, pathologic fracture, spinal cord compression, or hypercalcemia of malignancy. They have more modest benefits for pain and other quality-of-life measures. Regardless of the benefits of btas, it should always be remembered that the palliative management of metastatic bone disease is multimodal and multidisciplinary. The collaboration of all disciplines is essential for optimal patient care. Special consideration is given to these key questions: ■ What are btas, and what is their efficacy?■ What are their common toxicities?■ When should they be initiated?■ How do we choose the appropriate bta?■ What is the appropriate dose, schedule, and duration of btas?
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Affiliation(s)
- D Southcott
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - A Awan
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa
| | - K Ghate
- Department of Medicine, Division of Medical Oncology, Oakville Trafalgar Memorial Hospital, Oakville, ON
| | - M Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa
| | - R Fernandes
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
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Martins B, Rodrigues T, Ramalho J, Ambrósio A, Girão H, Fernandes R. Inflammation disrupts epithelial barrier function and induces the release of different populations of exosomes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.066] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction Age-related macular degeneration (AMD) is a degenerative retinal disease that affects central vision. Most of their phenotypical features are believed to be associated with the dysfunction of retinal pigment epithelium (RPE). The accumulation of damaged proteins in aged RPE is associated with disruption of proteolytic pathways and exocytic activity, with release of intracellular proteins via exosomes (Exo), that are important players in intercellular communication and can contribute to disease progression. However, the impact of their secretion by polarized RPE on outer blood retinal barrier (oBRB) breakdown remains largely elusive
Objectives Our aim was to explore the role of inflammation on the loss of RPE integrity and to understand the relative role of directional secretion of Exo by RPE in the loss of polarity and barrier disruption
Methodology We used a human RPE cell line (ARPE-19), highly polarized RPE primary cultures (pRPE) and porcine eyecups. To mimic the inflammatory conditions present in AMD, cells were treated with two inflammatory stimuli, TNF (10 ng/mL) or LPS (100 ng/mL)
Results TNF and LPS do not affect the viability of the RPE cells. RPE cells developed a confluent monolayer and reached a relatively constant TER of about 40 Ω/cm2 (ARPE-19) or higher than 150 Ω/cm2 (pRPE). Treatment with TNF significantly reduces the TER, decreased immunoreactivity and co-localization of the TJ proteins ZO-1 and occludin and increases MMP-2/-9 activity in the medium. Apical Exo isolated from the RPE cells are enriched in CD63 compared to the basolateral Exo, that are enriched in CD81. The Exo isolated from porcine eyecups, especially with the LPS stimulus, are enriched in CD81 and MMP-2 but have similar levels of CD63
Conclusion Overall, our results show that inflammation induces loss of RPE integrity and release of different populations of Exo. The unravelling of novel drug targets paves the way for development of new therapeutic strategies for AMD.
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Affiliation(s)
- B Martins
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra (FMUC), Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - T Rodrigues
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra (FMUC), Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - J Ramalho
- Centro de Estudos de Doenças Crónicas (CEDOC) and NOVA Medical School, Faculdade de Ciências Médicas (NMS/FCM), Portugal
| | - A Ambrósio
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra (FMUC), Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - H Girão
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra (FMUC), Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - R Fernandes
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra (FMUC), Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
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Balakumar C, Montauban P, Rait J, Iqbal S, Burr T, Taleb K, Featherstone B, Zarsadias P, Fernandes R, Basnyat P, Shah A. Surgeons' response to COVID-19 - Preparing from the sideline. Br J Surg 2020; 107:e192. [PMID: 32364257 PMCID: PMC7267587 DOI: 10.1002/bjs.11647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 11/20/2022]
Affiliation(s)
- C Balakumar
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Montauban
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - J Rait
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - S Iqbal
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - T Burr
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - K Taleb
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - B Featherstone
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Zarsadias
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - R Fernandes
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Basnyat
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - A Shah
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
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Weyh A, Nocella R, Abdelmalik M, Pucci R, Quimby A, Bunnell A, Fernandes R. An analysis of unplanned readmissions after head and neck microvascular reconstructive surgery. Int J Oral Maxillofac Surg 2020; 49:1559-1565. [PMID: 32475708 DOI: 10.1016/j.ijom.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/08/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
The 30-day readmission rate is a highly scrutinized metric of quality surgical care, because readmission is costly and perceived to be avoidable with planning and patient education. Head and neck surgery patients generally have multiple risk factors for readmission, as readmitted patients are generally older, with more co-morbidities, lower socio-economic status, and a history of multiple emergency department visits and readmissions. A retrospective cohort study was implemented to determine the incidence and etiology of 30-day readmission after microvascular head and neck reconstructive surgery, focusing on social risk factors. Data were analyzed by χ2 test, analysis of variance, t-test, and logistic regression, with statistical significance set at P<0.05. Of 209 patients included in this study, 35 (16.7%) had a 30-day readmission. Increased needs at discharge were associated with increased readmission, while other social risk factors were less significant for a readmission in this study.
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Affiliation(s)
- A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Nocella
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - M Abdelmalik
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Pucci
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - A Quimby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Balakumar C, Rait J, Montauban P, Zarsadias P, Iqbal S, Fernandes R. COVID-19: are frontline surgical staff ready for this? Br J Surg 2020; 107:e195. [PMID: 32364245 PMCID: PMC7267499 DOI: 10.1002/bjs.11663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- C Balakumar
- Department of General Surgery, William Harvey Hospital, Ashford, UK
| | - J Rait
- Department of General Surgery, William Harvey Hospital, Ashford, UK
| | - P Montauban
- Department of General Surgery, William Harvey Hospital, Ashford, UK
| | - P Zarsadias
- Department of General Surgery, William Harvey Hospital, Ashford, UK
| | - S Iqbal
- Department of General Surgery, William Harvey Hospital, Ashford, UK
| | - R Fernandes
- Department of General Surgery, William Harvey Hospital, Ashford, UK
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Soares J, Fernandes R, Brito D, Oliveira H, Neuparth T, Martins I, Santos MM. Environmental risk assessment of accidental marine spills: A new approach combining an online dynamic Hazardous and Noxious substances database with numerical dispersion, risk and population modelling. Sci Total Environ 2020; 715:136801. [PMID: 32007875 DOI: 10.1016/j.scitotenv.2020.136801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
The foreseen rise on maritime transportation of Hazardous and Noxious Substances (HNS) increases the likelihood of accidents, leading to a higher risk of chemical spillage that can have severe ecological impacts. Considering the lack of information on HNS spills, the response to these events is less well established than those involving oil. Moreover, a paramount knowledge of the physicochemical and ecotoxicological properties of the substance involved is required for an effective environmental risk assessment and response to an HNS spill. In the present work, a new online interface, in which a dynamic HNS database feeds a chemical numerical dispersion model, was developed with the aim to improve predictions regarding the behaviour and environmental risk of HNS spills on marine ecosystems. Potential impacts to pelagic organisms were characterized by coupling model outputs with toxicity risk ratios. Furthermore, a simple population model was developed, foreseeing impacts at the ecological level. The integration of the developed tools establishes an innovative framework, which aims to improve predictions related to HNS plumes' behaviour and potential hazards to the marine environment and associated ecosystem services. Further, this new approach fosters an improved preparedness and response to coastal pollution incidents, enhancing effective decision making and management by competent authorities.
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Affiliation(s)
- J Soares
- CIMAR/CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto,, Avenida General Norton de Matos S/N, 4450-208 Matosinhos, Portugal.
| | - R Fernandes
- Bentley Systems Portugal, Alameda dos Oceanos n° 63, escritório 3.1, 1990-208 Lisboa, Portugal
| | - D Brito
- Bentley Systems Portugal, Alameda dos Oceanos n° 63, escritório 3.1, 1990-208 Lisboa, Portugal
| | - H Oliveira
- CIMAR/CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto,, Avenida General Norton de Matos S/N, 4450-208 Matosinhos, Portugal
| | - T Neuparth
- CIMAR/CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto,, Avenida General Norton de Matos S/N, 4450-208 Matosinhos, Portugal
| | - I Martins
- CIMAR/CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto,, Avenida General Norton de Matos S/N, 4450-208 Matosinhos, Portugal
| | - M M Santos
- CIMAR/CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, Endocrine Disruptors and Emerging Contaminants Group, University of Porto,, Avenida General Norton de Matos S/N, 4450-208 Matosinhos, Portugal; FCUP - Department of Biology, Faculty of Sciences, University of Porto (U. Porto), Rua do Campo Alegre n° 1021/1055, 4169-007 Porto, Portugal.
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Clemons M, Fergusson D, Simos D, Mates M, Robinson A, Califaretti N, Zibdawi L, Bahl M, Raphael J, Ibrahim MFK, Fernandes R, Pitre L, Aseyev O, Stober C, Vandermeer L, Saunders D, Hutton B, Mallick R, Pond GR, Awan A, Hilton J. A multicentre, randomised trial comparing schedules of G-CSF (filgrastim) administration for primary prophylaxis of chemotherapy-induced febrile neutropenia in early stage breast cancer. Ann Oncol 2020; 31:951-957. [PMID: 32325257 DOI: 10.1016/j.annonc.2020.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The optimal duration of filgrastim as primary febrile neutropenia (FN) prophylaxis in early breast cancer patients is unknown, with 5, 7 or 10 days being commonly prescribed. This trial evaluates whether 5 days of filgrastim was non-inferior to 7/10 days. PATIENTS AND METHODS In this randomised, open-label trial, early breast cancer patients who were to receive filgrastim as primary FN prophylaxis were randomly allocated to 5 versus 7 versus 10 days of filgrastim for all chemotherapy cycles. A protocol amendment in November 2017 allowed subsequent patients (N = 324) to be randomised to either 5 or 7/10 days. The primary outcome was a composite of either FN or treatment-related hospitalisations. Secondary outcomes included chemotherapy dose reductions, delays and discontinuations. Analyses were carried out by per protocol (primary) and intention-to-treat, and the non-inferiority margin was set at 3% for the risk of having FN and/or hospitalisation per cycle of chemotherapy. RESULTS Patients (N = 466) were randomised to receive 5 (184, 39.5%), or 7/10 (282, 60.5%) days of filgrastim. In our primary analysis, the difference in risk of either FN or treatment-related hospitalisation per cycle was -1.52% [95% confidence interval (CI): -3.22% to 0.19%] suggesting non-inferiority of a 5-day filgrastim schedule compared with 7/10-days. The difference in events per cycle for FN was 0.11% (95% CI: -1.05 to 1.27) while for treatment-related hospitalisations it was -1.68% (95% CI: -2.73% to -0.63%). The overall proportions of patients having at least one occurrence of either FN or treatment-related hospitalisation were 11.8% and 14.96% for the 5- and 7/10-day groups, respectively (risk difference: -3.17%, 95% CI: -9.51% to 3.18%). CONCLUSION Five days of filgrastim was non-inferior to 7/10 days. Given the cost and toxicity of this agent, 5 days should be considered standard of care. CLINICALTRIALS. GOV REGISTRATION NCT02428114 and NCT02816164.
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Affiliation(s)
- M Clemons
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - D Fergusson
- Division of Clinical Epidemiology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - D Simos
- The Stronach Regional Cancer Center, Newmarket, Canada
| | - M Mates
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - A Robinson
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - N Califaretti
- Grand River Regional Cancer Centre, Kitchener, Canada
| | - L Zibdawi
- The Stronach Regional Cancer Center, Newmarket, Canada
| | - M Bahl
- Grand River Regional Cancer Centre, Kitchener, Canada
| | - J Raphael
- Department of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Canada; Division of Medical Oncology, London Regional Cancer Program, Western University, London, Canada
| | - M F K Ibrahim
- Thunder Bay Regional Health Research Institute, Thunder Bay, Canada
| | - R Fernandes
- Department of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Canada
| | - L Pitre
- The Northeast Cancer Centre, Sudbury, Canada
| | - O Aseyev
- Thunder Bay Regional Health Research Institute, Thunder Bay, Canada
| | - C Stober
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - L Vandermeer
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - D Saunders
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - B Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - R Mallick
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - G R Pond
- McMaster University, Hamilton, Canada
| | - A Awan
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - J Hilton
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada; Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Branco A, Silva R, Santos T, Jorge H, Rodrigues A, Fernandes R, Bandarra S, Barahona I, Matos A, Lorenz K, Polido M, Colaço R, Serro A, Figueiredo-Pina C. Suitability of 3D printed pieces of nanocrystalline zirconia for dental applications. Dent Mater 2020; 36:442-455. [PMID: 32001023 DOI: 10.1016/j.dental.2020.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The main goal of this work is to evaluate the suitability of nanostructured zirconia pieces obtained by robocasting additive manufacturing (AM), for dental applications. METHODS The density, crystalline structure, morphology/porosity, surface roughness, hardness, toughness, wettability and biocompatibility of the produced samples were compared with those of samples obtained by conventional subtractive manufacturing (SM) of a similar commercial zirconia material. Chewing simulation studies were carried out against dental human cusps in artificial saliva. The wear of the material was quantified and the wear mechanisms investigated, as well as the influence of glaze coating. RESULTS AM samples, that revealed to be biocompatible, are slightly less dense and more porous than SM samples, showing lower hardness, toughness and wettability than SM samples. After chewing tests, no wear was found both on AM and SM samples. However, the dental wear was significantly lower when AM samples were used as counterbody. Concerning the glazed samples, both coated surfaces and dental cusps suffered wear, being the cusps' wear higher than that found for unglazed samples. More, cusps tested against AM coated samples suffered less wear comparatively to those opposed to SM coated samples. SIGNIFICANCE Overall, the results presented in this paper show that AM processed nanostructured zirconia can be used in dental restorations, with important advantages from the point of view of processing and tribological performance. Moreover, the option for glaze finishing should be carefully considered both in SM and AM processed specimens.
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Rocha R, Fernandes R, Carvalho J, Pais J, Bras D, Guerreiro R, Aguiar J. P840 A surprising outcome. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
infective endocarditis(IE) is a high morbidity and mortality disease, and heart failure,central nervous system embolization and annular abscess account for common complications.Nevertheless,intracardiac fistula is rare and predicts higher mortality and urgency for surgery.
Case
84years old male patient,with an aortic bioprosthesis valve Perimount n23 since 2015,was admitted to internal medicine ward 3months before,due to Enterococcus faecalis bacteremia.at that time,transoesophageal echocardiography(TEE) revealed moderate to severe mitral valve(MV) regurgitation(vena contracta 0.7cm) and trivial tricuspid regurgitation,but did not showed any suggestive images of endocarditis.the patient was treated with 14days of amoxicillin-clavulanate.
On the current presentation,due to fadigue to mild physical activity and fever for 2weeks,he was admitted to cardiology ward for further investigation.blood cultures were positive for the previous agent,so antibiotherapy with ampicillin 12g/day and gentamicin 240mg id was started.TEE revealed thickening of aortic bioprosthesis’ leaflets with preserved systolic opening.aortic valve annulus thickening,mainly near the non-coronary cusp,was evident, without characteristic features of peri-annular abscess.on ventricular side of the prosthesis,there was a vegetation(10.7x10.8mm). a small nodule lesion,coherent with a second vegetation,was present on the MV’s posterior leaflet,without regurgitation’s worsening. a third one was observed on the septal leaflet of the tricuspid valve(7.3x6.5mm),which also caused an increasement in severity of the regurgitation,quantified as moderate.
On the sixth day,the patient presented with right arm paresis,so a brain CT was performed,showing an ischemic lesion on the left middle cerebral artery.Reevaluation,5days later,owing to new neurological changes,showed multiple acute vertebrobasilar embolic strokes.
As a result of poor medical response and embolic strokes,the patient was referred to surgical treatment. however, due to prohibitive surgical risk (euroscore 59%), the patient was refused.
After 6weeks of blood culture driven antibiotherapy,a reevaluation TEE revealed a periprosthetic pseudoaneurysm with small aorta-to-right atrium fistula.no vegetations were found.
Conclusion
rate complication of cardiac fistulae is high,60%of the patients develop heart failure and mortality rate is higher than 40%.although conservative treatment was addressed,after 8months discharge,the patient remains with few heart failure symptoms(NYHA classII).
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Affiliation(s)
- R Rocha
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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Abstract
Objectives: To assess sex hormones in men with obesity and prostate cancer (PCa) and to study association between androgens and the pathogenesis biology of PCa in vitro. Subjects and methods: One hundred and eighty-one men older than 45 years selected from of a population attending to Urology departments screening for PCa, (78 participants without PCa and 103 patients with PCa). All participants were assessed for body mass index (BMI), age, Gleason score, and PSA. Endocrine profile was determined for LH, total testosterone (TT), 17β-estradiol (E2), prolactin and leptin. Biochemical profile (HbA1c, triacylglycerols and lipoproteins) was also determined. In vitro experiments were also performed, involving the study of 5α-dihydrotestosterone (DHT) and E2 in the presence of adipocyte-conditioned medium (aCM). Results: All variables were continuous and described a Gaussian distribution unless mentioned. To determine the relation of aggressiveness, variable were transformed into categories. Thus, PCa aggressiveness is associated with the increase of age and BMI (p < .0001) but with is decreased with TT and E2 (p < .05). Moreover, adipocyte-secreted molecules increase aggressiveness of PCa cells in vitro. Lastly, DTH but not E2 enables invasiveness in vitro. Conclusions: It was observed a coexistence of hormone axis profile alteration with sex hormones and BMI in PCa patients, in accordance with the new perspective of PCa pathogenesis.
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Affiliation(s)
- M F Duarte
- Politécnico do Porto, Escola Superior de Saúde , Porto , Portugal
- Centro Hospitalar Universitário do Porto (CHUP) , Porto , Portugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto , Porto , Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto , Porto , Portugal
| | - C Luis
- Politécnico do Porto, Escola Superior de Saúde , Porto , Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto , Porto , Portugal
| | - P Baylina
- Politécnico do Porto, Escola Superior de Saúde , Porto , Portugal
| | - M I Faria
- Politécnico do Porto, Escola Superior de Saúde , Porto , Portugal
- Facultad de Medicina, Universidade de Santiago de Compostela (USC) , Santiago de Compostela , España
| | - R Fernandes
- Politécnico do Porto, Escola Superior de Saúde , Porto , Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto , Porto , Portugal
- Facultad de Medicina, Universidade de Santiago de Compostela (USC) , Santiago de Compostela , España
| | - J M La Fuente
- Centro Hospitalar Universitário do Porto (CHUP) , Porto , Portugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto , Porto , Portugal
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Gomes G, Formenton N, Lorenzi L, Muniz C, Lourenço G, Fernandes R, Codogno J. Programs of health promotion in primary care settings and its relation to hospitalization. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Faria Da Mota T, Sousa Bispo J, Azevedo P, Fernandes R, Guedes JP, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P844NAS2H score, a novel predictive score of 1-year all cause mortality in Acute Coronary Syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients admitted for Acute Coronary Syndromes (ACS), mortality is influenced by several clinical and therapeutical factors, and management of these patients should be guided by an estimate of individual risk.
Objective
To develop a simple predictive model of 1-year mortality in patients admitted for ACS.
Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for ACS in a Cardiology department between the 1st of October 2010 and the 1st of October 2017. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Patients with 1y mortality (1yM) events were studied regarding baseline demographic and clinical characteristics, risk factors and hospitalization data, and a correlational analysis with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%) was performed. Independent predictors of 1yM were identified through binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.
Results
A total of 3251 patients were included, 826 (25,4%) of which were female, with a mean age of 65,5±13,4 years. In the studied sample, 268 patients (8,2%) died in the year following hospital discharge; this group had a mean age of 65,6±13,2 years, and 80 (29,9%) were female patients. There was a significant association between 1yM and multiple clinical, therapeutical and laboratorial variables, but after multivariate analysis only age greater than 65 years old (yo) [p=0,001], previous stroke [p=0,005], haemoglobin (Hb) <10mg/dL [p<0,001], brain natriuretic peptide (BNP) >100pg/mL [p=0,001], and left ventricular ejection fraction (LVEF) <50% [p <0,001] proved to be independent predictors of the studied outcome. Using these variables, the authors developed a scoring model to predict 1yM in patients admitted for ACS with the following formula = 0,002 + (0,736 x Age >65yo) + (0,91 x previous stroke) + (2,562 x Hb <10) + (0,63 x BNP >100) - (1,207 x FEVE >50%). In this function, variables should be substituted by 1 or 0, depending on wheter they are present or not. The discrimination cutoff was 0,57, with a 70,6% sensibility and 75,9% specificity, and a discriminant power of 75,4%.
Conclusion
Defining the mortality risk of ACS patients after discharge represents a real challenge and demands a careful evaluation of multiple factors in an attempt to achieve an accurate estimation of risk. The authors developed a predicting model for 1yM in ACS patients, with a good discriminant power, based on simple variables. The present score will require validation in a larger cohort of ACS patients before it can be applied in a clinical context.
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Affiliation(s)
| | | | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J P Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Azevedo PM, Fernandes R, Mota T, Bispo J, Guedes J, Carvalho D, Santos W, Marques N, Pereira S, Mimoso J, Jesus I. P1698Age shock index is a simple bedside clinical risk stratification tool in patients with non-ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Shock index (SI), (heart rate (HR)/systolic blood pressure (SBP)), has been reported to predict worse outcomes in different acute settings. Two derivatives, named modified SI (MSI), defined as HR/mean BP; and Age SI, defined as SI multiplied by age, were later developed, but only the former was tested for short-term outcomes in patients with myocardial infarction (MI). We hypothesize that Age SI may demonstrate higher prognostic accuracy than SI and MSI due to the added prognostic value of age in this population.
Purpose
Compare the prognostic performance of admission age SI, MSI and SI for predicting in-hospital mortality in patients with NSTEMI.
Methods
Retrospective cohort study of consecutive patients admitted to the Cardiology department of a tertiary care hospital with the diagnosis of NSTEMI between October 2010 and September 2018. Very high-risk patients in need of emergent treatment were excluded. Of the initial cohort of 2476 patients, we excluded 5 who presented cardiac arrest before or at hospital admission, 4 with cardiogenic shock, 95 with acute pulmonary oedema, 10 with SBP <80 mmHg, 1 with HR <40bpm and 1 with HR >160bpm. The primary outcome was all-cause in-hospital mortality. The discriminatory capacity of Age SI, MSI, SI for the primary outcome was assed using the ROC-AUC and compared with the DeLong method, and the value with highest Youden-index was considered the optimal cut-off point. Calibration was assessed using the Hosmer-Lemeshow (HL) test and adjustment for confounding variables was performed using logistic regression analysis.
Results
2359 patients were included [mean age 66±13 years; 1732 (73.4%) men], of whom 40 (1.7%) died during hospitalization. Discrimination by ROC-AUC was highest for Age SI (0.78 [95% CI 0.71–0.86)], compared to MSI (0.69 [95% CI 0.61–0.78]) and SI (0.69 [95% CI 0.61–0.78)], p<0.01 for comparison. All indexes demonstrated adequate calibration (HL: Age SI 7.4; MSI 4.5; SI 6.4; p>0.5). The optimal cut-off for Age SI was 40, which was present in 684 patients (29%) and had 75% sensitivity, 72% specificity, 4.5% positive and 99.5% negative predictive value (NPV) for in-hospital mortality (4.4% vs 0.6%, p<0.001). After adjusting for covariates, an Age SI higher than 40 was associated with increased in-hospital mortality (adjusted OR 3.2, 95% IC 1.06–9.55), p=0.039).
Mortality and Age Shock Index
Conclusion
Age SI demonstrated better discriminatory capacity and equal calibration, compared to SI and MSI for in-hospital mortality. An age SI higher than 40 was associated with a 3-fold increased risk of in-hospital death. This cut-off demonstrated excellent negative predictive value (99.5%) and may allow very early risk assessment in patients with non-ST-segment elevation MI (NSTEMI), before laboratorial values are available for GRACE calculation. This may guide initial therapy and help select the most appropriate initial site of care.
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Affiliation(s)
| | | | - T Mota
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Bispo
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Carvalho
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - S Pereira
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Faria Da Mota T, Azevedo P, Fernandes R, S J, Guedes J, Bento D, Marques N, Santos W, Mimoso J, Jesus I. P4579Prediction of CABG indication in patients admitted for NSTEMI with the new CABG DAPE2S score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
A significant number of patients admitted for Non-ST Elevation Myocardial Infarction (NSTEMI) have multivessel complex coronary artery disease (CAD) and benefit from Coronary Artery Bypass Graft surgery (CABG). These patients frequently present high-risk surgical profiles, constituting a challenging group when it comes to balancing ischemic and haemorrhagic risk.
Objective
To develop a simple predictive risk model of referral to CABG in patients admitted for NSTEMI.
Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for NSTEMI in a Cardiology department between the 1st of October 2010 and the 1st of October 2018. Demographic profile, clinical characteristics, risk factors and hospitalization data of NSTEMI patients referred to CABG were studied, and a correlational analysis was performed with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%). Independent predictors of CABG in patients with NSTEMI were identified through Binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was subsequently applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.
Results
A total of 2476 patients were included, 668 (27%) of which were female, with a mean age of 68,5±13,4 years. In the studied sample, 273 patients (11%) were proposed to CABG. The authors found a significant association between CABG and multiple clinical, laboratorial and therapeutical variables, but after multivariate analysis only male sex, previous Diabetes Mellitus, previous angina, previous Percutaneous coronary intervention, absence of a normal EKG, ST segment depression at admission, sinus rythm and brain natriuretic peptide (BNP) >100pg/mL proved to be independent predictors of referral. Using these variables, the authors developed a risk model to predict CABG referral in NSTEMI patients: −0,614 − (0,756 x female sex) + (0,305 x diabetes) + (0,631 x angina) − (1,513 x previous PCI) + (1,216 x sinus rythm) + (0,672 x ST depression) − (0,806 x normal EKG) + (0,562 x BNP>100). In this function, variables should be substituted by 1 or 0, depending on wheter the condition they specify is present or absent. The optimal discrimination cutoff was 0,23, with a 64% sensibility and 59% specificity, and a discriminant power of 60%.
Conclusion
Being able to predict referral to surgical revascularization in NSTEMI may help physicians to optimize a specific approach in each patient, in particular with regard to anti-thrombotic strategies. The authors developed a risk predicting model for CABG in NSTEMI patients based on simple clinical and laboratory variables, which will require validation in a larger cohort, before it can be applied in a clinical context.
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Affiliation(s)
| | - P Azevedo
- Faro Hospital, Cardiology, Faro, Portugal
| | | | - J S
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Guedes
- Faro Hospital, Cardiology, Faro, Portugal
| | - D Bento
- Faro Hospital, Cardiology, Faro, Portugal
| | - N Marques
- Faro Hospital, Cardiology, Faro, Portugal
| | - W Santos
- Faro Hospital, Cardiology, Faro, Portugal
| | - J Mimoso
- Faro Hospital, Cardiology, Faro, Portugal
| | - I Jesus
- Faro Hospital, Cardiology, Faro, Portugal
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Bras D, Guerreiro RA, Pais J, Congo K, Carrington M, Semedo P, Picarra B, Fernandes R, Aguiar J. P130Impact of pre-test probability of CAD in post-test probability by Myocardial Perfusion Scintigraphy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R A Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - P Semedo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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