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Domingos S, Gaspar R, Marôco J. Exposure to heat wave risks across time and places: Seasonal variations and predictors of feelings of threat across heat wave geographical susceptibility locations. Risk Anal 2024. [PMID: 38514455 DOI: 10.1111/risa.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/15/2023] [Accepted: 02/11/2024] [Indexed: 03/23/2024]
Abstract
Vulnerability to heat waves and their negative effects on health vary not only due to individual factors but also due to situational factors, such as time and geography. Hence, we explored seasonal variations and predictors of heat wave feelings of threat across different heat wave geographical susceptibility locations in Portugal. A total of 238 Portuguese residents responded to a web-based longitudinal survey: before the summer, during a heat wave in the summer, during the summer, and after the summer. Geographical location was used as an indicator of risk exposure, operationalized as heat wave occurrence susceptibility (low, moderate, high). Heat wave demands and resources perceptions were assessed to compute an indicator of heat wave feelings of threat. During the heat wave, feelings of threat were higher among participants in high-susceptibility locations, with demands outweighing resources perceptions, suggesting greater distress and coping difficulty. Regression analysis suggested that older participants and female participants living in moderate-high-susceptibility locations had greater difficulty in recovering. Heat wave risk perception and positive affect about heat were identified as the most consistent predictors of heat wave feelings of threat, with risk perception increasing and positive affect decreasing such feelings. Participants with (individual and geographical) vulnerability profiles, who had greater difficulty in coping and recovering from heat waves, could benefit from resource-building/enhancing interventions. In a climatic crisis context, monitoring psychological responses to heat waves (e.g., threat) may enable anticipated action to build resilience before, rather than after, the effects become damaging to physical and psychological health.
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Affiliation(s)
- Samuel Domingos
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
- William James Center for Research, ISPA-Instituto Universitário, Lisboa, Portugal
| | - Rui Gaspar
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisboa, Portugal
| | - João Marôco
- William James Center for Research, ISPA-Instituto Universitário, Lisboa, Portugal
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Gaspar R, Silva M, Cardoso P, Goncalves R, Andrade P, Macedo G. Spleen stiffness: a new tool to predict high-risk varices in cirrhotic patients. J Gastroenterol Hepatol 2023; 38:1840-1846. [PMID: 37655720 DOI: 10.1111/jgh.16344] [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: 01/29/2023] [Revised: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Cirrhosis is one of the major causes of morbidity and mortality worldwide. Portal hypertension is the major contributor of cirrhosis-related complications and is defined as a hepatic venous pressure gradient (HVPG) > 5 mmHg. Measurement of HVPG is an invasive, difficult, and costly procedure. Therefore, it is only performed in specialized centers. Liver stiffness measured with transient elastography is one of the most studied noninvasive markers of portal hypertension, and spleen elastography has recently emerged as an important adjuvant tool. The development of a new probe (100 Hz) that more reliably reflect the grade of portal hypertension evaluated by spleen stiffness measurement has improved the accuracy of this technique. The aim of this work was to evaluate the accuracy of spleen stiffness with the new dedicated probe to predict the presence of high-risk varices, as well as to determine the ideal cutoff to predict it. METHODS Prospective study of cirrhotic patients admitted to upper endoscopy that were also submitted to liver and spleen elastography with the 100-Hz probe by the same blinded operator in a tertiary center. RESULTS We included 209 cirrhotic patients, with mean age of 61.9 years (±9.9), 77.0% male. The most common etiology was alcoholic liver disease (72.7%). The median value of liver elastography was 25.3 [4.5-75] kPa, and the median value of spleen elastography was 42.4 [7.6-100] kPa. At the cutoff of 53.25 kPa, we obtained sensitivity of 100% and specificity of 72.6% to predict high-risk varices, and, according to this cutoff, 133/175 of esophagogastroduodenoscopy could have been spared (76.0%), while according to Baveno guidelines, only 51/175 would have been spared (29.1%). CONCLUSION In the era of noninvasive exams, spleen elastography with the 100-Hz probe emerges as an excellent tool for prediction of presence of high-risk varices. At the cutoff of 53.25 kPa, spleen elastography avoids upper endoscopy for screening for high-risk varices, promising to be become part of the hepatologists' daily routine.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Raquel Goncalves
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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Oliveira Pinheiro F, Gaspar R, Fernandes BM, Peixoto A, Macedo G, Brito I. Cumulative dose and length of methotrexate treatment were not shown to be predictors of hepatic fibrosis by elastography - a monocentric cohort study. ARP Rheumatol 2023:AO220308. [PMID: 36811460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Methotrexate is used in several inflammatory diseases, such as rheumatoid arthritis (RA), spondyloarthritis (SpA) or inflammatory bowel disease (IBD). There has been some controversy regarding methotrexate liver toxicity, especially since the use of newer techniques. We aim to evaluate the prevalence of liver injury in methotrexate-treated patients with inflammatory diseases. METHODS We performed a cross-sectional study where consecutive patients diagnosed with RA, SpA or IBD, treated with methotrexate, were submitted to liver elastography. The cutoff for fibrosis was ≥7.1 kPa. Comparisons between groups were evaluated using chi-square, t test and Mann-Whitney U test. Correlations were made between continuous variables using Spearman correlation. Logistic regression was performed to determine predictors of fibrosis. RESULTS A total of 101 patients were included, 60 (59.4%) females, aged 46.2±12.6 years. Eleven patients (10.9%) had fibrosis, with a median score of 4.8 (4.1-5.9) kPa. Patients with fibrosis had higher rates of daily alcohol consumption (63.6% vs 31.1%, p=0.045). Methotrexate exposure time (OR 1.001, 95% CI 0.999-1.003, p=0.549) and cumulative dose (OR 1.000, 95% CI 1000-1000, p=0.629) were shown not to be predictors of fibrosis, unlike alcohol (OR 3.875, 95% CI 1.049-14.319, p=0.042). In multivariate logistic regression analysis, methotrexate cumulative and exposure times were not predictors of significant fibrosis, even when adjusted for alcohol consumption. CONCLUSIONS In this study, we found that fibrosis detected on hepatic elastography was not associated with methotrexate, unlike alcohol. Therefore, it is of paramount importance to redefine risk factors for liver toxicity in patients with inflammatory diseases under treatment with methotrexate.
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Affiliation(s)
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar Universitário de São João
| | | | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar Universitário de São João
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João
| | - Iva Brito
- Medicine Department, Faculty of Medicine, University of Porto
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Dias E, Andrade P, Lopes S, Gonçalves R, Cardoso P, Gaspar R, Cardoso H, Lopes J, Carneiro F, Macedo G. Liver biopsy in inflammatory bowel disease patients with sustained abnormal liver function tests: a retrospective single-center study. Ann Gastroenterol 2023; 36:54-60. [PMID: 36593810 PMCID: PMC9756023 DOI: 10.20524/aog.2023.0761] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/21/2022] [Indexed: 01/04/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) may be associated with a wide range of hepatobiliary manifestations. This study aimed to characterize the spectrum of hepatobiliary disorders in patients with IBD who underwent liver biopsy for sustained abnormal liver function tests (LFT). Method A retrospective study was performed of all patients with IBD who underwent liver biopsy between January 2010 and December 2020 for sustained abnormal LFT (at least 6-month duration). Results A total of 101 patients were included, mostly male (62.4%), with a mean age of 44.4±13.3 years. The most common IBD type was Crohn's disease (61.4%). Median time interval between abnormal LFT and biopsy was 14 (7-36) months. Abnormal LFT was predominantly hepatocellular in 40 patients (39.6%), cholestatic in 26 (25.7%) and mixed in 35 (34.7%). The most frequent diseases were nonalcoholic fatty liver disease (NAFLD) in 33 patients (32.7%), drug-induced liver disease (DILI) in 30 (29.7%), autoimmune hepatitis (AIH) in 13 (12.9%) and primary sclerosing cholangitis (PSC) in 13 (12.9%). Three patients had primary biliary cholangitis. Remarkably, 70 patients (69.3%) already had fibrosis by the time of liver biopsy and in 6 (5.9%) liver disease was already detected in the stage of cirrhosis. Conclusions Abnormal LFT in IBD patients had a wide range of etiologies and histology was often essential for reaching a correct diagnosis. NAFLD, DILI, AIH and PSC were the most common diagnoses and patients often presented in cirrhotic stage. Therefore, liver biopsy must be considered early in IBD patients with unexplained sustained abnormal LFT.
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Affiliation(s)
- Emanuel Dias
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Patrícia Andrade
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Susana Lopes
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Raquel Gonçalves
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Pedro Cardoso
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Rui Gaspar
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Hélder Cardoso
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
| | - Joanne Lopes
- Pathology Department (Joanne Lopes, Fátima Carneiro), Centro Hospitalar de São João, Porto, Portugal
| | - Fátima Carneiro
- Pathology Department (Joanne Lopes, Fátima Carneiro), Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department (Emanuel Dias, Patrícia Andrade, Susana Lopes, Raquel Gonçalves, Pedro Cardoso, Rui Gaspar, Hélder Cardoso, Guilherme Macedo)
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Ferreira-Silva J, Gaspar R, Liberal R, Cardoso H, Macedo G. Splenic-hepatic elastography index is useful in differentiating between porto-sinusoidal vascular disease and cirrhosis in patients with portal hypertension. Dig Liver Dis 2023; 55:75-80. [PMID: 36280435 DOI: 10.1016/j.dld.2022.09.018] [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: 07/12/2022] [Revised: 09/18/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In patients with portal hypertension (PH), the differential diagnosis between porto-sinusoidal vascular disease (PSVD) and cirrhosis is challenging. This study aims to evaluate the diagnostic accuracy of the SSM/LSM index in the diagnosis of PSVD. METHODS Prospective study of patients with PH and PSVD or cirrhosis. Transient liver and spleen elastography were performed and the ratio between spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) was calculated. The relation of SSM/LSM with the diagnosis of PSVD was evaluated. RESULTS Forty-four patients with PSVD and 44 patients with cirrhosis were evaluated. Median age was 57.5 (IQR 49.0-64.5) years, 66.3% were males. In patients with PSVD, median SSM was 59.4 (33.5-77.7) kPa, median LSM was 6.2 (5.2-10.2) kPa and median SSM/LSM was 5.62 (3.15-9.68). In patients with cirrhosis, median SSM was 47.3 (24.3-60.3) kPa, median LSM was 27.8 (17.7-53.9) kPa and median SSM/LSM was 1.55 (1.06-3.24). The SSM/LSM AUROC was 0.940 (p<0.001). Using 2 as a cut-off, we obtained good sensitivity (86.5%), specificity (92.7%), and accuracy (89.7%) for the diagnosis of PSVD. CONCLUSION The SSM/LSM index is useful in the differential diagnosis between liver cirrhosis and PSVD. Using the cut-off of 2 we achieved a good sensitivity and specificity for diagnosing PSVD.
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Affiliation(s)
- Joel Ferreira-Silva
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal.
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal. Alameda Prof. Hernâni Monteiro 4200 - 319 Porto, Portugal
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O'Malley M, Zafar S, Wolff T, Gaspar R. Re: medical imaging call centre: a communication success story. A reply. Clin Radiol 2022; 77:558-559. [PMID: 35487780 DOI: 10.1016/j.crad.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Affiliation(s)
- M O'Malley
- University of Toronto, Canada. Martin.O'
| | - S Zafar
- University of Toronto, Canada
| | - T Wolff
- University of Toronto, Canada
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Fromme M, Schneider CV, Pereira V, Hamesch K, Pons M, Reichert MC, Benini F, Ellis P, H Thorhauge K, Mandorfer M, Burbaum B, Woditsch V, Chorostowska-Wynimko J, Verbeek J, Nevens F, Genesca J, Miravitlles M, Nuñez A, Schaefer B, Zoller H, Janciauskiene S, Abreu N, Jasmins L, Gaspar R, Liberal R, Macedo G, Mahadeva R, Gomes C, Schneider KM, Trauner M, Krag A, Gooptu B, Thorburn D, Marshall A, Hurst JR, Lomas DA, Lammert F, Gaisa NT, Clark V, Griffiths W, Trautwein C, Turner AM, McElvaney NG, Strnad P. Hepatobiliary phenotypes of adults with alpha-1 antitrypsin deficiency. Gut 2022; 71:415-423. [PMID: 33632708 DOI: 10.1136/gutjnl-2020-323729] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Alpha-1 antitrypsin deficiency (AATD) is a common, potentially lethal inborn disorder caused by mutations in alpha-1 antitrypsin (AAT). Homozygosity for the 'Pi*Z' variant of AAT (Pi*ZZ genotype) causes lung and liver disease, whereas heterozygous 'Pi*Z' carriage (Pi*MZ genotype) predisposes to gallstones and liver fibrosis. The clinical significance of the more common 'Pi*S' variant remains largely undefined and no robust data exist on the prevalence of liver tumours in AATD. DESIGN Baseline phenotypes of AATD individuals and non-carriers were analysed in 482 380 participants in the UK Biobank. 1104 participants of a multinational cohort (586 Pi*ZZ, 239 Pi*SZ, 279 non-carriers) underwent a comprehensive clinical assessment. Associations were adjusted for age, sex, body mass index, diabetes and alcohol consumption. RESULTS Among UK Biobank participants, Pi*ZZ individuals displayed the highest liver enzyme values, the highest occurrence of liver fibrosis/cirrhosis (adjusted OR (aOR)=21.7 (8.8-53.7)) and primary liver cancer (aOR=44.5 (10.8-183.6)). Subjects with Pi*MZ genotype had slightly elevated liver enzymes and moderately increased odds for liver fibrosis/cirrhosis (aOR=1.7 (1.2-2.2)) and cholelithiasis (aOR=1.3 (1.2-1.4)). Individuals with homozygous Pi*S mutation (Pi*SS genotype) harboured minimally elevated alanine aminotransferase values, but no other hepatobiliary abnormalities. Pi*SZ participants displayed higher liver enzymes, more frequent liver fibrosis/cirrhosis (aOR=3.1 (1.1-8.2)) and primary liver cancer (aOR=6.6 (1.6-26.9)). The higher fibrosis burden was confirmed in a multinational cohort. Male sex, age ≥50 years, obesity and the presence of diabetes were associated with significant liver fibrosis. CONCLUSION Our study defines the hepatobiliary phenotype of individuals with the most relevant AATD genotypes including their predisposition to liver tumours, thereby allowing evidence-based advice and individualised hepatological surveillance.
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Affiliation(s)
- Malin Fromme
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Carolin V Schneider
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Vitor Pereira
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Monica Pons
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Federica Benini
- Gastroenterology Unit, Department of Medicine, Spedali Civili and University, Brescia, Italy
| | - Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katrine H Thorhauge
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Vienna, Austria
| | - Barbara Burbaum
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Vivien Woditsch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Tuberculosis and Lung Diseases Institute, Warszawa, Poland
| | - Jef Verbeek
- Department of Gastroenterology & Hepatology, KU Leuven University Hospitals Leuven, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Leuven, Flanders, Belgium
| | - Frederik Nevens
- Department of Gastroenterology & Hepatology, KU Leuven University Hospitals Leuven, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Leuven, Flanders, Belgium
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Alexa Nuñez
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Benedikt Schaefer
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | - Heinz Zoller
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | | | - Nélia Abreu
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Luís Jasmins
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Ravi Mahadeva
- Department of Respiratory Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Catarina Gomes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Kai Markus Schneider
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Vienna, Austria
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Bibek Gooptu
- NIHR Leicester BRC-Respiratory and Leicester Institute of Structural & Chemical Biology, University of Leicester, Leicester, Leicestershire, UK.,London Alpha-1 Antitrypsin Deficiency Service, Royal Free Hospital, London, UK
| | - Douglas Thorburn
- London Alpha-1 Antitrypsin Deficiency Service, Royal Free Hospital, London, UK.,Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - Aileen Marshall
- London Alpha-1 Antitrypsin Deficiency Service, Royal Free Hospital, London, UK.,Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - John R Hurst
- London Alpha-1 Antitrypsin Deficiency Service, Royal Free Hospital, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK
| | - David A Lomas
- London Alpha-1 Antitrypsin Deficiency Service, Royal Free Hospital, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Hannover Medical School (MHH), Hannover, Germany
| | - Nadine T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Virginia Clark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - William Griffiths
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Noel G McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE LIVER), Aachen, Germany
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Gaspar R, Branco CC, Macedo G. Liver manifestations and complications in inflammatory bowel disease: A review. World J Hepatol 2021; 13:1956-1967. [PMID: 35070000 PMCID: PMC8727205 DOI: 10.4254/wjh.v13.i12.1956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/27/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatobiliary manifestations are common in inflammatory bowel disease (IBD), with 30% of patients presenting abnormal liver tests and 5% developing chronic liver disease. They range from asymptomatic elevated liver tests to life-threatening disease and usually follow an independent course from IBD. The pathogenesis of liver manifestations or complications and IBD can be closely related by sharing a common auto-immune background (in primary sclerosing cholangitis, IgG4-related cholangitis, and autoimmune hepatitis), intestinal inflammation (in portal vein thrombosis and granulomatous hepatitis), metabolic impairment (in non-alcoholic fatty liver disease or cholelithiasis), or drug toxicity (in drug induced liver injury or hepatitis B virus infection reactivation). Their evaluation should prompt a full diagnostic workup to identify and readily treat all complications, improving management and outcome.
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Affiliation(s)
- Rui Gaspar
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Catarina Castelo Branco
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto, Porto 4200, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
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9
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Zafar S, Wolff T, Gaspar R, O'Malley M. Medical imaging call centre: a communication success story. Clin Radiol 2021; 77:188-194. [PMID: 34916046 DOI: 10.1016/j.crad.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Abstract
AIM To evaluate utilisation of a medical imaging call centre (MICC) at a multi-site, academic radiology department, focusing on communication of critical, urgent, or significant unexpected findings. MATERIALS AND METHODS Institutional research ethics board approval was obtained. All calls made to MICC from 1 January to 31 December 2019 were reviewed retrospectively. The total number of calls, date, and reason of each call, level of report alert, and turnaround time (TAT) were recorded. Level 1, 2, and 3 alerts were defined as "potentially life-threatening new/unexpected findings", "could result in morbidity/mortality", or "not immediately life-threatening or urgent", respectively. TAT was defined as the time from alert request received by the MICC until acknowledgement of receipt by the referring physician, with a desired TAT of 60 min, 3 h, and 3 days for each level, respectively. RESULTS The MICC received 29,799 calls in 2019, on average 2,483 (range 1,989-3,098) calls per month. The most common indications for contacting the MICC were to request imaging reports to be expedited (14,916 calls, 50%) and issuing report alerts to communicate unexpected or urgent findings (7,060 calls, 24%). Average number and range of calls for Level 1, 2, and 3 alerts were 57 (39-80), 345 (307-388), and 187 (127-215) per month, respectively. Average TAT for Level 1, 2, and 3 report alerts were 59 min, 2 h 26 min, and 19 h 39 min, respectively. CONCLUSION The MICC received a large volume of calls and was a successful method for timely communication of unexpected or urgent imaging findings using a three-tiered alert system.
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Affiliation(s)
- S Zafar
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - T Wolff
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - R Gaspar
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - M O'Malley
- Joint Department of Medical Imaging, University of Toronto, Canada. martin.o'
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10
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Ferreira-Silva J, Gaspar R, Liberal R, Cardoso H, Macedo G. Transient splenic elastography predicts high-risk esophageal varices in patients with non-cirrhotic portal hypertension. Scand J Gastroenterol 2021; 56:1462-1466. [PMID: 34428123 DOI: 10.1080/00365521.2021.1968485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Non-cirrhotic portal hypertension (NCPH) comprise a group of diseases that cause portal hypertension without cirrhosis, leading to a high risk of hemorrhage from esophageal varices. There are no non-invasive predictors of high-risk varices (HRV) described in the literature for NCPH. This study aimed to evaluate whether transient splenic elastography (TSE) can predict HRV in patients with NCPH. METHODS Prospective study of patients with NCPH who underwent a single timepoint evaluation with transient liver and spleen elastography, ultrasonography, upper endoscopy, and laboratory tests. The study was performed from January to September 2020. Patients were divided into two groups based on the presence of HRV. The relation between TSE, transient liver elastography (TLE), spleen size, and platelet count to the presence of HRV was evaluated. RESULTS Of 42 patients with NCPH, 50% (21/42) presented HRV. In univariate analysis, TSE (median, 58.4 vs. 28.3, p = 0.009) and spleen size (median, 17.5 vs. 14.5 cm, p = 0.013) were associated with HRV. No statistically significant relationship was found between the presence of HRV and platelet count or TLE. In multivariate analysis, TSE was the only variable related to HRV (OR 1.21, 95% CI 1.02-1.38). TSE had a good performance in predicting HRV in our population (AUROC 0.878; 95% CI 0.751-1000). TSE > 35.4 kPa presents 93.3% sensitivity, 60.0% specificity, and 90.9% negative predictive value. CONCLUSION In our population of patients with NCPH, TSE is useful in predicting HRV. TLE, spleen size, and platelet count were not related to HRV.
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Affiliation(s)
- Joel Ferreira-Silva
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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11
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Gaspar R, Ramalho R, Coelho R, Andrade P, Goncalves MR, Macedo G. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE Port J Gastroenterol 2021; 30:61-67. [PMID: 36743993 PMCID: PMC9891146 DOI: 10.1159/000519926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022]
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. Methods A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. Results We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2-15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6-25] months and 4 [2-18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. Conclusion The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,*Rui Gaspar,
| | - Rosa Ramalho
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Miguel R. Goncalves
- Noninvasive Ventilatory Support Unit, Pulmonology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,Emergency and Intensive Care Medicine Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,UNiC − Cardiovascular R&D Unit<bold>,</bold>Faculty of Medicine of the University of Porto, Porto, Portugal,CAI_Vent − Home Mechanical Ventilation Program, Centro Hospitalar São João, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
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Gaspar R, Castelo Branco C, Macedo G. Liver and COVID-19: From care of patients with liver diseases to liver injury. World J Hepatol 2021; 13:1367-1377. [PMID: 34786172 PMCID: PMC8568576 DOI: 10.4254/wjh.v13.i10.1367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases. We performed a comprehensive review about how COVID-19 can affect the liver, the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on COVID-19. We analyze the relationship between COVID-19 and non-alcoholic fatty liver disease, alcoholic liver disease, viral hepatitis, autoimmune liver disease, cirrhosis, hepatocellular carcinoma and liver transplantation, as well as the approach to SARS-CoV-2 vaccination.
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Affiliation(s)
- Rui Gaspar
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Catarina Castelo Branco
- Department of Internal Medicine, Centro Hospitalar e Universitário do Porto, Porto 4100, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
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13
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Santos A, Silva MA, Cardoso H, Marques M, Rodrigues-Pinto E, Peixoto A, Gaspar R, Lopes S, Macedo G. Lewis score: a useful tool for diagnosis and prognosis in Crohn's disease. Rev Esp Enferm Dig 2021; 112:121-126. [PMID: 31960694 DOI: 10.17235/reed.2020.6434/2019] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND videocapsule endoscopy (VCE) is currently the most sensitive diagnostic tool to detect early small bowel inflammation. A Lewis score (LS) of ≥ 135 as the cutoff value for the presence of significant inflammatory activity in patients undergoing VCE for suspected Crohn's disease (CD) has been suggested as a useful tool for the diagnosis of CD. The aim of this study was to evaluate the diagnostic and prognostic accuracy of the LS in patients with suspected CD undergoing VCE. METHODS a retrospective single-center study was performed that included patients who underwent VCE for suspected CD between January 2010 and December 2015. Inflammatory activity was assessed with the LS. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD; group 1: patients not fulfilling ICCE and group 2: patients with ≥ 2 ICCE criteria. RESULTS one hundred and ninety-one patients were included, 61% were female and the mean age was 39 ± 14 years. VCE detected significant inflammatory activity (LS ≥ 135) in 81 patients (42%); 24 patients from group 1 (32%) and 57 patients from group 2 (50%) (p = 0.014). During a mean follow-up period of 41 ± 21 months (12-79), a CD diagnosis was determined in 60 patients (31%); 55 patients with LS ≥ 135 (92%) and five patients with LS < 135 (5%) (p < 0.001). The LS showed a good diagnostic accuracy with an AUROC of 0.93 (p < 0.001). During the first year after diagnosis, there was a significant association between a higher LS and the need for immunomodulatory therapy, biological therapy, bowel resection surgery or hospital admission due to a CD flare-up. CONCLUSIONS the LS (cutoff ≥ 135) is very useful in the diagnosis of CD in patients undergoing VCE. Moreover, higher values of this score was associated with prognostic variables.
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Affiliation(s)
- Ana Santos
- Gastrenterologia, Centro Hospitalar de São João, Portugal
| | | | - Hélder Cardoso
- Gastrenterologia, Centro Hospitalar de São João, Portugal
| | | | | | | | - Rui Gaspar
- Gastrenterologia, Centro Hospitalar de São João, Portugal
| | - Susana Lopes
- Gastrenterologia, Centro Hospitalar de São João, Portugal
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14
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Blanco A, Larrinaga AR, Neto JM, Troncoso J, Méndez G, Domínguez-Lapido P, Ovejero A, Pereira L, Mouga TM, Gaspar R, Martínez B, Lemos MFL, Olabarria C. Spotting intruders: Species distribution models for managing invasive intertidal macroalgae. J Environ Manage 2021; 281:111861. [PMID: 33422911 DOI: 10.1016/j.jenvman.2020.111861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
Invasive macroalgae represent one of the major threats to marine biodiversity, ecosystem functioning and structure, as well as being important drivers of ecosystem services depletion. Many such species have become well established along the west coast of the Iberian Peninsula. However, the lack of information about the distribution of the invaders and the factors determining their occurrence make bioinvasions a difficult issue to manage. Such information is key to enabling the design and implementation of effective management plans. The present study aimed to map the current probability of presence of six invasive macroalgae: Grateloupia turuturu, Asparagopsis armata, Colpomenia peregrina, Sargassum muticum, Undaria pinnatifida, and Codium fragile ssp. fragile. For this purpose, an extensive field survey was carried out along the coast of the north-western Iberian Peninsula. Species distribution models (SDMs) were then used to map the presence probability of these invasive species throughout the study region on the basis of environmental and anthropogenic predictor variables. The southern Galician rias were identified as the main hotspots of macroalgal invasion, with a high probability of occurrence for most of the species considered. Conversely, the probability of presence on the Portuguese coast was generally low. Physico-chemical variables were the most important factors for predicting the distribution of invasive macroalgae contributing between 57.27 and 85.24% to the ensemble models. However, anthropogenic factors (including size of vessels, number of shipping lines, distance from ports, population density, etc.) considerably improved the estimates of the probability of occurrence for most of the target species. This study is one of the few to include anthropogenic factors in SDMs for invasive macroalgae. The findings suggest that management actions aimed at controlling these species should strengthen control and surveillance at ports, particularly in southern Galician rias. Early detection should be of main concern for risk assessment plans on the Portuguese coast.
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Affiliation(s)
- A Blanco
- Centro de Investigación Mariña, Universidade de Vigo, EcoCost, Facultade de Ciencias do Mar, Edificio CC Experimentais, Campus de Vigo, As Lagoas, Marcosende, 36310 Vigo, Spain; Departamento de Ecoloxía e Bioloxía Animal, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain.
| | - A R Larrinaga
- eNeBaDa, Calle Ponte do Sar, 43C-1F, 15702 Santiago de Compostela, A Coruña, Spain; Grupo de Estudo do Medio Mariño (GEMM), Porto deportivo s/n, Santa Uxía de Riveira, A Coruña, Spain
| | - J M Neto
- MARE - Marine and Environmental Sciences Centre, ESTM, Instituto Politécnico de Leiria, Peniche, Portugal; Marine and Environmental Sciences Centre (MARE), Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal
| | - J Troncoso
- Centro de Investigación Mariña, Universidade de Vigo, EcoCost, Facultade de Ciencias do Mar, Edificio CC Experimentais, Campus de Vigo, As Lagoas, Marcosende, 36310 Vigo, Spain; Departamento de Ecoloxía e Bioloxía Animal, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - G Méndez
- Departamento de Geociencias Mariñas e Ordenación do Territorio, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - P Domínguez-Lapido
- eNeBaDa, Calle Ponte do Sar, 43C-1F, 15702 Santiago de Compostela, A Coruña, Spain; Grupo de Estudo do Medio Mariño (GEMM), Porto deportivo s/n, Santa Uxía de Riveira, A Coruña, Spain
| | - A Ovejero
- Departamento de Geociencias Mariñas e Ordenación do Territorio, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - L Pereira
- Marine and Environmental Sciences Centre (MARE), Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal
| | - T M Mouga
- MARE - Marine and Environmental Sciences Centre, ESTM, Instituto Politécnico de Leiria, Peniche, Portugal
| | - R Gaspar
- Marine and Environmental Sciences Centre (MARE), Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal
| | - B Martínez
- Biology and Geology Department, Rey Juan Carlos University, Tulipán sn, 28933 Móstoles, Spain
| | - M F L Lemos
- MARE - Marine and Environmental Sciences Centre, ESTM, Instituto Politécnico de Leiria, Peniche, Portugal
| | - C Olabarria
- Centro de Investigación Mariña, Universidade de Vigo, EcoCost, Facultade de Ciencias do Mar, Edificio CC Experimentais, Campus de Vigo, As Lagoas, Marcosende, 36310 Vigo, Spain; Departamento de Ecoloxía e Bioloxía Animal, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
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15
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Liberal R, Gaspar R, Lopes S, Macedo G. Long-term outcome of patients with difficult-to-treat autoimmune hepatitis receiving mycophenolate mofetil. Clin Res Hepatol Gastroenterol 2021; 45:101487. [PMID: 32651078 DOI: 10.1016/j.clinre.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/22/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Most patients with autoimmune hepatitis (AIH) respond to a combination of prednisolone and azathioprine. For patients who are intolerant or refractory to azathioprine, proposed alternative therapies are based on scarce data, limited to transplant centres and with short-term follow-up periods. OBJECTIVE To evaluate the long-term efficacy and safety of MMF as a second-line therapy in patients with AIH managed at a tertiary non-transplant centre. METHODS Retrospective analysis of a prospectively collated database identified AIH patients who received MMF from 2006 to 2015. Clinical, biochemical and immunological parameters were assessed at 3-, 6- and 12-months, and at last follow-up. Biochemical response (BR) was defined as improvement of transaminases, complete remission (CR) as normalisation of transaminases and IgG, while others were considered non-responders (NR). RESULTS Eighteen out of 151 (12%) AIH patients received MMF. Nine received MMF due to azathioprine-intolerance (group 1), while nine due to refractory disease (group 2). In group 1, CR and BR was achieved in six (67%) and two (22%) patients respectively. In group 2, CR and BR was achieved in one (11%) and five (56%) patients respectively. Adverse events occurred in eight patients (44%), with one patient requiring drug discontinuation. After a medium follow-up of 78 (31-116) months, there was a significant decrease in transaminase levels, mirrored by decrease in prednisolone dose from 25 to 6.25 mg/day (P<0.05). CONCLUSION Long-term therapy with MMF is safe and effective in AIH patients requiring second-line therapies, and these patients can be effectively managed at tertiary non-liver transplant centres.
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Affiliation(s)
- Rodrigo Liberal
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Portugal.
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Portugal
| | - Susana Lopes
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; World Gastroenterology Organization (WGO) Porto Training Center, Portugal
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Rodrigues-Pinto E, Morais R, Sousa-Pinto B, Ferreira da Silva J, Costa-Moreira P, Santos AL, Silva M, Coelho R, Gaspar R, Peixoto A, Dias E, Baron TH, Vilas-Boas F, Moutinho-Ribeiro P, Pereira P, Macedo G. Development of an Online App to Predict Post-Endoscopic Retrograde Cholangiopancreatography Adverse Events Using a Single-Center Retrospective Cohort. Dig Dis 2021; 39:283-293. [PMID: 33429393 DOI: 10.1159/000514279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure with a high risk for adverse events (AEs). AIM evaluate patient- and procedure-related risk factors for ERCP-related AEs and develop an online app to estimate risk of AEs. METHODS retrospective study of 1,491 consecutive patients who underwent 1,991 ERCPs between 2012 and 2017 was conducted. AEs definition and severity were classified according to most recent ESGE guidelines. Each variable was tested for association with occurrence of overall AEs, post-ERCP pancreatitis (PEP) and cholangitis. For each outcome, 2 regression models were built, from which an online Shiny-based app was created. RESULTS Overall AE rate was 15.3%; in 19 procedures, >1 AE occurred. Main post-ERCP AE was PEP (7.5%), followed by cholangitis (4.9%), bleeding (1.3%), perforation (1%), cardiopulmonary events (0.9%), and cholecystitis (0.3%). Seventy-eight percent of AEs were mild/moderate; of severe (n = 55) and fatal (n = 20) AEs, more than half were related to infection, cardiac/pulmonary AEs, and perforation. AE-related mortality rate was 1%. When testing precannulation, procedural covariates, and ERCP findings, AE occurrence was associated with age (odds ratio [OR] 0.991), previous PEP (OR 2.198), ERCP complexity grade III/IV (OR 1.924), standard bile duct cannulation (OR 0.501), sphincterotomy (OR 1.441), metal biliary stent placement (OR 2.014), periprocedural bleeding (OR 3.024), and biliary duct lithiasis (OR 0.673). CONCLUSION Our app may allow an optimization of the patients' care, by helping in the process of decision-making, not only regarding patient or endoscopist's selection but also definition of an adequate and tailored surveillance plan after the procedure.
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Affiliation(s)
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | | | | | - Ana L Santos
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Emanuel Dias
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Hamid S, Alvares da Silva MR, Burak KW, Chen T, Drenth JP, Esmat G, Gaspar R, LaBrecque D, Lee A, Macedo G, McMahon B, Ning Q, Reau N, Sonderup M, van Leeuwen DJ, Armstrong D, Yurdaydin C. WGO Guidance for the Care of Patients With COVID-19 and Liver Disease. J Clin Gastroenterol 2021; 55:1-11. [PMID: 33230011 PMCID: PMC7713641 DOI: 10.1097/mcg.0000000000001459] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
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Affiliation(s)
- Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Kelly W. Burak
- Department of Medicine and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Tao Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, Radboud UMC, Nijmegen, The Netherlands
| | - Gamal Esmat
- Endemic Medicine and Hepatogastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Douglas LaBrecque
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Alice Lee
- Hepatitis Program, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Brian McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Qin Ning
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nancy Reau
- Section of Hepatology, Rush University Medical Center, Chicago, IL
| | - Mark Sonderup
- Department of Medicine, Division of Hepatology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Dirk J. van Leeuwen
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Armstrong
- Division of Gastroenterology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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18
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Yan Z, Gaspar R, Zhu T. How humans behave with emerging technologies during the COVID-19 pandemic? Hum Behav Emerg Technol 2021; 3:5-7. [PMID: 33821241 PMCID: PMC8013653 DOI: 10.1002/hbe2.249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Zheng Yan
- Educational and Counseling PsychologyState University of New YorkAlbanyNew YorkUSA
| | - Rui Gaspar
- School of Human SciencesUniversidade Catolica PortuguesaLisbonPortugal
- Catolica Research Centre for Psychological, Family and Social Wellbeing (CRC‐W)Universidade Católica PortuguesaLisbonPortugal
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19
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Gaspar R, Domingos S, Brito D, Leiras G, Filipe J, Raposo B, Telo de Arriaga M. Striving for crisis resolution or crisis resilience? The crisis layers and thresholds model and Information and Communication Technology
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mediated social sensing for evidence‐based crisis management and communication. Human Behav and Emerg Tech 2020. [DOI: 10.1002/hbe2.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rui Gaspar
- Faculdade de Ciências Humanas, Catolica Research Centre for Psychological ‐ Family and Social Wellbeing (CRC‐W) Universidade Católica Portuguesa Lisbon Portugal
| | - Samuel Domingos
- William James Centre for Research (WJCR) ISPA ‐ Instituto Universitário Lisbon Portugal
| | - Duarte Brito
- Public Health Unit ‐ ACES Lisbon Central Lisbon Portugal
| | - Gisela Leiras
- Directorate‐General for Health, Health Literacy and Wellbeing Division Lisbon Portugal
| | - Jessica Filipe
- Directorate‐General for Health, Health Literacy and Wellbeing Division Lisbon Portugal
| | - Beatriz Raposo
- Faculdade de Ciências Humanas, Catolica Research Centre for Psychological ‐ Family and Social Wellbeing (CRC‐W) Universidade Católica Portuguesa Lisbon Portugal
- Directorate‐General for Health, Health Literacy and Wellbeing Division Lisbon Portugal
| | - Miguel Telo de Arriaga
- Faculdade de Ciências Humanas, Catolica Research Centre for Psychological ‐ Family and Social Wellbeing (CRC‐W) Universidade Católica Portuguesa Lisbon Portugal
- Directorate‐General for Health, Health Literacy and Wellbeing Division Lisbon Portugal
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20
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Gaspar R, Liberal R, Tavares J, Morgado R, Macedo G. HIPPOCRATES ® project: A proof of concept of a collaborative program for hepatitis C virus micro-elimination in a prison setting. World J Hepatol 2020; 12:1314-1325. [PMID: 33442457 PMCID: PMC7772731 DOI: 10.4254/wjh.v12.i12.1314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus (HCV) infection. With the introduction of direct-acting antiviral agents (DAAs), sustained virological response (SVR) is achieved in more than 95% of the patients. The focus is now being turned to the global targets set by the World Health Organization, with the aim of achieving HCV elimination by 2030. Prison inmates constitute one of the high-risk groups, and receive treatment less frequently due to several barriers in access to health care.
AIM To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting, where tertial referral liver center specialists locally provide, on-site assessment and treatment for the prisoners.
METHODS A prospective observational study was conducted from April 2017 to March 2020, which included all HCV monoinfected prison inmates in the largest Northern Portugal prison. Demographic, clinical, and laboratory data, as well as transient elastography measurements, were collected onsite by the medical team and prospectively recorded. Patients were treated with DAA according to international guidelines. The primary endpoint was SVR at post-treatment week 12.
RESULTS There were 98 monoinfected HCV male inmates (mean age, 42.7 ± 8.6 years) included in the analysis. Injecting drugs or tattooing were reported in 74.5%, with 38.8% of the latter being done in prison. Alcohol consumption of more than 30 g/d was referred in 69.4%. The most prevalent genotype was 1a (54.1%), followed by 3 (27.6%), 4 (9.2%) and 1b (6.1%). Pretreatment fibrosis degree was mild-to-moderate (F0-F2) in 77.6% and severe in 22.4% (F3-F4). Treatment regimens chosen were: 45.9% elbasvir/grazoprevir, 29.6% sofosbuvir/velpatasvir, and 12.2% sofosbuvir/ledispavir and glecaprevir/pibrentasvir. No major adverse events were observed. SVR at post-treatment week 12 was 99%.
CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination, the onsite evaluation and treatment of HCV-infected prisoners, achieved an exceptional highly effective success rate. This type of collaborative program should be considered to be expanded, to support hepatitis C elimination efforts.
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Affiliation(s)
- Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Rodrigo Liberal
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Jorge Tavares
- Estabelecimento Prisional do Porto, Porto 4200, Portugal
| | - Rui Morgado
- Estabelecimento Prisional do Porto, Porto 4200, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
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21
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Pacheco D, Araújo GS, Cotas J, Gaspar R, Neto JM, Pereira L. Invasive Seaweeds in the Iberian Peninsula: A Contribution for Food Supply. Mar Drugs 2020; 18:E560. [PMID: 33207613 PMCID: PMC7697577 DOI: 10.3390/md18110560] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
The introduction of exotic organisms in marine ecosystems can lead to economic and ecological losses. Globally, seaweeds represent a significant part of these non-indigenous species (NIS), with 407 introduced algal species. Furthermore, the presence of NIS seaweeds has been reported as a major concern worldwide since the patterns of their potential invasion mechanisms and vectors are not yet fully understood. Currently, in the Iberian Peninsula, around 50 NIS seaweeds have been recorded. Some of these are also considered invasive due to their overgrowth characteristic and competition with other species. However, invasive seaweeds are suitable for industrial applications due to their high feedstock. Hence, seaweeds' historical use in daily food diet, allied to research findings, showed that macroalgae are a source of nutrients and bioactive compounds with nutraceutical properties. The main goal of this review is to evaluate the records of NIS seaweeds in the Iberian Peninsula and critically analyze the potential of invasive seaweeds application in the food industry.
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Affiliation(s)
- Diana Pacheco
- Department of Life Sciences, Marine and Environmental Sciences Centre (MARE), University of Coimbra, 3000-456 Coimbra, Portugal; (D.P.); (J.C.); (R.G.); (J.M.N.)
| | - Glacio Souza Araújo
- Federal Institute of Education, Science and Technology of Ceará–IFCE, Campus Aracati, CE 040, km 137,1, Aracati 62800-000, Ceará, Brazil;
| | - João Cotas
- Department of Life Sciences, Marine and Environmental Sciences Centre (MARE), University of Coimbra, 3000-456 Coimbra, Portugal; (D.P.); (J.C.); (R.G.); (J.M.N.)
| | - Rui Gaspar
- Department of Life Sciences, Marine and Environmental Sciences Centre (MARE), University of Coimbra, 3000-456 Coimbra, Portugal; (D.P.); (J.C.); (R.G.); (J.M.N.)
| | - João M. Neto
- Department of Life Sciences, Marine and Environmental Sciences Centre (MARE), University of Coimbra, 3000-456 Coimbra, Portugal; (D.P.); (J.C.); (R.G.); (J.M.N.)
| | - Leonel Pereira
- Department of Life Sciences, Marine and Environmental Sciences Centre (MARE), University of Coimbra, 3000-456 Coimbra, Portugal; (D.P.); (J.C.); (R.G.); (J.M.N.)
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22
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Dias E, Santos-Antunes J, Peixoto A, Gaspar R, Macedo G. Co-existence of eosinophilic esophagitis and Barrett's esophagus: a possible association? Acta Gastroenterol Belg 2020; 83:669-670. [PMID: 33321029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- E Dias
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - J Santos-Antunes
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A Peixoto
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - R Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - G Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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23
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Abstract
Background During events that involve health risks, people may feel the need personal and social resources to cope with the demands posed by event. Depending on their individual characteristics, people may perceive their resources as sufficient or as insufficient to face the situation. Risk perception analysis was conducted in Portugal during the COVID-19 outbreak, to develop communication strategies, customized to the changing needs, helping people make informed decisions. Methods Citizens messages on social networks of 3 official information sources, and 8 media sources were analyzed between 26th January and 5th March 2020. A sample of comments to publications related to COVID-19 were analyzed in 4-days periods and categorized. A qualitative theory-driven thematic analysis was carried out based on two global categories: Demands and Resources. From this analysis, the threat level ratio (Demands/Resources) was calculated. Results A total of 8,251 comments were analysed in 10 periods of 4 days of data collection, from 26th January to 5th March. The threat level ratio increased during the first 15 days of analysis, having its maximum (6.80) in the period between the 7th and 14th of February, mostly associated with the perceived danger associated with the lack of airports arrivals control from China. After the announcement of the first confirmed case of COVID-19 in a Portuguese citizen outside Portugal, on 23rd February, the risk perception increased 1,4% compared to the previous period of analysis. On the contrary, after announcing the first confirmed case in Portugal, on the 1st March, the risk perception decreased 1,6%, which is inferred to be associated with a shift in the media discourse and to the use of humour. Conclusions Awareness of risks is a necessary condition for people to adhere to the necessary recommendations to mitigate the crisis. During an epidemic, an effective communication strategy can become an opportunity to promote health literacy. Key messages Risk perception is essential to define effective communication strategies to promote health literacy and best practices among targeted populations. effective communication strategies customized to people’s needs and priorities help people making informed decisions during a public health emergency.
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Affiliation(s)
- G Leiras
- Baixo Mondego Health Cluster, IHMT, Porto, Portugal
| | - M Arriaga
- Directorate-General for Health, Lisbon, Portugal
| | - R Gaspar
- Católica Research Centre for Psychological - Family and Social Wellbeing, Lisbon, Portugal
- Faculty of Human Science, Universidade Católica Portuguesa, Lisbon, Portugal
| | - B Raposo
- Católica Research Centre for Psychological - Family and Social Wellbeing, Lisbon, Portugal
| | - S Domingos
- William James Centre for Research, ISPA-Instituto Universitário, Lisbon, Portugal
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24
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Garrido I, Liberal R, Gaspar R, Macedo G. Cirrhosis management in a major referral center during COVID-19. JHEP Rep 2020; 2:100146. [PMID: 32838246 PMCID: PMC7362857 DOI: 10.1016/j.jhepr.2020.100146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Isabel Garrido
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center
| | - Rodrigo Liberal
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Porto, Portugal.,World Gastroenterology Organization (WGO) Porto Training Center
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25
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Gaspar R, Rodrigues S, Andrade P, Liberal R, Macedo G. Reply to comment: "Hospital readmission of patients with hepatic encephalopathy: Is the introduction of the formal caregiver useful in care management?". Dig Liver Dis 2020; 52:790-791. [PMID: 32291168 DOI: 10.1016/j.dld.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- R Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal.
| | - S Rodrigues
- Swiss Liver Center, UVCM, Inselspital, Bern University Hospital, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - P Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
| | - R Liberal
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
| | - G Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
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26
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Cruz A, Henriques C, Ferreira A, Galvão S, Neves C, Gaspar R, Ambrósio A, Gomes C, Baptista F. Influence of prenatal exposure to dexamethasone on neurodevelopmental behaviour. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.034] [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
Introduction Early life stress, such as prenatal exposure to exogenous glucocorticoids (GC), can have a negative impact on brain development. Dexamethasone (DEX) is a synthetic GC used in preterm pregnancies to promote lung maturation. However, prenatal exposure to DEX induces an anxious-like behaviour in male and female offspring at adulthood. Notably, only males respond positively to therapeutics with a proposed anxiolytic.
Objectives Since the influence of prenatal DEX on neurodevelopmental behaviour remains to be elucidated and could help explain this difference in drug efficacy, we aim to clarify the effects of this GC on neurodevelopment during infancy, comparing male and female offspring neurodevelopment at this early age.
Methodology To obtain an animal model of chronic anxiety, Wistar pregnant dams were injected subcutaneously with DEX (1mg/kg) on gestational days 18 and 19. The vestibular system development, locomotion, upper limbs strength, discriminatory ability, auditory response and eye opening day were assessed in male and female offspring between P5 and P17. Animal procedures were approved by the Animal Welfare Committee and done in agreement with the law.
Results Male and female offspring prenatally exposed to DEX had a better performance in the tests assessing the vestibular system development and discriminatory ability, especially at P5 and P6. Additionally, DEX anticipated the day of eye opening and had a positive impact in the upper limb strength of the offspring of both sexes. However, the locomotor ability and auditory response were impaired comparing with controls.
Conclusion Exposure to DEX improves limb strength, balance, spatial orientation and anticipates eye opening. These results may suggest that prenatal DEX exposure promotes offspring development and maturation in both males and females. Prenatal DEX did not differently affect male and female neurodevelopment at early age. It remains to clarify the underlying motives that induce a dimorphic gender response to anxiolytic therapy in adulthood.
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Affiliation(s)
- A Cruz
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - C Henriques
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - A Ferreira
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - S Galvão
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - C Neves
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - R Gaspar
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - A Ambrósio
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - C Gomes
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, Portugal
| | - F Baptista
- iCBR - Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Portugal
- CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
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Costa-Moreira P, Gaspar R, Pereira P, Lopes S, Canão P, Lopes J, Carneiro F, Macedo G. Role of liver biopsy in the era of clinical prediction scores for "drug-induced liver injury" (DILI): experience of a tertiary referral hospital. Virchows Arch 2020; 477:517-525. [PMID: 32377873 DOI: 10.1007/s00428-020-02824-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/31/2020] [Revised: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
The clinical implications of the biopsy findings in cases of drug-induced liver injury (DILI) are not fully elucidated. The aim of this study was to evaluate the histopathological findings of cases diagnosed as DILI and to correlate them with clinical and biochemical findings (such as causality assessment algorithms). We searched our department database for all cases of liver biopsy with findings consistent with toxic liver disease and selected those with a clinical diagnosis of DILI. The causative relationships were established according to Roussel Uclaf Causality Assessment Method (RUCAM). A total of 53 cases of DILI were reviewed, most of them diagnosed in hospitalized patients (83%). The analytical toxicity profile was hepatocellular (R > 5) in 60% of the cases and cholestatic (R < 2) in 26.4% of cases. The group of drugs most implicated was the anti-microbials (18, 34%). The predominant histological patterns were "necroinflammation" (67.9%) and "cholestasis" (28.3%). The hepatocellular biochemical pattern was not associated with the presence of predominantly necroinflammatory findings in the biopsy (p = 0.44), and the biochemical cholestatic pattern was not associated with the presence of predominantly cholestatic findings in the biopsy (p = 0.51). This study supports that a better insight into the pathologic mechanisms associated with DILI should be based on liver biopsy due to the lack of a uniform correlation between clinical and biochemical patterns. Also, a liver biopsy may be used in those cases where clinical suspicion of DILI persists despite a low score on current causality assessment algorithms.
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Affiliation(s)
- Pedro Costa-Moreira
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal. .,Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Canão
- Pathology Deparment, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Joanne Lopes
- Pathology Deparment, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Fátima Carneiro
- Faculty of Medicine, University of Porto, Porto, Portugal.,Pathology Deparment, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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28
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Liberal R, Gaspar R, Lopes S, Macedo G. Primary biliary cholangitis in patients with inflammatory bowel disease. Clin Res Hepatol Gastroenterol 2020; 44:e5-e9. [PMID: 31171469 DOI: 10.1016/j.clinre.2019.05.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/24/2019] [Accepted: 05/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBD) are associated with various hepatobiliary disorders. There is a strong association for primary sclerosing cholangitis (PSC). Primary biliary cholangitis (PBC), another autoimmune cholestatic liver disease, is not usually associated with IBD. The aim of this study is to report cases of PBC-associated IBD, their clinical features, response to therapy, and long-term outcome. METHODS Retrospective analysis of a prospectively collated database identified patients presenting with PBC-associated IBD from 2006 to 2016. PBC has been diagnosed according to accepted criteria, and staged according to Ludwig classification. A magnetic resonance cholangiopancreatography (MRCP) was performed to rule out PSC. Response to ursodeoxycholic acid (UDCA) therapy has been assessed by using the Paris II criteria. RESULTS A total of six patients (five females) with PBC-associated IBD were identified. Median age at IBD diagnosis was 44.7 years (range 22.5-48.8). Three had Crohn's disease and three ulcerative colitis. PBC was diagnosed in all after IBD had been diagnosed. All patients presented with cholestasis, all were positive for anti-mitochondrial antibodies. MRCP was normal in all. Liver biopsy was consistent with PBC (stage I in one, stage II in five). One year after initiation of UDCA, all patients responded to therapy. CONCLUSION Herein we describe the largest series reported to date of PBC-associated IBD. Although the coexistence of the two conditions is rare, PBC should be considered during the work-up of abnormal liver function tests in patients with IBD.
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Affiliation(s)
- Rodrigo Liberal
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
| | - Rui Gaspar
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Susana Lopes
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology and Hepatology Department, Centro Hospitalar Sao Joao, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
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Pereira P, Santos S, Morais R, Gaspar R, Rodrigues-Pinto E, Vilas-Boas F, Macedo G. Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors. Dig Dis 2020; 38:431-440. [PMID: 31940612 DOI: 10.1159/000504910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Peroral cholangioscopy (POC) has shown to be a useful diagnostic procedure in the evaluation of biliary strictures; however, data regarding its role on preoperative staging are scarce. The aim of this study was to evaluate POC role in the diagnosis and preoperative intraductal staging of perihilar cholangiocarcinoma (CCA). METHODS Retrospective study that included all patients who underwent POC with SpyGlassTM Direct Visualization System for the diagnosis of biliary strictures or for preoperative evaluation of extrahepatic biliary tumors, between 2015 and 2019, in a single tertiary center. RESULTS Forty-three patients were included, 63% male with a median age of 62 years. Thirty-eight (88.3%) underwent POC due to indeterminate biliary strictures, 3 (7%) due to bile duct filling defect, and 2 (4.7%) for intraductal staging of perihilar CCA. In the follow-up, a final diagnosis of malignancy was established in 56% of the patients. Visual impression accuracy with SpyGlass was 95.1% (with 100% sensitivity and 89.5% specificity). SpyBite biopsies accuracy was 80.5% (63.6% sensitivity and 100% specificity). In the 19 patients with a final perihilar CCA diagnosis, intraductal evaluation with SpyGlass altered anatomic classification (Bismuth-Corlette) defined by previous imagiologic findings in 8 (42.1%) patients. Alteration in anatomic classification changed therapeutic approach in 4 (21%). CONCLUSIONS POC use for evaluating intraductal spread in potentially resectable perihilar CCA can detect more extensive and change surgical management. In the future, preoperative staging of perihilar CCA with POC combined with imagiologic evaluation of vascular extension of the lesions may optimize surgical results.
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Affiliation(s)
- Pedro Pereira
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal, .,Faculty of Medicine, University of Porto, Porto, Portugal,
| | - Sancha Santos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Morais
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipe Vilas-Boas
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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30
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Silva M, Cardoso H, Cunha R, Peixoto A, Gaspar R, Gomes S, Santos AL, Lopes S, Macedo G. Evaluation of Small-Bowel Patency in Crohn's Disease: Prospective Study with a Patency Capsule and Computed Tomography. GE Port J Gastroenterol 2019; 26:396-403. [PMID: 31832494 DOI: 10.1159/000499722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
Abstract
Background and Purpose Patency capsule (PC) examination is usually performed - previously to capsule endoscopy - to evaluate small-bowel patency in patients with established Crohn's disease (CD). The reported PC retention rate is significantly higher than expected. Our aims were to assess small-bowel patency, to determine the precise location of the retained PC in patients with CD, and to determine the false positive rate of evaluation with a radiofrequency identification tag (RFIT) scanner. Methods This is a prospective single-center study including CD patients with clinical indication for small-bowel capsule endoscopy. PillCam® PC examination was performed on all patients to assess small-bowel patency. On all patients with a positive identification of the PC using an RFIT scanner, 30 h after ingestion, an abdominal CT was performed in order to identify its precise location. Results Fifty-four patients were included. The PC retention rate, according to evaluation with the RFIT scanner, was 20% (in 11 patients) 30 h after ingestion. These patients were then submitted to abdominal CT, which revealed that there was small-bowel retention in 5 cases (9%). Higher CRP levels, penetrating disease, and a history of abdominal surgery were associated with an increased risk of PC retention (p = 0.007, p = 0.011, and p = 0.033, respectively). On multivariate analysis, there was an independent association between small-bowel PC retention and CRP levels >5 mg/dL (OR = 15.5; p = 0.03). Discussion The small-bowel PC retention rate (9%) was considerably lower than those found in previous reports. Our results show that, with this protocol, the false-positive cases of RFIT scans or plain abdominal X-rays may be avoided. This may contribute to more extensive application of capsule endoscopy without the risk of small-bowel retention.
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Affiliation(s)
- Marco Silva
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Hélder Cardoso
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Rui Cunha
- Department of Imagiology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Armando Peixoto
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Sara Gomes
- Department of General Practice, UCSP Rio Maior, ACES Lezíria, Rio Maior, Portugal
| | - Ana Luísa Santos
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Susana Lopes
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal
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Santos AL, Magno Pereira V, Coelho R, Gaspar R, Cardoso H, Lopes J, Macedo G. A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma. GE Port J Gastroenterol 2019; 27:203-206. [PMID: 32509927 DOI: 10.1159/000503150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/02/2019] [Indexed: 01/16/2023]
Abstract
The authors describe a case of a 76-year-old male with a medical history of Merkel cell carcinoma (MCC) of the right lower eyelid. He was admitted to the emergency department due to abdominal pain in the right hypochondrium, nauseas, asthenia, and choluria with 3 days of evolution. Biochemical liver workup revealed a cytocholestase pattern as well as a prolonged prothrombin time. After admission, the patient developed hepatic encephalopathy, and a clinical and analytical worsening was observed. Abdominal ultrasound showed a reduction in the caliber of the hepatic veins, in apparent relation to a parenchymal compression. Liver biopsy was performed and showed an extensive infiltration of the hepatic parenchyma by a solid neoplasm, which, upon immunohistochemical study, was compatible with a diffuse metastization of a MCC. We report this clinical case due to its rarity of presentation and to show the important role of liver biopsy in cases of acute hepatitis.
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Affiliation(s)
- Ana Luísa Santos
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Porto Medical School, University of Porto, Porto, Portugal.,World Gastroenterology Organisation (WGO) Oporto Training Center, Porto, Portugal
| | | | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Porto Medical School, University of Porto, Porto, Portugal.,World Gastroenterology Organisation (WGO) Oporto Training Center, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Porto Medical School, University of Porto, Porto, Portugal.,World Gastroenterology Organisation (WGO) Oporto Training Center, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Porto Medical School, University of Porto, Porto, Portugal.,World Gastroenterology Organisation (WGO) Oporto Training Center, Porto, Portugal
| | - Joanne Lopes
- Porto Medical School, University of Porto, Porto, Portugal.,Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Porto Medical School, University of Porto, Porto, Portugal.,World Gastroenterology Organisation (WGO) Oporto Training Center, Porto, Portugal
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32
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Giger J, Gaspar R. A look into future risks: A psychosocial theoretical framework for investigating the intention to practice body hacking. Human Behav and Emerg Tech 2019. [DOI: 10.1002/hbe2.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jean‐Christophe Giger
- Portugal and Centre for Research in Psychology – CIP‐UALUniversity of Algarve Lisbon Portugal
| | - Rui Gaspar
- Research Centre for Psychological, Family and Social Wellbeing (CRC‐W)Universidade Católica Portuguesa Lisbon Portugal
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Gaspar R, Rodrigues S, Silva M, Costa-Moreira P, Morais R, Andrade P, Cardoso H, Albuquerque A, Liberal R, Macedo G. Predictive models of mortality and hospital readmission of patients with decompensated liver cirrhosis. Dig Liver Dis 2019; 51:1423-1429. [PMID: 31113738 DOI: 10.1016/j.dld.2019.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/06/2019] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Complications of cirrhosis are one the major causes of hospital admission associated with high morbimortality rates and social and economic charges. The aims of this study were to evaluate hospital readmission and mortality rates and predictive factors for hospital readmission and mortality. METHODS Patients with decompensated cirrhosis admitted to our institution between 2008-2014 were retrospectively analyzed. RESULTS Included 427 admissions from 177 patients with cirrhosis with mean age of 59.0 ± 12.3 years. The major cause was alcoholic-related liver disease and the median duration of admission was 9.0 days (IQR 6.0-14.0). During the follow-up period,there were 250 readmissions from 95 patients, with a median of 58 (IQR27-134) days for readmission, representing 58.5% of the total number of admissions.The 180-day mortality rate was 35.0%. In the multivariate analysis, ascites, smoking and MELD Na were associated with 180-day mortality. Creatinine, albumin, esophageal variceal bleeding, previous variceal banding, lactulose, rifaximin and proton pump inhibitors use were independently associated with need of readmission. Based on regression analysis, two models were calculated to predict 180-day mortality (AUROC 0.74 (0.682-0.794)) and need for readmission(AUROC 0.821 (0.781-0.861)), p < 0.001. CONCLUSION The readmission rate and mortality of cirrhotic patients are still very high and it is a priority to determine preventable risk factors to improve patient outcome. Two models were created to predict 180-day mortality(AUROC 0.74) and need for readmission(AUROC 0.821), that could guide the management of the patients at the time of admission.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Susana Rodrigues
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Costa-Moreira
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patricia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Helder Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Andreia Albuquerque
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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34
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Gaspar R, Giger J. Emerging technologies, Emerging Risks: Current Approaches on the Future Risks of Human Enhancement Technologies. Human Behav and Emerg Tech 2019. [DOI: 10.1002/hbe2.178] [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: 11/10/2022]
Affiliation(s)
- Rui Gaspar
- Universidade Católica Portuguesa, Faculdade de Ciências Humanas, Catolica Research Centre for Psychological, Family and Social Wellbeing (CRC‐W) Lisbon Portugal
| | - Jean‐Christophe Giger
- University of Algarve Faro Portugal
- Centre for Research in Psychology – CIP‐UAL Lisbon Portugal
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35
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Gaspar R, Rohde P, Giger J. Unconventional settings and uses of human enhancement technologies: A non‐systematic review of public and experts' views on self‐enhancement and DIY biology/biohacking risks. Human Behav and Emerg Tech 2019. [DOI: 10.1002/hbe2.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rui Gaspar
- Universidade Católica PortuguesaFaculdade de Ciências Humanas, Catolica Research Centre for Psychological, Family and Social Wellbeing (CRC‐W) Lisbon Portugal
| | - Paul Rohde
- Universidade Católica PortuguesaFaculdade de Ciências Humanas, Centre for Research in Communication and Culture (CECC) Lisbon Portugal
| | - Jean‐Christophe Giger
- University of Algarve Faro Portugal
- Centre for Research in Psychology – CIP‐UAL Lisbon Portugal
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36
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Morais R, Liberal R, Santos A, Pita I, Coelho R, Gaspar R, Andrade A, Cardoso H, Rodrigues S, Macedo G. Another clinical unmet need in liver patients: Multidrug resistant bacteria in decompensated cirrhosis. J Hepatol 2019; 71:844-845. [PMID: 31362835 DOI: 10.1016/j.jhep.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Rui Morais
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Ana Santos
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Inês Pita
- Gastroenterology Department, IPO Porto, Porto, Portugal
| | - Rosa Coelho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Ana Andrade
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Hélder Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Susana Rodrigues
- Swiss Liver Center, UVCM, Inselspital, Bern University Hospital, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Hamesch K, Mandorfer M, Pereira VM, Moeller LS, Pons M, Dolman GE, Reichert MC, Schneider CV, Woditsch V, Voss J, Lindhauer C, Fromme M, Spivak I, Guldiken N, Zhou B, Arslanow A, Schaefer B, Zoller H, Aigner E, Reiberger T, Wetzel M, Siegmund B, Simões C, Gaspar R, Maia L, Costa D, Bento-Miranda M, van Helden J, Yagmur E, Bzdok D, Stolk J, Gleiber W, Knipel V, Windisch W, Mahadeva R, Bals R, Koczulla R, Barrecheguren M, Miravitlles M, Janciauskiene S, Stickel F, Lammert F, Liberal R, Genesca J, Griffiths WJ, Trauner M, Krag A, Trautwein C, Strnad P. Liver Fibrosis and Metabolic Alterations in Adults With alpha-1-antitrypsin Deficiency Caused by the Pi*ZZ Mutation. Gastroenterology 2019; 157:705-719.e18. [PMID: 31121167 DOI: 10.1053/j.gastro.2019.05.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Alpha-1 antitrypsin deficiency (AATD) is among the most common genetic disorders. Severe AATD is caused by a homozygous mutation in the SERPINA1 gene that encodes the Glu342Lys substitution (called the Pi*Z mutation, Pi*ZZ genotype). Pi*ZZ carriers may develop lung and liver diseases. Mutation-associated lung disorders have been well studied, but less is known about the effects in liver. We assessed the liver disease burden and associated features in adults with this form of AATD. METHODS We collected data from 554 Pi*ZZ adults (403 in an exploratory cohort, 151 in a confirmatory cohort), in 9 European countries, with AATD who were homozygous for the Pi*Z mutation, and 234 adults without the Pi*Z mutation (controls), all without pre-existing liver disease. We collected data on demographic parameters, comorbidities, lung- and liver-related health, and blood samples for laboratory analysis. Liver fibrosis was assessed non-invasively via the serum tests Aspartate Aminotransferase to Platelet Ratio Index and HepaScore and via transient elastography. Liver steatosis was determined via transient elastography-based controlled attenuation parameter. We performed histologic analyses of livers from transgenic mice that overexpress the AATD-associated Pi*Z variant. RESULTS Serum levels of liver enzymes were significantly higher in Pi*ZZ carriers vs controls. Based on non-invasive tests for liver fibrosis, significant fibrosis was suspected in 20%-36% of Pi*ZZ carriers, whereas signs of advanced fibrosis were 9- to 20-fold more common in Pi*ZZ carriers compared to non-carriers. Male sex; age older than 50 years; increased levels of alanine aminotransferase, aspartate aminotransferase, or γ-glutamyl transferase; and low numbers of platelets were associated with higher liver fibrosis burden. We did not find evidence for a relationship between lung function and liver fibrosis. Controlled attenuation parameter ≥280 dB/m, suggesting severe steatosis, was detected in 39% of Pi*ZZ carriers vs 31% of controls. Carriers of Pi*ZZ had lower serum concentrations of triglyceride and low- and very-low-density lipoprotein cholesterol than controls, suggesting impaired hepatic secretion of lipid. Livers from Pi*Z-overexpressing mice had steatosis and down-regulation of genes involved in lipid secretion. CONCLUSIONS In studies of AATD adults with the Pi*ZZ mutation, and of Pi*Z-overexpressing mice, we found evidence of liver steatosis and impaired lipid secretion. We identified factors associated with significant liver fibrosis in patients, which could facilitate hepatologic assessment and counseling of individuals who carry the Pi*ZZ mutation. ClinicalTrials.gov Number NCT02929940.
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Affiliation(s)
- Karim Hamesch
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network "Rare Liver" and the European Association for the Study of the Liver Registry Group "Alpha1-Liver," University Hospital Aachen, Aachen, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Vítor M Pereira
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Linda S Moeller
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Monica Pons
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Grace E Dolman
- Department of Hepatology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Carolin V Schneider
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Vivien Woditsch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jessica Voss
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Cecilia Lindhauer
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Malin Fromme
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Igor Spivak
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Nurdan Guldiken
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Biaohuan Zhou
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Anita Arslanow
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Benedikt Schaefer
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
| | - Elmar Aigner
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Martin Wetzel
- Department of Medicine I, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Britta Siegmund
- Department of Medicine I, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Carolina Simões
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Luís Maia
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Dalila Costa
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Mário Bento-Miranda
- Gastroenterology Department, Hospital Universitário de Coimbra, Coimbra, Portugal
| | - Josef van Helden
- Medical Care Centre, Dr Stein and Colleagues, Moenchengladbach, Germany
| | - Eray Yagmur
- Medical Care Centre, Dr Stein and Colleagues, Moenchengladbach, Germany
| | - Danilo Bzdok
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany; Jülich Aachen Research Alliance-Brain, Aachen, Germany
| | - Jan Stolk
- Clinic for Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wolfgang Gleiber
- Clinic for Pulmonology, University Hospital Frankfurt, Frankfurt, Germany
| | - Verena Knipel
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Ravi Mahadeva
- Department of Respiratory Medicine, Cambridge National Institute for Health Research, Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Robert Bals
- Department of Medicine V, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Rembert Koczulla
- Clinic for Pneumology, Marburg University Hospital, Marburg, Germany; Institute for Pulmonary Rehabilitation Research, Schoen Clinic Berchtesgadener Land, Member of the Deutsches Zentrum für Lungenforschung, Schönau am Königssee, Germany
| | - Miriam Barrecheguren
- Department of Pneumology, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain
| | - Marc Miravitlles
- Department of Pneumology, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain
| | - Sabina Janciauskiene
- Clinic for Pneumology, German Center for Lung Research, Medical University Hannover, Hannover, Germany
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - William J Griffiths
- Department of Hepatology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Christian Trautwein
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network "Rare Liver" and the European Association for the Study of the Liver Registry Group "Alpha1-Liver," University Hospital Aachen, Aachen, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Pavel Strnad
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network "Rare Liver" and the European Association for the Study of the Liver Registry Group "Alpha1-Liver," University Hospital Aachen, Aachen, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
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Gaspar J, Gaspar R, Esteves T, Rua J, Alcoforado G, Mendes JJ. Implant placement in the nasopalatine canal for the rehabilitation of severely atrophic maxillae‐ case series with 1 to 5 years follow‐up. Clin Oral Implants Res 2019. [DOI: 10.1111/clr.83_13509] [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: 11/30/2022]
Affiliation(s)
- Joo Gaspar
- Instituto Universit rio Egas Moniz, Portugal
| | | | | | - Joo Rua
- Instituto Universit rio Egas Moniz, Portugal
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Affiliation(s)
- Rodrigo Liberal
- Department of Gastroenterology and Hepatology, Sao Joao Hospital, Porto, Portugal.
| | - Rui Gaspar
- Department of Gastroenterology and Hepatology, Sao Joao Hospital, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology and Hepatology, Sao Joao Hospital, Porto, Portugal
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Godinho C, Gaspar R. Editorial – Past and future strategic changes and reviewers’ acknowledgments. Psychol Community Health 2019. [DOI: 10.5964/pch.v7i1.318] [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: 11/20/2022] Open
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Abstract
Abstract. This research tested whether observing members of a dyad behave in synchrony influences observers’ expectations and intentions about that dyad. In four studies, participants observed a dyad move in synchrony and were asked to make inferences about them. Results suggest that interpersonal synchrony serves as a social cue, such that observers expect the members of the dyad to work well together. Moreover, synchrony makes observers more likely to want to affiliate with the dyad. These findings shed light on how the social function of synchrony extends beyond the people who experience it to those who observe it.
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Affiliation(s)
| | - André Mata
- Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Portugal
| | - Cláudia Simão
- CUBE – Católica Lisbon School of Business and Economics, Lisboa, Portugal
| | - Rui Gaspar
- Catolica Research Center for Psychological, Family and Social Wellbeing (CRC-W), Universidade Católica Portuguesa, Lisboa, Portugal
- Departamento de Psicologia e Ciências da Educação, Universidade do Algarve, Faro, Portugal
| | - Ana Rita Farias
- Catolica Research Center for Psychological, Family and Social Wellbeing (CRC-W), Universidade Católica Portuguesa, Lisboa, Portugal
- Center for Economics and Finance, Faculty of Economics, Universidade do Porto, Porto, Portugal
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Gaspar R, Santos-Antunes J, Marques M, Liberal R, Melo D, Pereira P, Lopes S, Macedo G. Mixed Adenoneuroendocrine Tumor of the Rectum in an Ulcerative Colitis Patient. GE Port J Gastroenterol 2019; 26:125-127. [PMID: 30976618 DOI: 10.1159/000489409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
Patients with inflammatory bowel disease present a higher risk of colorectal cancer, especially patients with a high degree of disease activity. Although rare, carcinoid tumors can also be associated with inflammatory bowel disease. Mixed adenoneuroendocrine tumor is defined as a neoplasm with dual differentiation (neuroendocrine and adenoma) with each component accounting for at least 30% of the tumor. We present a case of a mixed adenoneuroendocrine tumor in a patient with inflammatory bowel disease.
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Affiliation(s)
- Rui Gaspar
- aGastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Margarida Marques
- aGastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rodrigo Liberal
- aGastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Daniel Melo
- bDepartment of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Pedro Pereira
- bDepartment of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Susana Lopes
- aGastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- aGastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Ferreira A, Galvão S, Ventura I, Gaspar R, Rodrigues-Neves A, Matafome P, Ambrósio A, Gomes C, Baptista F. Antenatal Glucocorticoid impact in peripheral metabolism: gender-specific alterations in glycemia levels. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz034.028] [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: 11/14/2022] Open
Affiliation(s)
- A Ferreira
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - S Galvão
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - I Ventura
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - R Gaspar
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - A Rodrigues-Neves
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - P Matafome
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
| | - A Ambrósio
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - C Gomes
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Portugal
| | - F Baptista
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
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Ventura I, Ferreira A, Galvão S, Rodrigues-Neves A, Gaspar R, Fontes-Ribeiro C, Ambrósio A, Baptista F, Gomes C. Prenatal exposure to betamethasone delays vestibular system development comparing with dexamethasone. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz034.004] [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: 11/13/2022] Open
Affiliation(s)
- I Ventura
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - A Ferreira
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - S Galvão
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - A Rodrigues-Neves
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - R Gaspar
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - C Fontes-Ribeiro
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Portugal
| | - A Ambrósio
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - F Baptista
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - C Gomes
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Portugal
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Galvão S, Ferreira A, Ventura I, Gaspar R, Rodrigues-Neves A, Ambrósio A, Baptista F, Gomes C. Neurodevelopmental assessment may anticipate chronic anxiety states at adulthood in individuals prenatally exposed to glucocorticoids. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz034.045] [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: 11/13/2022] Open
Affiliation(s)
- S Galvão
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - A Ferreira
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - I Ventura
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - R Gaspar
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - A Rodrigues-Neves
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - A Ambrósio
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - F Baptista
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
| | - C Gomes
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal
- Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Portugal
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Gaspar R, Giger J. Emerging technologies, Emerging Risks: Current Approaches on the Future Risks of Human Enhancement Technologies. Hum Behav & Emerg Tech 2019. [DOI: 10.1002/hbe2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gaspar R, Andrade P, Macedo G. An unexpected guest? Gastrointest Endosc 2019; 89:438-439. [PMID: 30172654 DOI: 10.1016/j.gie.2018.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/27/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Patricia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Affiliation(s)
- Zheng Yan
- Department of Educational and Counseling Psychology, University at Albany Albany New York
| | - Rui Gaspar
- Universidade Católica Portuguesa, School of Human Sciences & Católica Research Centre for Psychological, Family and Social Wellbeing Lisbon Portugal
| | - Tingshao Zhu
- Computational Cyber‐Psychology Lab, Chinese Academy of Sciences Beijing China
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Moutinho-Ribeiro P, Iglesias-Garcia J, Gaspar R, Macedo G. Early pancreatic cancer - The role of endoscopic ultrasound with or without tissue acquisition in diagnosis and staging. Dig Liver Dis 2019; 51:4-9. [PMID: 30337098 DOI: 10.1016/j.dld.2018.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023]
Abstract
Pancreatic cancer (PC) is one of the deadliest cancers with a 5-year overall survival of less than 6%. Due to its insidious clinical course and unspecific symptoms, the diagnosis is usually late, with only 15-20% patients presenting with potentially curable disease. It is, therefore, extremely important to identify patients with PC at early stages of the disease when tumors may be amenable to surgical resection. For unresectable and borderline resectable PC it is consensual to perform a biopsy to have a cyto/histological confirmation of malignancy before treatment. However, for patients presenting with promptly resectable disease, the role of biopsy is more debatable. There are, in the literature, arguments both for and against the usefulness of a preoperative biopsy. Endoscopic ultrasound (EUS) is an important technique assisting in the diagnosis and staging of PC. EUS-guided tissue acquisition is a well-established tool to demonstrate the malignant nature of a pancreatic lesion. This review focuses on the role of EUS in the diagnosis and staging of PC, and highlights the controversy related to the role of EUS-guided tissue acquisition in the preoperative assessment of patients presenting with promptly resectable tumors (early PC).
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Affiliation(s)
- Pedro Moutinho-Ribeiro
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal.
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain
| | - Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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