Lower low density lipoprotein cholesterol associates to higher mortality in non-diabetic heart failure patients

Background

In patients with established heart failure (HF) low total cholesterol levels associate with worse prognosis. Evidence concerning the impact of Low-density lipoprotein cholesterol (LDL-c) in HF is scarce. We aimed to evaluate the prognostic impact of LDL-c in patients with HF, both with and without diabetes mellitus (DM).

Methods

We retrospectively analyzed outpatients with chronic HF with systolic dysfunction followed in our HF clinic from January/2012 to May/2018. LDL-c was calculated using the Friedewald's formula. Patients without a complete lipid profile were excluded. The endpoint under analysis was all-cause mortality. Patients were followed until January/2021. A Cox-regression analysis was used to study the prognostic impact of LDL-c. The LDL-c cut-off used was 100 mg/dL (mean value). Analysis was stratified according to the coexistence of DM. Multivariate models were built adjusting for age, sex, coronary artery disease, atherosclerotic non-coronary artery disease, arterial hypertension, smoking status, statin use, severity of systolic dysfunction, creatinine clearance and evidence-based therapy.

Results

We studied 522 chronic HF patients, mean age was 70 years, 66.5% males. Severe systolic dysfunction was present in 42.7%, 30.5% had coronary heart disease, 60.5% had arterial hypertension, 41.6% had DM. A total of 92.0% were treated with beta blocker, 87.5% with an ACEi/ARB and 29.1% with a MRA. During a median follow-up of 53 (interquartile range 33-73) months, 235 (45%) patients died. Patients with LDL-c ≤100 mg/dL presented increased multivariate-adjusted risk of all-cause mortality: HR = 1.58 (95% CI: 1.08-2.30), p = 0.02. When patients were stratified according to DM, LDL-c ≤100 mg/dL was independently associated with increased death risk - HR = 1.55 (95% CI:1.05-2.30), p = 0.03 in patients without DM; in patients with DM no association was detected - multivariate-adjusted HR = 1.18 (95% CI: 0.77-1.80), p = 0.44.

Conclusion

Non-DM HF patients with LDL-c>100 mg/dL have a 35% reduction in the mortality risk when compared with those with lower values. The "cholesterol paradox" in HF also applies to LDL-c in non-DM patients.

Pharmacologic Treatment Strategies in Psoriatic Arthritis

PURPOSE

The goal of this narrative review was to provide current data on psoriatic arthritis (PsA) therapeutic strategies, supporting treatment decisions with a domain-based approach.

METHODS

This narrative review of treatment strategies for PsA focused on several disease domains (ie, peripheral arthritis, enthesitis, axial disease, dactylitis, skin and nail disease), as well as the so-called "related conditions" of uveitis, Crohn's disease, and ulcerative colitis. We searched PubMed, EMBASE, international guidelines, and recent congress abstracts.

FINDINGS

Currently, multiple approved treatment options offer a wide range of options, such as tumor necrosis factor (TNF) inhibitors; inhibitors of interleukin-17 (IL-17), IL-12/23 (IL-12/23), IL-23 (IL-23), and Janus kinase; the phosphodiesterase 4 inhibitor apremilast; and the T-cell modulator abatacept. However, no treatment option shows clear superiority concerning efficacy on peripheral arthritis and dactylitis over the others, whereas limited evidence suggests that the IL-17 inhibitor ixekizumab and the IL-12/23 inhibitor ustekinumab may be superior to TNF inhibitors in treating enthesitis. Recent data on enthesitis have also shown promising results for methotrexate. Treatment of axial PsA is mostly derived from axial spondyloarthritis, and more data are needed focusing on this specific subgroup of PsA patients. Thus far, the most important finding from the only randomized controlled trial in this specific population is that the IL-17 inhibitor secukinumab was superior to placebo in terms of clinical and radiologic end-points in axial PsA. Regarding psoriatic skin involvement, head-to-head trials in PsA as well as skin psoriasis showed the superiority of IL-17, IL-23, and IL-12/23 inhibitors over TNF inhibitors. When treating PsA with concurrent uveitis, according to the existing data, monoclonal TNF inhibitor antibodies should be preferred. In PsA and concomitant inflammatory bowel disease, treatment decisions must include the consideration of which specific type of inflammatory bowel disease (Crohn's disease or ulcerative colitis) is present, as some of the agents either lack data or are ineffective in treating these 2 conditions. In both types, IL-17 inhibitors should be avoided. When determining treatment strategy, comorbidities should be carefully assessed, and the corresponding risk profile of the respective treatment modalities should be taken into consideration.

IMPLICATIONS

There are many approved therapeutic options for treating patients with PsA, and additional emerging treatment options are in the pipeline. Individualized treatment decisions for each patient, depending on the leading disease phenotype, underlying comorbidities, and patient preferences, should be made based on shared decision-making.

POS1088 CHALLENGES IN THE MANAGEMENT OF PSORIATIC ARTHRITIS IN LATIN AMERICA: A SYSTEMATIC REVIEW

Background

In 2020, the International League of Associations for Rheumatology (ILAR) recommendations for management of psoriatic arthritis (PsA) were published. This aimed to adapt GRAPPA and EULAR recommendations to resource-poor settings. At that time, the paucity or absence of clinical studies endorsing the management of PsA patients in Latin America was remarked on by the international working group. Despite several challenges faced by patients and physicians in resource-poor countries, the literature on this theme is scarce.

Objectives

To recognize the main challenges on the management of PsA in Latin America described in recent publications.

Methods

A systematic literature review of clinical trials reporting at least one challenge/difficulty on the management of PsA in Latin America was conducted following PRISMA statements. References published in English, Spanish, French and Portuguese language and published in PubMed, Embase, and LILACS between 1980 and 2020 were included. The selection of references was conducted independently by two researchers in Rayyan QCRI program. Data were independently extracted by two reviewers. The Cochrane tool was used to assess the quality of studies. All challenges were noted and categorized into domains. Data analysis was descriptive.

Results

The search strategy resulted in 1505 references. Sixteen studies (15,145 PsA patients) were included in the final analysis: most were performed in Brazil (81.2%, N=13), recruited patients on biological therapy (75.0%, N=12) and were observational studies (87.5%, N=14). Difficulties faced by PsA patients and physicians in Latin America were the high incidence of opportunistic infections (described in 43.7% of publications, N=7), non-adherence to therapy (18.7%, N=3), discordance between patients and physicians regarding remission rates (18.7%, N=3), limited access to DMARDs (12.5%, N=2), issues related to the storage of biological drugs (12.5%, N=2), high impact of PsA on work and productivity (12.5%, N=2), elevated cost of biological drugs (12.5%, N=2), low drug persistence (6.2%, N=1), limited access to medical care (6.2%, N=1) and diagnostic delay (6.2%, N=1).

Conclusion

The challenges in the management of PsA in Latin America go beyond the care of opportunistic infections: special attention should be paid to logistical questions (e.g., correct medication storage, access to drugs and medical care) and educational problems (e.g., importance of adherence, patients understanding of disease and therapy)

References

[1]Elmamoun M, Eraso M, Anderson M, Maharaj A, Coates L, Chandran V; ILAR-PsA recommendations group, Abogamal A, Adebajo AO, Ajibade A, Ayanlowo O, Azevedo V, Bautista-Molano W, Carneiro S, Goldenstein-Schainberg C, Hernandez-Velasco F, Ima-Edomwonyi U, Lima A, Medina-Rosas J, Mody GM, Narang T, Ortega-Loayza AG, Ranza R, Sharma A, Toloza S, Vega-Espinoza L, Vega-Hinojosa O. International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings. Clin Rheumatol. 2020 Jun;39(6):1839-1850. doi: 10.1007/s10067-020-04934-7. Epub 2020 Jan 16. PMID: 31950441; PMCID: PMC7237392.

Disclosure of Interests

None declared

The effect of different pulp capping methods on the intrapulpal temperature when using light-cured procedures

Background

To evaluate the intra-pulpal temperature during different direct pulp capping methods and light-cured procedures.

Material and Methods

Class I preparations 5 mm long, 4 mm wide and 4 mm deep were performed in extracted third molars, leaving 0.5 mm of dentin at the pulpal floor with a 1 mm diameter of pulp exposure. Teeth were placed in a customized oral cavity chamber simulator in which the initial temperature was standardized at 36oC. The overall temperature variations (oC) in the pulp chamber during the light-activation processes were recorded live using an infrared camera (FLIR ONE PRO, FLIR Systems). The liners and bases evaluated were: Dycal (Dentisply), TheraCal LC (Bisco), Biodentin (Septodent), Vitrebond Plus (3M/ESPE), and Fuji IX GP (GC), followed by restoration with a bulk fill composite (EvoCeram Bulk Fill, Ivoclar Vivadent). All light-activation procedures were performed with the VALO Grand (Ultradent) light-curing unit. A power analysis was conducted to determine the sample size to provide a power of at least 0.8 with α=0.05. Statistical analyses were performed using ANOVA and Tukey’s test for multiple comparisons.

Results

The intrapulpal temperature increased above a 10oC to 20oC threshold difference for all liners and bases that were light cured. When added as second layers, neither of those could provide thermal insulation following additional light-activated procedures (p=0.25). The higher the number of procedures requiring light-activation, the longer the pulp temperature remained in those increased temperature thresholds.

Conclusions

For direct pulp capping procedures, a reduced number light activation procedures should be indicated to reduce the time intra-pulpal temperature rises above a 10oC threshold.

Key words:Liner, base, calcium hydroxide, glass ionomer, dental adhesive, bulkfill composite.

The burden of ischaemic heart disease in Brazil from 1990 to 2019 and the association between temporal changes and socioeconomic level

Introduction

The burden of ischaemic heart disease (IHD) has declined in several countries, although IHD remains the leading cause of death globally. Brazil is a large country with high inequality in income distribution across different regions.

Purpose

This study sought to evaluate the burden of IHD in Brazil from 1990 to 2019, as well as the relationship between temporal changes and socioeconomic level of the Federative Units.

Methods

Estimates of prevalence, mortality, and disability-adjusted life-years (DALYs) due to IHD were retrieved from the Global Burden of Disease Study 2019. We used databases from the Ministry of Health of Brazil to obtain the number of hospitalisations from acute coronary syndrome (ACS) and acute myocardial infarction (AMI) in the context of the public service. The Socio-demographic Index (SDI), a composite indicator of income per capita, average educational attainment, and fertility rate in females younger than 25 years, was used as a measure of socioeconomic status. Rates with 95% uncertainty intervals are reported.

Results

In 2019, the age-standardised prevalence rate of IHD was 1,709 (1,466–1,994) per 100,000 inhabitants. This rate remained stable from 1990 to 2019 (percent change: −1.1 [−2.6–0.5]). The estimate of deaths from IHD in 2019 was 171,246 (156,180–180,511), corresponding to 12% (11%-13%) of total deaths in the country (the leading cause) and 43% of all cardiovascular deaths. In 2019, the age-standardised mortality rate due to IHD was 75 (68–79) per 100,000. The unadjusted mortality rate due to IHD mildly increased from 2005 to 2019, while the age-standardised rate continuously decreased from 1990 to 2019 (cumulative percent change: −53 (−55 to −50, Figure 1). A negative correlation was observed between the change in age-standardised mortality rate from IHD in the period and the 2019 SDI (Figure 2). In 2019, the age-standardised DALY rate due to IHD was 1,563 (1,472–1,636) per 100,000. This DALY rate was equivalent to 5.7% (5.1%-6.3%) of total DALYs, meaning that IHD was the second most common cause of DALYs in Brazil in females and males. From 1990 to 2019, the crude DALY rate per 100,000 remained fairly stable, and the age- standardised DALY rate per 100,000 gradually declined (−50% [−52% to −48%]). There was a negative correlation between the change in age-standardised DALY rate from IHD in the period and the SDI (r2 0.59, p-value <0.01). The number of hospital admissions for ACS remained stable from 2008 to 2019 (33 per 100,000 in 2019). The number of hospitalisations due to AMI increased from 25 per 100,000 in 2008 to 39 per 100,000 in 2019 (percent change: 52%).

Conclusions

While age-standardised mortality, DALY rates continuously decreased from 1990 to 2019, the burden of IHD in Brazil remains high, probably due to ageing and population growth. Reductions in age-standardised mortality, DALY rates over time tend to be more pronounced in more developed regions.

Funding Acknowledgement

Type of funding sources: None. Mortality rate (per 100,000)Change in mortality rate and SDI

The major endocannabinoid anandamide (AEA) induces apoptosis of human granulosa cells

The endocannabinoid system (ECS) plays a crucial role in human reproduction. Changes in anandamide (AEA) levels affect reproductive events and has already been suggested as biomarker of reproductive potential of male and female gametes. Although cannabinoid-receptor 1 (CB1) was already identified in human granulosa cells (hGCs) the ECS was not characterized on granulosa cells line COV434 nor the effects of AEA on GCs viability and function depicted. Therefore, the aim of this study was to characterize the ECS elements and explore the effects of AEA on both COV434 and hGCs. Our results revealed that hGCs express the full enzymatic machinery responsible for AEA metabolism as well as cannabinoid receptors. In addition, AEA induced a reduction in both COV434 and hGCs viability in a concentration and time-dependent manner. Nevertheless, the effects of AEA in cell viability was independent of either CB1 or CB2 receptors. There was no ROS release in both cell models; however, AEA induced morphological changes, presenting chromatin condensation at 72 h, and variation on mitochondrial membrane potential. Moreover, AEA induced an increase in caspase -3/-7 activities in both cell models, but in hGCs there was also an increase in caspase 8 activity. This study supports the idea that ECS balance is crucial for folliculogenesis and oocyte quality as dysregulated AEA levels may compromise female fertility.

Early resynchronization of non-pregnant beef cows based in corpus luteum blood flow evaluation 21 days after Timed-AI

The study aimed to verify whether a hormone protocol started at Day 13 (D13) after Timed Artificial Insemination (TAI) influences the conception rate. Nelore cows (primiparous and multiparous) from two commercial beef farms (n = 1,431) were first TAI (D0). Timed AI was performed in lots (TAI Lots) ranging from 187 to 346 cows. On D13, regarding the TAI lot, cows were assigned for either receiving (Resynch group, n = 1,002) or not (Control group, a subset of approximately 30%, n = 429) another hormone protocol for resynchronization. The same hormone protocol was used for the first TAI and for the resynchronization, except for 1 mg instead of 2 mg of estradiol benzoate (EB) at the begging of the protocol. Eight days later (D21), the Resynch group was checked for corpus luteum blood flow by color Doppler ultrasonography, and in those detected as non-pregnant, the protocol was completed and a 2nd TAI was performed at D23. Pregnancy diagnosis was later (D30) performed by B-mode ultrasonography in the control group and confirmed in the presumptive pregnant cows from the 1st TAI of the Resynch group. The remaining cows were checked for pregnancy 30 days after the 2nd TAI (experimental Day 53). The statistical model to explain conception rate considered the effects of Group (Control or Resynch), Farm, Parity (primiparous or multiparous), Sire, Technician (who perform AI), TAI Lot and pertinent interactions (Group*Parity, Group*Farm and Group*TAI Lot). The statistical analyses of the model were performed using the Proc Glimmix (SAS virtual University Edition). The conception rate for the 1st TAI was similar (P > 0.4) between Control (50.3%, 216/429) and Resynch group (52.6%, 527/1002). The positive predictive diagnostic on D21 showed high relation with PD30 (90.7%, 527/581). In Resynch group, non-pregnant cows (n = 421, 1002 minus 581) were re-inseminated. The conception rate of the 2nd TAI (42.8%, 180/421) was affected (P < 0.002) by side effects of the Farm (48.5 vs. 33.1%) and Parity (51.2 vs. 40.3%, for multiparous vs. primiparous, p < 0.001). Nevertheless, after the 2 TAIs of the Resynch group, the cumulative conception rate was 70.5% (707/1002). In conclusion, the early resynchronization of cows with a low (1 mg) EB dose and progesterone device at D13 after TAI can be used as a strategy to reduce conception interval in beef cattle, and thus to increase the number of pregnant cows from artificial insemination after the breeding season.

Animal Models to Study Cancer and Its Microenvironment

Cancers are complex tissues composed by genetically altered cancer cells and stromal elements such as inflammatory/immune cells, fibroblasts, endothelial cells and pericytes, neuronal cells, and a non-cellular component, the extracellular matrix. The complex network of interactions and crosstalk established between cancer cells and the supportig cellular and non-cellular components of the microenvironment are of extreme importance for tumor initiation and progression, strongly impacting the course and the outcome of the disease. Therefore, a better understanding of the tumorigenic processes implies the combined study of the cancer cell and the biologic, chemical and mechanic constituents of the tumor microenvironment, as their concerted action plays a major role in the carcinogenic pathway and is a key determinant of the efficacy of anti-cancer treatments. The use of animal models (e.g. Mouse, Zebrafish and Drosophila) to study cancer has greatly impacted our understanding of the processes governing initiation, progression and metastasis and allowed the discovery and pre-clinical validation of novel cancer treatments as it allows to recreate tumor development in a more pathophysiologic environment.

Ionising radiation exposure from medical imaging - A review of Patient's (un) awareness

INTRODUCTION

Medical imaging is the main source of artificial radiation exposure. Evidence, however, suggests that patients are poorly informed about radiation exposure when attending diagnostic scans. This review provides an overview of published literature with a focus on nuclear medicine patients on the level of awareness of radiation exposure from diagnostic imaging.

METHODS

A review of available literature on awareness, knowledge and perception of ionising radiation in medical imaging was conducted. Articles that met the inclusion criteria were subjected to critical appraisal using the Mixed Methods Appraisal Tool.

RESULTS

140 articles identified and screened for eligibility, 24 critically assessed and 4 studies included in synthesis. All studies demonstrated that patients were generally lacking awareness about radiation exposure and highlighted a lack of communication between healthcare professionals and patients with respect to radiation exposure.

CONCLUSION

Studies demonstrate a need to better inform patients about their radiation exposure, and further studies focusing on nuclear medicine patients are particularly warranted.

IMPLICATIONS FOR PRACTICE

Adequate and accurate information is crucial to ensure the principle of informed consent is present.

Validation of Anthropometric Measures Self-Reported in a Randomized Controlled Trial of a Web-Based Platform for Weight Loss

INTRODUCTION

A great number of weight loss interventions have been delivered through digital solutions. Analysis of the effectiveness in terms of weight loss is fundamental to understand the real potential of digital technologies as tools for delivery of weight loss interventions. For this, we need accurate and reliable anthropometric data. For reasons of convenience, self-reported weight and height often replace actual measurements in these interventions. This might lead to misclassification of BMI status during selection of participants and to bias in the assessment of the outcomes. Therefore, it is fundamental to have validation studies of self-reported web-based data.

OBJECTIVES

We aimed to validate online self-reported height, weight and BMI in a POEmaS trial subsample.

METHODS

We included 12.5% of the POEmaS' population (n=159). Anthropometric data reported on the web-platform were compared to measured data by paired T-tests. Agreement was assessed by Bland-Altman plots. Multinomial regression was used to investigate factors associated with self-reported weight validity.

RESULTS

There was no significant difference between reported and measured weight (0.4 kg, SD 1.7; p=0.13) and BMI (0.03 kg/m2, SD 0.87; p=0.06). Reported height was on average 0.4 cm (SD 1.2) higher than the measured ones (p<0.001). For all anthropometric data, >=95% of the cases were within the limits of agreement. Higher measured BMI was the only factor associated with low accuracy of weight report. Each unit increase in BMI increased the odds that the reported weight was lower than the one measured (OR 1.13; 95%CI 1.01-1.26).

DISCUSSION

Self-reported weight and BMI change showed good agreement with measured ones. Since these are the primary outcomes of the POEmaS trial, the findings of the validation study suggest that the outcomes' accuracy is high and that it does not vary across gender, age, study group. These findings are relevant to digital health researchers and assessors and suggest that digital health interventions for weight loss might rely on self-reported assessment of outcomes. This might be particularly useful when other modes of assessment, such as anthropometry and e-scales, are not feasible or not available. However, we acknowledge that these results might not be applicable to low educated populations.

Long term prognosis of acute pulmonary embolism

BACKGROUND

Acute pulmonary embolism (PE) can be fatal if left untreated. Long-term prognosis of acute PE in the 21st century has not been fully reported. We aimed to determine the long-term prognosis of patients hospitalized with acute PE and compare survivalof patients with idiopathic and secondary PE.

MATERIALS AND METHODS

We retrospectively analysed a cohort of hospitalized patients with acute PE between 2006 and 2013.

EXCLUSION CRITERIA

<18 years, venous embolism of non-pulmonary veins, chronic thromboembolic pulmonary hypertension, and presumptive diagnosis without image confirmation. Only patients with a first PE episode were included. End-point: all-cause mortality. Patients were compared according to PE aetiology: idiopathic, secondary to neoplastic conditions and secondary to non-neoplastic conditions. A Cox-regression analysis was used to study the prognostic impact of PE aetiology.

RESULTS

We studied 872 hospitalized acute PE patients. Median age 70 years, 56.9% were women. PE was idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed for a median 25 months period and 508 (58.3%) died. Patients with PE attributed to a neoplastic condition had the worst survival. Patients with idiopathic PE had a multivariate-adjusted HR of mortality of 1.46 (1.08-1.99) during the over 2-year follow-up period when compared to those with acute PE attributed to a non-neoplastic condition.

CONCLUSIONS

Patients with idiopathic acute PE have an almost 50% higher death risk in a median 2-year follow-up period than those with acute PE secondary to a condition other than neoplasia.

Climate change potential effects on grapevine bioclimatic indices: A case study for the Portuguese demarcated Douro Region (Portugal)

In this work, bioclimatic parameters and indices relevant to the grapevine are estimated for the years 2000 (recent-pat), 2049 (medium-term future) and 2097 (long-term future), based on very high resolution (1 km × 1 km) MPI-WRF RCP8.5 climate simulations. The selected parameters and indices are the mean temperature during the grapevine growing season period (April to October, Tgs), the cumulative rainfall during the grapevine growing season period (Pgs), the Winkler index (WI), the Huglin heliothermic index (HI), the night cold index (CI) and the dryness index (DI). In general, a significant increase in mean temperature during the grapevine growing season period is observed, together with a significant decrease in precipitation. The recent-past WI is associated with the production of high-quality wines; the higher values predicted for the future represent intensive production of wines of intermediate quality. The HI shows the passage of a grapevine growing region considered as temperate-warm to a warm category of higher helio-thermicity. The recent-past CI indicates very cool conditions (associated with quality wines), while in the future there is a tendency for temperate or warmer nights. Finally, DI indicates an increase in water stress considered already high under the recent-past climate conditions. These results point to an increased climatic stress on the Douro region wine production and increased vulnerability of its vine varieties, providing evidence to support strategies aimed to preserve the high-quality wines in the region and their typicality in a sustainable way.

Prevalence of calcifications in soft tissues visible on a dental pantomogram: A retrospective analysis

OBJECTIVES

To determine the frequency and spectrum of soft tissues calcifications identified on Dental Pantomograms (DPT) at a University Dental Clinic in the northern region of Portugal and to compare the data obtained with those published in the literature.

METHODS

We conducted a 3-year descriptive analysis (2012-2014) of DPT calcifications within soft tissues at the University Clinic (CESPU), in Oporto, Portugal. Information on gender, age, location of the lesions and the radiographic diagnosis were analysed. DPTs were interpreted by two examiners (Kappa test 0.8). Data were entered into a database and analysed with Chi-square and Fisher exact tests. Statistical analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk test.

RESULTS

2375 DPTs were analysed, with 468 calcifications observed in the radiographs of 420 individuals. Calcifications of the stylohyoid and stylomandibular ligament were most common, with atheroma, sialoliths, tonsilloliths rhinoliths and antroliths also identified. A statistically significant relationship was observed between the presence of calcifications of the stylohyoid and stylomandibular ligaments, atheromatous calcifications in the carotid artery and tonsilloliths in individuals older than 40.

CONCLUSIONS

This is the largest sample analysis ever done in Portugal, providing useful information about the incidence and distribution of soft tissue calcifications identifiable on DPTs, allowing valuable comparison with other countries.

ADVANCES IN KNOWLEDGE

Despite mostly being incidental findings, panoramic radiography can be the first relevant test that aids dental practitioners in the process of requesting other imaging techniques or forwarding to the correct specialty.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Assessing bioink shape fidelity to aid material development in 3D bioprinting

During extrusion-based bioprinting, the deposited bioink filaments are subjected to deformations, such as collapse of overhanging filaments, which compromises the ability to stack several layers of bioink, and fusion between adjacent filaments, which compromises the resolution and maintenance of a desired pore structure. When developing new bioinks, approaches to assess their shape fidelity after printing would be beneficial to evaluate the degree of deformation of the deposited filament and to estimate how similar the final printed construct would be to the design. However, shape fidelity has been prevalently assessed qualitatively through visual inspection after printing, hampering the direct comparison of the printability of different bioinks. In this technical note, we propose a quantitative evaluation for shape fidelity of bioinks based on testing the filament collapse on overhanging structures and the filament fusion of parallel printed strands. Both tests were applied on a hydrogel platform based on poloxamer 407 and poly(ethylene glycol) blends, providing a library of hydrogels with different yield stresses. The presented approach is an easy way to assess bioink shape fidelity, applicable to any filament-based bioprinting system and able to quantitatively evaluate this aspect of printability, based on the degree of deformation of the printed filament. In addition, we built a simple theoretical model that relates filament collapse with bioink yield stress. The results of both shape fidelity tests underline the role of yield stress as one of the parameters influencing the printability of a bioink. The presented quantitative evaluation will allow for reproducible comparisons between different bioink platforms.

Effect of a peptide in cosmetic formulations for hair volume control

OBJECTIVE

The capacity of hair to absorb water causes changes in its physical and cosmetic properties under different environmental conditions. Hence, the control of hair volume in variable relative humidity settings is an important topic in cosmetics. The behaviour of two types of hair, Caucasian and Asian, was studied regarding their volume change in different relative humidity conditions. The ability of a peptide as a hair volume treatment was evaluated in two climate control formulations.

METHODS

Tresses of the two types of hair were tested in two relative humidity (RH) conditions: (A) variable relative humidity (2 h 40% RH, followed by 2 h 90% RH and 2 h of 40% RH), and (B) continuous high relative humidity (90% RH for 6 h). Changes in the hair tress volume were assessed throughout time. Hair treated with two climate control formulations, with and without a peptide (KP peptide), were tested under the two relative humidity conditions.

RESULTS

Caucasian hair had a higher change in volume compared to the Asian hair in variable and high relative humidity conditions. The hair volume increase when subject to high air humidity, and it was lower with the incorporation of a peptide into climate control formulations.

CONCLUSION

Caucasian hair showed higher volume than Asian hair when submitted to both relative humidity conditions. The incorporation of the peptide into the climate control formulations, a base (mostly composed of water ≈ 94%) and an ethanolic, was found to reduce the volume of Caucasian hair tresses. The presence of the peptide improved the hair volume change more than 60% in high relative humidity conditions.

Screening for Atrial Fibrillation

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Severe Mental Illness and Cancer – A Program for Psychiatric Patients in a Cancer Center

Introduction

The prevalence of severe mental illness (SMI) is estimated to be 4%. There are increased risk factors for cancer in SMI patients. People with SMI have deficient access and referral to routine cancer screening and psychiatric illness is often associated to late oncological diagnosis.

Objectives

Characterize the population of SMI patients that undergoes oncological treatment; establish a comparison with the general population in terms of stage at the time of diagnosis and the type of follow-up that ensued; characterize the psychiatric care available to these patients; propose the necessary changes to ensure adequate healthcare for SMI patients.

Aims

To assess and improve the quality of oncological care for SMI patients in our hospital.

Methods

We analyzed the data from SMI patients suffering from SMI observed by our group during a 12 month period.

Results

Low percentage of SMI patients being treated in our center regarding general rates; surprisingly high referral time to psychiatry unity; good compliance with treatments and appointments; have mostly been submitted to the standard oncological protocols of treatment.

Conclusion

In spite of serious psychiatric co-morbidity and psychosocial deficits, our SMI patients are able for standard cancer treatment and present sufficient compliance. We value the help of family members and social workers. We have to insist in educational sessions and psychiatric screening procedures for oncological teams. It is also fundamental to implement educational programs for mental health centers in Lisbon in order to sensitize for cancer risks among SMI and alert for the pivotal role of mental health staff, namely the psychiatrists.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Outcome and risk factors assessment for adverse events in advanced esophageal cancer patients after self-expanding metal stents placement

Self-expanding metal stents (SEMS) are the treatment of choice for advanced esophageal cancers. Literature is scarce on risk factors predictors for adverse events after SEMS placement. Assess risk factors for adverse events after SEMS placement in advanced esophageal cancer and evaluate survival after SEMS placement. Cross-sectional study of patients with advanced esophageal cancer referred for SEMS placement, during a period of 3 years. Ninety-seven patients with advanced esophageal cancer placed SEMS. Adverse events were more common when tumors were located at the level of the distal esophagus/cardia (47% vs 23%, P = 0.011, OR 3.1), with statistical significance being kept in the multivariate analysis (OR 3.1, P = 0.018). Time until adverse events was lower in the tumors located at the level of the distal esophagus/cardia (P = 0.036). Survival was higher in patients who placed SEMS with curative intent (327 days [126-528] vs. 119 days [91-147], P = 0.002) and in patients submitted subsequently to surgery compared with those who did just chemo/radiotherapy or who did not do further treatment (563 days [378-748] vs. 154 days [133-175] vs. 46 days [20-72], P < 0.001). Subsequent treatment kept statistical significance in the multivariate analysis (HR 3.4, P < 0.001). SEMS allow palliation of dysphagia in advanced esophageal cancer and are associated with an increased out-of-hospital survival, as long as there are conditions for further treatments. Tumors located at the level of the distal esophagus/cardia are associated with a greater number of adverse events, which also occur earlier.

Changing the shape of hair with keratin peptides

Here we propose a solution which will replace harsh reducing agents at alkaline pH by peptide formulations acting at neutral pH to change hair shape through the re-conformation of disulphide bonds.

Therapeutic Vaccine against Streptococcus sobrinus-induced Caries

Streptococcus sobrinus produces a virulence-associated immunomodulatory protein (VIP) which suppresses the host-specific immune response and induces the early production of IL-10. In this study, we evaluated the effects of therapeutic immunization with this VIP on the incidence of caries in S. sobrinus-infected rats. Groups of Wistar rats were orally infected with S. sobrinus and fed with sucrose-sweetened drinking water ad libitum. Five days later, rats were immunized intranasally with active or heat-inactivated VIP plus alum as adjuvant or PBS plus adjuvant (sham-immunized). After 3 wks, all rats were re-immunized as above. Evaluation of dental caries showed that VIP-immunized animals had significantly fewer enamel sulcal and proximal caries lesions than did the sham-immunized animals (p < 0.001). The protective effects following therapeutic VIP immunization were attributed to the induced salivary immunoglobulin A specific to the VIP. These results offer a promising and safe strategy for the development of a vaccine against dental caries.

Edge effects on the blowfly fauna (Diptera, Calliphoridae) of the Tijuca National Park, Rio de Janeiro, Brazil

In this contribution we examine the diversity, abundance and species richness of Calliphoridae in the Tijuca National Park, Rio de Janeiro, RJ. Specimens were collected monthly between September 2009 and August 2010, using sardines as bait, in three points: A, on the forest edge (22°56'846"S 43°17'496"W), B, 700 m from it (22°57'073"S 43°17'832"W) and C, 1,200 m into the forest (22°57'321"S 43°18'031"W), evaluating the indicator species at each point and the anthropogenic influences and abiotic factors that determine species distribution. A total of 16,364 Calliphoridae were collected and 17 species were identified. Species abundance was strongly positively correlated with temperature. The greatest number of flies was collected at A, but in this point, diversity was lower and most individuals collected belonged to the dominant species. Point C, conversely, had the lower abundance and the highest diversity. Chrysomya megacephala, an urban and synanthropic species, was dominant at point A, whereas Laneela nigripes and Mesembrinella peregrina, typically forest species, were considered indicators at points B and C, respectively, showing that the anthropogenic influence is more intense at the forest edge.

Microbial composition of atherosclerotic plaques

OBJECTIVE

The association of infections such as periodontitis with atherosclerotic diseases is well documented. In spite of the high diversity of the human oral microbiota, and its close contact with the circulatory system, few oral species were detected in atherosclerotic plaques. Thus, we attempted to evaluate the microbial diversity of atherosclerotic plaques from patients with different periodontal conditions, submitted to endarterectomy by a broad-range microbial method.

MATERIALS AND METHODS

Patients indicated for aorta endarterectomy due to myocardial infarction were recruited for periodontal clinical examination. The microbial diversity of atherosclerotic plaques (n = 35) was evaluated by sequence analysis of bacterial 16S rRNA libraries.

RESULTS

Bacterial DNA was detected in 12 endarterectomy specimens (34.3%). Twenty-three bacterial species/phylotypes were identified. Proteobacteria and Firmicutes comprised 78.3% and 21.7% of the identified taxa, respectively. Fifteen (60.9%) phylotypes were reported as yet uncultivable or as yet uncharacterized species. Two uncultured phylotypes were previously detected in the human mouth. The periodontopathogen Aggregatibacter actinomycetemcomitans was detected in seven samples (20%), followed by Pseudomonas species. There was no association between periodontal parameters and detection of A. actinomycetemcomitans or other phylotypes in atherosclerotic plaques.

CONCLUSION

Our results suggest a role of the oral microbiota in the development of inflammation in atherogenesis, particularly of A. actinomycetemcomitans.