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Monteiro S, Curate F, Garcia S, Cunha E. The Identification Potential of Atherosclerotic Calcifications in the Context of Forensic Anthropology. Biology (Basel) 2024; 13:66. [PMID: 38392285 PMCID: PMC10886313 DOI: 10.3390/biology13020066] [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: 12/23/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
Atherosclerosis is an inflammatory disease that, in its more developed stages, can lead to the calcification of fatty plaques on the walls of arteries, resulting in the appearance of new bone elements. It is a condition that has been studied and documented little in the context of paleopathology, especially in the framework of forensic anthropology. This article analyzed the skeletal remains of 71 individuals (35 females and 36 males) from the Luís Lopes Identified Collection of the National Museum of Natural History and Science in Lisbon, 31 of whom had an autopsy report. An attempt was made to ascertain whether these bone elements resulting from atherosclerotic calcification would resist cadaveric decomposition and whether they would be recoverable several years after burial, and a survey was carried out of their distribution according to sex and age, as well as their association with other pathologies, such as osteoporosis and cardiac and renal pathologies. An imaging analysis of an atherosclerotic plaque was also carried out to complement the macroscopic analysis and present other methods of identifying plaques. It was concluded that each atherosclerotic calcification has a unique profile, which can be useful for identification, especially in cases where the individual shows a severe condition. In terms of identification potential, the analysis of calcified atherosclerotic plaques can be useful, as they can corroborate or reject an identification. However, it always requires the existence of ante-mortem imaging exams and must always be used in addition to other identification methods. Regardless of the identification, these plaques are bone elements resulting from a pathology and should, therefore, be known and recognized by the scientific community.
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Affiliation(s)
- Sara Monteiro
- University of Coimbra, Centre for Functional Ecology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, 1150-334 Lisbon, Portugal
| | - Francisco Curate
- University of Coimbra, Research Centre for Anthropology and Health (CIAS), Department of Life Sciences, Faculty of Sciences and Technology, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
| | - Susana Garcia
- Centro de Administração e Políticas Públicas, Instituto Superior de Ciências Sociais e Políticas, Museu Nacional de História Natural e da Ciência, Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal
| | - Eugénia Cunha
- University of Coimbra, Centre for Functional Ecology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, 1150-334 Lisbon, Portugal
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Robalo A, Brandão J, Shibata T, Solo-Gabriele H, Santos R, Monteiro S. Detection of enteric viruses and SARS-CoV-2 in beach sand. Sci Total Environ 2023; 901:165836. [PMID: 37517729 DOI: 10.1016/j.scitotenv.2023.165836] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
Beach sand harbors a diverse group of microbial organisms that may be of public health concern. Nonetheless, little is known about the presence and distribution of viruses in beach sand. In this study, the first objective was to evaluate the presence of seven viruses (Aichi virus, enterovirus, hepatitis A virus, human adenovirus, norovirus, rotavirus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) in sands collected at public beaches. The second objective was to assess the spatial distribution of enteric viruses in beach sand. To that end, 27 beach sand samples from different beaches in Portugal were collected between November 2018 and August 2020 and analyzed for the presence of viruses. At seven beaches, samples were collected in the supratidal and intertidal zones. Results show that viruses were detected in 89 % (24/27) of the sand samples. Aichi virus was the most prevalent (74 %). Noroviruses were present in 19 % of the samples (norovirus GI - 15 %, norovirus GII - 4 %). Human adenovirus and enterovirus were detected in 48 % and 22 % of the samples, respectively. Hepatitis A virus and rotavirus were not detected. Similarly, SARS-CoV-2 in beach sand collected during the initial stages of the pandemic was also not detected. The detection of three or more viruses occurred in 15 % of the samples. Concentrations of viruses were as high as 7.2 log copies (cp)/g of sand. Enteric viruses were found in higher prevalence in sand collected from the supratidal zone compared to the intertidal zone. Human adenovirus was detected in 43 % of the supratidal and 14 % in the intertidal samples and Aichi virus in 57 % and 86 % of the intertidal and supratidal areas, respectively. Our findings suggest that beach sand can be a reservoir of enteric viruses, suggesting that it might be a vehicle for disease transmission, particularly for children, the elderly, and immunocompromised users.
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Affiliation(s)
- A Robalo
- Laboratorio Analises, Técnico Lisboa, Universidade Lisboa, Portugal
| | - J Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
| | - T Shibata
- Institute for the Study of the Environment, Sustainability, and Energy, Northern Illinois University, DeKalb, IL, USA; Center for Southeast Asian Studies, Northern Illinois University, DeKalb, IL, USA
| | - H Solo-Gabriele
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL, USA
| | - R Santos
- Laboratorio Analises, Técnico Lisboa, Universidade Lisboa, Portugal; Departamento de Engenharia e Ciências Nucleares, Técnico Lisboa, Universidade de Lisboa, Portugal
| | - S Monteiro
- Laboratorio Analises, Técnico Lisboa, Universidade Lisboa, Portugal; Departamento de Engenharia e Ciências Nucleares, Técnico Lisboa, Universidade de Lisboa, Portugal.
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Monteiro S, Capela M, Araújo AR, Tavares M, Pinto J. Recurrent Appendicitis in Children: The Impact of a Poorly Known Disease. Cureus 2023; 15:e46350. [PMID: 37920647 PMCID: PMC10618837 DOI: 10.7759/cureus.46350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/04/2023] Open
Abstract
Chronic and recurrent appendicitis is rare in pediatric patients and can be easily misdiagnosed due to its unusual presentation and low incidence rate. We present the case of an 11-year-old male with recurrent right lower quadrant (RLQ) pain persisting for 19 months. The patient experienced pain flare-ups accompanied by paleness and gait limp, without fever or other symptoms. Despite extensive medical examinations, including imaging and endoscopy, a definitive diagnosis remained elusive. As serial abdominal ultrasounds reported an appendix at the upper limit of the normal caliber and symptoms persisted despite medical therapy, a diagnostic laparoscopy was performed, revealing a congested ileocecal appendix with erosions and granulocytic inflammatory infiltrate, consistent with appendicitis. Post-appendectomy, the patient's symptoms resolved, significantly improving his quality of life (QoL), as evidenced by the DISABKIDS Chronic Generic Module (DCGM). This case underscores the challenges in diagnosing chronic and recurrent appendicitis, emphasizing the need for improved awareness, case definitions, and research to better understand and manage these conditions. Moreover, the report highlights the substantial impact of such conditions on patients' physical, social, and psychological well-being using the only health-related QoL instrument developed across cultures for children with chronic diseases: the DCGM.
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Affiliation(s)
- Sara Monteiro
- Paediatric Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Mariana Capela
- Paediatric Department, Hospital Lusíadas Porto, Porto, PRT
| | - Ana Rita Araújo
- Paediatric Allergology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Marta Tavares
- Paediatric Gastroenterology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João Pinto
- Paediatric Surgery Department, Hospital Escola da Universidade Fernando Pessoa, Porto, PRT
- Institute of Research, Innovation and Development, Fundação Fernando Pessoa (FP-I3ID), Porto, PRT
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, PRT
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Monteiro S, Teixeira B, Fraga C, Dias A, Cardoso AL, Meireles D, Sarmento A, Ferreira PR, Silva J, Garrido C, Gonçalves S. Acute Fulminant Cerebral Edema in a Child With Suspected Meningoencephalitis. Cureus 2023; 15:e45339. [PMID: 37849589 PMCID: PMC10577669 DOI: 10.7759/cureus.45339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Acute fulminant cerebral edema (AFCE) is a recently identified encephalitis type associated with significant morbimortality. Described as rare, limited data exists on its early detection and treatment. This paper describes a case of AFCE that progressed to unresponsive intracranial hypertension. A previously healthy four-year-old boy presented with fever, myalgias, and neurological symptoms. Diagnostic assessments showed cerebrospinal fluid abnormalities, and despite medical interventions, his condition deteriorated rapidly and developed severe cerebral edema and herniation within 24 hours. A decompressive craniectomy was attempted to decrease intracranial pressure, without success. This case emphasizes the urgency of early AFCE recognition and effective management strategies given its severe prognosis, aiming to improve understanding and spur further research.
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Affiliation(s)
- Sara Monteiro
- Paediatric Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Beatriz Teixeira
- Paediatric Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Carolina Fraga
- Paediatric Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Andreia Dias
- Paediatric Department, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, PRT
| | - Ana Lúcia Cardoso
- Paediatric Intensive Care Unit, Neonatology and Pediatrics Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Daniel Meireles
- Paediatric Intensive Care Unit, Neonatology and Pediatrics Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Alzira Sarmento
- Paediatric Intensive Care Unit, Neonatology and Pediatrics Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Paula Regina Ferreira
- Paediatric Intensive Care Unit, Neonatology and Pediatrics Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João Silva
- Neurosurgery Department, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Cristina Garrido
- Paediatric Neurology Unit, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Sara Gonçalves
- Paediatric Intensive Care Unit, Neonatology and Pediatrics Intensive Care Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Monteiro S, Barbosa L, Cardoso A, Machado L, Correia de Jesus M. Osteotomies around the knee are not correlated to substantial post-operative ankle pain. Knee Surg Sports Traumatol Arthrosc 2023; 31:3637-3645. [PMID: 34409552 DOI: 10.1007/s00167-021-06699-1] [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: 05/20/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The relationship between osteotomies around the knee and ankle alignment has been well established. However, little is known about the incidence of new-onset ankle pain after knee osteotomies in the setting of both varus and valgus lower limb malalignments. The purpose of this study is to determine the incidence and characteristics of ankle pain after knee osteotomies; and to clarify the relationship between knee alignment correction, coronal changes suffered by the ankle joint and the development of new-onset ankle pain. METHODS Fifty-four lower limbs in 51 consecutive patients, who underwent realignment osteotomies around the knee between April 2013 and October 2020, were retrospectively reviewed. Ultimately, 39 patients (42 knees) were enrolled: 34 had varus deformities and eight had valgus deformities. Ankle pain was assessed according to the Numerical Pain Rating Scale by telephonic interview. The magnitude of alignment correction and the consequent change of both knee and ankle joint lines were analyzed. Correlation between the former and the onset of post-operative ankle pain was evaluated. Patient satisfaction and complications were also noted. RESULTS The incidence of new-onset ankle pain after knee realignment osteotomy was 14%, at a mean follow-up of 55 ± 26 months (range 12-93 months). The mean time between osteotomy and onset of ankle pain was 21 ± 25 months (range 2-60 months). The degree of coronal correction was significantly correlated with ankle joint obliquity changes. However, a significant correlation with post-operative ankle pain was not found (p > 0.05). CONCLUSION Fourteen percent of the patients who underwent osteotomies around the knee developed new-onset persistent low-intensity ankle pain. The knee and ankle joint biomechanics are closely related, however, only a small percentage of patients suffer from low-intensity ankle pain which is successfully managed with occasional analgesics. Most osteotomies around the knee seem to require no particular concern for the ipsilateral ankle function.
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Affiliation(s)
- Sara Monteiro
- Department of Orthopaedics and Traumatology, Hospital do Divino Espírito Santo de Ponta Delgada, Avenida D. Manuel I, 9500-782, Ponta Delgada, São Miguel Island-Azores, Portugal.
| | - Luís Barbosa
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Afonso Cardoso
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Luís Machado
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
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Monteiro S, Dias J, Lourenço V, Partidário A, Lageiro M, Lampreia C, Fernandes J, Lidon F, Reboredo F, Alvarenga N. Development of a Functional Dark Chocolate with Baobab Pulp. Foods 2023; 12:foods12081711. [PMID: 37107506 PMCID: PMC10137990 DOI: 10.3390/foods12081711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
In recent years, cocoa and dark chocolate have attracted the interest of consumers not only for their sensory characteristics but also for their nutritional properties and positive impact on health. The baobab is a fruit of African origin with a sour and slightly sweet flavour, widely consumed by local communities due to its unique nutritional features. The aim of this work was to evaluate the impact of the concentration of baobab flour in the development of functional dark chocolate, including physical, chemical, nutritional and sensory evaluations. The results presented a positive correlation between the incorporation of baobab flour and the antioxidant activity (up to 2297 mmol TE/100 g), vitamin C content (up to 49.7 mg/100 g), calcium (up to 1052 mg/kg), potassium (up to 10,175 mg/kg), phosphorus (up to 795.9 mg/kg), chlorine (up to 235.4 mg/kg) and sulphur (up to 1158 mg/kg). The sensory evaluation of dark chocolate with 3% baobab presented the highest evaluation on the parameters "texture" and "overall flavour", while the parameter "overall flavour" presented the lowest evaluation on chocolate with 9% baobab. No influence was observed on fatty acid profile, protein, fat and hardness.
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Affiliation(s)
- Sara Monteiro
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - João Dias
- Instituto Politécnico de Beja, Escola Superior Agrária, Rua Pedro Soares, 7800-295 Beja, Portugal
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Vanda Lourenço
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- Center for Mathematics and Applications (NOVA Math), Department of Mathematics, NOVA SST, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Ana Partidário
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
| | - Manuela Lageiro
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
| | - Célia Lampreia
- Instituto Politécnico de Beja, Escola Superior Agrária, Rua Pedro Soares, 7800-295 Beja, Portugal
| | - Jaime Fernandes
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Fernando Lidon
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Fernando Reboredo
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Nuno Alvarenga
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
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Neves MC, Bártolo A, Prins JB, Sales CMD, Monteiro S. Taking Care of an Adolescent and Young Adult Cancer Survivor: A Systematic Review of the Impact of Cancer on Family Caregivers. Int J Environ Res Public Health 2023; 20:ijerph20085488. [PMID: 37107768 PMCID: PMC10138338 DOI: 10.3390/ijerph20085488] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Research usually investigates adolescents and young adults (AYA) with cancer in combination with younger and older cancer patients and survivors. However, AYAs with cancer are a unique group, and their caregivers' experience may also differ from other caregivers of cancer survivors. This systematic review aims to understand the impact of a cancer diagnosis on family caregivers, comparing the experience of caregivers of AYA childhood cancer survivors (AYA CCS) and caregivers of AYA with cancer. Relevant studies were identified through PubMed, Scopus, and Web of Science databases, and their quality was assessed using the Joanna Briggs Institute's critical appraisal checklists. Sixteen studies (17 reports) met the inclusion criteria. Findings were synthesized separately for caregivers of AYA CCS and caregivers of AYA with cancer. Results showed that caregivers in both groups experienced high distress after the diagnosis. Partners of AYAs with cancer experienced diminished quality of life (QoL) and over half reported moderate to high fear of cancer recurrence (FCR). Findings indicated that cancer negatively impacts family caregivers, regardless of the patient's age at diagnosis. However, findings are heterogeneous, and most do not focus on QoL or FCR. More research is needed on the impact of cancer among these family caregivers.
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Affiliation(s)
- Maria Carolina Neves
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
- Correspondence:
| | - Ana Bártolo
- I2P—Portucalense Institute of Psychology, 4200-072 Porto, Portugal
- RECI—Research in Education and Community Intervention, Piaget Institute—ISEIT/Viseu, 3515-776 Viseu, Portugal
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Judith B. Prins
- Department of Medical Psychology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Célia M. D. Sales
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
| | - Sara Monteiro
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- Departament of Social Sciences and Management, Open University, 1269-001 Lisboa, Portugal
- Center for Global Studies, Open University, 1269-001 Lisboa, Portugal
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Silva S, Bártolo A, Santos IM, Paiva D, Monteiro S. Validation of the Portuguese Version of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) in Portuguese Cancer Survivors. Healthcare (Basel) 2022; 10:healthcare10122466. [PMID: 36553990 PMCID: PMC9778322 DOI: 10.3390/healthcare10122466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
In 2020, around 60,000 people were diagnosed with cancer in Portugal, and many of them suffered some level of Fear of Progression (FoP) of the disease. Although this FoP is realistic, and is part of the normal and appropriate response to this type of disease, there is no instrument to assess and understand whether it is exaggerated in the face of the situation. The present study aimed to translate and validate the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for the Portuguese population. The sample consisted of 220 volunteers, aged 18 years or over and diagnosed with cancer for at least six months. Participants completed the FoP-Q-SF, the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C). The FoP-Q-SF demonstrated high internal reliability (α = 0.86) and the confirmatory factor analysis supported the one-dimensional structure of the FoP-Q-SF. Convergent validity was supported with significant positive correlations with psychological distress, especially anxiety (0.68). The FoP-Q-SF has been found to be a valid instrument to measure FoP in Portuguese cancer survivors.
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Affiliation(s)
- Sandra Silva
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- Correspondence: (S.S.); (S.M.)
| | - Ana Bártolo
- Center for Health Technology and Services Research (CINTESIS), Piaget Institute—ISEIT/Viseu, 3515-776 Viseu, Portugal
| | - Isabel M. Santos
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- William James Center for Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Débora Paiva
- Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Sara Monteiro
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- Department of Social Sciences and Management, University Aberta, 1269-001 Lisboa, Portugal
- Correspondence: (S.S.); (S.M.)
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Oliveira AF, Torres A, Teixeira RJ, Monteiro S, Pereira A, Santos IM. Perceived cognitive functioning in breast cancer patients treated with chemotherapy compared to matched healthy women: Evidence from a Portuguese study. Int J Nurs Pract 2022:e13119. [DOI: 10.1111/ijn.13119] [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: 10/22/2021] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ana F. Oliveira
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Ana Torres
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology University of Aveiro Aveiro Portugal
- Portuguese Red Cross School of Healthcare of the North Oliveira de Azeméis Portugal
| | - Ricardo J. Teixeira
- REACH—Clínica de Saúde Mental Porto Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC) Faculty of Psychology and Educational Sciences – University of Coimbra Coimbra Portugal
| | - Sara Monteiro
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Anabela Pereira
- Research Centre in Didactics and Technology in the Education of Trainers (CIDTFF), Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Isabel M. Santos
- William James Center for Research (WJCR), Department of Education and Psychology University of Aveiro Aveiro Portugal
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Baptista R, Monteiro P, Monteiro S, Goncalves F, Madeira M, Goncalves L. Comparing the long-term prognosis of myocardial infarction with non-obstructive coronary arteries to myocardial infarction with obstructive coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The long-term survival rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients is lower than in the general population. Nevertheless, there are conflicting results regarding the prognosis of MINOCA patients in comparison to myocardial infarction with obstructive coronary artery disease (MI-CAD) patients.
Purpose
The aim of this study was to assess the long-term all-cause mortality of MINOCA patients and compare it to MI-CAD patients.
Methods
Retrospective analysis of 2443 consecutively admitted patients for acute myocardial infarction (AMI), in a single coronary intensive care unit. Only patients with 5 years of follow-up and those who died before the 5-year mark were considered. Patients were divided into two groups according to the presence or absence of obstructive coronary artery disease on angiography (≥50% stenosis). Demographic characteristics, symptoms at presentation, past medical history, laboratory characteristics and medication at discharge were compared using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Five-year all-cause mortality was the target endpoint. Five-year survival was modelled through the Cox proportional hazard regression model. The variable of interest (MINOCA vs MI-CAD) and possible confounders that displayed statistically significant differences in the initial demographic analysis were included in univariable Cox regressions, and those with statistically significant associations were included in a multivariable model. Those that displayed non-significant associations in the multivariable model were subsequently removed until we were left with significant associations only, giving us an adjusted hazard ratio.
Results
Comparison between groups is presented in table 1. MINOCA patients were younger and more often women. They were less likely to have smoking habits, diabetes, or a previous history of AMI. They had a lower Killip class, as well as lower troponin I, serum creatinine and low-density lipoprotein cholesterol at admission. On the other hand, they had higher left ventricular ejection fractions. They were also less likely to have beta-blockers or aspirin prescribed at discharge.
All-cause mortality at 5 years was 13.1% among MINOCA patients and 28.3% among MI-CAD patients, with an unadjusted hazard ratio (HR) of 0.421 (95% CI 0.322–0.550), p<0.001. Adjusting for known confounders, the HR was 0.461 (95% CI 0.261–0.816), p=0.008.
Conclusions
Compared with MI-CAD patients, those with MINOCA were slightly younger and had fewer comorbidities. In spite of having a worse long-term prognosis when compared to the general population, MINOCA patients have a significantly higher 5-year survival rate than MI-CAD patients, even after adjustment of confounding factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - P Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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Ramalho D, Correia S, Realista R, Rocha G, Alves H, Almeida L, Ferreira E, Monteiro S, Oliveira MJ, Almeida MC. Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women. Acta Diabetol 2022; 59:1361-1368. [PMID: 35879479 DOI: 10.1007/s00592-022-01931-x] [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: 04/24/2022] [Accepted: 06/29/2022] [Indexed: 11/01/2022]
Abstract
AIMS To access the impact of increasing use of metformin on cesarean section and large for gestational age rates, when compared to insulin. METHODS A retrospective observational study was developed using data from the Portuguese National Registry, between 2011 and 2019, of 5038 Portuguese women with single pregnancies and gestational diabetes treated with metformin and/or insulin. Three groups were defined according to the therapeutic regimen adopted: g1-insulin in monotherapy (n = 3027[60.1%]); g2-metformin in monotherapy (n = 1366[27.1%]); g3-metformin and insulin (n = 645[12.8%]). Multivariate analysis was adjusted for statistically significant covariates. RESULTS The cesarean section rate in g1 was similar to g2 (g1:36.9% vs. g2:37%, p = 0.982), although g3 was associated with cesarean delivery (g3:43.6% vs. g1:36.9%, p = 0.005; g3:43.6% vs. g1:37.0%, p = 0.002), with no differences reported in the multivariate analysis adjusted for year of delivery and pregestational body mass index. A delivery of a large for gestational age newborn was less frequently observed in g2 than in g1 (g2:4.1% vs. g1:5.4%, p = 0.044) and in g3 (g2:4.1% vs. g3:9.1%, p < 0.001), and in g1, when compared to g3 (g1:5.4% vs. g3:9.1%, p < 0.001). In the multivariate analysis, g2 showed lower odds of delivering a large for gestational age newborn, compared to g1 (β = -0.511, OR = 0.596, CI95% = 0.428-0.832, p < 0.001). CONCLUSIONS The use of metformin was not associated with higher cesarean section rates, compared to insulin. Instead, it was suggested a protective role of metformin on large gestational age rates. The concomitant use of dual therapy suggests more complex pregnancies, requiring closer surveillance that mitigate serious perinatal and obstetrical outcomes.
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Affiliation(s)
- Diogo Ramalho
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal.
| | - Sara Correia
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Rodrigo Realista
- Obstetrics Department, Centro Hospitalar e Universitário de São João. Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Gustavo Rocha
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Helena Alves
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Lúcia Almeida
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Eva Ferreira
- Nutrition Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Sara Monteiro
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Maria João Oliveira
- Endocrinology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal
| | - Maria Céu Almeida
- Obstetrics Department, Maternidade Bissaya Barreto. Rua Augusta 36, 3000-045, Coimbra, Portugal
- Diabetes and Pregnancy Study Group of the Portuguese Society of Diabetology, Rua do Salitre 149, 1250-198, Lisbon, Portugal
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Monteiro S, Reboredo FH, Lageiro MM, Lourenço VM, Dias J, Lidon F, Abreu M, Martins APL, Alvarenga N. Nutritional Properties of Baobab Pulp from Different Angolan Origins. Plants 2022; 11:plants11172272. [PMID: 36079651 PMCID: PMC9460372 DOI: 10.3390/plants11172272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022]
Abstract
The baobab tree (Adansonia digitata L.) is found widely in the forests and savannas of sub-Saharan Africa. The baobab fruit has a sour and slightly sweet taste and is widely consumed by the natives, thus containing a high nutritional value and providing a source of income for rural people. This study aimed to compare the nutritional composition of baobab fruit pulp from different localities in the Namibe province (Angola). Twenty samples of baobab pulp were collected in markets of the four municipalities of Namibe. The results obtained showed that there is some geographic location dependence on nutritional and functional composition. The municipality of Camucuio showed samples with higher fibre content (56.62 g/100 g) and vitamin C (288.9 mg/100 g). Samples from the Virei municipality stood out for their antioxidant activity (1936 mmol TE/100 g), high K content (42.4 mg/g) and higher values of protein (2.42 g/100 g). The samples collected in the municipality of Bibala stood out for their high contents of carbohydrates (28.1 g/100 g), total phenolic compounds (972 mg GAE/100 g) and Ca (3.80 mg/g). Despite the differences in origin, the high nutritional value of baobab fruit has the potential to improve the diet of thousands of people in Africa qualitatively.
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Affiliation(s)
- Sara Monteiro
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Fernando H. Reboredo
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Maria Manuela Lageiro
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
| | - Vanda M. Lourenço
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- NOVA Math Research Center, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - João Dias
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- Instituto Politécnico de Beja, Rua Pedro Soares, 7800-295 Beja, Portugal
| | - Fernando Lidon
- Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
| | - Marta Abreu
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
- LEAF Research Center, ISA, Universidade de Lisboa, Tapada da Ajuda, 1349-017 Lisboa, Portugal
| | - António P. L. Martins
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
| | - Nuno Alvarenga
- GeoBioTec Research Center, Faculdade de Ciências e Tecnologia, Campus da Caparica, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal
- UTI, Instituto Nacional de Investigação Agrária e Veterinária IP, Quinta do Marquês, 2780-157 Oeiras, Portugal
- Correspondence:
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14
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Martinho A, Almeida J, Goncalves F, Monteiro S, Franco F, Goncalves L. Malnutrition: a mascaraed and underused prognostic marker in coronary patients. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Malnutrition had been associated with worse prognosis in heart failure (HF) patients, especially in elder. However, this association wasn’t demonstrated in coronary patients, after a ST-segment elevation myocardial infarction (STEMI). We want to evaluate the prognosis value of malnutrition, in elder patients, after a STEMI.
Methods
We conducted a retrospective, observational study of 200 elderly patients (365 years) consecutively admitted with STEMI between 2016 and 2017. At discharge, we applied a validated formula who evaluate nutritional status: "Prognostic Nutritional Index" (PNI), [10 x serum albumin at discharge (g/dL) + 0.005 x total lymphocytes at discharge], whose lowest values were associated with malnutrition. At 1 year follow-up, we evaluated the relation between PNI and major adverse cardiac events (MACE): myocardial infarction (MI), HF hospitalization, cardiovascular (CV) and all-cause death.
Results
Mean age was 74±8 years, 71% (n=149) were male and with multiples risks factors (75% hypertense, 63% with dyslipidemia, 33% diabetes and 11% smokers). At discharge, patients had a mean Left Ventricular Ejection Fraction (LVEF) of 47±8% and a mean PNI of 37±5. Low PNI values (malnutrition) were significant associated with MACE at 1-year [OR 0.87 (95% CI 0.78 to 0.97, p=0.01)], after adjusting for age, sex and LVEF. When evaluated individually, low PNI was associated with more incidence of 1-year HF hospitalization [OR 0.88 (95% CI 0.78 to 0.99, p=0.03)] and all-cause death [OR 0.84 (95% CI 0.75 to 0.95, p=0.004)], after adjusting for age, sex and LVEF, but not with MI and CV death.
Conclusion
Malnutrion associated with other comorbidities inherent to elderly people were associated with MACE, 1-year after STEMI, in this type of population. Thus, we want to draw attention to the importance of evaluating the nutritional status during hospitalization for STEMI, allowing to initiate measures that contribute to its improvement.
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Affiliation(s)
- A Martinho
- University Hospitals of Coimbra , Coimbra , Portugal
| | - J Almeida
- University Hospitals of Coimbra , Coimbra , Portugal
| | - F Goncalves
- University Hospitals of Coimbra , Coimbra , Portugal
| | - S Monteiro
- University Hospitals of Coimbra , Coimbra , Portugal
| | - F Franco
- University Hospitals of Coimbra , Coimbra , Portugal
| | - L Goncalves
- University Hospitals of Coimbra , Coimbra , Portugal
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Abstract
The current study examined whether an attentional bias exists for reproduction-related visual cues among breast cancer survivors and its relationship with fertility concerns and emotional distress. Breast cancer survivors (n = 38) aged 18-40 were compared to 37 healthy women recruited from the general population. Attentional bias was investigated using a visual dot-probe task and response times (RT) were measured. Participants also completed several questionnaires, including the Reproductive Concerns After Cancer Scale (RCACS) and the Hospital Anxiety and Depression Scale (HADS). Biased cognitive processing toward reproduction-related stimuli was observed for all young women. However, attentional bias was a significant predictor of concerns about partner disclosure of fertility status, with higher bias scores associated with higher levels of concern only for breast cancer survivors. The desire to have a (or another) biological child was also a significant predictor of higher concerns related with fertility potential for all young women. Higher vigilance regarding reproduction-related cues seems to lead to higher concerns among women with breast cancer history whose fertility is threatened. This result may have important research and clinical implications. Interventions focused on goal-oriented attention self-regulation and problem-solving can help to manage fertility concerns and distress in the course of the disease.
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Affiliation(s)
- Ana Bártolo
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Isabel M Santos
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Raquel Guimarães
- Breast Center, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Salomé Reis
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Monteiro
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Boal Carvalho P, Magalhães J, Dias de Castro F, Cúrdia Gonçalves T, Monteiro S, Xavier S, Rosa B, Cotter J. NSAIDs are not enough - a double blinded randomized controlled trial on the impact of intensive hydration for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Eur J Gastroenterol Hepatol 2022; 34:751-756. [PMID: 35412495 DOI: 10.1097/meg.0000000000002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Pancreatitis is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP). In patients receiving NSAID prophylaxis, we aimed to assess whether periprocedural intensive hydration (IH) resulted in a lower incidence of PEP when compared to standard hydration (SH). MATERIAL AND METHODS Prospective, single-center, double-blinded randomized controlled trial, with inclusion of consecutive patients submitted to inaugural ERCP between January 2015 and December 2018. Patients were randomized on admission, in a 1:1 ratio, to either SH-Ringer's Lactate (RL) at a rate of 1.5 mL/kg/h during and for 8 h following the procedure, or IH-RL at a rate of 3 mL/kg/h during and for 8 h following the procedure, with an additional bolus of 20 mL/kg at the end of the procedure. PEP incidence and severity were assessed according to the Atlanta Guidelines. RESULTS A total of 155 patients were randomized (83 to IH, 72 to SH). PEP was observed in 8,4% (n = 13) of the patients, and was significantly less frequent in IH patients when compared to SH (3,6% vs 13,9%, P = 0,021; relative risk 0.233 [95% IC, 0.061-0.881]); five patients in the SH group developed moderate to severe PEP, in contrast to 0 patients in the IH group (6.9% vs 0.0%, P = 0,020). CONCLUSIONS Intensive hydration significantly decreased the risk of post-ERCP pancreatitis by four-fold. Moreover, no cases of moderate or severe pancreatitis were observed in patients submitted to this intervention. Associated with nonsteroidal anti-inflammatory drugs, intensive hydration could constitute a new standard of care for patients undergoing ERCP.
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Affiliation(s)
- Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Joana Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Sara Monteiro
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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Monteiro S, Silva Gomes D, Moura N, Sarmento M, Cartucho A. Parsonage-Turner Syndrome Revisited: Four Case Reports and Literature Review. Gaz Med 2022. [DOI: 10.29315/gm.v1i1.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION: Parsonage-Turner syndrome is a rare disease characterized by acute and severe shoulder pain followed by upper extremity paralysis, that is severely underdiagnosed in clinical practice. The objective is to describe four illustrative clinical cases and provide a summary review of the topic.CASE REPORTS: Four patients (aged 56 to 84 years-old) diagnosed with Parsonage-Turner syndrome were followed up for functional recovery and patient satisfaction after conservative treatment. Despite presenting with typical sudden-onset pain in the shoulder region, followed by weakness in the shoulder/arm, all patients had delayed diagnosis. Only one patient reported a preceding viral infection, which is the most common trigger. Pain subsided after 3-8 days, but shoulder/arm weakness persisted. All patients recovered, totally or partially, with pain management and physical therapy. Recovery took 6-15 months and was monitored through clinical evaluation and electromyography. At last follow-up, all patients were satisfied.CONCLUSION: Parsonage-Turner syndrome has a higher incidence than previously assumed and is frequently underdiagnosed. It must be considered in the differential diagnosis of the painful shoulder, especially if muscle weakness is present. Despite being a self-limited condition, recovery is usually slow, and a prompt diagnosis is key for patient’s reassurance and starting adequate supportive treatment.
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Monteiro S, Gomes DS, Moura N, Sarmento M, Cartucho A. Sternoclavicular Septic Arthritis: Partial Resection is Still an Option - A Case Report. J Orthop Case Rep 2021; 11:34-38. [PMID: 35415114 PMCID: PMC8930333 DOI: 10.13107/jocr.2021.v11.i11.2506] [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] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Sternoclavicular joint (SCJ) infection is rare. Delayed diagnosis might lead to severe complications. Optimal surgical management is still under debate however extended resection of the joint requiring muscle flap coverage appears to be the favored approach nowadays in the cases with bony involvement. Case Presentation A 58-year-old man complained of isolated left shoulder and anterior chest pain for over a month. Careful examination revealed a mass over the SCJ. A Computed tomography scan confirmed joint effusion and adjacent bone erosion, with no retrosternal involvement, consistent with SCJ septic arthritis with significant bony involvement. Conclusion This case illustrates how a heightened index of suspicion is essential for diagnosis and prompt treatment, and how partial resection was effective and resulted in complete recovery of range of motion and pain resolution, despite bony involvement. There were no signs of recurrence 1 year after surgery.
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Affiliation(s)
- Sara Monteiro
- Department of Orthopedics and Traumatology, Hospital do Divino Espírito Santo, EPER, Ponta Delgada, Portugal,
Address of Correspondence: Dr. Sara Monteiro, Department of Orthopedics and Traumatology, Hospital do Divino Espírito Santo, EPER, Ponta Delgada, Portugal. E-mail:
| | - Diogo Silva Gomes
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
| | - Nuno Moura
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
| | - Marco Sarmento
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
| | - António Cartucho
- Department of Orthopedics, Shoulder and Elbow Unit, Orthopaedics Department-Hospital CUF Descobertas, Lisboa, Portugal
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Borges-Rosa J, Oliveira-Santos M, Simoes M, Carvalho P, Ibanez-Sanchez G, Fernandez-Llatas C, Costa M, Monteiro S, Goncalves L. The role of process mining tools in STEMI networks: where should we build a new primary PCI centre? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The “Centre” region of Portugal has heterogeneity in PCI assess due to geographical reasons.
Purpose
We aimed to explore time delays between regions using process mining (PM) tools.
Methods
We retrospectively assessed the Portuguese Registry of Acute Coronary Syndromes for patients with STEMI from October 2010 to September 2019, collecting information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We used a PM toolkit (PM4H – PMApp Version) to build two models (one national and one regional) that represent the flow of patients in a healthcare system, enhancing time differences between groups. One-way analysis of variance was employed for the global comparison of study variables between groups and post hoc analysis with Bonferroni correction was used for multiple comparisons.
Results
Overall, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model (Fig. 1A), in which primary PCI was the treatment of choice (73%), with the median time between admission and primary PCI <120 minutes in every region; “Lisboa” and “Centro” had the longest delays, (orange arrows). Fibrinolysis was performed in 4.5%, with a median time delay <1 hour in every region. In-hospital mortality was 5%, significantly higher for those without reperfusion therapy compared to PCI and fibrinolysis (10% vs. 4% vs. 4%, P<0.001). In the regional model (Fig. 1B) corresponding to the “Centre” region of Portugal divided by districts (n=773, 74% male, 47% from 51 to 70 years), only 61% had primary PCI, with “Guarda” (05:04) and “Castelo Branco” (06:50) showing significant longer delays between diagnosis and reperfusion treatment (orange and red arrows, respectively) than “Coimbra” (01:19) (green arrow); only 15% of patients from “Castelo Branco” had primary PCI. Fibrinolysis was chosen in 10% of patients, mostly in “Castelo Branco” (53%), followed by “Guarda” (30%), with a median time delay of 39 and 48 minutes, respectively. Regarding mortality, PCI and fibrinolysis groups had similar death rates while those patients without reperfusion had higher mortality (5% vs. 3% vs. 13%, P=0.001).
Conclusion
Process mining tools help to understand referencing networks visually, easily highlighting inefficiencies and potential needs for improvement. The “Centre” region of Portugal has lower rates and longer delay to primary PCI partially due to the geographical reasons, with worse outcomes in remote regions. The implementation of a new PCI centre in one of these districts, is critical to offer timely first-line treatment to their population.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
| | | | - M Simoes
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - P Carvalho
- Centre for Informatics and Systems of the University of Coimbra, Coimbra, Portugal
| | - G Ibanez-Sanchez
- Polytechnic University of Valencia, SABIEN-ITACA, Valencia, Spain
| | | | - M Costa
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Monteiro S, Ebdon J, Santos R, Taylor H. Elucidation of fecal inputs into the River Tagus catchment (Portugal) using source-specific mitochondrial DNA, HAdV, and phage markers. Sci Total Environ 2021; 783:147086. [PMID: 34088114 DOI: 10.1016/j.scitotenv.2021.147086] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
Determining the source of fecal contamination in a water body is important for the application of appropriate remediation measures. However, it has been suggested in the extant literature that this can best be achieved using a 'toolbox' of molecular- and culture-based methods. In response, this study deployed three indicators (Escherichia coli (EC), intestinal enterococci (IE) and somatic coliphages (SC)), one culture-dependent human marker (Bacteroides (GB-124) bacteriophage) and five culture-independent markers (human adenovirus (HAdV), human (HMMit), cattle (CWMit), pig (PGMit) and poultry (PLMit) mitochondrial DNA markers (mtDNA)) within the River Tagus catchment (n = 105). Water samples were collected monthly over a 13-month sampling campaign at four sites (impacted by significant specific human and non-human inputs and influenced by differing degrees of marine and freshwater mixing) to determine the dominant fecal inputs and assess geographical, temporal, and meteorological (precipitation, UV, temperature) fluctuations. Our results revealed that all sampling sites were not only highly impacted by fecal contamination but that this contamination originated from human and from a range of agricultural animal sources. HMMit was present in a higher percentage (83%) and concentration (4.20 log GC/100 mL) than HAdV (32%, 2.23 log GC/100 mL) and GB-124 bacteriophage with the latter being detected once. Animal mtDNA markers were detected, with CWMit found in 73% of samples with mean concentration of 3.74 log GC/100 mL. Correlation was found between concentrations of fecal indicators (EC, IE and SC), CWMit and season. Levels of CWMit were found to be related to physico-chemical parameters, such as temperature and UV radiation, possibly as a result of the increasing presence of livestock outside in warmer months. This study provides the first evaluation of such a source-associated 'toolbox' for monitoring surface water in Portugal, and the conclusions may inform future implementation of surveillance and remediation strategies for improving water quality.
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Affiliation(s)
- S Monteiro
- School of Environment and Technology, University of Brighton, Brighton, UK; Laboratorio Analises, Instituto Superior Tecnico, Lisbon, Portugal.
| | - J Ebdon
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - R Santos
- Laboratorio Analises, Instituto Superior Tecnico, Lisbon, Portugal
| | - H Taylor
- School of Environment and Technology, University of Brighton, Brighton, UK
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Monteiro S, Burling M, Doyle H. Late diagnosis of intraplacental choriocarcinoma co-existing with fetomaternal haemorrhage causing fetal demise: A case report. Case Rep Womens Health 2021; 31:e00341. [PMID: 34345596 PMCID: PMC8319208 DOI: 10.1016/j.crwh.2021.e00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Intraplacental choriocarcinoma (IC) is a rare disease, occurring in approximately 1 in 50,000 pregnancies. A 33-year-old woman, gravida 2 para 0, sustained an intrauterine fetal death due to fetomaternal haemorrhage (FMH) at 36 weeks of gestation after presenting with decreased fetal movements in the days prior. The placenta macroscopically appeared normal. However, histological examination revealed an intraplacental choriocarcinoma. Assessment of this woman's quantitative beta human chorionic gonadotropin (bHCG) level was negative and a computerized tomography scan of her chest, abdomen and pelvis revealed no metastatic disease yet a bulky uterus. After discussion at a multidisciplinary tumour board meeting, the patient had endometrial curettings to rule out any uterine pathology and serial bHCG tests until one year post-partum. Following this, the patient successfully carried and delivered a live female term infant. Although FMH is a rare clinical manifestation of IC it should always alert clinicians to investigate the cause further, through urgent and careful histopathological examination of the placenta. This will allow for appropriate management with chemotherapy if indicated and a reduction in maternal morbidity and mortality.
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Affiliation(s)
- S. Monteiro
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - M. Burling
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - H. Doyle
- Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
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22
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Borges-Rosa J, Campos GM, Martinho S, Almeida JL, Goncalves V, Ferreira C, Freitas AA, Milner J, Ferreira JA, Monteiro S, Goncalves F, Monteiro P, Baptista R, Oliveira-Santos M, Goncalves L. Myocardial infarction in young adults: are the risk profile and mortality outcomes different from older patients? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The incidence of acute myocardial infarction (AMI) among young patients is increasing. The YOUNG-MI Registry reported that those under 40 years had similar risk profiles and outcomes compared to those aged 41 to 50. We aimed to evaluate cardiovascular risk factors and mortality outcomes in two age cohorts from southern European.
Methods
We retrospectively evaluated 4758 patients admitted to our coronary intensive care unit between 2004 and 2017 with AMI. We only included patients <60 years in two subgroups: cohort A < 50 years and cohort B 50-60 years.
Results
From the 1233 patients included (mean age 50.5 ± 6.5 years, 82.2% male), 53% had STEMI. Cohort B had higher rates of hypertension (59.8 vs. 42.9%, p < 0.001), diabetes (41.8 vs. 28.9%, p < 0.001), and dyslipidemia (59.4 vs. 46.4%, p < 0.001), while cohort A had higher rates of familial premature coronary artery disease (20.9 vs. 13.2%, p < 0.001) and smoking habits (54.4 vs. 40.0%, p < 0.001). Regarding coronary angiography, cohort B had higher rates of obstructive disease in each epicardial artery, except for left main involvement and non-obstructive disease (Fig. 1). Cohort A had lower all-cause mortality rates at the index hospitalization (1.3 vs. 3.2%, p = 0.045), 6-months (2.9 vs.5.4, p = 0.038), 1-year (3.1 vs. 6.3%, p = 0.014), and 3-years (3.6 vs 8.4, p = 0.001). After multivariable adjustment, we found no relationship between age cohorts and all-cause mortality for any follow-up timing: HR 1.57 (95% CI 0.56-4.37), 1.37 (95% CI 0.50-3.74), and 0.92 (95% CI 0.35-2.39) at 6-months, 1-year, and 3-years, respectively.
Conclusion
Among patients who suffer AMI, those under 50 years old have a different risk profile, compared to the 50-60 years cohort. However, there is no significant difference in all-cause mortality.
Abstract Figure.
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Affiliation(s)
| | - GM Campos
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Martinho
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JL Almeida
- University Hospitals of Coimbra, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - AA Freitas
- University Hospitals of Coimbra, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JA Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - F Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - P Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Bártolo A, Santos IM, Guimarães R, Reis S, Monteiro S. Reproduction-related cognitive processing and distress among young adult women: the role of personal breast cancer history. Cogn Process 2021; 22:569-578. [PMID: 33797684 DOI: 10.1007/s10339-021-01026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
Breast cancer diagnosis can threaten fertility and biological motherhood in women of reproductive age due to the gonadotoxic effects of treatments. Much evidence documents these women fertility-related concerns and distress, but no study has attempted to understand how implicit cognitive processes can contribute to this maladjustment. In this research, we explored whether reproduction-related stimuli interfere with cognition among cancer survivors with infertility risk using an emotional Stroop task. Furthermore, we investigated the relationship between reproduction-related cognitive processing and psychological morbidity. Young cancer survivors aged 18-40 years who received anticancer treatments and an age-matched non-cancer control group without known fertility problems were compared. Color-naming times and error rates were assessed. Participants in both groups were slower naming the color of reproduction-related words in comparison to unrelated negative valence words. Although in the same direction, this difference did not reach statistical significance for positive and neutral unrelated word lists. Further analysis suggested that biased attention toward reproduction-related information was associated with higher depression levels in young women with personal breast cancer history, but not in healthy women. These findings suggest that biased processing of reproduction-related cues might be a vulnerability factor after a breast cancer diagnosis. Additionally, this study puts in evidence the potential usefulness of using experimental tasks to investigate attentional bias in a context where fertility is at risk.
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Affiliation(s)
- Ana Bártolo
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
| | - Isabel M Santos
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Raquel Guimarães
- Breast Center, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Salomé Reis
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Monteiro
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
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Nguyen A, Frobert L, Ismailaj A, Monteiro S, Favrod J. Qu’est-ce que les professionnels dévoilent d’eux-mêmes dans la relation thérapeutique avec les personnes atteintes de schizophrénie ? PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Torres A, Santos I, Rosa C, Monteiro S, Rodrigues F, Figueiredo A, Santos T, Ribeiro O, Queirós A, Pereira A, Silva C. Integrated efforts to promote mental health care during the SARS-CoV-2 pandemic: Reflecting on the experience of a university helpline. Eur Psychiatry 2021. [PMCID: PMC9528517 DOI: 10.1192/j.eurpsy.2021.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The SARS-CoV-2 pandemic is affecting numerous dimensions of our society since the beginning of the outbreak. A significant increase in emotional distress was expected in the general population, particularly among the high-risk groups such as the oldest, chronic patients, healthcare professionals, and psychopathology vulnerable people. There was an urgent need to adapt and create solutions to promote mental health. Given the recommendations to minimize face-to-face interactions, several helplines were widely developed. Objectives In this work, we aim to reflect on the experience of a university helpline, that integrated efforts with the regional mental health care services. Methods
A University helpline was created to give support to the regional community outside academia. The team was created on an online teamwork platform, to communicate through the chat, carry videoconference meetings, and store useful files. A Manchester screening decision tree was adopted, to define a set of guidelines to provide support to the callers, based mainly on the guidelines defined by the Order of Portuguese Psychologists. Liaison with the mental health care services, including other specific helplines, was established. Results Notwithstanding all the efforts, the number of received calls was scarce, similarly to helplines created by other national universities and by other entities. Conclusions A new approach to psychological intervention in crisis is needed, maintaining integrated efforts, and taking advantage of the opportunity to foster personalized mental health care in the digital era. It is important to continuously assess the value of integrated efforts in patient care and to the healthcare system.
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Pereira MDG, Pereira M, Vilaça M, Ferreira G, Faria S, Monteiro S, Bacalhau R. Validation of the Short-Form Survivor Unmet Needs Survey in older patients with myeloma. Psychogeriatrics 2021; 21:185-192. [PMID: 33465832 DOI: 10.1111/psyg.12653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/13/2020] [Accepted: 12/24/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Multiple myeloma (MM) affects mainly the older population and is the second most prevalent haematologic cancer. MM patients' unmet needs are diverse, arise at different stages, and are associated with greater psychological distress. This study examined the psychometric properties of the Short-Form Survivor Unmet Needs Survey (SF-SUNS) in Portuguese MM patients. METHODS This cross-sectional study included 213 MM patients. The internal consistency of the scale was analyzed with Cronbach's α. Principal component analysis and confirmatory factor analysis were used to assess construct validity. Convergent validity was examined by using correlations with quality of life, satisfaction with social support, and psychological morbidity. Multiple regression analyses were conducted to explore the contribution of sociodemographic and clinical variables to unmet needs. RESULTS The Portuguese SF-SUNS's factor structure follows the original's structure, although it includes fewer items. For each domain, Cronbach's α was ≤0.70, the minimum acceptable criterion. For construct validity, only unmet relationship and emotional needs had significant correlations (r ≥ 0.40)-specifically negative associations with quality of life and social support and positive associations with psychological morbidity. Regarding patient variables and SF-SUNS results, only cancer stage contributed significantly to unmet information needs, with patients at stage I reporting more needs than patients at stage III. CONCLUSIONS The SF-SUNS represents a valid and reliable tool to assess unmet needs among Portuguese MM patients. It may be useful in designing and monitoring interventions to improve well-being in cancer survivors.
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Affiliation(s)
- Maria da Graça Pereira
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Marta Pereira
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Margarida Vilaça
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Gabriela Ferreira
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Sara Faria
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Sara Monteiro
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - Rosário Bacalhau
- Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal
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Ferreira J, Goncalves V, Marques P, Martins R, Monteiro S, Teixeira R, Goncalves L. Left atrial functional assessment and mortality in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe. Both symptoms and systolic dysfunction can appear late in the course of the disease, being often synonym of irreversible damage to the myocardium when found. Thus, there is a necessity to find other sensitive markers present at an earlier stage of the disease.
Purpose
Our primary aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up.
Methods
We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated all 3 left atrial (LA) functional phases (reservoir, conduit and pump) by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and own patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up.
Results
After exclusion criteria, a total of 451 patients were included in the analysis (aged 74 ±11years, 54% male) and were followed during a median period of 73 months (interquartile range 44.5). A total of 55.8% of patients underwent AVR and 45,5% of patients registered the primary outcome. Left atrial emptying fraction (LAEF) was the best LA functional parameter in discriminating primary outcome (AUC 0.840, p < 0.001), even when compared to left ventricular ejection fraction, aortic valve area, aortic mean pressure gradient and aortic Vmax. Patients in the lower tercile of LAEF were older, had greater comorbidities, had greater AS severity, with greater degree of diastolic disfunction. After adjustment for clinical and demographic variables, cumulative survival of patients with LAEF <37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (adjusted HR 19.04, 95% CI 8.30-43.67, P < 0.001 and adjusted HR 4.09, 95% CI 1.85-9.06, P = 0.001). Survival was also higher in patients with LAEF 37 to 53% when compared to patients with LAEF <37% (adjusted HR 0.22, 95% CI 0.13-0.37, P < 0.001). All associations remained true after adjustment for AVR (LAEF <37% versus LAEF 37 to 53% and LAEF ≥54%, respectively, adjusted HR 3.97, 95% CI 1.80-8.78, P = 0.001 and adjusted HR 13.95, 95% CI 5.98-32.54, P < 0.001, respectively)
Conclusion(s) In patients with a first diagnosis of severe AS in hospital setting, LA function assessed by volumetric parameters is an independent predictor of all-cause mortality. Compared to classical severity parameters, different LA functional parameters were found to be more potent predictors of death. These data can be useful in clinical practice for risk stratification and therefore for decision of timing for AVR.
Abstract Figure. Survival of patients stratified by group
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Affiliation(s)
- J Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Marques
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Martins
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Machado C, Monteiro S, Barbosa M, Oliveira MJ. Síndrome de Cushing ACTH-dependiente durante el embarazo tratado con metirapona. Gal Clin 2021. [DOI: 10.22546/60/2055] [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: 11/22/2022] Open
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: 10.1177/2048872619883997] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: mj claeys, f roubille, g casella, r zukermann, n nikolaou, l de luca, m gierlotka, z iakobishvili, h thiele, m koutouzis, a sionis, s monteiro, c beauloye, c held, d tint, i zakke, p serpytis, z babic, j belohlavev, a magdy, m sivagowry rasalingam, k daly, d arroyo, m vavlukis, n radovanovic, e trendafilova, t marandi, c hassenger, m lettino, s price, e bonnefoy, organization of intensive cardiac care units in europe: results of a multinational survey, european heart journal.acute cardiovascular care, volume 9, issue 8, 1 december 2020, pages 993–1001, https:/doi.org/10.1177/2048872619883997] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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Ferreira J, Martins R, Goncalves V, Freitas A, Almeida J, Monteiro S, Goncalves L. Epicardial fat tissue: a new tool for identification of coronary artery disease patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Epicardial fat (EF), the true visceral fat depot of the heart, has been strongly correlated with both coronary artery disease (CAD) incidence and severity. However, the methods for its measurement were not always affordable. Its measurement by echocardiography is fast, accessible and easily reproducible, turning it into a promising clinical tool for assessing cardiovascular risk to predict the incidence of CAD.
Purpose
To determine the correlation between EF tissue dimensions measured by transthoracic echocardiography and the presence of CAD.
Methods
We prospectively analysed data from 196 consecutive patients admitted for acute coronary syndrome in our coronary care unit. All patients underwent diagnostic coronary angiography and echocardiogram during stay. EF dimensions were obtained with transthoracic echocardiography by measuring maximum EF diameter (mm) at the basal right ventricular free wall (PLAXB) level and mid-right ventricular free wall (PLAXM) level [in paraesternal long-axis view (PLAX)] and maximum right-ventricle free wall EF diameter at basal (PSAXB) level and papillary-muscle (PSAXM) level [in paraesternal short-axis view (PSAX)]. All measures were taken at end-systole. Patients were divided in 2 groups according to the presence of significant CAD (sCAD) or not (nCAD), defined as having at least 1 diseased epicardial vessel with a stenosis >50%.
Results
One-hundred and sixty-three (83.2%) had significant CAD. 22 patients (11.2%) were admitted for unstable angina, 60 patients (30.6%) for non-ST elevation myocardial infarction and 93 patients (47,4%) for ST-elevation myocardial infarction. Mean EF diameters were as follows: PLAXB (19,3±5.1 mm), PLAXM (11.3±2.6), PSAXB (10,6±2.8), PSAXM (10.5±2.8). We found a direct correlation between number of diseased epicardial coronary vessels and epicardial fat thickness in PLAXB (r=0.506, p<0.001), PLAXM (r=0.372, p<0.001), PSAXB (r=0.445, p<0.001) and PSAXM (r=0.372, p<0.001). EF was significantly different between groups: PLAXB (20,6±4.4 vs. 13.8±3,8, p<0.001), PLAXM (11.8±2.5 vs. 9.0±1.9, p<0.001), PSAXB (11.1±2.7 vs. 8.3±2.3, p<0.001) and PSAXM (11.0±2.6 vs. 8.2±4, p<0.001). Receiver operating characteristic curve analysis showed that the predictive value of mean right ventricular EF [(PLAXB+PSAXB)/2] for significant CAD was 0.895 (AUC=0.895, CI 95% 0.818–0,972, p<0.001). For a [(PLAXB+PLAXM)/2] value of 12.57 mm, sensitivity was 86.3% and specificity was 79.3%.
Conclusions
In a population of high suspicion of acute coronary syndromes, echocardiographic EF is a sensitive and specific marker of the presence of significant coronary disease and could become an important tool for coronary risk prediction.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Martins
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Freitas
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Almeida
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Ferreira C, Baptista R, Ribeiro A, Freitas A, Ferreira J, Milner J, Martinho A, Almeida J, Goncalves V, Campos G, Rosa J, Goncalves F, Monteiro S, Monteiro P, Goncalves L. Inequalities after STEMI in National Health Service: is there really a postcode lottery? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Failure to address the impact of social determinants of health attenuates efficacy of proven prevention recommendations, namely because important considerations related to socioeconomic disadvantage are not captured by existing cardiovascular disease (CDV) risk stratification methods. We aimed to assess how socioeconomic determinants influence recurrent MI and all-cause death after myocardial infarction (MI) in Portugal.
Methods
We conducted a retrospective, observational cohort study, including all patients with a ST-elevation MI (STEMI) admitted to and discharged alive from an intensive cardiac care unit between 2004 and 2017 (n=1809). The median (interquartile range) follow-up was 6 (4–9) years. We used survival models to assess the relationship between their municipal (i) income by purchasing power per capita (PPC), (ii) geographical accessibility to health care, (iii) illiteracy, iv) residential socioeconomic deprivation and recurrent MI and all-cause mortality. To assess residential socioeconomic deprivation, each individual's residential postcode was matched to the recently validated Portuguese version of European Deprivation Index (EDI). The index was categorized into quintiles (Q1-least deprived to Q5-most deprived).
Results
The mean age was 64±14 years; 74% were male. Regarding individual socioeconomic variables, PPC (HR 1.19; 95% CI 0.97–1.47 for Tertile 1 vs Tertile 2; HR 1.28; 95% CI 1.04–1.56 for Tertile 1 vs Tertile 3 and HR 1.07; 95% CI 0.85–1.34 for Tertile 2 vs Tertile 3) and medical appointments in primary health centers per inhabitant (HR 0.90; 95% CI 0.75–1.09 for Tertile 1 vs Tertile 2; HR 1.23; 95% CI 0.95–1.61 for Tertile 1 vs Tertile 3 and HR 1.37; 95% CI 1.06–1.76 for Tertile 2 vs Tertile 3) were predictors of all-cause mortality, but not recurrent MI; however, in multivariate analysis adjusted for sex, age and ejection fraction, this association was no longer significant (HR 1.00; 95% CI 0.99–1.00 and, HR 1.00; 95% CI 0.89–1.17, respectively). Additionally, no evident association between illiteracy and all-cause mortality or MI was present. Concerning EDI, demographic data was similar among the quintiles (Table 1). Although EDI quintiles were not associated with all-cause mortality (HR 1.17; 95% CI 0.82–1.66 for Q5 vs Q1), the EDI was an independent predictor of recurrent MI (Figure 1). On multivariate analysis, adjusted for age, sex, hypertension, diabetes and LDL cholesterol, the HR for the most deprived (Q5) to the least deprived (Q1) quintile was 1.91 (95% CI 1.05–3.49) for MI.
Conclusions
Our study shows clear socioeconomic differentials in cardiovascular outcomes in patients with STEMI which suggests that accounting for socioeconomic deprivation might improve risk prediction and therefore disease prognosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A.I Ribeiro
- University of Porto, Public Health Institute, Porto, Portugal
| | - A Freitas
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J.A Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Martinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J.P Almeida
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - G Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Rosa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - F Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Monteiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Borges-Rosa J, Ferreira J, Oliveira-Santos M, Monteiro S, Goncalves F, Monteiro P, Baptista R, Goncalves L. A real world analysis of NSTE-ACS in more than 4000 patients: accuracy of GRACE and TIMI scores in mortality prediction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
The TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) risk scores identify high-risk patients with Non-ST elevation acute coronary syndrome (NSTE-ACS) who can benefit from an early invasive strategy.
Purpose
We aimed to compare both scores predictive accuracy for mortality in a real-world cohort of patients presenting with NSTE-ACS.
Methods
We retrospectively evaluated 4264 patients admitted to our coronary intensive care unit between 2004 and 2017 with a diagnosis of NSTE-ACS. The TIMI and GRACE scores were calculated for each patient, and all-cause mortality was recorded during hospitalization, at one month and one year. To better characterize global troponin release, we defined Total Troponin (TT) as the sum of initial and discharge troponin. We used the area under the receiver operating characteristic curve (AUC) to compare the predictive value of both scores for mortality during hospitalization, at one month and one year.
Results
Mean patient age was 67.6±12.4 years and 66.4% were male (n=2833). Mean GRACE score was 124.6±35.8 and mean TIMI score was 2.7±1.6. There was a weak correlation between GRACE and TIMI score (r=0.3, p<0.001). In-hospital mortality was 2.8%: the GRACE score showed higher AUC (0.845, 95% CI 0.805–0.804, p<0.001) compared to TIMI (0.581, 95% CI 0.519–0.643, p=0.009) (Figure 1). Mortality at one month was 5.1%: the GRACE score showed higher AUC (0.842, 95% CI 0.814–0.869, p<0.001) compared to TIMI (0.586, 95% CI 0.541–0.630, p<0.001). Mortality at one year was 11.4%: the GRACE score showed higher AUC (0.811, 95% CI 0.789–0.822, p<0.001) compared to TIMI (0.591, 95% CI 0.560–0.622, p<0.001) (Fig. 1). Analyzing Unstable Angina and Non-ST segment elevation myocardial infarction separately, the GRACE score also showed higher AUC compared to TIMI. Exploratory analyses revealed a combined indicator (GRACE score + TT) which had higher AUC (0.876, 95% CI 0.844–0.907, p<0.001) compared to GRACE score (0.855, 95% CI 0.823–0.887, p<0.001) for one month mortality and for one year mortality (0.818, 95% CI 0.792–0.844, p<0.001 vs. 0.813, 95% CI 0.788–0.839, p<0.001).
Conclusion
In patients with NSTE-ACS, GRACE risk score is a better predictor of in-hospital, one month and one-year mortality, compared to TIMI risk score. TT, as a measure of ischemia burden, might improve accuracy of GRACE score in predicting short and long-term mortality.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - J Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - F Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - P Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Borges-Rosa J, Oliveira-Santos M, Simoes M, Teixeira C, Ibanez-Sanchez G, Fernandez-Llatas C, Monteiro S, Carvalho P, Goncalves L. Process mining tools: where should we build another PCI centre to reduce STEMI mortality? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The expected delay of transport between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy in ST-segment elevation myocardial infarction (STEMI). The central region of Portugal has heterogeneity in PCI assess due to geographical reasons. However, this data is usually presented numerically without providing a visual distribution of patients.
Purpose
We aimed to analyse the impact of distance to PCI centres on mortality in patients with STEMI through visual maps of patients' flow by using an experimental process mining tool, integrated in EIT Health's project PATHWAYS.
Methods
Using the Portuguese Registry of Acute Coronary Syndromes (ProACS), we retrospectively assessed patients with an established diagnosis of STEMI, geographical presentation specified, reperfusion option identified (PCI, fibrinolysis or no reperfusion), short-term outcomes defined as discharge or in-hospital death. With the 2 317 patients that fulfilled the criteria, we used a process mining tool to build national and regional models that represent the flow of patients in a healthcare system, enhancing differences between groups.
Results
Colour gradient in nodes and arrows changes from green to red, with green representing a lower number of patients as opposed to red. In the national model, most patients from all regions had PCI. Mortality was similar between PCI and fibrinolysis groups (4%) but higher in those without reperfusion (9%). In the central region model, one third of the patients were more than 120 minutes away from a PCI centre. Despite that, almost one third of these patients had PCI instead of fibrinolysis. In this model, fibrinolytic therapy had higher in-hospital survival rate than PCI (98% vs. 94%). Overall mortality was higher in the central model compared with the national model (6.92% vs. 5%). Central region had less PCI (53% vs. 73%), more fibrinolysis (15% vs. 7%) and more patients with no reperfusion (32% vs. 20%).
Conclusion
In the ProACS registry, mortality was higher in the central region compared with national data. Even though global interpretation of these findings is limited by underrepresentation from certain central areas, process mining offers an easily understandable view of patients flow. With its statistical upgrade and continuous development, this tool will facilitate the analysis of big data and comparison between groups.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): EIT Health
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Affiliation(s)
| | | | - M Simoes
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - C Teixeira
- Centre for Informatics and Systems of the University of Coimbra, Coimbra, Portugal
| | | | | | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - P Carvalho
- University of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Sousa J, Lopes P, Azevedo P, Baptista R, Gavina C, Monteiro S. Parenteral anticoagulation in non-ST segment elevation acute coronary syndromes: which option to pick? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
According to the 2015 European Society of Cardiology's non-ST segment elevation acute coronary syndrome (NSTE-ACS) clinical practice guideline, fondaparinux is the parenteral anticoagulant with the most favorable efficacy/safety profile. Thus, it is recommended over enoxaparin, for instance, in that setting. However, its use and performance in a contemporary portuguese cohort has not been fully described.
Purpose
To assess fondaparinux utilization degree and to compare its in-hospital efficacy and safety profiles with those of enoxaparin, in a contemporary portuguese cohort of NSTE-ACS patients.
Methods
Patients consecutively admitted with NSTE-ACS, between October 2010 and January 2019, were retrospectively identified from a national registry of acute coronary syndromes and were further divided in two groups, as per parenteral anticoagulation strategy (fondaparinux vs. enoxaparin). Key exclusion criteria were specific contraindications to both agents, recent hemorrhagic stroke and indications for anticoagulation other than ACS. The primary efficacy endpoint was a composite of in-hospital reinfarction and mortality, whereas the primary safety endpoint was moderate-to-severe bleeding, as defined by the GUSTO criteria.
Results
A total of 5843 NSTE-ACS patients (mean age 65±13 years, 72.4% males) were included. Of these, 89.2% had a myocardial infarction, while the remaining 10.8% were diagnosed with unstable angina. The most frequent cardiovascular comorbidities were hypertension (71.3%), dyslipidemia (63.0%) and diabetes mellitus (31.7%). Fondaparinux was the anticoagulant of choice in 27.5% of patients, whereas the remainder were treated with enoxaparin. Compared with patients receiving enoxaparin, those in the fondaparinux group were younger, had less hypertension or diabetes mellitus and exhibited a less severe presentation; nonetheless, they had more often a previous history of coronary artery disease or hemorrhagic events. An invasive approach in terms of revascularization was adopted in 87.7% of the cohort (79.1% in the fondaparinux group vs. 90.9% in the enoxaparin group, p<0.001). The primary efficacy and safety endpoints occurred in 2.4% and 4.7% of patients, respectively. After adjustment for relevant covariates, the use of fondaparinux was independently associated with a lower rate of both the primary efficacy (OR 0.56 [0.32–0.95], p=0.034) and the primary safety endpoints (OR 0.37 [0.23–0.59], p<0.001).
Conclusion
In a contemporary portuguese cohort of NSTE-ACS patients, fondaparinux was underused but still independently associated with a lower risk of both a composite of in-hospital reinfarction or mortality event and major hemorrhage.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - P Lopes
- Centro Hospitalar de Lisboa Ocidental, Cardiology, Lisbon, Portugal
| | - P Azevedo
- Algarve University Hospital Center, Cardiology, Faro, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Gavina
- Hospital Pedro Hispano, Medicine, Matosinhos, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
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Pessoa Amorim G, Santos-Ferreira D, Azul Freitas A, Santos H, Belo A, Gavina C, Terenas Baptista R, Monteiro S. An invasive strategy is associated with improved short- and long-term outcomes in acute myocardial infarction independently of frailty status and GRACE score: a nationwide analysis of 12144 episodes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures.
Purpose
To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario.
Methods
We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI >25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine >2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (>3 cardiovascular drugs), admission haemoglobin <10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI>0.25 (i.e. ≥6 features).
Results
Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p<0.001). Delayed angiography (>72h) was more common among NSTEMI frail patients (p<0.001), and radial access was less commonly used overall (p<0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p<0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p<0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p<0.05), their 1-year prognostic benefit remained unaffected (Wald test p>0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p<0.001).
Conclusion
Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients.
Invasive strategy and 1-year outcomes
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology
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Affiliation(s)
- G Pessoa Amorim
- Faculty of Medicine University of Porto, Cardiovascular R&D Unit - Department of Surgery and Physiology, Porto, Portugal
| | - D Santos-Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - A Azul Freitas
- University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology Department, Barreiro, Portugal
| | - A Belo
- Centro Nacional de ColeÇõÇœo de Dados, Coimbra, Portugal
| | - C Gavina
- Hospital Pedro Hispano, Cardiology Department, Matosinhos, Portugal
| | - R Terenas Baptista
- University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Cardiology Department, Coimbra, Portugal
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Abstract
Objectives: This study aimed to assess the relationship between sociodemographic, clinical, and psychological variables with quality of life (QoL) and the moderating role of caregivers' age and caregiving duration in caregivers of patients with Multiple Myeloma.Method: The sample included 118 caregivers who completed questionnaires that assessed psychological morbidity, satisfaction with social support, coping, burden, unmet needs, and QoL.Results: High psychological morbidity, burden and information, financial and emotional unmet needs were associated with lower QoL, while higher satisfaction with social support and more effective use of coping strategies were associated with better QoL. Women caregivers reported more satisfaction with social support and those who did not choose to care reported greater financial unmet needs and more use of coping strategies. The relationship between caregivers' psychological morbidity/social support and QoL was mediated by emotional needs and double mediated by coping and burden. The caregivers' age moderated the relationship between psychological morbidity/social support and emotional needs.Conclusion: Interventions to support the caregiver's emotional needs to promote their QoL are needed. These should be particularly tailored for older caregivers reporting greater psychological morbidity and younger caregivers less satisfied with their social support, as they have a negative indirect impact on their QoL.
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Affiliation(s)
- M Graça Pereira
- School of Psychology, University of Minho, Braga, Portugal.,Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Margarida Vilaça
- School of Psychology, University of Minho, Braga, Portugal.,Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Marisa Pinheiro
- School of Psychology, University of Minho, Braga, Portugal.,Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Gabriela Ferreira
- School of Psychology, University of Minho, Braga, Portugal.,Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Marta Pereira
- School of Psychology, University of Minho, Braga, Portugal.,Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Sara Faria
- School of Psychology, University of Minho, Braga, Portugal.,Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Sara Monteiro
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.,Center for Health Technologies and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - Rosário Bacalhau
- School of Psychology, University of Minho, Braga, Portugal.,Portuguese Institute of Oncology Francisco Gentil, Lisboa, Portugal
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Sarda-Estève R, Baisnée D, Guinot B, Mainelis G, Sodeau J, O’Connor D, Besancenot JP, Thibaudon M, Monteiro S, Petit JE, Gros V. Atmospheric Biodetection Part I: Study of Airborne Bacterial Concentrations from January 2018 to May 2020 at Saclay, France. Int J Environ Res Public Health 2020; 17:ijerph17176292. [PMID: 32872373 PMCID: PMC7504533 DOI: 10.3390/ijerph17176292] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
Background: The monitoring of bioaerosol concentrations in the air is a relevant endeavor due to potential health risks associated with exposure to such particles and in the understanding of their role in climate. In this context, the atmospheric concentrations of bacteria were measured from January 2018 to May 2020 at Saclay, France. The aim of the study was to understand the seasonality, the daily variability, and to identify the geographical origin of airborne bacteria. Methods: 880 samples were collected daily on polycarbonate filters, extracted with purified water, and analyzed using the cultivable method and flow cytometry. A source receptor model was used to identify the origin of bacteria. Results: A tri-modal seasonality was identified with the highest concentrations early in spring and over the summer season with the lowest during the winter season. Extreme changes occurred daily due to rapid changes in meteorological conditions and shifts from clean air masses to polluted ones. Conclusion: Our work points toward bacterial concentrations originating from specific seasonal-geographical ecosystems. During pollution events, bacteria appear to rise from dense urban areas or are transported long distances from their sources. This key finding should drive future actions to better control the dispersion of potential pathogens in the air, like persistent microorganisms originating from contaminated areas.
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Affiliation(s)
- Roland Sarda-Estève
- Laboratoire des Sciences du Climat et de l’Environnement, LSCE/IPSL, Unité mixte de recherche CEA-CNRS-UVSQ, 91190 Saint-Aubin, France; (D.B.); (J.-E.P.); (V.G.)
- Correspondence: ; Tel.: +33-1-69-08-97-47
| | - Dominique Baisnée
- Laboratoire des Sciences du Climat et de l’Environnement, LSCE/IPSL, Unité mixte de recherche CEA-CNRS-UVSQ, 91190 Saint-Aubin, France; (D.B.); (J.-E.P.); (V.G.)
| | - Benjamin Guinot
- Laboratoire d’Aérologie, Université Toulouse III, CNRS, UPS, 31400 Toulouse, France;
- Réseau National de Surveillance Aérobiologique, 69690 Brussieu, France; (J.P.B.); (M.T.)
| | - Gediminas Mainelis
- Department of Environmental Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901-8525, USA;
| | - John Sodeau
- Department of Chemistry and Environmental Research Institute, University College Cork, T12 YN60 Cork, Ireland;
| | - David O’Connor
- School of Chemical and Pharmaceutical Sciences, Technological University of Dublin, D06F793 Dublin 6, Ireland;
| | - Jean Pierre Besancenot
- Réseau National de Surveillance Aérobiologique, 69690 Brussieu, France; (J.P.B.); (M.T.)
| | - Michel Thibaudon
- Réseau National de Surveillance Aérobiologique, 69690 Brussieu, France; (J.P.B.); (M.T.)
| | - Sara Monteiro
- Themo Fisher Scientific, 18 avenue de Quebec, 91941 Villebon Courtaboeuf, France;
| | - Jean-Eudes Petit
- Laboratoire des Sciences du Climat et de l’Environnement, LSCE/IPSL, Unité mixte de recherche CEA-CNRS-UVSQ, 91190 Saint-Aubin, France; (D.B.); (J.-E.P.); (V.G.)
| | - Valérie Gros
- Laboratoire des Sciences du Climat et de l’Environnement, LSCE/IPSL, Unité mixte de recherche CEA-CNRS-UVSQ, 91190 Saint-Aubin, France; (D.B.); (J.-E.P.); (V.G.)
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Bártolo A, Santos IM, Valério E, Costa A, Reis S, Raposo S, Monteiro S. The European Portuguese version of the Reproductive Concerns After Cancer Scale (RCACS): A psychometric validation for young adult female cancer survivors. Eur J Oncol Nurs 2020; 47:101781. [PMID: 32563843 DOI: 10.1016/j.ejon.2020.101781] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/19/2020] [Accepted: 06/04/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the psychometric properties of the Portuguese version of the 18-item Reproductive Concerns After Cancer Scale (RCACS) among young adult female cancer survivors. METHODS The psychometric validation was conducted based on a convenience sample of 192 cancer survivors aged between 18 and 40 years. An exploratory factor analysis (EFA) was used to test the factor structure of the Portuguese version of RCACS and reliabilities were examined. Convergent and discriminant validity was also used to assess the construct validity. The Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORT QLQ-C30) and the need for parenthood and rejection of child-free lifestyle subscales of the Fertility Problem Inventory (FPI) were used as convergent measures. RESULTS A five-factor model was obtained with acceptable fit indexes and internal consistencies (.72<α<.89): (1) fertility potential, (2) children's health risk and future life, (3) partner disclosure, (4) barriers to getting pregnant/having children and (5) acceptance. Overall, convergent and discriminant validities were confirmed. Levels of anxiety and depression symptoms as well as health-related quality of life (QoL) had weak-to-moderate associations with reproductive concerns. Women who had a child or did not want a biological child were less concerned. CONCLUSION This scale proved to be a reliable and valid measure of reproductive concerns for the Portuguese population with potential relevance for application in clinical practice.
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Affiliation(s)
- Ana Bártolo
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.
| | - Isabel M Santos
- William James Center for Research, University of Aveiro, Aveiro, Portugal.
| | - Elisabete Valério
- Breast Clinic, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
| | - Antónia Costa
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Women and Children, Faculty of Medicine, University of Porto, Porto, Portugal; i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal.
| | - Salomé Reis
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Sofia Raposo
- Department of Gynecology, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal.
| | - Sara Monteiro
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.
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Monteiro S, Camões J, Carvalho D, Araújo R, Gomes E. Improving medical emergency system: Results of a multi-professional questionnaire. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:301-315. [PMID: 32448739 DOI: 10.1016/j.redar.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aimed to identify ways to improve the Medical Emergency System (MES) in its different components and infer Medical Emergency Team (MET) activation failure causes. METHODS A questionnaire regarding opinions and attitudes towards the MES was conducted, targeting all professionals at the hospital, which has an implemented MES with Basic Life Support (BLS) since 1998. RESULTS Thirty two percent (n=585) of hospital professionals answered, from these 37.8% were neither doctors nor nurses. In mean six years passed since the BLS certification, yet 102 professionals (17.4%) had not done it. A relevant percentage admitted to not being familiarized with the different components of the MES (activation criteria 16.4%, telephone number 4.1%, content of the resuscitation trolleys 42.4% and defibrillator-monitor 47.4%), percentages lessened among those had taken the BLS course. The majority highly valued MET, however 83 (23%) could not confirm that debriefingand 17 (4.4%) that allocation of tasks happened after and during activation, respectively. When activating MET 52 (18.1%) admitted fear of criticism and 38 (13.3%) agreed that they needed validation by another professional, factors not influenced by BLS course completion. Excessive workload as a barrier to recognize ill patients was pointed by 127 (45.7%) of the respondents. CONCLUSION Despite educational and auditing efforts, the MES is not fully integrated into hospital culture. BLS certification for all professionals and non-technical skills of MET were identified has major areas for MES improvement. Unfamiliarity with activation criteria, fear of criticism and excessive workload were identified as failure of activation causes.
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Affiliation(s)
- S Monteiro
- Medicina Interna, Departamento de Medicina, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos, Matosinhos, Portugal.
| | - J Camões
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
| | - D Carvalho
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
| | - R Araújo
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
| | - E Gomes
- Medicina Intensiva, Departamento de Urgencias y Medicina Intensiva, Hospital Pedro Hispano, Unidad Local de Salud Matosinhos , Matosinhos, Portugal
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Soares EM, Granjo T, Monteiro S, Bemposta S, Salvador A. Accessible communication in the transport of non-urgent people with communication impairments. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction Paramedics may find innumerous circumstances that require careful consideration of the patient’s clinical condition. Because of that, communication between paramedics and patients in a critical condition must be as clear and effective as possible.
Objectives This study aims to identify the communicative needs of ambulance’s crew members when transporting non-urgent people with communicative impairments and to create a tool that facilitates the communicative process.
Methodology A brainstorming was held at Associação de São Jorge to gather information regarding the needs and difficulties experienced by the ambulance’s crew members. An audio record of this meeting was collected and a qualitative analysis was carried out. Additionally, a questionnaire was fulfilled. Based on these results, a first version of the communicative tool was developed. A pluridisciplinary focus group was held to discuss it, regarding content, form and utility. After this focus group, the second version of the communicative tool was elaborated to be tested by the crew members of this association. As so, a dynamic of three hours was implemented to empower these professionals to use this tool and other communicative strategies.
Results The qualitative analysis of the first meeting collected data recognize as crew member’s needs: communicating basic and immediate needs at clinical level and at colloquial discourse. This data allowed to establish parameters for the construction of the first version of the communicative tool. The referred focus group identified the need to improve it, considering: format, content and also the need to complement this tool with other communicative facilitators (e.g. braille; gestures).
Conclusion This study shows the need of facilitating the communication in non-urgent transportation. Despite the modifications that have to be done, the communicative tool that was developed already shows a positive impact in the ambulance crew and in the community.
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Affiliation(s)
- EM Soares
- Politécnico de Leiria, ESSLei – School of Health Sciences, Portugal
- ciTechCare - Center for Innovative Care and Health Technology, Leiria, Portugal
| | - T Granjo
- Politécnico de Leiria, ESSLei – School of Health Sciences, Portugal
| | - S Monteiro
- Politécnico de Leiria, ESSLei – School of Health Sciences, Portugal
| | - S Bemposta
- Politécnico de Leiria, ESSLei – School of Health Sciences, Portugal
| | - A Salvador
- Politécnico de Leiria, ESSLei – School of Health Sciences, Portugal
- CIEd – Research Centre on Education, Braga, Portugal
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Bártolo A, Santos IM, Valério E, Monteiro S. Depression and Health-Related Quality of Life Among Young Adult Breast Cancer Patients: The Mediating Role of Reproductive Concerns. J Adolesc Young Adult Oncol 2020; 9:431-435. [PMID: 32208042 DOI: 10.1089/jayao.2019.0144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Biological motherhood plays an important role in the lives of many young women facing breast cancer and threats to reproduction may be disruptive. In this study, we explored the indirect effects of the importance of parenthood and childlessness on depression and health-related quality of life (HRQoL) among cancer patients 18-40 years of age (n = 104) through reported reproductive concerns. These specific concerns fully mediated the relationship between the importance of parenthood in women's lives and HRQoL. Greater importance of parenthood was directly associated with higher depression symptoms. Interventions should address the reproductive needs and concerns of patients to improve their HRQoL.
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Affiliation(s)
- Ana Bártolo
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Isabel M Santos
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Elisabete Valério
- Breast Clinic, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
| | - Sara Monteiro
- Center for Health Technology and Services Research (CINTESIS), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Monteiro S, Imramovský A, Pauk K, Růžičková Z, Carvalho C, Pavlík J. Synthesis of Alfaprostol Key Intermediate Ynol via Br/Mg Exchange. ORG PREP PROCED INT 2020. [DOI: 10.1080/00304948.2020.1716623] [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: 10/24/2022]
Affiliation(s)
- Sara Monteiro
- Institute of Organic Chemistry and Technology, Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Aleš Imramovský
- Institute of Organic Chemistry and Technology, Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Karel Pauk
- Institute of Organic Chemistry and Technology, Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Zdeňka Růžičková
- Department of General and Inorganic Chemistry, Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Catarina Carvalho
- Institute of Organic Chemistry and Technology, Faculty of Chemical Technology, University of Pardubice, Pardubice, Czech Republic
| | - Jan Pavlík
- Cayman Pharma Ltd, Neratovice, Czech Republic
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Machado C, Monteiro S, Oliveira MJ. Impact of overweight and obesity on pregnancy outcomes in women with gestational diabetes - results from a retrospective multicenter study. Arch Endocrinol Metab 2020; 64:45-51. [PMID: 31576966 PMCID: PMC10522280 DOI: 10.20945/2359-3997000000178] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the impact of pre-pregnancy body mass index (BMI) on pregnancy outcomes in women with gestational diabetes (GD). Subjects and methods Retrospective multicenter study using data from the Portuguese National Register. We included women with GD with a singleton pregnancy. GD diagnosis was according to the International Association of the Diabetes and Pregnancy Study Group criteria. Women were divided into groups according to their pre-pregnancy BMI: < 18.5 kg/m2 (underweight), ≥ 18.5 and < 25.0 kg/m2 (normal weight), ≥ 25 and < 30 kg/m2 (overweight) and ≥ 30 kg/m2 (obese). Results We included 3,103 pregnant women with GD, 29.6% (n = 918) were overweight and 27.3% (n = 846) were obese. Compared to normal weight, the overweight and obese groups had a higher percentage of gestational hypertension (4.0% and 8.5% vs. 2.1%), cesarean delivery (32.8% and 41.3% vs. 27.9%), macrosomia (3.9% and 6.7% vs. 2.4%), and large for gestational age (LGA) newborns (8.3% and 13.5% vs. 6.0%). Obesity increased the risk of gestational hypertension (OR 4.5, p < 0.001), preeclampsia (OR 1.9, p = 0.034), cesarean delivery (OR 2.0, p < 0.001), macrosomia (OR 3.1, p < 0.001) and LGA (OR 2.3, p < 0.001). Conclusion In pregnant women with GD, pregnancy complications increase with pre-pregnancy BMI. In obese women, appropriate diet and counseling prior to gestation and more aggressive medical intervention during pregnancy are needed in order to prevent macrosomic and LGA newborns and to reduce maternal complications.
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Affiliation(s)
- Catarina Machado
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
| | - Sara Monteiro
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
| | - Maria João Oliveira
- Departamento de Endocrinologia, Centro Hospitalar de Vila Nova de Gaia, Espinho, Porto, Portugal
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Machado C, Tavares P, Monteiro S, Oliveira MJ. Insulinoma masquerading as neurologic disease – Case report and review of the literature. Gal Clin 2020. [DOI: 10.22546/56/1871] [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: 11/22/2022] Open
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Monteiro S, Pinto J, Mira Coelho A, Leão M, Dória S. Identification of Copy Number Variation by Array-CGH in Portuguese Children and Adolescents Diagnosed with Autism Spectrum Disorders. Neuropediatrics 2019; 50:367-377. [PMID: 31398764 DOI: 10.1055/s-0039-1694797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Autism spectrum disorders (ASD) affect many children with an estimated prevalence of 1%. Array-comparative genomic hybridization (CGH) offers significant sensitivity for the identification of submicroscopic chromosomal abnormalities and it is one of the most used techniques in daily practice. The main objective of this study was to describe the usefulness of array-CGH in the etiologic diagnosis of ASD. METHODS Two-hundred fifty-three patients admitted to a neurogenetic outpatient clinic and diagnosed with ASD were selected for array-CGH (4 × 180K microarrays). Public databases were used for classification in accordance with the American College of Medical Genetics Standards and Guidelines. RESULTS About 3.56% (9/253) of copy number variations (CNVs) were classified as pathogenic. When likely pathogenic CNVs were considered, the rate increased to 11.46% (29/253). Some CNVs apparently not correlated to the ASD were also found. Considering a phenotype-genotype correlation, the patients were divided in two groups. One group according to previous literature includes all the CNVs related to ASDs (23 CNVs present in 22 children) and another with those apparently not related to ASD (10 CNVs present in 7 children). In 18 patients, a next-generation sequencing (NGS) panel were performed. From these, one pathogenic and 16 uncertain significance variants were identified. CONCLUSION The results of our study are in accordance with the literature, highlighting the relevance of array-CGH in the genetic of diagnosis of ASD population, namely when associated with other features. Our study also reinforces the need for complementarity between array-CGH and NGS panels or whole exome sequencing in the etiological diagnosis of ASD.
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Affiliation(s)
- S Monteiro
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal.,MMED, Master's Degree in Medicine, University of Porto, Porto, Portugal
| | - J Pinto
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - A Mira Coelho
- Department of Child Psychiatry Consultation, Centro hospitalar de São João (CHSJ) Porto, Porto, Portugal
| | - M Leão
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Neurogenetic Consultation, Centro hospitalar de São João (CHSJ) Porto, Porto, Portugal
| | - S Dória
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Arieira C, Monteiro S, Dias de Castro F, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. Capsule endoscopy: Is the software TOP 100 a reliable tool in suspected small bowel bleeding? Dig Liver Dis 2019; 51:1661-1664. [PMID: 31281069 DOI: 10.1016/j.dld.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Small bowel capsule endoscopy (SBCE) is the reference standard tool for diagnosing small bowel bleeding (SBB). The "TOP 100", which performs an automatic selection of the 100 images that mostly likely contain abnormalities, emerged as a new functionality of the RAPID Reader® software in 2017. AIM To compare the concordance of findings between the standard reading (SR) and the use of TOP 100 in suspected SBB. METHODS Retrospective study, including consecutive patients submitted to SBCE for suspected SBB. Two experienced readers performed SR and reported the most important findings. Another experienced reader, who was blinded to the SR results, reviewed all the SBCE videos using TOP 100 and reported the most important findings. The relevant findings were defined as the presence of high bleeding potential lesions (P2). RESULTS 97 patients were included. The TOP 100 detected 81/97(83.5%) of the P2 lesions, in particular 64/67(95.5%) of the angioectasias and 17/30(56.7%) of the ulcers. The TOP 100 identified all sites of active bleeding (n = 9). CONCLUSION The TOP 100 identified all sites of active bleeding, as well as the vast majority of significant lesions (83.5%); in particular, it detected over 95% of the angioectasias. Although SR remains the reference standard in the SBCE review, these findings demonstrate that TOP 100 allows for a quick preview reading constituting an important asset in the identification of lesions that may require priority full review and intervention planning.
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Affiliation(s)
- Cátia Arieira
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Sara Monteiro
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Silva J, Pereira A, Monteiro S, Bártolo A. PSYCHOMETRIC QUALITY OF PORTUGUESE MEASURES OF SPIRITUALITY: A SYSTEMATIC REVIEW. Psic , Saúde & Doenças 2019. [DOI: 10.15309/19psd200314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Affiliation(s)
- Sara Monteiro
- Institute of Organic Chemistry and TechnologyFaculty of Chemical TechnologyUniversity of Pardubice Studentská 95 532 10 Pardubice Czech Republic
| | - Georgios Paraskevopoulos
- Skin Barrier Research GroupFaculty of Pharmacy in Hradec KrálovéCharles University Akademika Heyrovského 1203/8 500 05 Hradec Králové Czech Republic
| | - Aleš Imramovský
- Institute of Organic Chemistry and TechnologyFaculty of Chemical TechnologyUniversity of Pardubice Studentská 95 532 10 Pardubice Czech Republic
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Ferreira J, Freitas F, Goncalves V, Ferreira C, Milner J, Alves P, Marinho V, Monteiro S, Baptista R, Monteiro P, Goncalves L. P6404Myocardial infarction with nonobstructive coronary arteries: does aspirin have a place in the treatment of this entity? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is still a clinical enigma that is being increasingly recognised, as the number of coronary angiographies we perform in our centres also increase. However, the treatment for this entity is still a matter of important debate, not only due to the different causative mechanisms of this disease but also because there are no major trials regarding MINOCA treatment.
Purpose
To determine the association between acetylsalicylic acid (ASA) use after discharge and mortality after discharge in MINOCA patients admitted to a coronary care unit (CCU).
Methods
We analyzed data from 370 (11.7% of the global sample) patients admitted with MINOCA in our CCU. Patients with other final diagnoses, missing mortality data, previous acute myocardial infarction, contra-indications to aspirin and known heart failure before admission were excluded. All patients underwent transthoracic echocardiography and coronary angiography at any point during hospitalisation. After adjusting data for relevant comorbidities we then compared mortality after hospital discharge between the ASA group and the no-ASA group.
Results
Of all MINOCA patients admitted in our CCU, 84 (22.7%) were diagnosed with ST-elevation myocardial infarction (STEMI) and 286 (77.3%) with non-ST elevation myocardial infarction (NSTEMI). 296 (80%) patients received ASA after discharge. Both groups were homogeneous as we did not find any significant differences between groups regarding age (p=0.106), left ventricle ejection fraction (p=0.100), GRACE score at hospitalisation (p=0.150), Killip-Kimball class at hospitalisation (p=0.604), incidence of acute kidney injury (p=0.450), maximum c-reactive protein during stay (p=0.804) and low-density lipoprotein levels at hospitalization (p=0.055). There was also no difference in the incidence of diabetes (p=0.350), exposure to daily stress (p=0.767), active smoking (p=0.569), dyslipidemia (p=0.229), hypertension (p=0.057) and type of myocardial infarction (STEMI vs NSTEMI – p=0.215). In this MINOCA cohort (5 years follow-up) a total of 47 patients died (12.7%). ASA vs. no-ASA 1-month (3.1% vs. 0.0%, p=0.214), 6-month (4.5% vs. 1.4%, p=0.317), 1-year (5.9% vs 5.6%, p=0.900), 3-year (10.5% vs. 8.3%, p=0.668) and 5-year (13.3% vs. 12.5%, p=0.860) all-cause mortality was not significantly different. The same non-significant trend towards higher mortality with ASA was obtained when survival curves were taken into account.
Conclusions
MINOCA remains a challenging entity. In our study, the systematic use of ASA in all patients following MINOCA was not associated with better survival after long-term follow-up.
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Affiliation(s)
- J Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - F Freitas
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Monteiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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