1
|
Kokavec A, Zahabi S, Rocha T, Rotenberg BW, Sowerby LJ. Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08655-4. [PMID: 38652299 DOI: 10.1007/s00405-024-08655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events. METHODS A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded. RESULTS 1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months. CONCLUSION Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures.
Collapse
Affiliation(s)
- Andrew Kokavec
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Sarah Zahabi
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| |
Collapse
|
2
|
Cabral S, Rocha T, Caetano S, Mari J, Borschmann R, Asevedo E. Decrease in suicide rates in Brazil during the COVID-19 pandemic. Psychiatry Res 2023; 329:115443. [PMID: 37769372 DOI: 10.1016/j.psychres.2023.115443] [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: 02/08/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
Natural disasters such as public health epidemics may potentially affect suicide rates. The global COVID-19 pandemic poses an unprecedented challenge for healthcare systems and general populations worldwide. In this retrospective ecological study, we aimed to examine any changes in the suicide rates during the COVID-19 pandemic and to assess the relationship between COVID-19 death rates and deaths by suicide in Brazil. Data on suicide and COVID-19 case numbers were extracted from the Ministry of Health agencies and grouped weekly. We performed a time series analysis of suicide rates, a comparison of mean suicide rates between the pre-COVID-19 period and the COVID-19 period, and conducted a Poisson regression to examine the relationship between deaths due to COVID-19 and suicide rates. Our results showed decreased suicide rates during the COVID-19 pandemic. We also found that deaths owing to COVID-19 impact those owing to suicide after 10 weeks in the upward direction; however, we did not observe for enough time to see a change in the suicide rate curve. These findings are fundamental to understand suicidal behaviors in epidemic situations. However, the field needs more studies evaluating the impact of significant public health events on suicidality, incorporating extended follow-up periods.
Collapse
Affiliation(s)
- S Cabral
- Unidade de Psiquiatria, Hospital de Base, Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF), Distrito Federal, DF, Brazil; Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - T Rocha
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - S Caetano
- Unidade de Psiquiatria, Hospital de Base, Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF), Distrito Federal, DF, Brazil
| | - J Mari
- Unidade de Psiquiatria, Hospital de Base, Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGESDF), Distrito Federal, DF, Brazil
| | - R Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, Carlton, Victoria, Australia; Department of Psychiatry, University of Oxford, Warneford Hospital, UK; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - E Asevedo
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| |
Collapse
|
3
|
Sowerby LJ, Almubarak Z, Biadsee A, Rocha T, Hopkins C. Coronavirus disease 2019 related parosmia: an exploratory survey of demographics and treatment strategies. J Laryngol Otol 2023; 137:1256-1260. [PMID: 37194063 PMCID: PMC10627779 DOI: 10.1017/s0022215123000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To investigate the clinical features, therapeutic efficacy and symptom time course of post-coronavirus disease 2019 parosmia. METHODS A 22-item online questionnaire was distributed to AbScent research group and Facebook coronavirus disease 2019 anosmia group adult members to assess clinical features, interventions and their subjective efficacy for parosmia. RESULTS A total of 209 participants (86 per cent females) reported: smell loss on average 3 days after coronavirus symptoms, recovery 4 weeks later, and first parosmia symptoms 12 weeks post infection. Respondents reported 10 per cent body weight loss, and listed onion and garlic as significant parosmia triggers. Regarding quality of life, depression was the most cited item (54 per cent). Smell training was trialled by 74 per cent of participants, followed by nasal corticosteroid spray (49 per cent). Stellate ganglion block, trialled by 16 per cent of respondents, had the highest reported improvement (45 per cent), with 21 per cent reporting a sustained benefit - the highest rate amongst registered treatment options. CONCLUSION Post-coronavirus parosmia has a significant impact and remains challenging to treat. Stellate ganglion block appears to be successful relative to other reported treatments. Further research into the pathophysiology, efficacy and mechanism of stellate ganglion block effect is warranted.
Collapse
Affiliation(s)
- L J Sowerby
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Z Almubarak
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A Biadsee
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Otorhinolaryngology – Head and Neck Surgery, Meir Medical Center, Kfar-Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Rocha
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - C Hopkins
- Department of ENT, Guy's Hospital, London, UK
| |
Collapse
|
4
|
Tselapedi-Sekeitto B, Rocha T, Sowerby LJ, Rotenberg B, Biadsee A. Telemedicine as an environmental ally - The social, financial, and environmental impact of virtual care in the otolaryngology clinic. Am J Otolaryngol 2023; 44:103791. [PMID: 36706717 PMCID: PMC9851917 DOI: 10.1016/j.amjoto.2023.103791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/26/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Synchronous virtual care rapidly expanded worldwide amid the COVID-19 pandemic to provide remote medical assessment, minimizing contact and disease transmission risk. Despite its benefits, such an abrupt expansion has shed light on the need to address patients' level of satisfaction with this service delivery. The purpose of this study was to investigate patients' satisfaction, travel cost, productivity loss, and CO2 emissions involved with synchronous virtual care and in-person assessments in rhinology and sleep apnea clinics. MATERIALS AND METHODS This prospective comparative study included patients managed via virtual care, or in-person clinic visit at St. Joseph Hospital, London, Canada, from December/2020 to April/2021, with rhinology pathologies or sleep apnoea. Patient satisfaction questionnaire (PSQ-18) scores were assessed. The overall scores of respondents were recorded including cost implications. RESULTS A total of 329 patients were invited, 28.5 % responded (n = 93). 33 virtual care (age 48 ± 6), and 60 in-person (age 51 ± 19). There was no statistical significance in PSQ-18 scores. However, under a diagnosis-based subgroup analysis, allergic rhinitis patients on virtual care presented a significantly lower PSQ-18 scores on the general satisfaction (3.28 vs. 4.25, p = 0.04). The time spent with the doctor was directly correlated with age for patients seen in-person (r = 0.27; p = 0.037). The estimated loss of productivity for the Virtual care group was CAD 12, patients assessed in-person presented an average loss of productivity about six times higher (CAD 74 ± 40). CONCLUSIONS Overall patients' satisfaction did not depend on whether they were seen virtually or in-person. However, time spent with the doctor contributed to higher satisfaction levels, but only among older patients who were seen in person. Nonetheless, allergic rhinitis patients seemed less satisfied with the virtual care option. Virtual care demonstrates economic benefits.
Collapse
Affiliation(s)
- Boipelo Tselapedi-Sekeitto
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ameen Biadsee
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar-Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
5
|
Roseiro M, Henriques J, Paredes S, Rocha T, Sousa J. An interpretable machine learning approach to estimate the influence of inflammation biomarkers on cardiovascular risk assessment. Comput Methods Programs Biomed 2023; 230:107347. [PMID: 36645940 DOI: 10.1016/j.cmpb.2023.107347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/28/2022] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular disease has a huge impact on health care services, originating unsustainable costs at clinical, social, and economic levels. In this context, patients' risk stratification tools are central to support clinical decisions contributing to the implementation of effective preventive health care. Although useful, these tools present some limitations, in particular, some lack of performance as well as the impossibility to consider new risk factors potentially important in the prognosis of severe cardiac events. Moreover, the actual use of these tools in the daily practice requires the physicians' trust. The main goal of this work addresses these two issues: (i) evaluate the importance of inflammation biomarkers when combined with a risk assessment tool; (ii) incorporation of personalization and interpretability as key elements of that assessment. METHODS Firstly, machine learning based models were created to assess the potential of the inflammation biomarkers applied in secondary prevention, namely in the prediction of the six month risk of death/myocardial infarction. Then, an approach based on three main phases was created: (i) set of interpretable rules supported by clinical evidence; (ii) selection based on a machine learning classifier able to identify for a given patient the most suitable subset of rules; (iii) an ensemble scheme combining the previous subset of rules in the estimation of the patient cardiovascular risk. All the results were statistically validated (t-test, Wilcoxon-signed rank test) according to a previous verification of data normality (Shapiro-Wilk). RESULTS The proposed methodology was applied to a real acute coronary syndrome patients dataset (N = 1544) from the Cardiology Unit of Coimbra Hospital and Universitary centre. The first assessment was based on the GRACE tool and a Random Forest classifier, the incorporation of inflammation biomarkers achieved SE=0.83; SP=0.84 whereas the original GRACE risk factors reached SE=0.75; SP=0.85. In the second phase, the proposed approach with inflammation biomarkers achieved SE=0.763 and SP=0.778. CONCLUSIONS This approach confirms the potential of combining inflammation markers with the GRACE score, increasing SE and SP, when compared with the original GRACE. Additionally, it assures interpretability and personalization, which are critical issues to allow its application in the daily clinical practice.
Collapse
Affiliation(s)
- M Roseiro
- CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal
| | - J Henriques
- CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal
| | - S Paredes
- Polytechnic Institute of Coimbra, Coimbra Institute of Engineering (IPC/ISEC), Rua Pedro Nunes, Coimbra 3030-199, Portugal; CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal.
| | - T Rocha
- Polytechnic Institute of Coimbra, Coimbra Institute of Engineering (IPC/ISEC), Rua Pedro Nunes, Coimbra 3030-199, Portugal; CISUC, Center for Informatics and Systems of University of Coimbra, Coimbra 3030-290, Portugal
| | - J Sousa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra 3004-561, Portugal
| |
Collapse
|
6
|
Dickie A, Rocha T, Maniaci A, Ingrassia A, Maria Saibene A, Spagnolini S, Locatello LG, Tucciarone M, Radulesco T, Rotenberg B, Sowerby LJ. How deep do you go? Clinical prediction of nasopharyngeal depth based on facial measurements. Clin Anat 2023; 36:285-290. [PMID: 36477854 DOI: 10.1002/ca.23985] [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: 10/11/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
Nasopharyngeal depth (ND) prediction is clinically relevant in performing medical procedures, and in enhancing technique accuracy and patient safety. Nonetheless, clinical predictive variables and normative data in adults remain limited. This study aimed to determine normative data on ND and its correlation to external facial measurements. A multicenter cross-sectional study obtained data from adults presenting to otolaryngology clinics at five sites in Canada, Italy, and Spain. Investigators compared endoscopically measured depth from the nasal sill (soft tissue between the nasal ala and columella) to nasopharynx along the nasal floor to the "curved distance from the alar-facial groove along the face to the tragus" and "distance from the tragus to a plane perpendicular to the philtrum." When sinus computed tomography images were available, the distance from the nasopharynx to the nasal sill was also collected. 371 patients participated in the study (41% women; 51 years old, SD 18). Average ND was 9.4 cm (SD 0.86) and 10.1 cm (SD 0.9) for women and men, respectively (p < 0.001; 95% CI 0.46-0.86). Perpendicular distance was strongly correlated to ND (r = 0.775; p < 0.001), with an average underestimation of 0.1 cm (SD 0.65; 95% CI 0.06-0.2). The equation: ND (cm) = perpendicular distance*0.773 + 2.344, generated from 271 randomly selected participants, and validated on 100 participants, resulted in a 0.03 cm prediction error (SD 0.61; 95% CI -0.08-0.16). Nasopharyngeal depth can be approximated by the distance from the tragus to a plane perpendicular to the philtrum.
Collapse
Affiliation(s)
- Alexander Dickie
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Taciano Rocha
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia ENT Section, University of Catania, Catania, Italy
| | - Angelo Ingrassia
- Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia ENT Section, University of Catania, Catania, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Sofia Spagnolini
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | | | - Manuel Tucciarone
- Department of Otorhinolaryngology, University Hospital of Jerez, Cádiz, Spain
| | - Thomas Radulesco
- Aix-Marseille Univ, APHM, IUSTI, CNRS, La Conception University Hospital, Department of Oto-Rhino-Laryngology Head and Neck Surgery, Marseille, France
| | - Brian Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| |
Collapse
|
7
|
Maza-Solano J, Biadsee A, Sowerby LJ, Calvo-Hernández C, Tucciarone M, Rocha T, Maniaci A, Saibene AM, Chiesa-Estomba CM, Radulesco T, Metwaly O, Lechien JR, Alobid I, Locatello LG. Chronic rhinosinusitis with nasal polyps management in the biologic therapy era: an international YO-IFOS survey. Eur Arch Otorhinolaryngol 2022; 280:2309-2316. [PMID: 36454385 DOI: 10.1007/s00405-022-07762-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To investigate the consistency between the international guidelines recommendations and worldwide standard practices regarding diagnostic work-up and follow-up strategies for managing patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the era of monoclonal antibodies. METHODS A questionnaire developed by the Rhinology section of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) included items regarding the management of CRSwNP patients, monoclonal prescription, surgical and follow-up procedures, awareness of biologicals availability, and other relevant clinical practices. The online survey was directed to otolaryngologists and distributed in Europe, North America, South America, and the Middle East through otolaryngological and/or rhinological societies. RESULTS A total of 202 responses were analyzed; the mean participants' age was 45 ± 11 (73% men and 27% women), and 31% were from the United States, Canada 19%, Europe 45%, Middle East and South America 5%. Only 60% of the respondents declared using validated symptoms and endoscopic score systems in their clinical practice. Several practice discrepancies emerged in our cohort, including preferred surgical approach, prescription of preoperative oral steroids, and perioperative antibiotics (59% and 58%, respectively), as well as divergent awareness levels of available biologics for CRSwNP worldwide. CONCLUSIONS CRSwNP needs a complex and time-consuming assessment, according to the latest guidelines. There seems to be a gap between these recommendations and the real-world data, which should draw more attention to bringing them into uniform clinical practice in the near future.
Collapse
Affiliation(s)
- Juan Maza-Solano
- Rhinology Unit, Department of Otolaryngology-Head and Neck Surgery, University Hospital Virgen Macarena, Seville, Spain
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Christian Calvo-Hernández
- Department of Otolaryngology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Tucciarone
- Department of Otolaryngology and Head and Neck Surgery, University Hospital of Jerez, Cádiz, Spain
| | - Taciano Rocha
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Antonino Maniaci
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Carlos M Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Donostia University Hospital, Biodonostia Research Institute, St. Sebastien, Spain
| | - Thomas Radulesco
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, Aix-Marseille Univ, APHM, IUSTI, CNRS, La Conception University Hospital, Marseille, France
| | - Osama Metwaly
- Otorhinolaryngology-Head and Neck Surgery Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Jerome R Lechien
- Department of Otolaryngology, Polyclinique de Poitiers, Elsan Hospital, Poitiers, France
| | - Isam Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clinic, University of Barcelona, CIPERES, Spain
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| |
Collapse
|
8
|
Valente F, Paredes S, Henriques J, Rocha T, de Carvalho P, Morais J. Interpretability, personalization and reliability of a machine learning based clinical decision support system. Data Min Knowl Discov 2022. [DOI: 10.1007/s10618-022-00821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
9
|
Instrum RS, Koch RW, Rocha T, Rohani SA, Ladak H, Agrawal SK, Sowerby LJ. Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers. Laryngoscope 2022; 133:38-42. [PMID: 35102548 PMCID: PMC9015425 DOI: 10.1002/lary.30034] [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: 12/10/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Nasopharyngeal swabs currently remain the gold standard for COVID-19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false-negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D-printed nasal swab simulator to expedite health care workers' skill acquisition. STUDY DESIGN Prospective pre-post interventional study. METHODS A nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID-19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self-evaluate procedure accuracy. A five-point Likert scale was collected regarding the NSTT's educational value and procedural fidelity. RESULTS Sixty-two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self-assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety-four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty-one indicated that the simulator should be used at all COVID-19 testing sites, with 77% stating province-wide implementation was warranted. CONCLUSIONS The nasal swab task trainer is an effective educational tool that appears well-suited for improved skill acquisition in COVID-19 testing and may be useful for training other nasal swab applications. LEVEL OF EVIDENCE 3 Laryngoscope, 133:38-42, 2023.
Collapse
Affiliation(s)
- Ryan S. Instrum
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Robert W. Koch
- School of Biomedical EngineeringWestern UniversityLondonOntarioCanada
| | - Taciano Rocha
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Seyed Alizera Rohani
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Hanif Ladak
- Department of Electrical and Computer EngineeringWestern UniversityLondonOntarioCanada
| | - Sumit K. Agrawal
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Leigh J Sowerby
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| |
Collapse
|
10
|
Isaacson J, Joiner A, Kozhumam A, Caruzzo N, Andrade L, Iora P, Costa D, Vissoci B, Sartori M, Rocha T, Vissoci J. 91 Access to Care for Emergency Care-Sensitive Conditions in Brazil: A Geographic Information System Approach. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.100] [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: 11/29/2022]
|
11
|
Rocha T, Rhem R, Sowerby LJ, Dolovich MB. Handling budesonide nebules to maximize the dispensed drug. Pediatr Allergy Immunol 2021; 32:1566-1568. [PMID: 34002879 DOI: 10.1111/pai.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Taciano Rocha
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rod Rhem
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Myrna B Dolovich
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
12
|
Sowerby LJ, Patel KB, Schmerk C, Rotenberg BW, Rocha T, Sommer DD. Effect of low salicylate diet on clinical and inflammatory markers in patients with aspirin exacerbated respiratory disease - a randomized crossover trial. J Otolaryngol Head Neck Surg 2021; 50:27. [PMID: 33892819 PMCID: PMC8063291 DOI: 10.1186/s40463-021-00502-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). In addition to the therapeutic routines and surgical options available, a low dietary intake of food salicylate has been suggested as adjunctive therapy for this condition. This study aimed to assess the influence of a short-term low salicylate diet on inflammatory markers in patients with AERD and whether that would result in symptomatic improvement. Methods Prospective study with randomization to either a high or low salicylate diet for 1 week, followed by cross-over to the other study arm. Participants were asked to record their dietary salicylate for each week of the study. Urinary creatinine, salicylate and leukotriene levels were measured at the time of recruitment, end of week one and end of week two and the SNOT-22 questionnaire was filled out at the same time points. Results A total of seven participants completed the study. There was no statistical difference in the urinary salicylate and leukotriene levels between the two diets; nevertheless, participants on low salicylate diet reported improved SNOT-22 symptoms scores (p = 0.04), mainly in the rhinologic, ear/facial, and sleep dysfunction symptom domains. In addition, these last two domains outcomes were more significant than the minimal clinically important difference. Conclusions A short-term low salicylate diet may not result in biochemical outcomes changes but seems to provide significant symptomatic relief for patients with AERD. Trial registration NCT01778465 (www.clinicaltrials.gov) Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00502-4.
Collapse
Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada.
| | - Krupal B Patel
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Crystal Schmerk
- Department of Medicine, Western University, London, ON, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Department of Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
13
|
Cerqueira M, Pereira R, Nunes de Mesquita G, Rocha T, Galvao de Moura Filho A. Influence of Blood Flow Restriction Level on Muscle Fatigue during an Intermittent Isometric Exercise Taken to Failure. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.03.2020.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M.S. Cerqueira
- Department of Physical Therapy, Federal University of Pernambuco, Pernambuco, Brazil
| | - R. Pereira
- Department of Biological Sciences, State University of Southwest Bahia, Bahia, Brazil
| | - G. Nunes de Mesquita
- Department of Physical Therapy, Federal University of Pernambuco, Pernambuco, Brazil
| | - T. Rocha
- Department of Physical Therapy, Federal University of Pernambuco, Pernambuco, Brazil
| | | |
Collapse
|
14
|
Esmaeilizand R, Rocha T, Harrison A, Gray S, Fusch G, Dolovich M, Mukerji A. Efficiency of budesonide delivery via a mesh nebulizer in an in-vitro neonatal ventilator model. Pediatr Pulmonol 2020; 55:2283-2288. [PMID: 32519801 DOI: 10.1002/ppul.24897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the delivery efficiency of budesonide aerosol via a mesh nebulizer in a neonatal ventilator model. DESIGN/METHOD In an in-vitro ventilated neonatal model, budesonide suspension was administered using a mesh nebulizer. A collection filter was placed distal to the endotracheal tube and budesonide captured by the filter was measured using UV spectroscopy. The ventilator was, in turn, either on high frequency or conventional ventilation mode and the nebulizer was placed either proximal (close to the endotracheal tube) or distal (between the wet side of humidifier and the inspiratory circuit). Each combination (nebulizer position and ventilation mode) to assess budesonide delivery was tested five times. RESULTS Overall delivery of budesonide to the distal end of the endotracheal tube a small percentage of the total dose administered. The deposition with conventional ventilation was 2.12% (±1.06) and 1.26% (±0.27), with proximal and distal placement of the nebulizer, respectively. With high-frequency ventilation, the deposition percentages were 1.82% (±0.82) and 1.69% (±0.23), with proximal and distal nebulizer placement, respectively. CONCLUSION Only a small percentage of administered budesonide is delivered to the distal endotracheal tube, irrespective of ventilation mode, and nebulizer placement.
Collapse
Affiliation(s)
| | - Taciano Rocha
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Ava Harrison
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shari Gray
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Myrna Dolovich
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
15
|
Rocha T, Rattes C, Morais C, Souza R, Rolim N, Brandão S, Fink JB, Dornelas de Andrade A. Predictive anatomical factors of lung aerosol deposition in obese individuals. Would modified mallampati score be relevant? Clinical trial. Respir Med 2020; 171:106083. [PMID: 32917355 DOI: 10.1016/j.rmed.2020.106083] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/13/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is a highly prevalent condition worldwide that aggravates symptoms of already existing conditions such as asthma and COPD. The limited effectiveness of inhaled medications in these individuals may be related to anatomic characteristics of their upper airways, mainly due to compressive factors. METHODS Controlled clinical trial with obese and nonobese individuals. The following variables were evaluated: anthropometric characteristics, Lung and airway deposition of radiolabeled aerosol (pulmonary scintigraphy), upper airways anatomy (CT scans), and modified Mallampati score. RESULTS 29 subjects (17 nonobese and 12 obese) participated. Obese volunteers presented 30% lower aerosol lung deposition compared to nonobese. Moreover, obese subjects Mallampati classification of 4 presented an aerosol lung deposition two times lower than nonobese subjects (p = 0.021). The cross-sectional area of the retropalatal region and retroglossal region were lower in obese patients (p < 0.05), but no correlation to aerosol lung deposition was observed. BMI was associated with 32% of the variance of lung deposition (p < 0.001; β -0.28; 95% CI -0.43 to -0.11). CONCLUSION High BMI correlated to reduced percentage lung deposition. Also, modified Mallampati class 4 was even more detrimental to aerosol delivery into the lungs. Obese subjects have narrower upper airways, compared to nonobese, but this is not reflected in higher radiolabeled aerosol impaction into their oropharynx and does not predict the percentage of lung deposition in this group. CLINICAL TRIAL REGISTRATION NCT03031093 (clinicaltrials.org).
Collapse
Affiliation(s)
- Taciano Rocha
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Catarina Rattes
- Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Caio Morais
- Department of Pneumology, Universidade de São Paulo, São Paulo, Brazil
| | - Renata Souza
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Nadja Rolim
- Imaging Medicine, Hospital das Clínicas da UFPE, Universidade Federal de Pernambuco, Recife, Brazil
| | - Simone Brandão
- Department of Nuclear Medicine, Hospital das Clínicas da UFPE, Recife, Brazil
| | | | | |
Collapse
|
16
|
Gonçalves JM, Rocha T, Mestre NC, Fonseca TG, Bebianno MJ. Assessing cadmium-based quantum dots effect on the gonads of the marine mussel Mytilus galloprovincialis. Mar Environ Res 2020; 156:104904. [PMID: 32174334 DOI: 10.1016/j.marenvres.2020.104904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/03/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
This study assesses the sex-specific effects induced by CdTe QDs, on the marine mussel Mytilus galloprovincialis in comparison to its dissolved counterpart. A 14 days exposure to CdTe QDs and dissolved Cd was conducted (10 μg Cd L-1), analysing Cd accumulation, oxidative stress, biotransformation, metallothionein and oxidative damage in the gonads. Both Cd forms caused significant antioxidant alterations, whereby QDs were more pro-oxidant, leading to oxidative damage, being females more affected. Overall, biochemical impairments on gonads of M. galloprovincialis demonstrate that the reproductive toxicity induced by CdTe QDs in mussels are sex-dependent and mediated by oxidative stress and lipid peroxidation. It is crucial to acknowledge how gametes are affected by metal-based nanoparticles, such as Cd-based QDs. As well as understanding the potential changes they may undergo at the cellular level during gametogenesis, embryogenesis and larval development potentially leading to serious impacts on population sustainability and ecosystem health.
Collapse
Affiliation(s)
- J M Gonçalves
- CIMA, Centre of Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - T Rocha
- CIMA, Centre of Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal; Laboratory of Environmental Biotechnology and Ecotoxicology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - N C Mestre
- CIMA, Centre of Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - T G Fonseca
- CIMA, Centre of Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - M J Bebianno
- CIMA, Centre of Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal.
| |
Collapse
|
17
|
Nunes D, Rocha T, Traver V, Teixeira C, Ruano M, Paredes S, Carvalho P, Henriques J. Latent states extraction through Kalman Filter for the prediction of heart failure decompensation events. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:3947-3950. [PMID: 31946736 DOI: 10.1109/embc.2019.8857591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac function deterioration of heart failure patients is frequently manifested by the occurrence of decompensation events. One relevant step to adequately prevent cardiovascular status degradation is to predict decompensation episodes in order to allow preventive medical interventions.In this paper we introduce a methodology with the goal of finding onsets of worsening progressions from multiple physiological parameters which may have predictive value in decompensation events. The best performance was obtained for the model composed by only two features using a telemonitoring dataset (myHeart) with 41 patients. Results were achieved by applying leave-one-subject-out validation and correspond to a geometric mean of 83.67%. The obtained performance suggests that the methodology has the potential to be used in decision support solutions and assist in the prevention of this public health burden.
Collapse
|
18
|
Mora AG, Furquim SR, Tartarotti SP, Andrade DR, Janussi SC, Krikorian K, Rocha T, Franco-Penteado CF, Priolli DG, Priviero FBM, Claudino MA. Progression of micturition dysfunction associated with the development of heart failure in rats: Model of overactive bladder. Life Sci 2019; 226:107-116. [PMID: 30965053 DOI: 10.1016/j.lfs.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
Heart failure (HF) has a strong association with the development of lower urinary tract symptoms, especially overactive bladder (OAB); although this condition remains poorly investigated. In this study, we assess the aortocaval fistula (ACF) model as a novel experimental model of micturition dysfunction, associated with HF, focused on the molecular and functional studies to evaluate the autonomic nervous system and urinary bladder remodeling. Male rats were submitted to ACF for HF induction. Echocardiography, cystometric, histomorphometry and molecular analysis, as well as concentration-response curves to carbachol and ATP and frequency-response curves to electrical field stimulation (EFS) were evaluated in Sham and HF (4- and 12-weeksendpoint) groups. Compared to SHAM, HF groups exhibited progressive increases in the left ventricle (LV) mass and fractional shortening which indicates cardiac dysfunction, although HF was characterized only after 12 weeks by the reduced ejection fraction. For micturition function, HF groups presented increased non-voiding contractions (NVC) and decreased bladder capacity; however, when comparing HF groups, these urinary parameters were significantly impaired over the weeks (12-weeks). The contractile responses induced by CCh, ATP and EFS were greater in detrusor muscle (DSM) from HF rats. mRNA expression for muscarinic receptors (M2 and M3) was higher in DSM only after 12 weeks of ACF, in addition to MMP9 and TGF-beta. Histomorphometric revealed increased urothelium thickness in both HF groups, whereas DSM thickness occurred only after 12 weeks. Thus, the ACF model induced cardiac dyfunction with progressive micturition dysfunction over the weeks, characterized by increased DSM contractile mechanisms as well as extracellular matrix remodeling in the urinary bladder, representing a useful tool to evaluate the OAB associated with HF.
Collapse
Affiliation(s)
- A G Mora
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - S R Furquim
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - S P Tartarotti
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - D R Andrade
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - S C Janussi
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - K Krikorian
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - T Rocha
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - C F Franco-Penteado
- Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil; Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - D G Priolli
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - F B M Priviero
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - M A Claudino
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil.
| |
Collapse
|
19
|
Fluhr S, Andrade ADD, Oliveira EJB, Rocha T, Medeiros AIC, Couto A, Maia JN, Brandão DC. Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women. ACTA ACUST UNITED AC 2019; 45:e20170395. [PMID: 31166554 PMCID: PMC6715028 DOI: 10.1590/1806-3713/e20170395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/12/2018] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. Methods: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. Results: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. Conclusions: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])
Collapse
Affiliation(s)
- Sandra Fluhr
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | | | | - Taciano Rocha
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | | - Amanda Couto
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | - Juliana Netto Maia
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | |
Collapse
|
20
|
Cerqueira MS, Pereira R, Mesquita GND, Rocha T, Moura Filho AGD. Rate of force development to evaluate the neuromuscular fatigue and recovery after an intermittent isometric handgrip task with different blood flow restriction conditions. Motriz: rev educ fis 2019. [DOI: 10.1590/s1980-6574201900010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
21
|
Nunes D, Leal A, Rocha T, Traver V, Teixeira C, Ruano M, Paredes S, Carvalho P, Henriques J. Risk Prediction of Heart Failure Decompensation Events in Multiparametric Feature Spaces. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:4030-4033. [PMID: 30441241 DOI: 10.1109/embc.2018.8513096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac function deterioration of heart failure patients is frequently manifested by the occurrence of decompensation events. One relevant step to adequately prevent cardiovascular status degradation is to predict decompensation episodes in order to allow preventive medical interventions. In this paper we introduce a methodology with the goal of finding relevant feature spaces from multiple physiological parameters which may have predictive value in decompensation events. The best performance was obtained for the feature space comprising the following features: mean weight, standard deviation of the blood pressure and mean of extra-thoracic impedance in a time window of 20 days. Results were achieved by applying leave-one-out validation and correspond to a geometric mean of 88.32%. The obtained performance suggests that the methodology has the potential to be used in decision support solutions and assist in the prevention of this public health burden.
Collapse
|
22
|
Silva CRDS, Costa ADS, Rocha T, de Lima DAM, do Nascimento T, de Moraes SRA. Quadriceps muscle architecture ultrasonography of individuals with type 2 diabetes: Reliability and applicability. PLoS One 2018; 13:e0205724. [PMID: 30335818 PMCID: PMC6193658 DOI: 10.1371/journal.pone.0205724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/01/2018] [Indexed: 12/25/2022] Open
Abstract
Muscle architecture parameters performed using ultrasound serve as an aid to monitor muscle changes derived from diseases, however there are no studies that determine the reliability and applicability of this evaluation in individuals with type 2 diabetes (DM2). Three raters captured three images of measurements of thickness of the rectus femoris (RF), vastus intermedius and anterior quadriceps, RF muscle cross-sectional area, RF pennation angle in 17 individuals with DM2 above 50 and sedentary. Intra and inter-raters analysis showed reliability from high to very high for the three raters (ICC> 0.87), except for the RF pennation angle with moderate to low intra-raters (ICC = 0.58, 0.48, 0.51), and high inter-rater reliability (ICC = 0.70). Ultrasound measurements of quadriceps muscles showed high to very high intra and inter-raters reliability, thus allowing its use to monitor muscle changes provoked by diabetes or interventions in individuals with DM2.
Collapse
Affiliation(s)
- Camilla Rodrigues de Souza Silva
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, Universidade Federal de Pernambuco, Recife, Brasil
- * E-mail:
| | | | - Taciano Rocha
- Programa de Pós-Graduação em Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | | | | | | |
Collapse
|
23
|
Arredondo J, Strathdee SA, Cepeda J, Abramovitz D, Artamonova I, Clairgue E, Bustamante E, Mittal ML, Rocha T, Bañuelos A, Olivarria HO, Morales M, Rangel G, Magis C, Beletsky L. Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico. Harm Reduct J 2017; 14:72. [PMID: 29117858 PMCID: PMC5678566 DOI: 10.1186/s12954-017-0198-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/20/2017] [Indexed: 01/07/2023] Open
Abstract
Background Mexico’s 2009 “narcomenudeo reform” decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers’ drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. Methods Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar’s tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers’ ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. Results Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4–3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3–4.3), methamphetamine (aOR 2.2, 95% CI 1.4–3.2), and marijuana (aOR 2.5, 95% CI 1.6–4). Conclusions Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.
Collapse
Affiliation(s)
- J Arredondo
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA. .,San Diego State University, San Diego, CA, USA.
| | - S A Strathdee
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - J Cepeda
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - D Abramovitz
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - I Artamonova
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - E Clairgue
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - E Bustamante
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - M L Mittal
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
| | - T Rocha
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,San Diego State University, San Diego, CA, USA
| | - A Bañuelos
- Secretaría de Seguridad Pública Municipal, Dirección de Planeación y Proyectos Estratégicos, Tijuana, Mexico
| | - H O Olivarria
- Secretaría de Seguridad Pública Municipal, Instituto de Capacitación y Adiestramiento Profesional (ICAP), Tijuana, Mexico
| | - M Morales
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,San Diego State University, San Diego, CA, USA
| | - G Rangel
- Comisión de Salud Fronteriza, México-Estados Unidos, Tijuana, Mexico
| | - C Magis
- Centro Nacional para la Prevención y el Control del VIH y el SIDA (Censida), Mexico City, Mexico
| | - L Beletsky
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, USA
| |
Collapse
|
24
|
Hertz J, Fu Y, Flanagan B, Vissoci J, Limkakeng A, Staton C, Rocha T. 197 Geographic Distribution of Diagnostic Testing for Acute Coronary Syndrome in Brazil. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Mendes D, Paredes S, Rocha T, Carvalho P, Henriques J, Morais J. An interpretable data-driven approach for rules construction: Application to cardiovascular risk assessment. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:2646-2649. [PMID: 29060443 DOI: 10.1109/embc.2017.8037401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The development of models able to produce an understandable decision by the clinicians is of great importance to support their decision. Therefore, the research of methodologies able to extract useful knowledge from existing datasets, as well as to integrate this knowledge into the current clinical evidence, is a key aspect in the enhancement of the clinical decision. This work focuses on the development of interpretable models to assess the patient's condition based on supervised clustering theories, enabling the discovery of a set of features that best represents that condition. At the same time, the technique is supported on a structure that enables the formulation of simple and interpretable rules. Despite its general applicability, the proposed methodology is applied to coronary artery disease (CAD), particularly, in the risk of death assessment (30 days after the admission) of patients that have been admitted to the emergency unit. The validation is performed using a real dataset with Acute Coronary Syndromes, provided by the Portuguese Society of Cardiology. While the methodology produces simple and interpretable rules, the performance achieves an improvement of 7% in relation to geometric mean, when compared with GRACE model (commonly used in Portugal).
Collapse
|
26
|
Henriques J, Carvalho P, Rocha T, Paredes S, Cabiddu R, Trimer R, Mendes R, Borghi-Silva A, Kaminsky L, Ashley E, Arena R, Myers J. A non-exercise based V02max prediction using FRIEND dataset with a neural network. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:4203-4206. [PMID: 29060824 DOI: 10.1109/embc.2017.8037783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The main goal of this work is the development of models, based on computational intelligence techniques, in particular neural networks, to predict the maximum oxygen consumption value. While the maximum oxygen consumption is a direct mark of the cardiorespiratory fitness, several studies have also confirmed it also as a powerful predictor of risk for adverse outcomes, such as hypertension, obesity, and diabetes. Therefore, the existence of simpler and accurate models, establishing an alternative to standard cardiopulmonary exercise tests, with the potential to be employed in the stratification of the general population in daily clinical practice, would be of major importance. In the current study, different models were implemented and compared: 1) the traditional Wasserman/Hansen equation; 2) linear regression and; 3) non-linear neural networks. Their performance was evaluated based on the "FRIEND - Fitness Registry and the Importance of Exercise: The National Data Base" [1] being, in the present study, a subset of 12262 individuals employed. The accuracy of the models was performed through the computation of sensitivity and specificity values. The results show the superiority of neural networks in the prediction of maximum oxygen consumption.
Collapse
|
27
|
Fuzari HKB, Leite J, Souza H, Rocha T, de Andrade AD, Marinho P. Exercise effectiveness of arteriovenous fistula maturation in chronic renal patients: A systematic review with meta-analysis. International Journal of Therapy and Rehabilitation 2017. [DOI: 10.12968/ijtr.2017.24.3.98] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: The purpose of this research is to evaluate the effectiveness of upper limb exercises to improve arteriovenous fistula maturation in patients with chronic kidney disease. Methods: A bibliographic search was carried out from February to August 2015 in the following databases: PUBMED, CINAHL, Web of Science, SCOPUS, LILACS, SCIELO and CENTRAL. Results: Three studies were included, involving 134 participants (total). According to the total effect estimation, a mean difference of 0.36 (-0.95–1.67) was found for vein diameter, meanwhile a mean difference of 107.87 (-3.90–219.64) was found for blood flow. Conclusion: It was not possible to determine the effect size of the treatment due to a high bias risk of all included studies. Given this, the available evidence is still insufficient to support the prescription of upper limb exercises in order to improve arteriovenous fistula maturation. Therefore, randomised and controlled clinical trials monitored by methodological rigour should be developed in order to verify if the AVF maturation process can be evidenced through exercise.
Collapse
Affiliation(s)
- Helen KB Fuzari
- Physiotherapist, Physiotherapy Department, Federal University of Pernambuco, Recife, Brazil
| | - Jéssica Leite
- Physiotherapist, Physiotherapy Department, University of Pernambuco, Recife, Brazil
| | - Helga Souza
- Physiotherapist, Physiotherapy Department, University of Pernambuco, Recife, Brazil
| | - Taciano Rocha
- Physiotherapist, Physiotherapy Department, University of Pernambuco, Recife, Brazil
| | - Armèle Dornelas de Andrade
- Professor, Cardiopulmonary Laboratory, Physiotherapy Department, Universidade Federal de Pernambuco, Recife, Brasil
| | - Patricia Marinho
- Professor, Cardiopulmonary Laboratory, Physiotherapy Department, University of Pernambuco, Recife, Brazil
| |
Collapse
|
28
|
Rocha T, Castro MA, Guarda-Nardini L, Manfredini D. Subjects with temporomandibular joint disc displacement do not feature any peculiar changes in body posture. J Oral Rehabil 2017; 44:81-88. [DOI: 10.1111/joor.12470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- T. Rocha
- Escola Superior De Tecnologia de Saude; University of Coimbra; Coimbra Portugal
| | - M. A. Castro
- Escola Superior De Tecnologia de Saude; University of Coimbra; Coimbra Portugal
| | - L. Guarda-Nardini
- Section of Dentistry and Maxillofacial Surgery; Hospital of Treviso; Treviso Italy
| | - D. Manfredini
- School of Dentistry; University of Padova; Padova Italy
| |
Collapse
|
29
|
Fonseca TG, Morais MB, Rocha T, Abessa DMS, Aureliano M, Bebianno MJ. Ecotoxicological assessment of the anticancer drug cisplatin in the polychaete Nereis diversicolor. Sci Total Environ 2017; 575:162-172. [PMID: 27744150 DOI: 10.1016/j.scitotenv.2016.09.185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023]
Abstract
Anticancer drugs are designed to inhibit tumor cell proliferation by interacting with DNA and altering cellular growth factors. When released into the waterbodies of municipal and hospital effluents these pharmaceutical compounds may pose a risk to non-target aquatic organisms, due to their mode of action (cytotoxic, genotoxic, mutagenic and teratogenic). The present study aimed to assess the ecotoxicological potential of the alkylating agent cisplatin (CisPt) to the polychaete Nereis diversicolor, at a range of relevant environmental concentrations (i.e. 0.1, 10 and 100ngPtL-1). Behavioural impairment (burrowing kinetic impairment), ion pump effects (SR Ca2+-ATPase), neurotoxicity (AChE activity), oxidative stress (SOD, CAT and GPXs activities), metal exposure (metallothionein-like proteins - MTLP), biotransformation (GST), oxidative damage (LPO) and genotoxicity (DNA damage), were selected as endpoints to evaluate the sublethal responses of the ragworms after 14-days of exposure in a water-sediment system. Significant burrowing impairment occurred in worms exposed to the highest CisPt concentration (100ngPtL-1) along with neurotoxic effects. The activity of antioxidant enzymes (SOD, CAT) and second phase biotransformation enzyme (GST) was inhibited but such effects were compensated by MTLP induction. Furthermore, LPO levels also increased. Results showed that the mode of action of cisplatin may pose a risk to this aquatic species even at the range of ngL-1.
Collapse
Affiliation(s)
- T G Fonseca
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal; NEPEA, Núcleo de Estudos em Poluição e Ecotoxicologia. Aquática, São Paulo State University - UNESP, Campus Experimental do Litoral Paulista, Praça Infante Dom Henrique, s/n, 11330-900, São Vicente, SP, Brazil
| | - M B Morais
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - T Rocha
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - D M S Abessa
- NEPEA, Núcleo de Estudos em Poluição e Ecotoxicologia. Aquática, São Paulo State University - UNESP, Campus Experimental do Litoral Paulista, Praça Infante Dom Henrique, s/n, 11330-900, São Vicente, SP, Brazil
| | - M Aureliano
- CCMar, Centre of Marine Sciences, University of Algarve, Campus de Gambelas, 8005-135 Faro, Portugal
| | - M J Bebianno
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal.
| |
Collapse
|
30
|
Rocha T. Contagious equine metritis in Portugal: A retrospective report of the first outbreak in the country and recent contagious equine metritis test results. Open Vet J 2016; 6:263-267. [PMID: 28116252 PMCID: PMC5223286 DOI: 10.4314/ovj.v6i3.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022] Open
Abstract
Contagious equine metritis (CEM), a highly contagious bacterial venereal infection of equids, caused by Taylorella equigenitalis, is of major international concern, causing short-term infertility in mares. Portugal has a long tradition of horse breeding and exportation and until recently was considered CEM-free. However, in 2008, T. equigenitalis was isolated at our laboratory from a recently imported stallion and 2 mares from the same stud. Following this first reported outbreak, the Portuguese Veterinary Authority (DGVA) performed mandatory testing on all remaining equines at the stud (n=30), resulting in a further 4 positive animals. All positive animals were treated and subsequently tested negative for T. equigenitalis. Since this outbreak, over 2000 genital swabs from Portuguese horses have been tested at our laboratory, with no further positive animals identified. The available data suggests that this CEM outbreak was an isolated event and we have no further evidence of CEM cases in Portugal, however, an extended and wider epidemiological study would be needed to better evaluate the incidence of the disease in Portuguese horses.
Collapse
Affiliation(s)
- T Rocha
- Bacteriology Laboratory, National Reference Laboratory for CEM, Instituto Nacional de Investigação Agrária e Veterinária- INIAV (National Institute of Agrarian and Veterinary Research), Avenida da República, Quinta do Marquês, 2784-157 Oeiras, Portugal
| |
Collapse
|
31
|
Mendes D, Paredes S, Rocha T, Carvalho P, Henriques J, Morais J. Improving clinical models based on knowledge extracted from current datasets: a new approach. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2016:2295-2298. [PMID: 28268786 DOI: 10.1109/embc.2016.7591188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Cardiovascular Diseases (CVD) are the leading cause of death in the world, being prevention recognized to be a key intervention able to contradict this reality. In this context, although there are several models and scores currently used in clinical practice to assess the risk of a new cardiovascular event, they present some limitations. The goal of this paper is to improve the CVD risk prediction taking into account the current models as well as information extracted from real and recent datasets. This approach is based on a decision tree scheme in order to assure the clinical interpretability of the model. An innovative optimization strategy is developed in order to adjust the decision tree thresholds (rule structure is fixed) based on recent clinical datasets. A real dataset collected in the ambit of the National Registry on Acute Coronary Syndromes, Portuguese Society of Cardiology is applied to validate this work. In order to assess the performance of the new approach, the metrics sensitivity, specificity and accuracy are used. This new approach achieves sensitivity, a specificity and an accuracy values of, 80.52%, 74.19% and 77.27% respectively, which represents an improvement of about 26% in relation to the accuracy of the original score.
Collapse
|
32
|
Muniz de Souza H, Rocha T, Campos SL, Brandão DC, Fink JB, Aliverti A, de Andrade AD. Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Respir Physiol Neurobiol 2016; 227:27-33. [DOI: 10.1016/j.resp.2016.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 12/18/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
|
33
|
Bezerra de Morais AT, Santos Cerqueira M, Moreira Sales R, Rocha T, Galvão de Moura Filho A. Upper limbs total occlusion pressure assessment: Doppler ultrasound reproducibility and determination of predictive variables. Clin Physiol Funct Imaging 2016; 37:437-441. [DOI: 10.1111/cpf.12330] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Taciano Rocha
- Department of Physiotherapy; Federal University of Pernambuco; Recife Brazil
| | | |
Collapse
|
34
|
Tavares M, Paredes S, Rocha T, Carvalho P, Ramos J, Mendes D, Henriques J, Morais J. Expert knowledge integration in the data mining process with application to cardiovascular risk assessment. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:2538-42. [PMID: 26736809 DOI: 10.1109/embc.2015.7318909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The data mining process, when applied to clinical databases, suffers from critical data problems, from noisy acquisitions to missing or incomplete data points. Expert knowledge, in the form of practitioners' experience and clinical guidelines, is already used to manually correct some of these problems, while enhancing expert's confidence in such systems. In this work, we propose the Knowledge-Biased Tree (KB3), a knowledge biased decision tree inducer that is able to exploit IF THEN rules to guide the tree inducing process. The KB3 approach was tested against its unbiased counterpart, the C5.0 algorithm in the cardiovascular risk assessment task. Using a clinical dataset provided by the hospital of Sta Cruz (Lisbon, Portugal) the performance of the proposed algorithm is compared against the unbiased C5.0 and the state of the art risk score used in clinical practice (GRACE risk score).
Collapse
|
35
|
Mendes D, Paredes S, Rocha T, Carvalho P, Henriques J, Cabiddu R, Morais J. Assessment of cardiovascular risk based on a data-driven knowledge discovery approach. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:6800-3. [PMID: 26737855 DOI: 10.1109/embc.2015.7319955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The cardioRisk project addresses the development of personalized risk assessment tools for patients who have been admitted to the hospital with acute myocardial infarction. Although there are models available that assess the short-term risk of death/new events for such patients, these models were established in circumstances that do not take into account the present clinical interventions and, in some cases, the risk factors used by such models are not easily available in clinical practice. The integration of the existing risk tools (applied in the clinician's daily practice) with data-driven knowledge discovery mechanisms based on data routinely collected during hospitalizations, will be a breakthrough in overcoming some of these difficulties. In this context, the development of simple and interpretable models (based on recent datasets), unquestionably will facilitate and will introduce confidence in this integration process. In this work, a simple and interpretable model based on a real dataset is proposed. It consists of a decision tree model structure that uses a reduced set of six binary risk factors. The validation is performed using a recent dataset provided by the Portuguese Society of Cardiology (11113 patients), which originally comprised 77 risk factors. A sensitivity, specificity and accuracy of, respectively, 80.42%, 77.25% and 78.80% were achieved showing the effectiveness of the approach.
Collapse
|
36
|
Rocha T, Souza H, Brandão DC, Rattes C, Ribeiro L, Campos SL, Aliverti A, de Andrade AD. The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial. J Physiother 2015; 61:182-9. [PMID: 26386894 DOI: 10.1016/j.jphys.2015.08.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 10/31/2014] [Revised: 03/10/2015] [Accepted: 08/07/2015] [Indexed: 01/08/2023] Open
Abstract
QUESTIONS In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen? DESIGN Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. PARTICIPANTS Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease. INTERVENTION The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen. OUTCOME MEASURES The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments. RESULTS The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small. CONCLUSION The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease. TRIAL REGISTRATION NCT02212184.
Collapse
Affiliation(s)
- Taciano Rocha
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Helga Souza
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Daniela Cunha Brandão
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Catarina Rattes
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Luana Ribeiro
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Shirley Lima Campos
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, Milan, Italy
| | | |
Collapse
|
37
|
Paredes S, Rocha T, de Carvalho P, Henriques J, Morais J, Ferreira J. Integration of Different Risk Assessment Tools to Improve Stratification of Patients with Coronary Artery Disease. Med Biol Eng Comput 2015. [PMID: 26215518 DOI: 10.1007/s11517-015-1342-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular disease (CVD) causes unaffordable social and health costs that tend to increase as the European population ages. In this context, clinical guidelines recommend the use of risk scores to predict the risk of a cardiovascular disease event. Some useful tools have been developed to predict the risk of occurrence of a cardiovascular disease event (e.g. hospitalization or death). However, these tools present some drawbacks. These problems are addressed through two methodologies: (i) combination of risk assessment tools: fusion of naïve Bayes classifiers complemented with a genetic optimization algorithm and (ii) personalization of risk assessment: subtractive clustering applied to a reduced-dimensional space to create groups of patients. Validation was performed based on two ACS-NSTEMI patient data sets. This work improved the performance in relation to current risk assessment tools, achieving maximum values of sensitivity, specificity, and geometric mean of, respectively, 79.8, 83.8, and 80.9 %. Additionally, it assured clinical interpretability, ability to incorporate of new risk factors, higher capability to deal with missing risk factors and avoiding the selection of a standard CVD risk assessment tool to be applied in the clinical practice.
Collapse
Affiliation(s)
- S Paredes
- Computer Science and Systems Engineering Department, Polytechnic Institute of Coimbra (IPC/ISEC), Rua Pedro Nunes, 3030-199, Coimbra, Portugal.
| | - T Rocha
- Computer Science and Systems Engineering Department, Polytechnic Institute of Coimbra (IPC/ISEC), Rua Pedro Nunes, 3030-199, Coimbra, Portugal.
| | - P de Carvalho
- CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290, Coimbra, Portugal.
| | - J Henriques
- CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290, Coimbra, Portugal.
| | - J Morais
- Cardiology Department, Leiria Hospital Centre, Leiria, Portugal.
| | - J Ferreira
- Cardiology Department, Santa Cruz Hospital, Lisbon, Portugal.
| |
Collapse
|
38
|
Madureira P, Pimenta S, Vieira R, Fonseca R, Gonçalves D, Aguiar F, Rocha T, Bernardo A, Bernardes M, Costa L. AB0504 The Role of Corticosteroids in Rheumatoid Arthritis Patients Under Biologic Therapy. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6198] [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: 11/04/2022]
|
39
|
Madureira P, Pimenta S, Vieira R, Fonseca R, Gonçalves D, Aguiar F, Rocha T, Bernardo A, Bernardes M, Costa L. SAT0130 Effect of Smoking on Therapeutic Response in Rheumatoid Arthritis Patients Under Biologics. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6151] [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: 11/04/2022]
|
40
|
Fonseca R, Vieira R, Madureira P, Rosa-Gonçalves D, Aguiar F, Rocha T, Bernardo A, Mariz E, Bernardes M, Costa L. THU0225 The Induction of Antinuclear Antibodies in Spondyloarthritis Patients Under Anti-TNF Alpha: A New Outcome Predictor? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Fonseca R, Vieira R, Madureira P, Rosa-Gonçalves D, Aguiar F, Rocha T, Bernardo A, Mariz E, Bernardes M, Costa L. FRI0365 Antinuclear Antibodies Induced by Anti-TNF Alpha and its Impact in Clinical Response to Treatment in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
42
|
Fonseca R, Vieira R, Madureira P, Rosa-Gonçalves D, Aguiar F, Rocha T, Bernardo A, Mariz E, Bernardes M, Costa L. AB1167 Antinuclear Antibodies in Rheumatoid Arthritis: Predictors of Response to Anti-TNF Alpha Treatment? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3965] [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: 11/04/2022]
|
43
|
Rolon M, Mandujano EP, Beletsky L, Arredondo J, Rocha T, Olivarria O, Bañuelos A, Gomez MR, Strathdee S. Más miedo a una enfermedad que a un balazo [More afraid of a disease than
a bullet]: Implementation of system-wide needlestick injury surveillance
system in the Tijuana police department, Mexico. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.534] [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: 11/29/2022] Open
|
44
|
Paredes S, Marques T, Rocha T, de Carvalho P, Henriques J, Morals J. Personalization algorithms applied to cardiovascular disease risk assessment. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:2726-9. [PMID: 25570554 DOI: 10.1109/embc.2014.6944186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiovascular disease (CVD) is the major cause of death in the world. Clinical guidelines recommend the use of risk assessment tools (scores) to identify the CVD risk of each patient as the correct stratification of patients may significantly contribute to the optimization of the health care strategies. This work further explores the personalization of CVD risk assessment, supported on the evidence that a specific CVD risk assessment tool may have good performance within a given group of patients and might perform poorly within other groups. Two main personalization methods based on the proper creation of groups of patients are presented: i) clustering patients approach; ii) similarity measures approach. These two methodologies were validated in a Portuguese population (460 Acute Coronary Syndrome with non-ST segment elevation (ACS-NSTEMI) patients). The similarity measures approach had the best performance, achieving maximum values of sensitivity, specificity and geometric mean of, respectively, 77.7%, 63.2%, 69.7%. These values represent an enhancement in relation to the best performance obtained with current CVD risk assessment tools applied in clinical practice (78.5%, 53.2%, 64.4%).
Collapse
|
45
|
Souza H, Rocha T, Pessoa M, Rattes C, Brandao D, Fregonezi G, Campos S, Aliverti A, Dornelas A. Effects of Inspiratory Muscle Training in Elderly Women on Respiratory Muscle Strength, Diaphragm Thickness and Mobility. J Gerontol A Biol Sci Med Sci 2014; 69:1545-53. [DOI: 10.1093/gerona/glu182] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Henriques J, Carvalho P, Paredes S, Rocha T, Habetha J, Antunes M, Morais J. Prediction of Heart Failure Decompensation Events by Trend Analysis of Telemonitoring Data. IEEE J Biomed Health Inform 2014; 19:1757-69. [PMID: 25248206 DOI: 10.1109/jbhi.2014.2358715] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper aims to assess the predictive value of physiological data daily collected in a telemonitoring study in the early detection of heart failure (HF) decompensation events. The main hypothesis is that physiological time series with similar progression (trends) may have prognostic value in future clinical states (decompensation or normal condition). The strategy is composed of two main steps: a trend similarity analysis and a predictive procedure. The similarity scheme combines the Haar wavelet decomposition, in which signals are represented as linear combinations of a set of orthogonal bases, with the Karhunen-Loève transform, that allows the selection of the reduced set of bases that capture the fundamental behavior of the time series. The prediction process assumes that future evolution of current condition can be inferred from the progression of past physiological time series. Therefore, founded on the trend similarity measure, a set of time series presenting a progression similar to the current condition is identified in the historical dataset, which is then employed, through a nearest neighbor approach, in the current prediction. The strategy is evaluated using physiological data resulting from the myHeart telemonitoring study, namely blood pressure, respiration rate, heart rate, and body weight collected from 41 patients (15 decompensation events and 26 normal conditions). The obtained results suggest, in general, that the physiological data have predictive value, and in particular, that the proposed scheme is particularly appropriate to address the early detection of HF decompensation.
Collapse
|
47
|
Chohfi de Miguel G, Laranjo M, Abrantes A, Teixo R, Rocha T, Serra A, Piñeiro M, Rocha-Gonsalves A, Botelho M, Priolli D. 931: Photodynamic therapy as an option for osteosarcoma. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
48
|
Rocha T, Paredes S, de Carvalho P, Henriques J. An effective wavelet strategy for the trend prediction of physiological time series with application to pHealth systems. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2013:6788-91. [PMID: 24111302 DOI: 10.1109/embc.2013.6611115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This work proposes a wavelet decomposition based scheme to estimate the evolution trend of physiological time series. The scheme does not involve the explicit development of a model and is essentially supported on the hypothesis that future evolution of a biosignal can be estimated from similar historic patterns. The strategy considers an a-trous wavelet decomposition, where the most representative trends are extracted from the historic similar patterns. Then, a set of distance-based measures able to assess the prediction likelihood of each representative trend, is introduced. From these measures and through an optimization process, a subset of these trends is selected and aggregated to derive the required time series evolution trend. The effectiveness of the methodology is validated in the prediction of blood pressure signals collected in two telemonitoring studies: TEN-HMS and MyHeart. Additionally, Friedman and Nemenyi statistics tests are implemented to rank several methods, confirming the value of the proposed strategy.
Collapse
|
49
|
Aguillar-Gomes L, Lopes C, Barbieri D, Rocha T, Randazzo-Moura P. Toxic effects of glibenclamide in fetuses of normoglycemic rats: an alternative therapy for gestational diabetes mellitus. Open Vet J 2014; 4:59-64. [PMID: 26623340 PMCID: PMC4629593] [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: 01/20/2014] [Accepted: 04/27/2014] [Indexed: 12/03/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as glucose intolerance first diagnosed during the second or third trimester of pregnancy. The treatment aims at glycemic control through changes in the patient's diet with or without exercise, but some patients need insulin therapy. An alternative would be to use oral hypoglycemic agents such as glibenclamide (GLIB). The present study aims to analyze the toxic effects of GLIB in fetuses of pregnant rats which received 5 or 20mg/kg doses of GLIB. Glycemic dosage reveals no significant difference between control (deionized water) and treated groups, showing that these concentrations of GLIB were not effective to cause hypoglycemia in rats. The vitality of the fetuses in all groups was 100%. GLIB administration promoted increase in weight and significant changes in measures of external morphological parameters of treated fetuses. Histological analysis revealed that liver lobes, lobules and central lobular veins were well defined for all treatments. However, GLIB animals presented a light brownish precipitate into the center-lobular veins and in the liver parenchyma among the hepatocytes. These results indicated a possible passage of the drug through the blood-placental membrane, without serious changes that impair the development of neither bone tissue, nor the liver of these animals.
Collapse
Affiliation(s)
- L. Aguillar-Gomes
- Universidade São Francisco, Avenida São Francisco de Assis, 218, Jardim São José, Bragança Paulista, 12916-900 SP, Brazil
| | - C.M. Lopes
- Pontifícia Universidade Católica, Rua Joubert Wey, 290, Sorocaba, 18030-070 SP, Brazil
| | - D.S. Barbieri
- Pontifícia Universidade Católica, Rua Joubert Wey, 290, Sorocaba, 18030-070 SP, Brazil
| | - T. Rocha
- Universidade São Francisco, Avenida São Francisco de Assis, 218, Jardim São José, Bragança Paulista, 12916-900 SP, Brazil,Corresponding Author: Prof. Thalita Rocha. Universidade São Francisco, Avenida São Francisco de Assis, 218, Jardim São José. Bragança Paulista, 12916-900 SP, Brazil. Tel.: +55 11 4034-8000.
| | - P. Randazzo-Moura
- Pontifícia Universidade Católica, Rua Joubert Wey, 290, Sorocaba, 18030-070 SP, Brazil
| |
Collapse
|
50
|
Farret A, França R, Lima G, Rocha T. Atrial Embolization of a Vena Cava Filter with Dual Fixing System. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2013.09.001] [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: 11/29/2022]
|