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Dignass A, Danese S, Matsuoka K, Ferrante M, Long M, Redondo I, Gibble TH, Moses R, Li X, Morris N, Milch C, Abreu M, Jones J. A185 SUSTAINED SYMPTOM CONTROL WITH MIRIKIZUMAB IN PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS IN THE LUCENT-2 MAINTENANCE TRIAL. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991200 DOI: 10.1093/jcag/gwac036.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Mirikizumab (miri) improved symptom control in a Phase 3, multicenter, randomized, double-blind, parallel, placebo-controlled induction study at Week (W)12, in patients (pts) with moderately-to-severely active ulcerative colitis (UC; LUCENT-1). Purpose This analysis assessed sustained symptom control during the maintenance phase through W40 (W52 of continuous therapy), among pts who were induced into clinical response with miri. Method During the 40W maintenance study (LUCENT-2), pts (N=544) who achieved clinical response to miri 300mg Q4W by W12 of induction, were re-randomized 2:1 to subcutaneous (SC) miri 200mg (n=365) or PBO Q4W (n=179). We evaluated sustained control of stool frequency (SF), rectal bleeding (RB), bowel movement urgency (BU) and abdominal pain (AP). The proportion of pts achieving SF Remission (defined as SF=0, or SF=1 with a ≥1-point decrease from induction baseline [BL]), RB Remission (RB=0), Symptomatic Remission (both SF and RB Remission), Stable Maintenance of Symptomatic Remission (defined as pts in Symptomatic Remission for at least 7 out of 9 visits from W4 to W36 and also at Week 40 among pts in Symptomatic Remission and Clinical Response at the end of LUCENT-1), and AP Improvement (Numeric Rating Scale [NRS] pain score ≥30% improvement from BL in pts with baseline AP NRS ≥3) were assessed. BU NRS change from baseline, and the proportion of pts achieving BU Remission (NRS 0 or 1 in pts with BU NRS ≥3 at baseline) were evaluated. Result(s) A greater proportion of miri-treated pts achieved SF Remission, RB Remission and Symptomatic Remission compared to PBO at W40 (Table), with significant differences observed from W8 of LUCENT-2 (p=0.042; p=0.004; p=0.036, respectively) and maintained through W40. Miri-treated pts had a significantly higher percentage of Stable Maintenance of Symptomatic Remission (p<0.001). Pts in the miri-treatment group had a significantly greater mean reduction in BU NRS change from induction BL starting at W12 (p=0.034) onwards compared to PBO (Table). Pts assigned to miri accrued an additional 13.6 percentage-point benefit in BU Remission during the first 8W of maintenance therapy and achieved a significant greater improvement at W40 compared to PBO (p<0.001, Table). Similarly, AP was significantly improved for the miri-treated group starting at W16 (p=0.034) onwards compared to PBO. Image ![]()
Conclusion(s) Miri provides sustained control of UC symptoms including BU, RB, and SF compared to PBO in pts with moderately to severely active UC. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Eli Lilly and Company Disclosure of Interest A. Dignass Consultant of: AbbVie, Abivax, Amgen, Arena Pharmaceuticals, Bristol Myers Squibb (Celgene), Celltrion, Dr. Falk Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos, Gilead Sciences, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Pharmacosmos, Roche, Sandoz/Hexal, Takeda, Tillotts Pharma AG, and Vifor Pharma; has received lecture fees or honoraria from: AbbVie, Amgen, Bristol Myers Squibb, Dr. Falk Pharma, Ferring Pharmaceuticals, Galapagos, High5Md, Janssen, Materia, Merck Sharp & Dohme, Pfizer, Sandoz, Takeda, Tillotts Pharma AG, and Vifor Pharma, S. Danese Consultant of: AbbVie, Alimentiv, Allergan, Amgen, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr. Falk Pharma, Eli Lilly and Company, Enthera, Ferring Pharmaceuticals, Gilead Sciences, Hospira, Inotrem, Janssen, Johnson & Johnson, Merck Sharp & Dohme, Mundipharma, Mylan, Pfizer, Roche, Sandoz Sublimity, Takeda, TiGenix, UCB Pharma, and Vifor Pharma, Speakers bureau of: AbbVie, Amgen, Ferring Pharmaceuticals, Gilead Sciences, Janssen, Mylan, Pfizer, and Takeda, K. Matsuoka Grant / Research support from: AbbVie, EA Pharma, JIMRO, Kissei Pharmaceutical, Kyowa Kyorin, Mitsubishi Tanabe, Mochida Pharmaceutical, and Zeria Pharmaceutical Nippon; lecture fees from: AbbVie, EA Pharma, JIMRO, Kissei Pharmaceutical, Kyowa Kyorin, Mitsubishi Tanabe, Mochida Pharmaceutical, Takeda, and Zeria Pharmaceutical Nippon, M. Ferrante Grant / Research support from: AbbVie, Amgen, Biogen, Janssen Cilag, Pfizer, Takeda, and Viatris, Consultant of: AbbVie, Boehringer Ingelheim, Celltrion, Eli Lilly and Company, Janssen Cilag, Medtronic, Merck Sharp & Dohme, Pfizer, Regeneron, Sandoz, Takeda, and Thermo Fisher Scientific, Speakers bureau of: AbbVie, Amgen, Biogen, Boehringer Ingelheim, Celltrion, Dr. Falk Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Janssen, Lamepro, Medtronic, Merck Sharp & Dohme, Mylan, Pfizer, Samsung Bioepis, Sandoz, Takeda, and Thermo Fisher Scientific, M. Long Consultant of: AbbVie, Bristol Myers Squibb, Calibr, Eli Lilly and Company, Genentech, Janssen, Pfizer, Prometheus Biosciences, Roche, Takeda, TARGET PharmaSolutions, and Theravance Biopharma, I. Redondo Employee of: Eli Lilly and Company, T. Gibble Employee of: Eli Lilly and Company, R. Moses Employee of: Eli Lilly and Company, X. Li Employee of: Eli Lilly and Company, N. Morris Employee of: Eli Lilly and Company, C. Milch Employee of: Former employee, was employed at Eli Lilly and Company at the time of study, M. Abreu Grant / Research support from: Pfizer, Prometheus Biosciences, and Takeda, Consultant of: AbbVie, Arena Pharmaceuticals, Bristol Myers Squibb, Eli Lilly and Company, Gilead Sciences, Janssen, Microba Life Sciences, Prometheus Biosciences, UCB Pharma, and WebMD, Speakers bureau of: Alimentiv, Intellisphere LLC (HCP Live Institutional Perspectives in GI), Janssen, Prime CME, and Takeda, J. Jones: None Declared
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Affiliation(s)
- A Dignass
- Agaplesion Markus Krankenhaus, Medizinische Klinik I, Frankfurt, Germany
| | - S Danese
- Vita-Salute San Raffaele University - IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - K Matsuoka
- Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - M Long
- University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - I Redondo
- Produtos Farmacêuticos, Lda., Eli Lilly Portugal, Lisbon, Portugal
| | | | - R Moses
- Eli Lilly and Company, Indianapolis
| | - X Li
- Eli Lilly and Company, Indianapolis
| | - N Morris
- Eli Lilly and Company, Indianapolis
| | - C Milch
- Eli Lilly and Company, Indianapolis
| | - M Abreu
- Miller School of Medicine, Crohn's and Colitis Center, University of Miami, Miami, United States
| | - J Jones
- Department of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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Danese S, Dignass A, Matsuoka K, Ferrante M, Long M, Redondo I, Gibble TH, Moses R, Morris N, Li X, Milch C, Abreu M, Jones J. A184 EARLY SYMPTOM CONTROL WITH MIRIKIZUMAB IN PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS IN THE LUCENT-1 INDUCTION TRIAL. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991172 DOI: 10.1093/jcag/gwac036.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Mirikizumab (miri), an anti-IL23/p19 monoclonal antibody, demonstrated efficacy compared with placebo (PBO) in the Phase 3, multicentre, randomized, double-blind LUCENT-1 induction study in patients with moderately to severely active ulcerative colitis (UC, NCT03518086). Purpose This analysis assessed early onset of symptomatic improvement and symptomatic control during induction. Method During the 12-week (W) induction study, 1162 adult patients (pts) with inadequate response, loss of response, or were intolerant to conventional therapy or biologic or tofacitinib therapy for UC, received miri IV Q4W (N=868) or PBO (N=294). We evaluated improvement for symptoms of stool frequency (SF), rectal bleeding (RB) and bowel movement urgency (BU), abdominal pain and fatigue. BU Numeric Rating Scale (NRS) change from baseline (BL), BU Clinical Meaningful Improvement (CMI), BU Remission, Fatigue NRS change from BL, Abdominal Pain Improvement, as well as SF Remission, RB Remission, Symptomatic Response and Symptomatic Remission were assessed. Result(s) As early as W2, miri-treated pts achieved a significantly greater reduction in RB subscores (p=0.001) and in SF subscores (p=0.035). From W2 and W4, a significantly greater percentage achieved SF Remission and RB Remission, respectively compared to PBO. A significantly greater percentage of miri-treated pts achieved Symptomatic Response compared to PBO from W2 (p=0.003) and of Symptomatic Remission compared with PBO from W4 (p<0.001). Miri-treated pts showed a significantly greater mean reduction in BU NRS scores as early as W2 compared to PBO (p=0.004). From W4, a significantly greater percentage of miri-treated pts achieved BU CMI versus PBO (p=0.044). From W7 onwards, a significantly greater percentage achieved BU Remission (p=0.002). The pts showed a significantly greater mean reduction in Fatigue NRS scores from W2 compared to PBO (p=0.014). As early as W4, a significant reduction of at least 30% in Abdominal Pain NRS score from BL was observed in the miri-treated pts compared with PBO (p=0.007). At W12, a significantly greater proportion of miri-treated pts achieved Symptomatic Response, Symptomatic Remission, RB Remission, SF Remission, BU change from BL, BU CMI and Remission, as well as Fatigue and Abdominal Pain Improvement, compared to PBO (Table). Image ![]()
Conclusion(s) Miri provides rapid control of UC symptoms, including BU and fatigue, as early as W2 compared with PBO in pts with moderately to severely active UC. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Eli Lilly and Company Disclosure of Interest S. Danese Consultant of: AbbVie, Alimentiv, Allergan, Amgen, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr. Falk Pharma, Eli Lilly and Company, Enthera, Ferring Pharmaceuticals, Gilead Sciences, Hospira, Inotrem, Janssen, Johnson & Johnson, Merck Sharp & Dohme, Mundipharma, Mylan, Pfizer, Roche, Sandoz Sublimity, Takeda, TiGenix, UCB Pharma, and Vifor Pharma, Speakers bureau of: AbbVie, Amgen, Ferring Pharmaceuticals, Gilead Sciences, Janssen, Mylan, Pfizer, and Takeda, A. Dignass Consultant of: AbbVie, Abivax, Amgen, Arena Pharmaceuticals, Bristol Myers Squibb (Celgene), Celltrion, Dr. Falk Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos, Gilead Sciences, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Pharmacosmos, Roche, Sandoz/Hexal, Takeda, Tillotts Pharma AG, and Vifor Pharma, Speakers bureau of: AbbVie, Amgen, Bristol Myers Squibb, Dr. Falk Pharma, Ferring Pharmaceuticals, Galapagos, High5Md, Janssen, Materia, Merck Sharp & Dohme, Pfizer, Sandoz, Takeda, Tillotts Pharma AG, and Vifor Pharma, K. Matsuoka Grant / Research support from: AbbVie, EA Pharma, JIMRO, Kissei Pharmaceutical, Kyowa Kyorin, Mitsubishi Tanabe, Mochida Pharmaceutical, and Zeria Pharmaceutical Nippon, Speakers bureau of: AbbVie, EA Pharma, JIMRO, Kissei Pharmaceutical, Kyowa Kyorin, Mitsubishi Tanabe, Mochida Pharmaceutical, Takeda, and Zeria Pharmaceutical Nippon, M. Ferrante Grant / Research support from: AbbVie, Amgen, Biogen, Janssen Cilag, Pfizer, Takeda, and Viatris, Consultant of: AbbVie, Boehringer Ingelheim, Celltrion, Eli Lilly and Company, Janssen Cilag, Medtronic, Merck Sharp & Dohme, Pfizer, Regeneron, Sandoz, Takeda, and Thermo Fisher Scientific, Speakers bureau of: AbbVie, Amgen, Biogen, Boehringer Ingelheim, Celltrion, Dr. Falk Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Janssen, Lamepro, Medtronic, Merck Sharp & Dohme, Mylan, Pfizer, Samsung Bioepis, Sandoz, Takeda, and Thermo Fisher Scientific, M. Long Consultant of: AbbVie, Bristol Myers Squibb, Calibr, Eli Lilly and Company, Genentech, Janssen, Pfizer, Prometheus Biosciences, Roche, Takeda, TARGET PharmaSolutions, and Theravance Biopharma, I. Redondo Employee of: Eli Lilly and Company, T. Gibble Employee of: Eli Lilly and Company, R. Moses Employee of: Eli Lilly and Company, N. Morris Employee of: Eli Lilly and Company, X. Li Employee of: Eli Lilly and Company, C. Milch Employee of: former employee, was employed at Eli Lilly and Company at the time of study, M. Abreu Grant / Research support from: Pfizer, Prometheus Biosciences, and Takeda, Consultant of: AbbVie, Arena Pharmaceuticals, Bristol Myers Squibb, Eli Lilly and Company, Gilead Sciences, Janssen, Microba Life Sciences, Prometheus Biosciences, UCB Pharma, and WebMD, Speakers bureau of: Alimentiv, Intellisphere LLC (HCP Live Institutional Perspectives in GI), Janssen, Prime CME, and Takeda, J. Jones: None Declared
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Affiliation(s)
- S Danese
- Gastrointestinal immunopathology, Vita-Salute San Raffaele University - IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Dignass
- Agaplesion Markus Krankenhaus, Medizinische Klinik I, Frankfurt, Germany
| | - K Matsuoka
- Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - M Long
- University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - I Redondo
- Produtos Farmacêuticos, Lda., Eli Lilly Portugal, Lisbon, Portugal
| | | | - R Moses
- Eli Lilly and Company, Indianapolis
| | - N Morris
- Eli Lilly and Company, Indianapolis
| | - X Li
- Eli Lilly and Company, Indianapolis
| | - C Milch
- Eli Lilly and Company, Indianapolis
| | - M Abreu
- Miller School of Medicine, Crohn's and Colitis Center, University of Miami, Miami, United States
| | - J Jones
- Department of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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Ravn C, Neyt J, Benito N, Abreu M, Achermann Y, Bozhkova S, Coorevits L, Ferrari M, Gammelsrud K, Gerlach UJ, Giannitsioti E, Gottliebsen M, Jørgensen N, Madjarevic T, Marais L, Menon A, Moojen D, Pääkkönen M, Pokorn M, Pérez-Prieto D, Renz N, Saavedra-Lozano J, Sabater-Martos M, Sendi P, Tevell S, Vogely C, Soriano A, the SANJO guideline group. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect 2023; 8:29-37. [PMID: 36756304 PMCID: PMC9901514 DOI: 10.5194/jbji-8-29-2023] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This clinical guideline is intended for use by orthopedic surgeons and physicians who care for patients with possible or documented septic arthritis of a native joint (SANJO). It includes evidence and opinion-based recommendations for the diagnosis and management of patients with SANJO.
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Affiliation(s)
- Christen Ravn
- Dept. of Orthopaedic Surgery and Traumatology, Aarhus University
Hospital, Aarhus, Denmark,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared first authorship
| | - Jeroen Neyt
- Dept. of Orthopedic Surgery, University Hospitals Ghent, Ghent, Belgium,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared first authorship
| | - Natividad Benito
- Dept. of Infectious Diseases, Hospital de la Santa Creu i Sant Pau,
Barcelona, Spain,Members of the Steering Committee for the EBJIS Guideline Project on SANJO
| | | | - Yvonne Achermann
- Dept. of Internal Medicine, Hospital Zollikerberg, Zürich, Switzerland
| | - Svetlana Bozhkova
- Dept. of Prevention and Treatment of Wound Infection, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | | | - Matteo Carlo Ferrari
- Dept. of Internal Medicine, IRCCS Ospedale Galeazzi Sant'Ambrogio,
Milano, Italy
| | | | - Ulf-Joachim Gerlach
- Dept. of Septic Orthopedic Surgery and Traumatology, BG Klinikum
Hamburg, Hamburg, Germany
| | | | - Martin Gottliebsen
- Dept. of Orthopaedic Surgery and Traumatology, Aarhus University
Hospital, Aarhus, Denmark
| | | | | | - Leonard Marais
- Dept. of Orthopaedic Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Aditya Menon
- Dept. of Orthopaedics, P.D. Hinduja Hospital and Medical Research
Centre, Mumbai, India
| | - Dirk Jan Moojen
- Dept. of Orthopaedic and Trauma Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Markus Pääkkönen
- Dept. of Orthopaedics and Traumatology, Turku University Hospital,
Turku, Finland
| | - Marko Pokorn
- Dept. of Infectious Diseases, Ljubjana University Medical Center,
Ljubjana, Slovenia
| | - Daniel Pérez-Prieto
- Dept. of Orthopaedic Surgery and Traumatology, Hospital del Mar,
Barcelona, Spain
| | - Nora Renz
- Dept. of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Jesús Saavedra-Lozano
- Dept. of Pediatric Infectious Diseases Unit, Gregorio Marañón
Hospital, Madrid, Spain
| | - Marta Sabater-Martos
- Dept. of Orthopaedic Surgery and Traumatology, Hospital Clínic,
Barcelona, Spain
| | - Parham Sendi
- Dept. of Infectious Diseases, University Hospital of Basel, Basel, Switzerland,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Staffan Tevell
- Dept. of Infectious Diseases, Karlstad Hospital and Centre for Clinical
Research, Karlstad, Sweden
| | - Charles Vogely
- Dept. of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the
Netherlands,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared last authorship
| | - Alex Soriano
- Dept. of Infectious Diseases, Hospital Clínic, Barcelona, Spain,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared last authorship
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Diniz SE, Ribau A, Vinha A, Oliveira J, Abreu M, Sousa R. Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition. J Bone Jt Infect 2023; 8:109-118. [PMID: 37032977 PMCID: PMC10077577 DOI: 10.5194/jbji-8-109-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: diagnosis of periprosthetic joint infection (PJI) is challenging, as no single test has absolute accuracy. The purpose of this study was to assess the utility of different simple synovial biomarkers in the diagnosis of PJI as defined by the European Bone and Joint Infection Society (EBJIS). Methods: we retrospectively identified all patients undergoing revision hip or knee arthroplasty from 2013 to 2019 on our prospectively maintained database. Only patients with minimum required infection diagnostic workup were included in the study. Patients with comorbidities that may influence the accuracy of synovial biomarkers were excluded. Receiver operator characteristic (ROC) curves were utilised to assess the diagnostic utility of synovial fluid white blood cell (WBC) count, polymorphonuclear leukocyte percentage (PMN %), C-reactive protein (CRP), adenosine deaminase (ADA), and alpha-2-microglobulin (A2M). Results: in total, 102 patients met the inclusion criteria. Of these, 58 were classified as infection unlikely, 8 as infection likely, and 36 as infection confirmed. Synovial WBC count (area under the curve (AUC) 0.94) demonstrated the best utility for the diagnosis of PJI, followed by PMN % (AUC 0.91), synovial CRP (AUC 0.90), ADA (AUC 0.82), and A2M (AUC 0.76). We found added value in the combined interpretation of different biomarkers. We calculated high sensitivity and negative predictive value if at least two of them are negative and high specificity and positive predictive value if at least two are elevated. Conclusion: current results show that synovial fluid investigation is a useful tool for the diagnosis of PJI, and the combined interpretation of simple and inexpensive biomarkers demonstrated improved diagnostic accuracy.
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Affiliation(s)
- Sara Elisa Diniz
- Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Ana Ribau
- Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - André Vinha
- Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Carlos Oliveira
- Department of Laboratory Pathology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Miguel Araújo Abreu
- Department of Infectious Diseases, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- part of the Porto Bone and Joint Infection Group (GRIP), Porto, Portugal
| | - Ricardo Sousa
- Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- part of the Porto Bone and Joint Infection Group (GRIP), Porto, Portugal
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André R, Azevedo F, Gonçalves M, Romão J, Saraiva R, Croca M, Abreu M. Body dysmorphic disorder treatment: about a clinical case. Eur Psychiatry 2022. [PMCID: PMC9566748 DOI: 10.1192/j.eurpsy.2022.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Body dysmorphic disorder (BDD) is a relatively common disorder characterized by a preoccupation with non-existent or slight defects in appearance. It was first described in 1886 by Morselli as dysmorphophobia.
Objectives
This work reviews the current available data on BDD and its treatment options and describes a clinical case that reports an improvement in symptomatology after surgery.
Methods
Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “body dysmorphic disorder”, “dysmorphophobia”. Clinical file consultation.
Results
The usual treatment involves a combination of psychotherapy and pharmacotherapy. Antidepressant medication, mainly selective serotonin reuptake inhibitors (SSRIs) have been used. If the symptoms do not improve, a different SSRI can be considered or clomipramine, venlafaxine or second-generation antipsychotics can be useful.
Conclusions
The role of surgery remains controversial, several studies indicating that the symptoms typically worsen after an aesthetic procedure because the preoccupation shifts to a different body area. However a recent study reported 32 of the 41 patients that underwent surgery were highly satisfied with the outcome. In our clinical case, our patient, a 20-year-old female with non-delusional dysmorphic ideas about her nose initiated treatment with paroxetine with poor response and was, against medical opinion, submitted to a rhinoplasty. Three weeks after the surgery there was an improvement in preoccupation about her nose. More research should be made to clarify the role of surgery in this disorder that often lacks adequate therapeutical response.
Disclosure
No significant relationships.
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González-Horta E, Vargas Y, Burgueño J, Abreu M, Toledo J. P-305 Oxidized-LDL promotes colorectal cancer progression and growth of human colonoides. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.394] [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: 11/16/2022] Open
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Romão J, Gonçalves M, André R, Félix F, Saraiva R, Abreu M. From Akute Primäre Verruckheit to Bouffée Delirante: The background of Acute Transient Psychosis. Eur Psychiatry 2022. [PMCID: PMC9567350 DOI: 10.1192/j.eurpsy.2022.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Ever since the end of the 19th century that descriptions of acute and transient psychosis (ATP) have been found in the literature. Psychiatrists from different countries gave different names for these types of episodes, throughout the ages. Those early descriptions were an important part of the development of the concept of acute and transient psychotic disorders (F23: ICD-10). Objectives This review aims to provide historical background of the development of different concepts to describe ATP. Methods Non-systematic review of literature on acute and transient psychotic disorders, bouffee delirante, brief psychotic disorder, atypical psychosis. Results In 1876, K.Westphal introduced the term akute primäre Verruckheit, refering to a sudden paranoia associated with delusion ideas and hallucinations. In 1895, Magnan described Bouffée delirante, characterized by a recorrent, sudden psychosis with polymorphic symptoms. Later (1924), the term cycloid psychosis was introduced by K.Kleist: phasic psychosis with good prognosis. Different concepts appeared throughout history: psychogenic psychosis (Wimmer,1916); atypical psychosis (Mitsuda,1942), holodisfrenia (Barahona,1957). Nowadays, the classification systems include many of these concepts in the same categories: Schizophreniform disorder, Brief psychotic disorder (DSM-5), and ATP (F23 in ICD-10). Conclusions All throughout the History of Psychiatry, there was an evolution of concepts associated to ATP. They were strongly influenced by different time epochs. It is important to have context on the historical background of the concepts used in the contemporaneous Psychiatry. Diagnosis is challenging due to their heterogeneous presentation. There are not many studies available, because of ATP’s low diagnostic stability. Disclosure No significant relationships.
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Romão J, Gonçalves M, Ribeiro M, André R, Saraiva R, Abreu M. Growing use of valproic acid in substance use disorders. Eur Psychiatry 2022. [PMCID: PMC9567128 DOI: 10.1192/j.eurpsy.2022.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Valproic acid is an antiepileptic drug used in different fields of Psychiatry. It is known mostly for its use in managing patients with bipolar affective disorder. In psychiatry of addiction, there is still no approved indications for its usage, but it is widely prescribed in treating alcohol and cocaine abuse, due to the existence of studies in these addictions. Objectives This review aims to clarify the relation between valproic acid and dependences, particularly cocaine. Methods Non-systematic literature review using a PubMed search, using the following key words: “valproate”; “cocaine use”. Results Cocaine dependence can decrease GABA levels in humans. Valproic acid has multiple mechanisms that favour the synthesis of GABA, potentiating its release and postsynaptic GABAergic response. Because of this, valproic acid was found effective in promoting abstinence and in reducing the use of cocaine. There are studies that support the valproic acid’s use in alcohol and cocaine dependences. Valproic acid has been shown to be promising in relapse prevention. It has also showed efficacy in the management of impulsivity and irritability, what makes it useful in managing patients with borderline personality disorder – patients at higher risk for alcohol or substance use disorders. Conclusions Cocaine addiction involves different phenomena and may respond to distinct pharmacologic approaches. Although some studies need to be confirmed by larger clinical trials, valproic acid seems a promising agent as one of some potential treatments for cocaine dependence. Further studies are required in this field to come to more reliable conclusions. Disclosure No significant relationships.
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André R, Romão J, Azevedo F, Gonçalves M, Sereijo C, Saraiva R, Croca M, Abreu M. The phenomenology of motivation. Eur Psychiatry 2022. [PMCID: PMC9567828 DOI: 10.1192/j.eurpsy.2022.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction The concept of motivation pervades our professional and personal lives. Motivation is almost impossible to be observed directly, it is a construct for the interpretation of a behaviour that “calls the attention”. Objectives This work reviews the current available data on the phenomenological description of motivation and the abnormalities of motivation. Methods Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “motivation”, “psychopathology”, “phenomenology”. Results Abnormalities in motivation may involve diminution or exacerbation. Anhedonia is the absence of pleasure in relation to usually pleasurable activities, it occurs in depression and schizophrenia where the pleasurable intrinsic motivation that acts as incentive for behaviour may be lost. In mania it may be increased so that mundane activities become unduly fascinating and rewarding. Conclusions Countless theories have been proposed to explain human motivation but each sheds light on specific aspects of motivation, neglecting others. This diversity creates confusion because most theories have areas of conceptual overlap and disagreement. To facilitate the development of studies, an agreement should be achieved on an operational definition of motivation. Disclosure No significant relationships.
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Gonçalves M, Romão J, André R, Félix F, Andrade G, Saraiva R, Dornelles E, Fernandes E, Abreu M, Chendo I, Ismail F. Cannabis use and cognitive impairment in schizophrenia. Eur Psychiatry 2022. [PMCID: PMC9566952 DOI: 10.1192/j.eurpsy.2022.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Neurocognitive deficits amongst patients with schizophrenia are considered one of schizophrenia’s central features. These deficits appear to be present from the first episode of psychosis (FEP) and certain cognitive impairments could be components of a genetic vulnerability to schizophrenia. Regarding research on cannabis and cognition in schizophrenia, different studies have assessed neurocognitive functions: memory, attention/vigilance, processing speed, verbal learning, executive functions, and verbal fluency. Objectives The aim is to do a review of recent findings concerning the association of cannabis use with cognition in schizophrenia. Methods A literature review was conducted using the PubMed search database. Results Patients with schizophrenia and concomitant cannabis use are associated with worse performance in immediate verbal learning, and in some studies with worse working memory performance. There is an improvement of verbal memory when they cease the cannabis’ consumption. Regarding attention capacity and memory types assessed, the results are controversial. In FEP, heavy cannabis use during the previous year correlates with slower processing speed. Also, FEP-patients with cannabis use but no family history of psychosis perform worse in executive functions, while those with a family history of psychosis perform better. Conclusions The studies of psychosis, cannabis and cognition differ in relevant aspects, which might be connected to the result variability. Therefore, before solid conclusions can be reached, it is important to carry out longitudinal studies to understand the changes in the cognitive variables, which can depend on the pattern of cannabis’ use (concurrent or prior to the FEP). Possible confounding variables that might be present should be acknowledged. Disclosure No significant relationships.
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Leibovitzh H, Lee S, Xue M, Raygoza Garay J, Hernandez-Rocha C, Madsen K, Meddings J, Guttmen DS, Espin Garcia O, Goethel A, Griffiths A, Moayyedi P, Huynh HQ, Jacobson K, Mack DR, Abreu M, Bernstein CN, Marshall J, Turner D, Xu W, Turpin W, Croitoru K. A238 ALTERED GUT MICROBIOME COMPOSITION AND FUNCTION ARE ASSOCIATED WITH GUT BARRIER DYSFUNCTION IN HEALTHY RELATIVES OF CROHN’S DISEASE PATIENTS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859348 DOI: 10.1093/jcag/gwab049.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The gut microbiome may play a role in gut barrier homeostasis including epithelial barrier function, but data are scarce and limited to animal studies Aims To assess if alterations in gut microbiome are associated with gut barrier function Methods We utilized the Genetic Environmental Microbial (CCC GEM) cohort of healthy first-degree relatives (FDRs) of Crohn’s disease (CD) patients. Gut barrier function was assessed using the ratio of urinary fractional excretion of lactulose to mannitol (LMR). Stool bacterial DNA was extracted and sequenced for the V4 hypervariable region of the 16S rRNA gene using MiSeq and processed using QIIME2. Microbial functions were imputed using PICRUSt2. The cohort was divided into a North American discovery cohort (n=2,472) and non-North American external validation cohort (n=655). LMR>0.025 was defined as abnormal. LMR-microbiome associations were assessed using multivariable regression model and Random Forest (RF) classifier algorithm. q<0.05 was considered significant when multiple tests were performed Results The median age of the entire cohort was 17.0 years [IQR 12.0; 24.0], 52.6% were females and 25.4% had LMR>0.025. In the discovery cohort, subjects with LMR>0.025 had markedly reduced alpha diversity (Chao1 index, estimate= -0.0037, p=4.0e-04) and altered beta diversity (Bray-Curtis dissimilarity index, PERMANOVA: pseudo-F statistic = 2.99, p=1.0e-03). We identified eight bacterial genera and 52 microbial pathways associated with LMR>0.025 (q<0.05). Four genera (decreased Adlercreutzia [odds ratio(OR)=0.74, 95% confidence interval (CI) 0.6–0.91], Clostridia-UCG-014 [OR=0.71, 95%CI 0.59–0.86], and Clostridium-sensu-stricto-1 [OR=0.75, 95%CI 0.61–0.92] and increased Colidextribacter [OR=1.65, 95%CI 1.2–2.26]) and eight pathways (including decreased biosynthesis of glutamate [OR=0.4, 95%CI 0.21–0.74], tryptophan [OR=0.06, 95%CI 0.01–0.27] and threonine [OR=0.038, 95%CI 0.003–0.41]) were replicated. Bacterial community composition was associated with gut barrier homeostasis as defined by the RF analysis (p= 1.4e-6) Conclusions Gut microbiome community and pathways are associated with gut barrier function. These findings may identify potential microbial targets to modulate barrier function Submitted on behalf of the CCC-GEM Consortium Funding Agencies CCC, CIHRCrohn’s and Colitis Canada Genetics Environment Microbial (CCC-GEM) III; The Leona M. and Harry B. Helmsley Charitable Trust; Kenneth Croitoru is the recipient of the Canada Research Chair in Inflammatory Bowel Diseases
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Affiliation(s)
- H Leibovitzh
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - S Lee
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - M Xue
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - J Raygoza Garay
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Hernandez-Rocha
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
| | - J Meddings
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - D S Guttmen
- University of Toronto Department of Cell and Systems Biology, Toronto, ON, Canada
| | - O Espin Garcia
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - A Goethel
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - A Griffiths
- The Hospital for Sick Children, Toronto, ON, Canada
| | - P Moayyedi
- McMaster University Department of Medicine, Hamilton, ON, Canada
| | - H Q Huynh
- University of Alberta, Edmonton, AB, Canada
| | - K Jacobson
- BC Children’s Hospital, Vancouver, BC, Canada
| | - D R Mack
- University of Ottawa, Ottawa, ON, Canada
| | - M Abreu
- University of Miami School of Medicine, Miami, FL
| | | | - J Marshall
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - D Turner
- Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
| | - W Xu
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - W Turpin
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - K Croitoru
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
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Keating D, Zundel CG, Abreu M, Krengel M, Aenlle K, Nichols MD, Toomey R, Chao LL, Golier J, Abdullah L, Quinn E, Heeren T, Groh JR, Koo BB, Killiany R, Loggia ML, Younger J, Baraniuk J, Janulewicz P, Ajama J, Quay M, Baas PW, Qiang L, Conboy L, Kokkotou E, O'Callaghan JP, Steele L, Klimas N, Sullivan K. Boston biorepository, recruitment and integrative network (BBRAIN): A resource for the Gulf War Illness scientific community. Life Sci 2021; 284:119903. [PMID: 34453948 DOI: 10.1016/j.lfs.2021.119903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/31/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022]
Abstract
AIMS Gulf War Illness (GWI), a chronic debilitating disorder characterized by fatigue, joint pain, cognitive, gastrointestinal, respiratory, and skin problems, is currently diagnosed by self-reported symptoms. The Boston Biorepository, Recruitment, and Integrative Network (BBRAIN) is the collaborative effort of expert Gulf War Illness (GWI) researchers who are creating objective diagnostic and pathobiological markers and recommend common data elements for GWI research. MAIN METHODS BBRAIN is recruiting 300 GWI cases and 200 GW veteran controls for the prospective study. Key data and biological samples from prior GWI studies are being merged and combined into retrospective datasets. They will be made available for data mining by the BBRAIN network and the GWI research community. Prospective questionnaire data include general health and chronic symptoms, demographics, measures of pain, fatigue, medical conditions, deployment and exposure histories. Available repository biospecimens include blood, plasma, serum, saliva, stool, urine, human induced pluripotent stem cells and cerebrospinal fluid. KEY FINDINGS To date, multiple datasets have been merged and combined from 15 participating study sites. These data and samples have been collated and an online request form for repository requests as well as recommended common data elements have been created. Data and biospecimen sample requests are reviewed by the BBRAIN steering committee members for approval as they are received. SIGNIFICANCE The BBRAIN repository network serves as a much needed resource for GWI researchers to utilize for identification and validation of objective diagnostic and pathobiological markers of the illness.
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Affiliation(s)
- D Keating
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - C G Zundel
- Boston University School of Medicine, Behavioral Neuroscience Program, 72 East Concord St., Boston, MA 02118, USA.
| | - M Abreu
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - M Krengel
- Boston University School of Medicine, Department of Neurology, 72 East Concord St., Boston, MA 02118, USA.
| | - K Aenlle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - M D Nichols
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA
| | - R Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - L L Chao
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA 94143, USA.
| | - J Golier
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, USA; Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, USA.
| | - L Abdullah
- Roskamp Institute, 2040 Whitfield Ave, Sarasota, FL 34243, USA; Open University, Milton Keynes, United Kingdom; James A. Haley Veterans' Hospital, Tampa, FL, USA.
| | - E Quinn
- Boston University School of Public Health, Department of Biostatistics, 715 Albany St., Boston, MA 02118, USA.
| | - T Heeren
- Boston University School of Public Health, Department of Biostatistics, 715 Albany St., Boston, MA 02118, USA.
| | - J R Groh
- Boston University School of Medicine, Behavioral Neuroscience Program, 72 East Concord St., Boston, MA 02118, USA.
| | - B B Koo
- Boston University School of Medicine, Department of Anatomy and Neurobiology, 72 East Concord St., Boston, MA 02118, USA.
| | - R Killiany
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA; Boston University School of Medicine, Department of Neurology, 72 East Concord St., Boston, MA 02118, USA; Boston University School of Medicine, Department of Anatomy and Neurobiology, 72 East Concord St., Boston, MA 02118, USA.
| | - M L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - J Younger
- Neuroinflammation, Pain & Fatigue Lab, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, USA.
| | - P Janulewicz
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - J Ajama
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - M Quay
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
| | - P W Baas
- Drexel University College of Medicine, Department of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - L Qiang
- Drexel University College of Medicine, Department of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - L Conboy
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
| | - E Kokkotou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
| | - J P O'Callaghan
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
| | - L Steele
- Baylor College of Medicine Neuropsychiatry Division, Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.
| | - N Klimas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Institute for Neuroimmune Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; Geriatric Research Education and Clinical Center, Miami VA Medical Center, Miami, FL 33125, USA.
| | - K Sullivan
- Boston University School of Public Health, Department of Environmental Health, 715 Albany St. T4W, Boston, MA 02118, USA.
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Ferreira C, Abreu M, Castro G, Goncalves L, Baptista R, Girao H. Metabolic reprogramming in pulmonary arterial hypertension: is it a cancer-like disease? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Idiopathic pulmonary arterial hypertension (iPAH) is a rare and chronic disease associated with poor outcomes. Previously considered a disease restricted to the pulmonary circulation, PAH is now being recognized as a systemic disorder that is associated with metabolic dysfunction. The aim of this study is to analyze the metabolic reprogramming in the lung and peripheral blood mononuclear cell (PBMCs) of iPAH patients and explore their potential roles in PAH pathophysiology.
Methods
Five independent datasets, containing transcriptomic data of human PBMCs (GSE22356 and GSE33463) and lung (GSE48149 GSE113439 and GSE117261) samples, from 139 iPAH patients and 96 healthy controls, were downloaded at the GEO database. In each dataset, the samples were normalized and a pair-wise comparison between control and iPAH samples was performed using limma package, for the R programming language. Genes with a p-value lower than 0.05 were considered differentially expressed between the two groups. A subset of metabolism related genes was selected, and their expression was compared across the datasets.
Results
Among the 13 genes with differential expression identified, only 10 had a coherent expression across all datasets (Figure 1). Firstly, we report an association with insulin resistance through impairment of PI3K signaling in iPAH patients, by expressing lower levels of the heterodimer PIK3CD and regulatory PIK3IP1 and PIKR1 subunits in PBMCs, and by expressing higher levels of its downstream targets in the lung (TBC1D4). However, more extensive metabolic dysfunction was observed. A significant glycolytic shift in the lung and PBMCs was present, as a consequence of deregulation in genes involved in aerobic glycolysis and decreased fatty acid oxidation, namely increased expression of PD1K and lower levels of expression of LDHB. The findings of decreased SLC25A1 protein in both PBMCs and lung suggest impairment of the tricarboxylic acid (TCA) cycle flux in PAH. Additionally, SLC1A5 highlights the involvement of glutamine metabolism and glutaminolysis derangements in PAH. Conversely, SREBP1 is involved in sterol biosynthesis and lower levels in PMBCs results in impaired resolution of inflammatory responses. Finally, although the role of autophagy in iPAH is complex, higher levels of expression of ATG13 in PBMCs and lower levels in the lung confirm autophagy deregulation in iPAH. Interestingly, all the metabolic pathways identified (Figure 2) are hallmarks of the metabolic reprogramming seen in cancer cells, a finding already suggested by the clonal proliferation of pulmonary artery smooth muscle cells described in plexiform lesions.
Conclusion
Our results provide novel insights into the metabolic regulation in iPAH. Molecularly, these cells exhibit many features common to cancer cells, suggesting the opportunity to exploit therapeutic strategies used in cancer to treat iPAH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Abreu
- Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal
| | - G Castro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - H Girao
- Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal
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Abreu M, Monticielo O, Fernandes V, Cristovão Maiorano A, Dos Santos Beserra F, Lamarao F, David N, De Veras B, Bica B, Sávio Nunes de Lima D, Maria Das Chagas Medeiros M. POS0747 MAPPING THE NATIONWIDE CLINICAL PROFILE AND PATTERNS OF CARE OF SLE IN BRAZIL – FINDINGS FROM THE MACUNAÍMA STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is an autoimmune disease with wide clinical variability. Brazil has vast regional diversity, both from an ethnic and socio-cultural point of view.Objectives:To map the clinical profile of SLE in Brazil and explore how this distribution is associated with regional disparities.Methods:This cross-sectional study (GSK Study 207353) evaluated 300 Brazilian patients ≥18 years old with SLE (American College of Rheumatology [ACR] criteria, 1997) who had been under SLE care for ≥1 year. Five SLE reference teaching facilities were selected, one in each of the following Brazilian regions: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Each region included 60 patients. Clinical and demographic characteristics, and patterns of care were measured through questionnaires completed by physicians or nurses. The SLE Disease Activity Index (SLEDAI) score described disease activity and the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) described damage accrual. To assess the potential association between regional disparities and clinical outcomes, a hospitalisation profile was described. A bootstrapping approach of logistic regression was used to explore potential factors associated with hospitalisation.Results:Overall, 92.3% of patients were female, with a mean (standard deviation; SD) age of 41.8 (12.7) years and a mean (SD) disease duration of 11.8 (7.9) years. Overall, 161 (53.7%) patients were of Latino origin; in the NO this proportion was 88%. White patients predominated in the SU (58.3%); and black patients in the SE (31.7%). The mean (SD) number of years of schooling was 11.3 (4.6), and was highest in the NO (14.2 [3.6]) and lowest in the SU (9.0 [4.0]; p<0.001). With regard to the distribution of the SLE clinical profile according to ACR criteria, arthritis was found in 221 patients and predominated in all regions (mean 73.7%), with a lower prevalence in the CO (40%; p<0.001; Figure 1A). The mean (SD) SLEDAI score was 4.33 (5.39) at the time of interview. The main contributing factors to disease activity, according to SLEDAI, were complement consumption (18%), arthritis (15.3%), and alopecia (15%). The SDI scale was scored for cataracts (15%), proteinuria (8.7%), and thrombosis (7.3%). Among the associated comorbidities, hypertension was predominant in the NO (35%; p=0.001). Smoking predominated in the SU (23%; p<0.001); obesity (27%; p=0.059) and dyslipidemia (35%; p=0.023), in the SE. Regarding patterns of care (Figure 1B), antimalarials were most frequently prescribed in the SE (88.3%) and the SU (91.7%). Corticosteroids prevailed in the NO (96.7%). The mean (SD) time between home and care facility was 4.5 (12.6) hours. Patients in the NO reported the longest transport time to reach the care facility (11.5 [25.4] hours; p<0.001). The hospitalisation rate during the study period was 21.3% across all regions, with no statistical difference between centres (p=0.651). Reasons for hospitalisation included disease activity (36 [12%]), infection (19 [6.3%]), surgery (10 [3.3%]), and management of clinical morbidities (6 [2.0%]). Hospitalisation was associated with ethnicity (p<0.016), occupational status (p<0.001), age (p=0.02), and the use of hydroxychloroquine (HCQ) or chloroquine (CQ; p<0.001).Conclusion:This nationwide study highlights ethnic, social, and patterns-of-care disparities among Brazilian patients with SLE. The modelling shows evidence that such disparities contribute to the divergent clinical spectrum observed in Brazil.Funding:GSKFigure 1.Distribution of the A) Brazilian SLE clinical profile according to the ACR Classification Criteria and B) Brazilian prescriptive profile for SLE treatment according to the use of immunosuppressive drugs, biological agents, and corticosteroids during the study (12 months)ANA, antinuclear antibodyAcknowledgements:Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared
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Abreu M, Monticielo O, Fernandes V, Cristovão Maiorano A, Dos Santos Beserra F, Lamarao F, David N, De Veras B, Bica B, Sávio Nunes de Lima D, Maria Das Chagas Medeiros M. POS1430 EPIDEMIOLOGY OF LUPUS NEPHRITIS IN BRAZIL: FINDINGS FROM THE MACUNAÍMA STUDY - A NATIONWIDE MULTICENTRIC STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lupus nephritis (LN) is one of the most serious organic manifestations of systemic lupus erythematosus (SLE). Ethnicity can contribute to disparities in the prevalence and disease activity of LN.Objectives:To assess the prevalence of LN in Brazilian patients with SLE and to determine factors associated with LN activity across the country.Methods:This cross-sectional study (GSK Study 207353) was carried out through face-to-face interviews and review of medical records (12-month study period). Adult patients with SLE (American College of Rheumatology [ACR] criteria, 1997) were included. Five SLE reference teaching centres were selected: North (NO), Northeast (NE), Midwest (CO), Southeast (SE), and South (SU). Patients with another disease whose morbidity surpassed SLE were excluded. LN was defined as reported in the medical record or history of confirmed renal biopsy; disease activity by pre-defined changes in SLE Disease Activity Index (SLEDAI) or the patient’s kidney disease during the study. Activity was assessed during (T0), 6 months before (T6), and 12 months before (T12) the interview. Systemic Lupus International Collaborating Clinics/ACR Damage Index score mapped damage accrual. Two pairings were performed, aiming to discriminate factors associated with LN and its activity, respectively. Matching technique was used to select similar individuals based on propensity scores, obtained from a logistic regression model. A bootstrapping method explored characteristic variables associated with the risk of progressing to LN.Results:Overall, 300 Brazilian patients with SLE were included in the study. Two groups were paired: LN group (N=150) and non-LN group (N = 141). The prevalence of LN in the paired sample (N=291) was 51.5%, with a disparity between centres (p<0.001; Figure 1A). Most patients were female (LN: 92.7%; non-LN: 94.3%) and the mean (standard deviation [SD]) age for the LN and non-LN groups was 39.46 (11.86) and 43.96 (12.18), respectively. History of serositis was associated with the presence of LN (42 [28.0%] vs 21 [14.9%] non-LN; p=0.010). Type IV histological class predominated in both groups, with no disparity between centres. Social disparities were noted between groups. Non-active workers prevailed among the LN group (115 [76.7%] vs 98 [69.5%] for non-LN, p=0.024).When pairing for disease activity at T12, 73 (50.3%) patients with LN (N=145) had active disease. There was regional disparity in terms of disease activity (Figure 1B), with a predominance of active LN in the NO (28 [68.3%]) and SU (16 [55.2%], p=0.026). Type IV histological class was the component most associated with active LN (active: 32 [43.8%]; non-active: 11 [15.3%], p<0.001). Variation in SLEDAI during the study period discriminated between active and non-active LN. The mean (SD) SLEDAI score at T12 was substantially higher in those with active LN compared with non-active LN (7.18 [4.83] vs 2.47 [4.63], p<0.001). As for the pattern of care, corticosteroids users prevailed in those with active LN (62 [84.9%] vs 45 [62.5%] for non-active LN, p=0.004). There was no disparity in the use of immunosuppressants, with the exception of cyclophosphamide use, noted among 16 (21.9%) patients with active LN and 6 (8.3%) patients with non-active LN (p=0.041). Psychotropic or anticonvulsant use was higher in patients with non-active LN (32 [44.4%] vs 17 [23.3%] patients with active LN, p=0.012). Consultation with a neurologist was verified in 15 (20.8%) patients with non-active LN and 6 (8.2%) with active LN (p=0.055). Hospitalisation occurred in 17 patients with non-active (23.6%) and active (23.3%) LN.Conclusion:Disparities in the prevalence of LN and its activity were evident between the regions across Brazil, highlighting differences in clinical factors, regional factors, and patterns of care.Funding:GSKFigure 1.Prevalence of A) LN among regional centres, comparing them to disease activity profile and prescriptive practice, and B) Active and non-active LN according to prescriptive practiceCQ, chloroquine; HCQ, hydroxychloroquine*At T12Acknowledgements:Medical writing assistance was provided by Helen Taylor, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Mirhelen Abreu Grant/research support from: GSK, Amgen, Biogen, Libbs, Odirlei Monticielo Speakers bureau: GSK, AbbVie, UCB, Roche, Novartis, Consultant of: GSK, AbbVie, Janssen, Vander Fernandes Speakers bureau: Janssen, Novartis, Roche, AbbVie, Pfizer, Grant/research support from: Novartis, GSK, Pfizer, Alexandre Cristovão Maiorano: None declared, Fernando dos Santos Beserra: None declared, Flavia Lamarao Employee of: GSK, Nathalie David Shareholder of: GSK, Employee of: GSK, Bruna de Veras Employee of: GSK, Blanca Bica: None declared, Domingos Sávio Nunes de Lima Grant/research support from: GSK, Marta Maria das Chagas Medeiros: None declared
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Basualto S, Ziroldo Lopes JV, Rizzo Borges A, Abreu M, Albuquerque C, Araújo N, Bacchiega AB, Bica B, Brito D, Duarte A, Realle P, Ferreira G, Wagner Poti Gomes K, Melo AK, Stadler B, Maria Kakehasi A, Klumb E, Mariz H, Marques C, Mota L, Munhoz G, Paiva E, Pereira H, Salviato Pileggi G, Pinheiro M, Provenza JR, Gomides AP, Reis Neto E, Ribeiro S, Sato E, Laroca Skare T, De Souza V, Teodoro MLM, Valadares LDDA, Valim V, Calderaro D. AB0848 PARTICIPATION OF UNDERGRADUATE MEDICAL STUDENTS AS INVESTIGATORS IN A RHEUMATOLOGIC COHORT: IMPACT ON DEPRESSION, ANXIETY & STRESS SCALE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Mental health was widely affected during the new coronavirus pandemic. In addition, some measures adopted by most countries in order to contain the virus spread, such as isolation and social distancing, leading to the interruption of routine activities, including partial or complete interruption of face-to-face classes may be associated with increased stress, depression and anxiety among undergraduate medical students (1). From March to September, 2020, the Brazilian Society of Rheumatology carried out the Mario Pinotti II Project (MPII), a prospective, multicenter, observational cohort study designed to monitor the COVID-19 in patients with rheumatic disease on hydroxychloroquine, using periodic telephone calls performed by undergraduate medical students (2).Objectives:To compare the mental health status of medical students who were participating from the MPII with theirs colleagues not involved in this project.Methods:A web-based survey via google forms platform was developed by a panel composed of undergraduate medical students, rheumatologists, medical school professors, and a psychology professor. It included details on demographic and life habits data and domains regarding depression, anxiety and stress, using the DASS-21 (Depression, Anxiety & Stress Scale), Brazilian version. Data collection occurred from July 20th to August 31st, 2020. Statistical analysis was performed using the SPSS version 20.0. Univariate and multivariate linear regression analysis were performed to verify associations with the DASS-21, defined as dependent variable. A p-value < 0.05 was deemed as significant. This study was approved by the Institutional Research Ethics Committee.Results:A total of 684 undergraduate medical students were included in this study, of whom 228 as MPII volunteers (VG) and 456 as control group (CG). Median age was 23 years (IQ 21-24) and the CG was older than the VG (p<0.03). Most of them were white (68.8%) and women (63%). There were no significant differences regarding comorbidities, ethnicity, smoking status, alcohol intake and physical activity. Older age, male gender, participation of MPII study, absence of a worsening in sleep pattern during the pandemic and a lower number of prior comorbidities were associated with lower DASS21 scores, suggesting a better mental health (Table 1).Conclusion:Several aspects may be involved with mental health, including increased emotional maturity, gender and sleep pattern. Although with marginal independent association, medical students with participation in the MPII study had better mental health than their student colleagues not engaged with this research. Our data pointed out that voluntary participation in a research project which foresees interaction by telephone contact with rheumatic patients, professors, rheumatologists, and colleagues is associated with better mental health.References:[1]Meo SA, Abukhalaf AA, Alomar AA, Sattar K, Klonoff DC. Covid-19 pandemic: Impact of quarantine on medical students’ mental wellbeing and learning behaviors. Pakistan J Med Sci 2020;36(COVID19-S4):S43–8.[2]Gomides A, Ferreira G, Kakehas A, Lacerda M, Marques C, Paiva E et al. Impact of chronic use of antimalarials on SARS-COV-2 infection in patients with immune-mediated rheumatic diseases: protocol design for a multicentric observational cohort in Brazil. JMIR Research Protocols, 2020.PreprintTable 1.Univariate and multivariate analysis of predictors associated to the DASS-21 in undergraduate medical students during the COVID-19 pandemicUnivariate analysisMultivariate analysisVariableB95%CIp-ValueB95%CIp-ValueAge-0.32-0.61 to -0.030.03-0.47-0.81 to -0.130.008Female gender4.883.021 to 6.76<0.001---Stable love relationship-2.49-4.35 to -0.640.008-2.5-4.4 to -0.590.01Number of previous comorbidities reported4.693.71 to 5.68<0.0014.823.73 to 5.92<0.001MP-II volunteering-2.81-4.74 to -0.860.005---Worsening in sleep pattern6.414.62 to 8.20<0.0015.013.07 to 6.96<0.001Disclosure of Interests:None declared
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Salviato Pileggi G, Ferreira G, Gomides AP, Reis Neto E, Abreu M, Albuquerque C, Araújo N, Bacchiega AB, Bianchi D, Bica B, Bonfa E, Borba E, Brito D, Duarte A, Peixoto Gu e Silva de Souza M, Wagner Poti Gomes K, Maria Kakehasi A, Cavalheiro Do Espírito Santo R, Realle P, Klumb E, Lanna CC, Marques C, Monticielo O, Mota L, Munhoz G, Paiva E, Pereira H, Provenza JR, Ribeiro S, Rocha Jr L, Sampaio C, Sampaio V, Sato E, Laroca Skare T, De Souza V, Valim V, Lacerda M, Xavier R, Pinheiro M. POS1252 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES ON CHRONIC USE OF HYDROXYCHLOROQUINE IN A LARGE BRAZILIAN COHORT – A 24-WEEK PROSPECTIVE STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion.Objectives:To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil.Methods:Participants were enrolled and monitored through 24-week (From March 29th to Sep 30th, 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis.Results:A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren’s syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91; 95%CI 1.45-2.53), presence of two comorbidities (OR=1.31; 95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69; 95%CI 1.23-2.32). Interestingly, age >=65 years (OR=0.20; 95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37; 95%CI 1.92-293), SSc (OR=2.25; 95%CI 1.05-4.83) and rituximab use (OR=1.92; 95%CI 1.13-3.26). In addition, age >=65 years (OR=5.47; 95%CI 1.7-19.4) and heart disease (OR=2.60; 95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate.Conclusion:Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice.Table 1.Frequency and severity of COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine compared to their household controlsCOVID-19 outcomesTotal(%)GroupsPPatients(%)Controls (%)DiagnosisNo9256 (89.1)5300 (88.3)3956 (90.2)0.002Yes1132 (10.9)704 (11.7)428 (9.8)SeverityMild1059 (93.6)662 (94.0)397 (92.8)0.391Moderate52 (4.6)32 (4.5)20 (4.7)Severe21 (1.9)10 (1.4)11 (2.6)HCQ: hydroxychloroquine.Moderate and severe COVID-19 included the need for any of the following: hospitalization, intensive care, mechanical ventilation or death.Acknowledgements:To the Brazilian Society of Rheumatology for technical support and rapid nationwide mobilization.To all the 395 interviewers (medical students and physicians) who collaborated in the study and the participantsTo CNPq (Number 403442/2020-6)Disclosure of Interests:None declared
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Abstract
Introduction The mental health effects of Coronavirus2019(COVID-19) outbreak might be profound, including higher suicide rates.This phenomena is likely to become a more pressing concern as the pandemic spreads.While remarkable social distancing interventions have been implemented to reduce the rate of new infections,the potential for adverse outcomes on suicide risk is high, especially among vulnerable populations. Objectives The aim is to do a review of the literature of suicide prevention during the COVID-19 outbreak. Methods Non-systematic review of the literature with selection of scientific articles published in the last 7 months; by searching the Pubmed databases, the following MeSH terms were used: Suicide prevention; COVID-19 Results In order to prevent suicide, urgent consideration must be extend beyond general mental health approaches. A wide-ranging interdisciplinary response that recognises how the pandemic might heighten risk is needed. The application of knowledge about effective suicide prevention is the key. Mental health services should develop clear remote assessment and care pathways, and staff training to support new ways of dealing with. Publications on mental health and psychological effects of COVID-19 outbreak provide important information and recommendations for all three levels of suicide prevention: primary, secondary, and tertiary. Conclusions The challenge of the COVID-19 outbreak might bring with it an opportunity to advance the field of suicide prevention and, thus, to save lives, which also represent a public health priority. The mental health community, backed by active vigilance and international collaboration, should be prepared and can use this challenging period to advance suicide prevention.
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André R, Gonçalves M, Sereijo C, Abreu M. Washing COVID-19 away: COVID-19 and obsessive compulsive disorder. Eur Psychiatry 2021. [PMCID: PMC9471775 DOI: 10.1192/j.eurpsy.2021.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
We are facing a crisis caused by an extremely infectious disease, Covid-19. The mechanisms of infection and transmission of this coronavirus are largely unknown but some of the clearer recommendations are washing hands and surfaces. Obsessive-Compulsive Disorder has a lifetime prevalence of 2-3%, among the multiple symptoms, fear of dirt or being contaminated, and excessive washing are the most common affecting about 50% of patients.ObjectivesWe reviewed the available information to understand if there are changes in OCD symptoms during the pandemic.MethodsNon-systematic review of the literature with selection of scientific articles published in the past 6 months; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: Covid-19; SARS-Cov2; pandemic; obsessive compulsive disorder; OCD.ResultsFrom a theoretical point of view, the increased frequency of hand washing and the importance of following hand-washing steps can add to a ritualistic pattern, also cleaning hands every time a person comes from outside or contacts with others can be justified as a preventive action rather than considered a problem and it can be “normalized” by others as a pandemic response.ConclusionsIn conclusion, there is evidence that during quarantine an overall increase in obsession and compulsion severity emerged with contamination symptoms associated with worse outcomes. There is data on an increase in relapses with patients not asking for help in a timely manner. The current situation is unpredictable and rapidly changing. It is likely that more information about this topic will arise in the next months.
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André R, Sereijo C, Abreu M. Can atypical antipsychotic drugs cause hepatotoxicity? Eur Psychiatry 2021. [PMCID: PMC9471850 DOI: 10.1192/j.eurpsy.2021.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Neuropsychiatric drugs account for 16% of drugs that can lead to hepatotoxicity and psychiatric patients can have multiple comorbidities that can increase the incidence of liver disorders such as alcoholism, drug abuse and polymedication. The continuous use of atypical antipsychotic drugs (AAD) has raised questions over their tolerability over endocrine, metabolic and cardiovascular systems. They are also associated with mild elevation of aminotransferases and occasionally cause idiosyncratic liver injury with varying phenotypes. Hepatotoxicity is defined based on biological parameters such as elevation of alkaline phosphatase enzyme, SGPT, SGOT and GGT or clinical abnormalities (jaundice and hepatitis). Objectives This work reviewed the current available evidence on the hepatic damage produced by AAD. Methods Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: atypical antipsychotic drugs; hepatotoxicity; hepatic; Olanzapine; Clozapine; Risperidone; Aripiprazol; Paliperidone. Results Atypical Antipsychotic Drugs are generally well tolerated and hepatic alterations are in general very low or rare. The cases published were observed with Clozapine, Olanzapine and Risperidone. Atypical Antipsychotic drugs have a better profile than Chlorpromazine. Conclusions In conclusion, the hepatic injury generally occurs within the first weeks of treatment and is usually reversible with drug withdrawal. Hepatic check-ups may be relevant, especially in the beginning of treatment. Disclosure No significant relationships.
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Gonçalves M, Sereijo C, André R, Andrade G, Saraiva R, Linhares L, Chendo I, Abreu M. Stigmatization as a barrier in opioid substitution therapy patients. Eur Psychiatry 2021. [PMCID: PMC9479865 DOI: 10.1192/j.eurpsy.2021.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionGoffman defined stigma as an “attribute that is deeply discrediting” and in the last two decades research on this subject grew substantially.Opioids were ranked as the second most common form of illicit drug used worldwide and there is consensus in the literature that opioid substitution therapy (OST), methadone or buprenorphine, are the most effective treatments, although remain underutilized. People with an history of substance use disorders (SUD) are widely stigmatized, a significant barrier to detection and treatment efforts. Care workers were cited as the second most common source of stigma.ObjectivesThe aim is to do a review of the literature of stigma as a significant barrier to OST and present several potential strategies to reduce stigma.MethodsNon-systematic review of the literature with selection of scientific articles published in the last 5 years; by searching the Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: Opioid Use Disorder; Stigma; Opioid Substitution TherapyResultsOST providers should actively bring up the topic of stigma in clinic appointments to determine whether the patient is experiencing stigma, and if so, whether it is adversely affecting their ability to continue in the treatment. More active measures need to be taken to help reducing the stigma through public awareness campaigns at local levels, continuing education of health care providers regarding substance OST, and greater incorporation of family members into the program.ConclusionsIn conclusion, further research is required to understand and address this issue.DisclosureNo significant relationships.
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André R, Sereijo C, Abreu M. Suicide: The pandemic inside the pandemic. Eur Psychiatry 2021. [PMCID: PMC9528292 DOI: 10.1192/j.eurpsy.2021.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionCovid-19 was declared a pandemic by the WHO on March 11th and efforts have been made to minimize the impact that this new disease can produce. The mental health effects of this pandemic can be severe considering that each year close to 800.000 people die by suicide. This pandemic could increase those numbers, although this is not inevitable.ObjectivesThis work reviewed the current available data on possible causes for a suicide rate increase and to try to understand if suicide is already increasing worldwide.MethodsNon-systematic review of the literature with selection of scientific articles published in the past 6 months; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: Covid-19; suicide; SARS-Cov2; pandemic.Results
Multiple factors can account for an increase in suicide rates such as isolation with a sense of decreased belongingness and increased burdensomeness. A synergy with known suicide precipitants can also occur such as domestic violence, intra-familiar conflicts, alcohol consumption and access to means. Media communication can represent a danger with constant reports about the crisis. And lastly the loss of employment and financial stressors can produce an important impact.ConclusionsIn conclusion, Covid-19 will produce an important impact in many spheres of society, one of which will be mental health. If at the start of this crisis a widespread sense of solidarity was present with the maintenance of precipitant factors for suicide we expect to see an increase in suicide rates.
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Costa MI, Cipriano A, Santos FV, Valdoleiros SR, Furtado I, Machado A, Abreu M, Bastos HN. Clinical profile and microbiological aetiology diagnosis in adult patients hospitalized with community-acquired pneumonia. Pulmonology 2020; 28:358-367. [PMID: 33358259 DOI: 10.1016/j.pulmoe.2020.11.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022] Open
Abstract
Early introduction of appropriate antibiotherapy is one of the major prognostic-modifying factors in community acquired pneumonia (CAP). Despite established guidelines for empirical therapy, several factors may influence etiology and, consequently, antibiotic choices. The aims of this study were to analyze the etiology of CAP in adults admitted to a northern Portugal University Hospital and evaluate the yield of the different methods used to reach an etiological diagnosis, as well as analyze of the impact of patient demographic and clinical features on CAP etiology. We retrospectively analyzed 1901 cases of CAP with hospitalization. The diagnostic performance increased significantly when blood and sputum cultures were combined with urinary antigen tests. The most frequent etiological agent was Streptococcus pneumoniae (45.7%), except in August, when it was overtaken by gram-negative bacilli (GNB) and Legionella pneumophila infections. Viral infections were almost exclusive to winter and spring. A negative microbiological result was associated with increasing age, non-smoking and lack of both blood/sputum cultures. Younger age was a predictor for S. pneumoniae, Influenza and L. pneumophila infections. Active smoking without any previously known respiratory disease was a risk factor for legionellosis. COPD was associated with Haemophilus influenzae cases, while dementia was typical in GNB and S. aureus patients. Diabetes mellitus (DM) and heart disease were negative predictors of S. pneumoniae and H. influenzae, respectively. P. aeruginosa was an independent risk factor for mortality (OR 13.02, 95% CI 2.94-57.7). This study highlights the importance of a comprehensive microbiological diagnostic workup and provides clues to predicting the most probable CAP causative agents, based on a patient's clinical profile. These may be taken into account when establishing first line antibiotherapy.
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Affiliation(s)
- M I Costa
- Department of Pulmonology of Porto Hospital Center, Porto, Portugal.
| | - A Cipriano
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - F V Santos
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - S R Valdoleiros
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - I Furtado
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - A Machado
- Department of Internal Medicine of Porto Hospital Center, Porto, Portugal
| | - M Abreu
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Univesity of Porto, Portugal
| | - H N Bastos
- Department of Pulmonology of São João Hospital Center, Porto, Portugal; Faculty of Medicine of University of Porto, Porto, Portugal; IBMC/i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Almeida F, Macedo A, Trigo D, Abreu M, Guimarães M, Luís N, Pinho R, Tavares R. Neurocognitive evaluation using the International HIV Dementia Scale (IHDS) and Montreal Cognitive Assessment Test (MoCA) in an HIV-2 population. HIV Med 2020; 22:212-217. [PMID: 33012065 DOI: 10.1111/hiv.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to characterize neurocognitive impairment (NI) in an HIV-2 population using an observational cross-sectional study in four Portuguese hospitals. METHODS Adult HIV-2-infected patients were included. Montreal Cognitive Assessment Test (MoCA) and International HIV Dementia Scale (IHDS) scales were applied for screening of NI. Patient Health Questionnaire-9 (PHQ-9) and Instrumental Activities of Daily Living (IADL) scales were used for assessment of depression and functionality. A multivariate analysis was performed to assess for risk factors for NI. RESULTS Eighty-one patients were included, 50.6% of African origin (n = 41) and 49.4% of Portuguese origin (n = 40). The MoCA scale showed alterations in 81.5% of patients (100% of migrants vs. 62.5% of non-migrants, P < 0.001) and the IHDS scale showed alterations in 42%. Both scales were altered simultaneously in 35.8%. Variables independently associated with NI were age [odds ratio (OR) = 0.885] and migrant status (OR = 9.150). CONCLUSIONS Neurocognitive impairment (both scales altered) was present in 35.8%, which is comparable to what is described for HIV-1. The MoCA performed worse in the migrant population and might not be applicable in this setting.
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Affiliation(s)
- F Almeida
- Infectious Diseases department, Centro Hospitalar de São João, Porto, Portugal
| | - A Macedo
- Keypoint Group, Lisbon, Portugal
| | - D Trigo
- Infectious Diseases department, Fernando Fonseca Hospital, Amadora, Portugal
| | - M Abreu
- Infectious Diseases department, Centro Hospitalar do Porto, Porto, Portugal
| | - M Guimarães
- Infectious Diseases department, Dr. José de Almeida, Hospital, Cascais, Portugal
| | - N Luís
- Infectious Diseases department, São Bernardo Hospital, Setúbal, Portugal
| | - R Pinho
- Infectious Diseases department, Algarve Hospital Centre, Portimão, Portugal
| | - R Tavares
- Infectious Diseases department, Beatriz Ângelo Hospital, Loures, Portugal
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Sarmento-Castro R, Méndez J, Horta A, Gonçalves C, Vasconcelos O, Seabra J, Abreu M, Gonçalves MJ, Santos MJ, Tavares AP. Hepatitis C treatment outcome in former or current intravenous drug users coinfected with HIV, with or without directly observed therapy. Infect Dis (Lond) 2020; 53:9-18. [PMID: 32820689 DOI: 10.1080/23744235.2020.1806352] [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] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Intravenous drug users (IDUs) with hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfection are recognised as a high-risk, vulnerable group. METHODS Between February 2015 and April 2018, a single-centre, non-interventional cohort study was conducted in an outpatient setting, to evaluate the sustained virologic response (SVR12) and assess treatment uptake models. The study included 385 former or recent IDUs divided into two groups: A-without use of opioid substitution treatment (OST) and B-patients taking opioid substitution; patients in group B received OST and self-administered therapy (B1) or OST and therapy under DOT (B2). Patients were characterised by demographic and clinical features and compared for treatment response. Correlations between SVR12 and independent variables were determined by logistic regression. RESULTS Patients were mostly males (88.3%) with a mean age of 46 ± 5 years and HCV genotype 1a (63.7%). Approximately 28% were treatment-experienced and 84.9% received sofosbuvir/ledipasvir. The mean CD4+T count was 649 cells/mm3, and most individuals were on antiretroviral therapy with undetectable viral loads (97.4%). SVR12 was achieved in 94.8%, and only eight patients relapsed. No significant differences were found in treatment effect between individuals taking opioid substitutes under different treatment models. Correlations were found between HCV viral response and both HIV suppression and albumin levels. CONCLUSIONS IDU with HCV/HIV coinfection, including individuals on self-administration of HCV therapy and opioid substitution treatments or in DOT programmes, are no longer considered a difficult-to-treat group, as they achieve high rates of SVR12.
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Affiliation(s)
- R Sarmento-Castro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - J Méndez
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - A Horta
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - C Gonçalves
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - O Vasconcelos
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - J Seabra
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - M Abreu
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - M J Gonçalves
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
| | - M J Santos
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal.,ARSN - Administração Regional De Saúde Do Norte I.P, Porto, Portugal
| | - A P Tavares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário do Porto - Largo Prof. Abel Salazar, Porto, Portugal
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Freitas C, Ribeiro K, Valote P, Jaguaribe T, Abreu M, Sousa M, Morenz M, Gomide C. PSXI-3 Tussock dynamics in pastures of BRS Zuri and BRS Quênia under rotational stocking. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Freitas
- Universidade Federal de Viçosa, Viçosa, Brazil
| | - K Ribeiro
- Universidade Federal de Viçosa, Viçosa, Brazil
| | - P Valote
- Federal Rural University of Rio de Janeiro, Seropédica, Brazil
| | - T Jaguaribe
- Federal University of Juiz de For a, Juiz de For a, Brazil
| | - M Abreu
- IFET Rio Pomba,Rio Pomba, Brazil
| | - M Sousa
- Federal University of Bahia,Salvador, Brazil
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Radar A, Carvalho A, Macedo J J, Abreu M, Oliveira M, Saraiva A, Faísca P, Payan-Carreira R, Pires M. Feline Endometrial Adenocarcinomas: Stromal Characterization for Muscle Invasion Identification. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.193] [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: 10/20/2022]
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Varkas G, Thevissen K, De Brabanter G, Van Praet L, Czul-Gurdian F, Cypers H, De Kock J, Carron P, De Vos M, Hindryckx P, Arts J, Vanneuville I, Schoenaers P, Claerhout B, Abreu M, Van den Bosch F, Elewaut D. An induction or flare of arthritis and/or sacroiliitis by vedolizumab in inflammatory bowel disease: a case series. Ann Rheum Dis 2016; 76:878-881. [PMID: 27899374 DOI: 10.1136/annrheumdis-2016-210233] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [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: 07/18/2016] [Revised: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND In inflammatory bowel disease (IBD), a new biological therapy has recently been approved. Vedolizumab is a humanised IgG1 monoclonal antibody to α4β7 integrin that modulates gut lymphocyte trafficking. Although an exclusively local effect of vedolizumab could be expected based on the restricted presence of the α4β7-mucosal vascular addressin cell adhesion molecule 1 complex in the gut, past combined success with anti-tumour necrosis factor, and previous demonstration of α4β7 integrin in the joint, led to the expectation of a therapeutic efficacy in spondyloarthritis. Nonetheless, the effect of vedolizumab on extraintestinal manifestations-and especially the joint-has not been reported so far. CASE REPORT A series of five patients with IBD who were treated with vedolizumab and promptly developed new onset or exacerbation of sacroiliitis or arthritis are reported. CONCLUSIONS Vedolizumab therapy does not seem to show any efficacy in and might even induce arthritis and/or sacroiliitis. However, larger cohort studies are needed to provide information on the prevalence, the evolution and underlying mechanism.
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Affiliation(s)
- G Varkas
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - K Thevissen
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium
| | - G De Brabanter
- Department of Rheumatology, AZ Sint-Lucas Brugge, Bruges, Belgium
| | - L Van Praet
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - F Czul-Gurdian
- The Crohn's and Colitis Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - H Cypers
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - J De Kock
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - P Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium
| | - M De Vos
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - P Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - J Arts
- Department of Gastroenterology, AZ Sint-Lucas Brugge, Bruges, Belgium
| | - I Vanneuville
- Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium
| | - P Schoenaers
- Department of Gastroenterology, AZ Alma, Sijsele-Eeklo, Belgium
| | - B Claerhout
- Department of Gastroenterology, AZ Alma, Sijsele-Eeklo, Belgium
| | - M Abreu
- The Crohn's and Colitis Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - F Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - D Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
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Marconi A, Di Marcantonio P, D'Odorico V, Cristiani S, Maiolino R, Oliva E, Origlia L, Riva M, Valenziano L, Zerbi FM, Abreu M, Adibekyan V, Allende Prieto C, Amado PJ, Benz W, Boisse I, Bonfils X, Bouchy F, Buchhave L, Buscher D, Cabral A, Canto Martins BL, Chiavassa A, Coelho J, Christensen LB, Delgado-Mena E, de Medeiros JR, Di Varano I, Figueira P, Fisher M, Fynbo JPU, Glasse ACH, Haehnelt M, Haniff C, Hansen CJ, Hatzes A, Huke P, Korn AJ, Leão IC, Liske J, Lovis C, Maslowski P, Matute I, McCracken RA, Martins CJAP, Monteiro MJPFG, Morris S, Morris T, Nicklas H, Niedzielski A, Nunes NJ, Palle E, Parr-Burman PM, Parro V, Parry I, Pepe F, Piskunov N, Queloz D, Quirrenbach A, Rebolo Lopez R, Reiners A, Reid DT, Santos N, Seifert W, Sousa S, Stempels HC, Strassmeier K, Sun X, Udry S, Vanzi L, Vestergaard M, Weber M, Zackrisson E. EELT-HIRES the high-resolution spectrograph for the E-ELT. ACTA ACUST UNITED AC 2016. [DOI: 10.1117/12.2231653] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - V. D'Odorico
- INAF - Osservatorio Astronomico di Trieste (Italy)
| | - S. Cristiani
- INAF - Osservatorio Astronomico di Trieste (Italy)
| | | | - E. Oliva
- INAF - Osservatorio Astrofisico di Arcetri (Italy)
| | - L. Origlia
- INAF - Osservatorio Astronomico di Bologna (Italy)
| | - M. Riva
- INAF - Osservatorio Astronomico di Brera (Italy)
| | | | | | | | | | | | - P. J. Amado
- Instituto de Astrofísica de Andalucía (Spain)
| | | | - I. Boisse
- Lab. d'Astrophysique de Marseille (France)
| | - X. Bonfils
- Observatoire de Science de l'Univ. de Grenoble (France)
| | | | | | | | | | | | - A. Chiavassa
- Lab. Lagrange, Univ. Côte d'Azur, Observatoire de la Côte d'Azur (France)
| | | | | | | | | | - I. Di Varano
- Leibniz-Institut für Astrophysik Potsdam (Germany)
| | | | | | | | | | | | | | | | - A. Hatzes
- Thüringer Landessternwarte Tautenburg (Germany)
| | - P. Huke
- Univ. of Göttingen (Germany)
| | | | - I. C. Leão
- Federal Univ. of Rio Grande do Norte (Brazil)
| | | | | | | | | | | | | | | | | | | | | | | | | | - E. Palle
- Instituto de Astrofísica de Canarias (Spain)
| | | | - V. Parro
- Instituto Mauá de Tecnologia (Brazil)
| | - I. Parry
- Univ. of Cambridge (United Kingdom)
| | - F. Pepe
- Univ. de Genève (Switzerland)
| | | | | | | | | | | | | | | | | | | | | | | | - X. Sun
- Univ. of Cambridge (United Kingdom)
| | - S. Udry
- Univ. de Genève (Switzerland)
| | - L. Vanzi
- Pontificia Univ. Católica de Chile (Chile)
| | | | - M. Weber
- Leibniz-Institut für Astrophysik Potsdam (Germany)
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Barbhaiya M, Abreu M, Amigo M, Avcin T, Bertolaccini M, Branch W, de Groot P, de Jesus G, Levy R, Lockshin M, Tektonidou M, Wahl D, Willis R, Zuily S, Costenbader K, Erkan D. AB0561 Needs-Assessment Survey for the Update of the Current Antiphospholipid Syndrome (APS) Classification Criteria. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1330] [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]
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31
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Ayala LG, Abreu M, Avila M, Bergamini BC, Neto AC, Zin WA, Neto AG, Carvalho AR. 0548. Effects of sedation and muscle paralysis on inflammation during mechanical ventilation. Intensive Care Med Exp 2014. [PMCID: PMC4798140 DOI: 10.1186/2197-425x-2-s1-p32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Cavalcanti AB, Suzumura EA, Abreu M, Ribeiro GF, Kodama A, Moreira F, Guimarães HP, Romano E, Amato MB, Berwanger O, Carvalho CR, Investigators ART. Alveolar Recruitment for ARDS Trial: preliminary results. Crit Care 2013. [PMCID: PMC3642524 DOI: 10.1186/cc12047] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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33
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Bejarano D, Rafailovici L, Tavella M, Picasso M, Abreu M, Aviles L, Vazquez V, Falomo S, Chiozza J, Filomia M. Comparative Analysis of Acute Radiation Dermatitis in Breast Cancer Treatment: Concomitant Versus Sequential Paclitaxel and Radiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.642] [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: 10/27/2022]
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34
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Pereira P, Navarro E, Arruda C, Abreu M. Indeterminate form of Chagas disease: Risk for cardiovascular disease in older individuals in Sao Paulo State, Brazil. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.011] [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: 11/16/2022]
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35
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Jiménez S, Domingo A, Abreu M, Brazeiro A. Structure of the seabird assemblage associated with pelagic longline vessels in the southwestern Atlantic: implications for bycatch. ENDANGER SPECIES RES 2011. [DOI: 10.3354/esr00378] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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36
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Corsetti A, Abreu M, Ulbrich L, Dutra N, Leite M, Puricelli E. Effect of buried magnetic field on bone healing process in rat femurs. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.635] [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: 10/16/2022]
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37
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Gonçalves E, Pinheiro J, Abreu M, Brandão T, Silva C. Kinetics of quality changes of pumpkin (Curcurbita maxima L.) stored under isothermal and non-isothermal frozen conditions. J FOOD ENG 2011. [DOI: 10.1016/j.jfoodeng.2011.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Abreu M, Carvalheiro H, Duarte C, Pereira-da-Silva JA, Souto-Carneiro M, Rodrigues-Santos P. Expression of CD62L, CD27 and CD11b define a marked cytotoxic effector role for NK cells in rheumatoid arthritis. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.148999.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Gonçalves E, Pinheiro J, Abreu M, Brandão T, Silva C. Carrot (Daucus carota L.) peroxidase inactivation, phenolic content and physical changes kinetics due to blanching. J FOOD ENG 2010. [DOI: 10.1016/j.jfoodeng.2009.12.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Dal Secco D, Olivon V, Corrêa T, Celes MR, Abreu M, Rossi M, Oliveira AM, Cunha F, Assreuy J. Cardiovascular hyporesponsiveness in sepsis is associated with G-protein receptor kinase expression via a nitric oxide-dependent mechanism. Crit Care 2010. [PMCID: PMC3254952 DOI: 10.1186/cc9137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Chaves-Fonseca RM, Matos OS, Lordelo RA, Abreu M, Farias MG, Coutinho JF, Ribeiro MN, Matteoni-Athayde L, Lessa I, Pousada J, Oliveira M, Lopes C, Strock E, Mazze R. Implementation of a systematic approach to diabetes in primary care in Bahia, Brazil improves metabolic outcomes: PRODIBA-Programa de Interiorização da Assistência ao Diabetes na Bahia (Project for Dissemination of Diabetes Care in the State of Bahia). Diabet Med 2009; 26:286-92. [PMID: 19317824 DOI: 10.1111/j.1464-5491.2008.02656.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Staged Diabetes Management (SDM) improves glycaemic control and reduces diabetes-related complications in primary care. METHODS An 18-month randomized controlled cohort study was conducted in two municipalities in the state of Bahia, Brazil, involving 100 patients with Type 2 diabetes in each municipality. In one municipality, healthcare professionals were trained to use SDM customized protocols for clinical decisions and, in the other municipality, no protocols for diabetes care were implemented. We hypothesized that, in the municipality with SDM trained professionals, patients would have better outcomes, including a fall in glycated haemoglobin (HbA(1c)). RESULTS Improvements in some metabolic parameters were observed in the SDM group, including a 22% decrease in mean random glucose, a significant 15% decrease in mean HbA(1c), a 6% decrease in systolic blood pressure and an 11% decrease in diastolic blood pressure. There were no differences in body mass index and lipid profile. CONCLUSIONS SDM customized algorithms are effective, practical and easy to use in primary healthcare teams with very limited resources.
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Affiliation(s)
- R M Chaves-Fonseca
- Centre for Diabetes and Endocrinology in the State of Bahia (CEDEBA), Salvador, Bahia, Brazil.
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Barrocas D, Coentre R, Chendo I, Mendes T, Abreu M, Maltez J. Maintenance ECT in Affective Disorders. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ECT is the most powerful therapeutic tool in the treatment of acute mood episodes. However, data on the efficacy and safety of ECT in the long term management of affective disorders is lacking, despite overwhelming rates of chronicity and/or frequent relapses among patients with unipolar and bipolar depression. In this presentation we will review the data of the ECT unit of Hospital de Santa Maria, Lisboa, on maintenace ECT (m-ECT) in these patients. We compare intra and inter-individual evolution prior and after the institution of m-ECT. Considering the number of hospital admissions, mood symptoms and other parameters, our data support the use of this technique as a prophylatic approach for patients with mood disorders and a previous good response to ECT in the acute phase of disease.
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Barrocas D, Coentre R, Chendo I, Mendes T, Abreu M, Maltez J. Maintenance ECT in Affective Disorders. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ECT is the most powerful therapeutic tool in the treatment of acute mood episodes. However, data on the efficacy and safety of ECT in the long term management of affective disorders is lacking, despite overwhelming rates of chronicity and/or frequent relapses among patients with unipolar and bipolar depression. In this presentation we will review the data of the ECT unit of Hospital de Santa Maria, Lisboa, on maintenace ECT (m-ECT) in these patients. We compare intra and inter-individual evolution prior and after the institution of m-ECT. Considering the number of hospital admissions, mood symptoms and other parameters, our data support the use of this technique as a prophylatic approach for patients with mood disorders and a previous good response to ECT in the acute phase of disease.
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44
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Gonçalves E, Pinheiro J, Abreu M, Brandão T, Silva C. Modelling the kinetics of peroxidase inactivation, colour and texture changes of pumpkin (Cucurbita maxima L.) during blanching. J FOOD ENG 2007. [DOI: 10.1016/j.jfoodeng.2007.01.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abreu M, Johnson K, Chung CB, De Lima JE, Trudell D, Terkeltaub R, Pe S, Resnick D. Calcification in calcium pyrophosphate dihydrate (CPPD) crystalline deposits in the knee: anatomic, radiographic, MR imaging, and histologic study in cadavers. Skeletal Radiol 2004; 33:392-8. [PMID: 15138720 DOI: 10.1007/s00256-004-0767-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Revised: 02/05/2004] [Accepted: 02/09/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To demonstrate and determine the frequency and location of calcification within cadaveric knees with or without calcification typical of calcium pyrophosphate dihydrate (CPPD), utilizing histologic, radiographic and MR imaging techniques. DESIGN AND PATIENTS Ten cadaveric knees of elderly individuals that demonstrated no radiographic evidence of prior surgery or trauma were studied with MR imaging and subsequently sectioned in planes corresponding to those obtained with MR imaging. The slices were imaged with high-resolution radiography. Two musculoskeletal radiologists correlated the anatomic, MR and radiographic findings. Three of the knees, which did not demonstrate calcifications, were utilized as controls. Histologic sections were obtained from four knees that contained calcifications and from the three controls, and analyzed with special histologic stains that demonstrate phosphorus and calcium. RESULTS Radiographic imaging and histologic analysis demonstrated widespread CPPD crystal deposition in four of the 10 knee specimens (40%). MR imaging demonstrated some calcifications only within the articular cartilage of the femoral condyles in three of the four (75%) specimens that had CPPD deposits. In all four specimens radiographs and histologic analysis were more sensitive than MR imaging. Histologic analysis demonstrated no evidence of CPPD crystals in the control specimens. CONCLUSION MR imaging is insensitive to the presence of CPPD deposits in the knee, even when such deposits are widespread. Our study suggests that the sensitivity of MR imaging was significantly better in detecting CPPD deposits in the hyaline cartilage of the femoral condyles when compared with other internal structures, even when such structures contained a higher amount of calcification.
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Affiliation(s)
- M Abreu
- Department of Musculoskeletal Radiology, University of California, San Diego, VA San Diego Healthcare System, 3350 La Jolla Village Drive, CA 92162, San Diego, USA
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Abstract
OBJECTIVE To compare the diagnostic performances provided by tuned aperture computed tomography (TACT) slices and the multiple images that they originate from in the detection of primary caries on the proximal surfaces of posterior teeth. STUDY DESIGN Eight direct digital radiography images of each of 40 posterior teeth were acquired with a digital sensor. These source images were used to generate TACT slices of the teeth. Eight trained observers were calibrated in the use of both TACT slices and the eight source images of each tooth. They were asked to assess the presence/absence of proximal caries in the teeth using a 5-point rating scale. Observers' assessments were compared with the ground truth provided by histological examination of tooth sections. Areas under the receiver operating characteristic (ROC) curves (Az) were calculated for each combination of observer and image modality. Analysis of variance (ANOVA) was used to test the ROC values for potential statistical differences. RESULTS Mean ROC Az values were 0.760 for TACT slices and 0.771 for its multiple source images for the detection of primary proximal caries. ANOVA showed no statistically significant differences either between modalities (P = 0.656) or between observers (P = 0.851). CONCLUSION TACT slices and its multiple source images provide comparable diagnostic performance for proximal caries detection.
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Affiliation(s)
- M Abreu
- Department of Stomatology, Federal University of Santa Catarina School of Dentistry, Florianopolis, SC, Brasil.
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Oliva JP, Cruz T, Pimentel G, Quesada W, Ortiz R, Abreu M, Sánchez I, Díaz N, Baum RP. Radioinmunolocalización de tumores de cabeza y cuello con un nuevo anticuerpo monoclonal contra el receptor del EGF. Resultados preliminares. ACTA ACUST UNITED AC 2004; 23:273-8. [PMID: 15207212 DOI: 10.1016/s0212-6982(04)72298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To show the results of Radioimmunodetection (RID) using Cuban monoclonal antibody (MoA) anti-egf-ior-egf-r3 labeled with 99mTc for the detection of primary tumors and/or metastases of head and neck epithelial malignant tumors. MATERIAL AND METHODS Thirteen patients aged from 16-62 years (mean: 54.8 years) with primary tumors and metastases in the regional cervical lymph nodes were retrospectively evaluated. The labelling dose was 1480-2220 MBq (40-60 mCi). Planar images were performed after 10 minutes and together with SPECT images after 18-24 hours following MoA administration. The matrix was 128 x 128. SPECT images were reconstructed using the Butterworth 4/16 filter. A positive result was defined when the lesions were visualized. RESULTS RID localized 11 of the known primary tumors in the 13 patients studied. In the two other patients, in whom the primary tumor site was unknown, cervical lymph node metastases were found. The results of 3 of the RID were false negative but in the other 10, RID was able to localize the primary tumor and cervical lymph node metastases. Sensitivity was 77 % and the predictive positive value was 100 %. CONCLUSIONS The results of this study show that the Cuban MoA ior-egf-r3 can be employed for RID of primary head and neck tumors and their metastases. The radiation dose is adequate for RID.
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Affiliation(s)
- J P Oliva
- Departamento de Medicina Nuclear, Instituto Nacional de Oncología y Radiobiología, (INOR), Habana, Cuba.
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Trindade P, Beirão-da-Costa M, Moldão-Martins M, Abreu M, Gonçalves E, Beirão-da-Costa S. THE EFFECT OF HEAT TREATMENTS AND CALCIUM CHLORIDE APPLICATIONS ON QUALITY OF FRESH-CUT MANGO. ACTA ACUST UNITED AC 2003. [DOI: 10.17660/actahortic.2003.599.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pabla T, Ludlow JB, Tyndall DA, Platin E, Abreu M. Effect of data compression on proximal caries detection: observer performance with DenOptix photostimulable phosphor images. Dentomaxillofac Radiol 2003; 32:45-9. [PMID: 12820853 DOI: 10.1259/dmfr/19650275] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To study the effect of lossy image compression on caries detection. Null hypothesis states no difference in caries detection efficacy among observers using original digital images versus images compressed at various rates of compression. METHODS Digital images of 41 extracted posterior teeth were obtained with a storage phosphor DenOptix (Gendex DenOptix Imaging system) system. Images were exported in Tagged Image File Format (TIFF) and compressed with Joint Photographic Experts Group File Interchange Format (JFIF), as provided by the software of the imaging system. The compressions options JFIF100%, JFIF75% and JFIF50% resulted in reducing the image size to 1:2, 1:11 and 1:16, respectively. Eight observers evaluated the presence or absence of caries on a 5-point confidence scale. The actual caries status of each proximal surface was determined by ground section histology. Responses were evaluated by receiver operating characteristic (ROC) analysis. Areas under the curves (Az) were assessed using analysis of variance (ANOVA). RESULTS The mean Az scores were 0.85 for original/uncompressed images, and 0.89 for JFIF100%, 0.88 for JFIF75% and 0.88 for JFIF50% images. These differences were not statistically significant (P = 0.26). Differences between observers were also not statistically significant (P = 0.12). CONCLUSIONS JFIF compression at the level of 1:16 can be used without significant deterioration in diagnostic accuracy for proximal caries detection.
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Affiliation(s)
- T Pabla
- Oral and Maxillofacial Radiology, University of North Carolina, Chapel Hill, NC, USA.
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Salgado P, Martins J, Carvalho F, Abreu M, Freire J, Toullec R, Lallès J, Bento O. Component digestibility of lupin (Lupinus angustifolius) and pea (Pisum sativum) seeds and effects on the small intestine and body organs in anastomosed and intact growing pigs. Anim Feed Sci Technol 2002. [DOI: 10.1016/s0377-8401(02)00027-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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