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Cazeiro DI, Plácido R, Raposo MA, Brito J, Borba A, Guimarães T, Pinto E, Freitas P, Pinto FJ. Pulmonary Arterial Hypertension with Features of Venous Involvement: A Detective's Task. Arq Bras Cardiol 2024; 121:e20230565. [PMID: 38695472 PMCID: PMC11081196 DOI: 10.36660/abc.20230565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/30/2023] [Accepted: 01/18/2024] [Indexed: 05/12/2024] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome.
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Affiliation(s)
- Daniel Inácio Cazeiro
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Rui Plácido
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Miguel Azeredo Raposo
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Joana Brito
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Alexandra Borba
- Centro Hospitalar Universitário Lisboa CentralServiço de PneumologiaLisboaPortugalServiço de Pneumologia – Centro Hospitalar Universitário Lisboa Central, Lisboa – Portugal
| | - Tatiana Guimarães
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Eugénia Pinto
- Centro Hospitalar Universitário Lisboa CentralServiço de PatologiaLisboaPortugalServiço de Patologia – Centro Hospitalar Universitário Lisboa Central, Lisboa – Portugal
| | - Pedro Freitas
- Centro Hospitalar Universitário Lisboa OcidentalServiço de CardiologiaCarnaxidePortugalServiço de Cardiologia – Centro Hospitalar Universitário Lisboa Ocidental, Carnaxide – Portugal
| | - Fausto J. Pinto
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
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Guimarães T. Pregnancy, the exception to the indexing of echocardiographic parameters? Rev Port Cardiol 2024; 43:129-130. [PMID: 37690514 DOI: 10.1016/j.repc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- Tatiana Guimarães
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Norte - Hospital Santa Maria, Lisboa, Portugal.
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Leal C, Strogoff-de-Matos J, Theodoro C, Teixeira R, Perez R, Guaraná T, de Tarso Pinto P, Guimarães T, Artimos S. Incidence and Risk Factors of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C Treated with Direct-Acting Antivirals. Viruses 2023; 15:221. [PMID: 36680260 PMCID: PMC9863874 DOI: 10.3390/v15010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Conflicting data regarding the incidence of hepatocellular carcinoma (HCC) after cure of HCV infection with direct-acting antivirals (DAAs) remains. We investigated the incidence and risk factors to HCC after treatment with DAAs followed up for five years. METHODS A total of 1075 HCV patients ≥ 18 years were treated with DAAs from 2015 to 2019 and followed until 2022. Ultrasonography was performed before DAAs and each 6 months thereafter. RESULTS Of the total, 51/1075 (4.7%) developed HCC in the median of 40 (IQR 25-58) months: 26/51 (51%) male, median age 60 (IQR 54-66) years, alpha-fetoprotein (AFP) 12.2 (IQR 6.1-18.8) ng/mL, 47/51 (92.1%) cirrhotic 78.7%, 8/51 (15.7%) without sustained virological response (SVR). Seventeen percent had non-characterized nodules before DAAs. Cumulative HCC incidence was 5.9% in 5 years. Overall incidence was 1.46/100 patient-years (PY) (95% CI = 1.09-1.91), being 2.31/100 PY (95% CI = 1.70-3.06), 0.45/100 PY (95% CI = 0.09-1.32) and 0.20/100 PY (95% CI 0.01-1.01) in METAVIR F4, F3 and F2, respectively, and the main risks to HCC were non-characterized nodule, cirrhosis, high AFP values and non-SVR. CONCLUSION HCV cure reduced risk for HCC, but it still occurred particularly in cirrhotic patients. Some risk factors can be identified to predict early HCC diagnosis.
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Affiliation(s)
- Cassia Leal
- Gastroenterology and Hepatology Unit, Internal Medicine Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil
- Gastroenterology and Hepatology Unit, Antônio Pedro Universitary Hospital, Fluminense Federal University, Rio de Janeiro 24033-900, Brazil
| | - Jorge Strogoff-de-Matos
- Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro 24033-900, Brazil
| | - Carmem Theodoro
- Gastroenterology and Hepatology Unit, Internal Medicine Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil
- Gastroenterology and Hepatology Unit, Antônio Pedro Universitary Hospital, Fluminense Federal University, Rio de Janeiro 24033-900, Brazil
| | - Rosangela Teixeira
- Departamento de Clínica Médica, Faculdade de Medicina, Instituto Alfa de Gastroenterologia Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil
- Hospital Felício Rocho, Belo Horizonte 30110-934, Brazil
| | - Renata Perez
- Hepatology Division, D’Or Institute for Research and Education (IDOR), Rio de Janeiro 22281-100, Brazil
- Hepatology Division, Federal University of Rio de Janeiro, Rio de Janeiro 21941913, Brazil
| | - Thais Guaraná
- Gastroenterology and Hepatology Unit, Antônio Pedro Universitary Hospital, Fluminense Federal University, Rio de Janeiro 24033-900, Brazil
| | - Paulo de Tarso Pinto
- Gastroenterology and Hepatology Unit, Internal Medicine Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro 20221-161, Brazil
| | - Tatiana Guimarães
- Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro 24033-900, Brazil
| | - Solange Artimos
- Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro 24033-900, Brazil
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Ferreira Guerra J, Pina J, Andrade V, Medeiros M, Fernandes F, Guimarães T, Gil M, Cunha J, Silva P, Pinheiro L. What is the benefit of performing saturation prostate biopsies in addition to multiparametric magnetic resonance imaging targeted biopsies? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02486-7] [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: 11/11/2022] Open
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Mendes Andrade V, Silva P, Cunha J, Gil M, Guerra J, Medeiros M, Guimarães T, Calais F, Severo L, Campos Pinheiro L. Peyronie’s disease: Differences in male and female personal experience. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mendes Andrade V, Guimarães T, Medeiros M, Guerra J, Gil M, Cunha J, Silva P, Pina J, Campos Pinheiro L. Will be the systematic biopsy useful when added to the MRI/TRUS fusion biopsy? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00665-6] [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: 10/18/2022] Open
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Cabral DR, Guimarães T, Almeida AG, Campos P, Martins SR, da Silva PC, Pinto FJ, Plácido R. Chest pain in a patient with pulmonary arterial hypertension. Rev Port Cardiol 2022; 41:73-80. [DOI: 10.1016/j.repc.2020.05.021] [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] [Received: 11/09/2019] [Revised: 03/18/2020] [Accepted: 05/05/2020] [Indexed: 10/20/2022] Open
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Plácido R, Guimarães T, Jenkins D, Cortez-Dias N, Pereira SC, Campos P, Mineiro A, Lousada N, Martins SR, Moreira S, Dias AR, Resende CL, Vieira R, Pinto FJ. Chronic thromboembolic pulmonary hypertension: Initial experience of patients undergoing pulmonary thromboendarterectomy. Rev Port Cardiol 2021; 40:741-752. [PMID: 34857112 DOI: 10.1016/j.repce.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/13/2020] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary endarterectomy (PEA) is a potentially curative procedure in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study reports the initial experience of a Portuguese PH center with patients undergoing PEA at an international surgical reference center. METHODS Prospective observational study of consecutive CTEPH patients followed at a national PH center, who underwent PEA at an international surgical reference center between October 2015 and March 2019. Clinical, functional, laboratory, imaging and hemodynamic parameters were obtained in the 12 months preceding the surgery and repeated between four and six months after PEA. RESULTS 27 consecutive patients (59% female) with a median age of 60 (49-71) years underwent PEA. During a median follow-up of 34 (21-48) months, there was an improvement in functional class in all patients, with only one cardiac death. From a hemodynamic perspective, there was a reduction in mean pulmonary artery pressure from 48 (42-59) mmHg to 26 (22-38) mmHg, an increase in cardiac output from 3.3 (2.9-4.0) L/min to 4.9 (4.2-5.5) L/min and a reduction in pulmonary vascular resistance from 12.1 (7.2-15.5) uW to 3.5 (2.6-5,2) uW. During the follow-up, 44% (n=12) of patients had no PH criteria, 44% (n=12) had residual PH and 11% (n=3) had PH recurrence. There was a reduction of N-terminal pro-B-type natriureticpeptide from 868 (212-1730) pg/mL to 171 (98-382) pg/mL. Rright ventricular systolic function parameters revealed an improvement in longitudinal systolic excursion and peak velocity of the plane of the tricuspid ring from 14 (13-14) mm and 9 (8-10) cm/s to 17 (16-18) mm and 13 (11-15) cm/s, respectively. Of the 26 patients with preoperative right ventricular dysfunction, 85% (n=22) recovered. The proportion of patients on specific vasodilator therapy decreased from 93% to 44% (p<0.001) and the proportion of those requiring oxygen therapy decreased from 52% to 26% (p=0.003). The six-minute walk test distance increased by about 25% compared to the baseline and only eight patients had significant desaturation during the test. CONCLUSION Pulmonary endarterectomy performed at an experienced high-volume center is a safe procedure with a very favorable medium-term impact on functional, hemodynamic and right ventricular function parameters in CTEPH patients with operable disease. It is possible for PH centers without PEA differentiation to refer patients safely and effectively to an international surgical center in which air transport is necessary.
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Affiliation(s)
- Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal.
| | - Tatiana Guimarães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - David Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Inglaterra, United Kingdom
| | - Nuno Cortez-Dias
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Sara Couto Pereira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Paula Campos
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Lisboa, Portugal
| | - Ana Mineiro
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Nuno Lousada
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Susana R Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Susana Moreira
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Rocha Dias
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | | | - Rita Vieira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
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Plácido R, Guimarães T, Jenkins D, Cortez-Dias N, Pereira SC, Campos P, Mineiro A, Lousada N, Martins SR, Moreira S, Dias AR, Resende CL, Vieira R, Pinto FJ. Chronic thromboembolic pulmonary hypertension: initial experience of patients undergoing pulmonary thromboendarterectomy. Rev Port Cardiol 2021; 40:S0870-2551(21)00248-1. [PMID: 34474956 DOI: 10.1016/j.repc.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary endarterectomy (PEA) is a potentially curative procedure in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study reports the initial experience of a Portuguese PH center with patients undergoing PEA at an international surgical reference center. METHODS Prospective observational study of consecutive CTEPH patients followed at a national PH center, who underwent PEA at an international surgical reference center between October 2015 and March 2019. Clinical, functional, laboratory, imaging and hemodynamic parameters were obtained in the 12 months preceding the surgery and repeated between four and six months after PEA. RESULTS 27 consecutive patients (59% female) with a median age of 60 (49-71) years underwent PEA. During a median follow-up of 34 (21-48) months, there was an improvement in functional class in all patients, with only one cardiac death. From a hemodynamic perspective, there was a reduction in mean pulmonary artery pressure from 48 (42-59) mmHg to 26 (22-38) mmHg, an increase in cardiac output from 3.3 (2.9-4.0) L/min to 4.9 (4.2-5.5) L/min and a reduction in pulmonary vascular resistance from 12.1 (7.2-15.5) uW to 3.5 (2.6-5, 2) uW. During the follow-up, 44% (n=12) of patients had no PH criteria, 44% (n=12) had residual PH and 11% (n = 3) had PH recurrence. There was a reduction of N-terminal pro-B-type natriureticpeptide from 868 (212-1730) pg/mL to 171 (98-382) pg/mL. Rright ventricular systolic function parameters revealed an improvement in longitudinal systolic excursion and peak velocity of the plane of the tricuspid ring from 14 (13-14) mm and 9 (8-10) cm/s to 17 (16-18) mm and 13 (11-15) cm/s, respectively. Of the 26 patients with preoperative right ventricular dysfunction, 85% (n=22) recovered. The proportion of patients on specific vasodilator therapy decreased from 93% to 44% (p<0.001) and the proportion of those requiring oxygen therapy decreased from 52% to 26% (p=0.003). The six-minute walk test distance increased by about 25% compared to the baseline and only eight patients had significant desaturation during the test. CONCLUSION Pulmonary endarterectomy performed at an experienced high-volume center is a safe procedure with a very favorable medium-term impact on functional, hemodynamic and right ventricular function parameters in CTEPH patients with operable disease. It is possible for PH centers without PEA differentiation to refer patients safely and effectively to an international surgical center in which air transport is necessary.
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Affiliation(s)
- Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal.
| | - Tatiana Guimarães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - David Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Inglaterra
| | - Nuno Cortez-Dias
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Sara Couto Pereira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Paula Campos
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Lisboa, Portugal
| | - Ana Mineiro
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Nuno Lousada
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Susana R Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Susana Moreira
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Rocha Dias
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | | | - Rita Vieira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
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Carneiro A, Guimarães T, Gomes D, Mendonça C, Pesquero J, Palmisano G, Moreira J, Pereira M. Rabdomiólise em militares: uma missão de reconhecimento para prevenção. ACTA ACUST UNITED AC 2021. [DOI: 10.29073/jim.v2i1.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
O treinamento físico regular faz parte do cotidiano militar, com intuito de aprimorar competências físicas essenciais para tarefas de combate. No entanto, quando executado de forma extenuante ou desenvolvido em condições climáticas adversas pode ocasionar o desenvolvimento da rabdomiólise por esforço físico. A rabdomiólise por esforço físico é definida como uma síndrome decorrente da necrose das células musculares, com sintomas variáveis, como dor muscular, fraqueza e aumento plasmático de enzimas musculares. A severidade da rabdomiólise por esforço físico varia individualmente, porém, pode se tornar clinicamente relevante, contribuindo para a hospitalização, insuficiência renal aguda, incapacidade permanente ou óbito. Sendo assim, o objetivo desta revisão narrativa é apresentar possíveis causas e fatores de risco para rabdomiólise, discutir sua fisiopatologia, seus possíveis diagnósticos e suas principais complicações, enfatizando o contexto militar.
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Guimarães T, Oliveira C, Crespo J, Porto B, Cunha R, Rocha A. Congenital stricture of the vestibulo‐vaginal fold in a mare with normal karyotype. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T. Guimarães
- Abel Salazar Biomedical Institute (ICBAS) University of Porto PortoPortugal
- Centre for the Study of Animal Sciences (CECA/ICETA) University of Porto PortoPortugal
| | - C. Oliveira
- Abel Salazar Biomedical Institute (ICBAS) University of Porto PortoPortugal
| | | | - B. Porto
- Abel Salazar Biomedical Institute (ICBAS) University of Porto PortoPortugal
| | - R. Cunha
- Abel Salazar Biomedical Institute (ICBAS) University of Porto PortoPortugal
- Centre for the Study of Animal Sciences (CECA/ICETA) University of Porto PortoPortugal
| | - A. Rocha
- Abel Salazar Biomedical Institute (ICBAS) University of Porto PortoPortugal
- Centre for the Study of Animal Sciences (CECA/ICETA) University of Porto PortoPortugal
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Marques P, Nunes‐Ferreira A, António PS, Aguiar‐Ricardo I, Lima da Silva G, Guimarães T, Bernardes A, Santos I, Pinto FJ, Sousa J. Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2020; 31:2954-2963. [DOI: 10.1111/jce.14750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/28/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pedro Marques
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Cardiac Rhythm Abnormalities, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Lisboa Portugal
| | - Afonso Nunes‐Ferreira
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Cardiac Rhythm Abnormalities, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Lisboa Portugal
- Heart Failure and Cardiomyopathies, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Portugal
| | - Pedro S. António
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
| | - Inês Aguiar‐Ricardo
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Heart Failure and Cardiomyopathies, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Portugal
| | - Gustavo Lima da Silva
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Cardiac Rhythm Abnormalities, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Lisboa Portugal
| | - Tatiana Guimarães
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Heart Failure and Cardiomyopathies, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Portugal
| | - Ana Bernardes
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
| | - Igor Santos
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
| | - Fausto J. Pinto
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Structural and Coronary Heart Disease, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Portugal
| | - João Sousa
- Cardiology Department Centro Hospitalar Universitário Lisboa Norte Lisboa Portugal
- Cardiac Rhythm Abnormalities, CAML, CCUL, Lisbon School of Medicine Universidade de Lisboa Lisboa Portugal
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Nunes-Ferreira A, Agostinho JR, Rigueira J, Aguiar-Ricardo I, Guimarães T, Santos R, Rodrigues T, Cunha N, António PS, Pereira SC, Morais P, Pedro MM, Veiga F, Pinto FJ, Brito D. Non-invasive telemonitoring improves outcomes in heart failure with reduced ejection fraction: a study in high-risk patients. ESC Heart Fail 2020; 7:3996-4004. [PMID: 32949226 PMCID: PMC7754718 DOI: 10.1002/ehf2.12999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Non-invasive telemonitoring (TM) in patients with heart failure (HF) and reduced left ventricular ejection fraction (HFrEF) may be useful in the early diagnosis of HF decompensation, allowing therapeutic optimization and avoiding re-hospitalization. We describe a TM programme in this population and evaluate its effectiveness during a 12 month period. METHODS AND RESULTS We conducted a single-centre study of patients discharged from hospital after decompensated HF, allocated into three groups: prospective TM programme, prospective HF protocol follow-up programme (PFP) with no TM facilities, and retrospective propensity-matched usual care (UC). TM effectiveness was assessed by all-cause hospitalizations and mortality; HF-related hospitalization (HFH), days lost to unplanned hospital admissions/death, functional capacity and quality of life (New York Heart Association, Kansas City Cardiomyopathy Questionnaire, 6 min walk test, and plasma N-terminal pro-brain natriuretic peptide) were also evaluated. A total of 125 patients were included [65.9 ± 11.9 years, 32% female, left ventricular ejection fraction 27% (21-32)]. TM was similar to PFP regarding effectiveness; TM reduced all-cause hospitalization and mortality (HR 0.27; 95% CI 0.11-0.71; P < 0.01) and HFH (HR 0.29; 95% CI 0.10-0.89; P < 0.05) as compared with UC. TM reduced the average number of days lost due to unplanned hospital admissions or all-cause death as compared with PFP (5.6 vs. 12.4 days, P < 0.05) and UC (5.6 vs. 48.8 days, P < 0.01). Impact on quality of life was similar between TM and PFP (P = 0.36). CONCLUSIONS In patients with HFrEF and recent HF hospitalization, non-invasive TM reduced 12 month all-cause hospitalization/mortality and HFH as compared with usual care. TM also reduced the number of days lost due to unplanned hospital admission/death as compared with either an optimized protocol-based follow-up programme or usual care.
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Affiliation(s)
- Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - João R Agostinho
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Inês Aguiar-Ricardo
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Tatiana Guimarães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Rafael Santos
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Nelson Cunha
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Pedro Silvério António
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Sara Couto Pereira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Pedro Morais
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Mónica Mendes Pedro
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Fátima Veiga
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
| | - Dulce Brito
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon, 1649-028, Portugal
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Azevedo Coutinho MC, Cortez-Dias N, Cantinho G, Gonçalves S, Menezes MN, Guimarães T, Lima da Silva G, Francisco AR, Agostinho J, Santos L, Conceição I, Pinto FJ. The sensitivity of DPD scintigraphy to detect transthyretin cardiac amyloidosis in V30M mutation depends on the phenotypic expression of the disease. Amyloid 2020; 27:174-183. [PMID: 32482106 DOI: 10.1080/13506129.2020.1744553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: There is a growing need for a non-invasive test to detect cardiac involvement in patients with transthyretin-related hereditary amyloidosis (ATTR) caused by V30M mutation. 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy is a promising method, but its accuracy in this particular mutation remains unknown.Methods: A cohort of 179 patients: 92 with early-onset disease (EoD, symptoms <50-years-old), 33 with late-onset disease (LoD) and 54 asymptomatic carriers were prospectively evaluated and underwent DPD scintigraphy, which was compared with the results of echocardiogram, ambulatory blood pressure monitoring, 24 h-Holter, myocardial 123I-metaiodobenzylguanidine imaging and NT-proBNP.Results: Amyloid cardiomyopathy, defined as septal thickness ≥13 mm, was present in 32 patients (17.9%) and was more frequent in those with LoD (OR: 3.68, p = .003). Cardiac DPD uptake was present in 22 individuals (12.3%) and correlated with parameters indicative of cardiac amyloidosis. DPD imaging was strongly influenced by the age of disease onset: among patients with myocardial thickening, cardiac DPD retention was present in 11/15 (73.3%) with LoD, in contrast to only 4/17 (26.7%) with EoD (p = .005). Two patients with myocardial thickening and normal DPD scintigraphy underwent endomyocardial biopsy that confirmed ATTR amyloidosis.Conclusion: DPD scintigraphy presents suboptimal sensitivity to detect cardiac involvement in ATTRV30M, particularly in symptomatic patients with EoD.
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Affiliation(s)
- Maria C Azevedo Coutinho
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal.,Translational Clinical Physiology Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Cortez-Dias
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal.,Programme for Advanced Medical Education, Fundação Calouste Gulbenkian, Ministry of Health and Foundation for Science and Technology, Lisbon, Portugal
| | - Guilhermina Cantinho
- Institute of Nuclear Medicine, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Gonçalves
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - Miguel Nobre Menezes
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - Tatiana Guimarães
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - Gustavo Lima da Silva
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - Ana Rita Francisco
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - João Agostinho
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - Laura Santos
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
| | - Isabel Conceição
- Translational Clinical Physiology Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Neurology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte and Cardiovascular Centre at Universidade de Lisboa, Faculty of Medicine, Lisbon, Portugal
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15
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Plácido R, Sousa I, Antunes D, Guimarães T, Pinto FJ. More than a rare cause of pulmonary hypertension in the elderly. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2019.06.014] [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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16
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Agostinho JR, Gonçalves I, Rigueira J, Aguiar-Ricardo I, Nunes-Ferreira A, Santos R, Guimarães T, Alves P, Cunha N, Rodrigues T, André ŃZ, Pedro M, Veiga F, Pinto FJ, Brito D. Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life. Rev Port Cardiol 2020; 38:755-764. [PMID: 32005587 DOI: 10.1016/j.repc.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life. METHODS A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis. RESULTS No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in all-cause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001). CONCLUSION A protocol-based follow-up program for patients with heart failure led to a significant reduction in readmission and mortality rates, and was associated with better quality of life.
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Affiliation(s)
- João R Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Inês Gonçalves
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Joana Rigueira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Rafael Santos
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tatiana Guimarães
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Pedro Alves
- Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Nelson Cunha
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tiago Rodrigues
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - ŃZinga André
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Mónica Pedro
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fátima Veiga
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Fonseca AC, Marto JP, Pimenta D, Guimarães T, Alves PN, Inácio N, Viana-Baptista M, Pinho E Melo T, Pinto FJ, Ferro JM, Almeida AG. Undetermined stroke genesis and hidden cardiomyopathies determined by cardiac magnetic resonance. Neurology 2019; 94:e107-e113. [PMID: 31792090 DOI: 10.1212/wnl.0000000000008698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To determine whether cardiac magnetic resonance imaging (CMR) could be useful in identifying previously undiagnosed cardiomyopathies in a cohort of patients with ischemic stroke who underwent standard etiologic investigation and to describe the type and frequency of these cardiomyopathies. METHODS We performed a subanalysis of a previously collected prospective cohort of patients with ischemic stroke. Patients with structural changes on echocardiography that are considered causal for stroke in the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3T CMR was performed. We compared the frequency of the cardiomyopathies that we found with reference values for the general population. RESULTS One hundred thirty-two patients with a mean age of 68.4 years were included. In 7 patients (5.3%, 95% confidence interval 2.59%-10.54%) CMR identified cardiomyopathy. Four patients had hypertrophic cardiomyopathy, 2 had restrictive cardiomyopathy, and 1 had noncompaction cardiomyopathy. Six of these patients had been classified after standard evaluation as having undetermined stroke and 1 patient as having cardioembolic stroke (atrial fibrillation). We found a higher frequency of hypertrophic cardiomyopathy in the entire cohort and in the undetermined cause group compared to the general population (3.03% and 5.81% vs 0.2%, respectively, p = 0.001 and p < 0.001). The frequency of noncompaction cardiomyopathy was also higher in our cohort (0.76% vs 0.05%, respectively, p < 0.001). CONCLUSIONS Although rare, cardiomyopathies should be considered as a possible cause of ischemic stroke classified as of undetermined etiology after standard evaluation.
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Affiliation(s)
- Ana Catarina Fonseca
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal.
| | - João Pedro Marto
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Daniela Pimenta
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Tatiana Guimarães
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Pedro N Alves
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Nuno Inácio
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Miguel Viana-Baptista
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Teresa Pinho E Melo
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Fausto J Pinto
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - José M Ferro
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
| | - Ana G Almeida
- From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal
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Xavier P, Magalhães M, Sampaio-Norton S, Guimarães T, Oliveira JG. Differences for T-Cell Subtypes in Aspiration Biopsies of Patients With Kidney Transplant Under Polyclonal and Monoclonal Immunosuppressive Treatments. Transplant Proc 2019; 51:3271-3274. [PMID: 31732211 DOI: 10.1016/j.transproceed.2019.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/05/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022]
Abstract
Thymoglobulin, or antithymocyte globulin (ATG), and anti-interleukin 2α (IL-2α) chain receptor antibody (IL-2αRAb) achieve comparable good results in kidney transplantation notwithstanding different actions on immune cells. Previously, we reported the usefulness of flow cytometry (FC) analysis of lymphocyte subsets present in peripheral blood sample (PBL) and fine-needle aspiration biopsies (FNABs) for clinical surveillance, as, FC reaches very high predictive positive values for acute rejection diagnosis. Now we report an FC study on 2 kidney transplantation (KT) groups under ATG (n = 19) and IL-2αRAb (n = 24) treatment. Both groups were further treated with calcineurin inhibitors mycophenolate mofetil (MMF) and prednisone. PBL and FNAB samples were collected on day 7 post-KT, stained for several T- and B-lymphocyte subsets, and acquired using FACScan. Statistical analysis were done by Mann-Whitney U test. FNAB results showed a significant downregulation by ATG of CD3 (P < .001), CD4 (P = .009), CD4CD29 (P = .003), and CD2 (P ≤ .001) and significant upregulation of death receptor (DR) (P = .03), CD3CD69 (P < .001), and CD3CD25 (P < .0001) as compared to groups treated with IL-2αRAb. For PBL, the same trend was seen for CD3, CD4, CD2, CD3CD25, CD3CD69, CD4CD29, and DR plus a downregulation of CD45RO (P = .001) and an upregulation of CD4CD45RA (P < .0001) in IL-2αRAb. This study shows that among stable KTs, ATG as compared to IL-2αRAb induces a significant downregulation of a subset of T-memory (CD4CD29) cells but an upregulation of antigen-experienced cells (CD45RO). Further, ATG decreases CD2, CD3, CD4, and naïve (CD45RA) and stimulates T cells as translated by CD3CD69 and DR. As it should be expected from an IL-2αRAb agent, CD25 cells were virtually eliminated.
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Affiliation(s)
- P Xavier
- Portuguese Institute of Blood and Transplantation, Porto, Portugal.
| | - M Magalhães
- Department of Clinical Pathology, S. João Hospital Center, Porto, Portugal
| | - S Sampaio-Norton
- Department of Nephrology, S. João Hospital Center, Porto, Portugal
| | - T Guimarães
- Department of Clinical Pathology, S. João Hospital Center, Porto, Portugal
| | - J G Oliveira
- CINTESIS/Department of Medicine, Faculty of Medicine, University of Porto, Portugal
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Gonçalves IS, Agostinho JR, Silva G, Guimarães T, Bernardes A, Santos I, Pinto P, Bárbara C, de Sousa J, Pinto FJ, Marques P. Accuracy and utility of a pacemaker respiratory monitoring algorithm for the detection of obstructive sleep apnea in patients with atrial fibrillation. Sleep Med 2019; 61:88-94. [DOI: 10.1016/j.sleep.2019.01.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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Guimarães T, Plácido R, Almeida AG. Divertículo submitral congénito. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.04.024] [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: 10/14/2022]
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21
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Guimarães T, Magalhães A, Veiga A, Fiuza M, Ávila W, Pinto FJ. Heart disease and pregnancy: State of the art. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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22
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Guimarães T, Plácido R, Almeida AG. Congenital Submitral Diverticulum. Rev Esp Cardiol (Engl Ed) 2019; 72:417. [PMID: 29778499 DOI: 10.1016/j.rec.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal.
| | - Rui Plácido
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
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Coelho A, Fernandes A, Silva T, Guimarães T. Treatment satisfaction and patient’s beliefs about medicines and its influence on medication adherence on chronic diseases: a pilot study in local pharmacies in the Lisbon and Tagus Valley Region. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz035.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Coelho
- H&TRC- Health & Technology Research Center, Lisbon School of Health Technology, Polytechnic Institute of Lisboa, Portugal
| | - A Fernandes
- H&TRC- Health & Technology Research Center, Lisbon School of Health Technology, Polytechnic Institute of Lisboa, Portugal
| | - T Silva
- H&TRC- Health & Technology Research Center, Lisbon School of Health Technology, Polytechnic Institute of Lisboa, Portugal
| | - T Guimarães
- H&TRC- Health & Technology Research Center, Lisbon School of Health Technology, Polytechnic Institute of Lisboa, Portugal
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Guimarães T, Plácido R, Quadros AC, Costa JMD, Pinto FJ. Unexpected Mass in the Left Atrium. Arq Bras Cardiol 2018; 111:226-227. [PMID: 30183992 PMCID: PMC6122916 DOI: 10.5935/abc.20180110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/26/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - Rui Plácido
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - Ana Catarina Quadros
- Anatomopathology Department, Santa Maria University Hospital, CHLN, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - José Marques da Costa
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
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Lima da Silva G, Guimarães T, Pinto FJ, Brito D. Un caso único de distrofia muscular facioscapulohumeral tipo 1 y miocardiopatía hipertrófica sarcomérica. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Falcao G, Andrade V, Medeiros V, Guimarães T, Bernardino R, Fernandes F, Carneiro C, Pinheiro L. 536 Brachyterapy and sexual morbidity. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Marques P, Nobre Menezes M, Lima da Silva G, Guimarães T, Bernardes A, Cortez-Dias N, Carpinteiro L, de Sousa J, Pinto FJ. Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation: follow-up results from a prospective observational study. Europace 2018; 20:986-992. [PMID: 28430960 DOI: 10.1093/europace/eux036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/16/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Cardiac Resynchronization Therapy (CRT) is associated with a particularly high non-response rate in patients with atrial fibrillation (AF). We aimed to assess the effectiveness of triple-site (Tri-V) pacing CRT in this population. Methods and results Prospective observational study of patients with permanent AF who underwent CRT implantation with an additional right ventricle lead in the outflow tract septal wall. After implantation, programming mode (Tri-V or biventricular pacing) was selected based on cardiac output determination. Patients were classified as responders if NYHA class was reduced by at least one level and echocardiographic ejection fraction (EF) increased ≥ 10%, and as super-responders if in NYHA class I and EF ≥ 50%. Forty patients (93% male, mean age 72 ± 10 years) were included. Thirty-three were programmed in Tri-V. The following results pertain to this subgroup. At baseline, 58% were in NYHA class III and 36% NYHA class II. At 1 year follow-up, Minnesota QoL score was reduced (36 ± 23 vs. 8 ± 6; P = 0.001) and the 6MWT distance improved (384 ± 120 m to 462 ± 87 m, P = 0.003). Mean EF increased (26% ± 8 vs. 39 ± 10; P < 0.001 at 6 months and 41 ± 10; P < 0.001 at 12 months). Responder rate was 59% at 6 months and 79% at 12 months. Super-responder rate was 9% at 6 months and 16% at 12 months. One year survival free from heart failure hospitalization was 87.9%. Conclusion Tri-V CRT yielded higher response and super-response rates than usually reported for CRT in patients with permanent AF using clinical and remodeling criteria.
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Affiliation(s)
- Pedro Marques
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Miguel Nobre Menezes
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Ana Bernardes
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Luis Carpinteiro
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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Guimarães T, Bernardes A, de Sousa J, Marques P. Persistent left superior vena cava - A vascular access without limitations. Rev Port Cardiol 2018; 37:627-628. [PMID: 29804886 DOI: 10.1016/j.repc.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/19/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tatiana Guimarães
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal.
| | - Ana Bernardes
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - João de Sousa
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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Guimarães T, Nobre Menezes M, Cruz D, do Vale S, Bordalo A, Veiga A, Pinto FJ, Brito D. Hypercalcemic crisis and primary hyperparathyroidism: Cause of an unusual electrical storm. Rev Port Cardiol 2017; 36:959.e1-959.e5. [PMID: 29221681 DOI: 10.1016/j.repc.2016.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/04/2016] [Revised: 12/12/2016] [Accepted: 12/17/2016] [Indexed: 10/18/2022] Open
Abstract
Hypercalcemia is a known cause of heart rhythm disorders, however its association with ventricular arrhythmias is rare. The authors present a case of a fifty-three years old male patient with a ischemic and ethanolic dilated cardiomyopathy, and severely reduced ejection fraction, carrier of cardiac resynchronization therapy (CRT) with cardioverter defibrillator (ICD), admitted in the emergency department with an electrical storm, with multiple appropriated ICD shocks, refractory to antiarrhythmic therapy. In the etiological investigation was documented severe hypercalcemia secondary to primary hyperparathyroidism undiagnosed until then. Only after the serum calcium level reduction ventricular tachycardia was stopped.
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Affiliation(s)
- Tatiana Guimarães
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal.
| | - Miguel Nobre Menezes
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Diogo Cruz
- Serviço de Medicina Interna, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Sónia do Vale
- Serviço de Endocrinologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Armando Bordalo
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Arminda Veiga
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
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30
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Guimarães T, Nobre Menezes M, Cruz D, do Vale S, Bordalo A, Veiga A, Pinto FJ, Brito D. Hypercalcemic crisis and primary hyperparathyroidism: Cause of an unusual electrical storm. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2016.12.025] [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: 11/16/2022] Open
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31
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Salomão MC, Guimarães T, Duailibi DF, Perondi MBM, Letaif LSH, Montal AC, Rossi F, Cury AP, Duarte AJS, Levin AS, Boszczowski I. Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: prevalence, risk factors, and acquisition rate. J Hosp Infect 2017; 97:241-246. [PMID: 28826688 DOI: 10.1016/j.jhin.2017.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/14/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) have been reported worldwide and are associated with high mortality rates. Intestinal colonization acts as a reservoir and fosters exchange of resistance mechanisms. AIM To investigate the prevalence of patients harbouring CRE on hospital admission, risk factors associated, and the acquisition rate within the emergency department (ED). METHODS This was a cross-sectional survey with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain reaction (PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE. FINDINGS Forty-six patients were colonized; all positive PCR were Klebsiella pneumoniae carbapenemase. The acquisition rate was 18%. Previous exposure to healthcare in the last year, liver disease, and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community. CONCLUSION Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.
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Affiliation(s)
- M C Salomão
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, Brazil; Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, Brazil.
| | - T Guimarães
- Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - D F Duailibi
- Department of Infectious Diseases, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M B M Perondi
- Emergency Department, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - L S H Letaif
- Emergency Department, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - A C Montal
- Emergency Department, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - F Rossi
- Central Laboratory Division, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - A P Cury
- Central Laboratory Division, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - A J S Duarte
- Central Laboratory Division, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - A S Levin
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, Brazil; Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, Brazil; LIM54, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - I Boszczowski
- Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, Brazil
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Lima da Silva G, Guimarães T, Pinto FJ, Brito D. A Unique Case of Type-1 Facioscapulohumeral Muscular Dystrophy and Sarcomeric Hypertrophic Cardiomyopathy. ACTA ACUST UNITED AC 2017; 71:765-766. [PMID: 28697927 DOI: 10.1016/j.rec.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Cardiovascular Center, University of Lisbon, Lisbon, Portugal.
| | - Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Cardiovascular Center, University of Lisbon, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Cardiovascular Center, University of Lisbon, Lisbon, Portugal
| | - Dulce Brito
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Cardiovascular Center, University of Lisbon, Lisbon, Portugal
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Guimarães T, Lima da Silva G, Bernardes A, de Sousa J, Marques P. Active fixation coronary sinus lead extraction – A safe procedure. Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2015.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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34
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Francisco ARG, Menezes MN, Guimarães T, Pinto FJ, Almeida AG. Giant coronary aneurysm in a patient with non-ST myocardial infarction. Eur Heart J Cardiovasc Imaging 2016; 17:778. [PMID: 27044918 DOI: 10.1093/ehjci/jew064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ana Rita G Francisco
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Miguel Nobre Menezes
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
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35
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Macías-García B, González-Fernández L, Loux SC, Rocha AM, Guimarães T, Peña FJ, Varner DD, Hinrichs K. Effect of calcium, bicarbonate, and albumin on capacitation-related events in equine sperm. Reproduction 2014; 149:87-99. [PMID: 25349439 DOI: 10.1530/rep-14-0457] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Repeatable methods for IVF have not been established in the horse, reflecting the failure of standard capacitating media to induce changes required for fertilization capacity in equine sperm. One important step in capacitation is membrane cholesterol efflux, which in other species is triggered by cholesterol oxidation and is typically enhanced using albumin as a sterol acceptor. We incubated equine sperm in the presence of calcium, BSA, and bicarbonate, alone or in combination. Bicarbonate induced an increase in reactive oxygen species (ROS) that was abolished by the addition of calcium or BSA. Bicarbonate induced protein tyrosine phosphorylation (PY), even in the presence of calcium or BSA. Incubation at high pH enhanced PY but did not increase ROS production. Notably, no combination of these factors was associated with significant cholesterol efflux, as assessed by fluorescent quantitative cholesterol assay and confirmed by filipin staining. By contrast, sperm treated with methyl-β-cyclodextrin showed a significant reduction in cholesterol levels, but no significant increase in PY or ROS. Presence of BSA increased sperm binding to bovine zonae pellucidae in all three stallions. These results show that presence of serum albumin is not associated with a reduction in membrane cholesterol levels in equine sperm, highlighting the failure of equine sperm to exhibit core capacitation-related changes in a standard capacitating medium. These data indicate an atypical relationship among cholesterol efflux, ROS production, and PY in equine sperm. Our findings may help to elucidate factors affecting failure of equine IVF under standard conditions.
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Affiliation(s)
- B Macías-García
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - L González-Fernández
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - S C Loux
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - A M Rocha
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - T Guimarães
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - F J Peña
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - D D Varner
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - K Hinrichs
- CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain CECA/ICETA - Animal Sciences CentreICBAS-University of Porto, Campus Agrario de Vairão, Rua Padre Armando Quintas, 4485-661 Vairão, PortugalDepartments of Veterinary Physiology and PharmacologyLarge Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, Texas, USALaboratory of Equine ReproductionFaculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
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Guimarães T, Lopes G, Pinto M, Silva E, Miranda C, Correia MJ, Damásio L, Thompson G, Rocha A. Colloid centrifugation of fresh stallion semen before cryopreservation decreased microorganism load of frozen-thawed semen without affecting seminal kinetics. Theriogenology 2014; 83:186-91. [PMID: 25287189 DOI: 10.1016/j.theriogenology.2014.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 04/15/2014] [Revised: 09/03/2014] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Abstract
Freezability of equine semen may be influenced by microorganism population of semen. The objective of this study was to verify the effect of single-layer density gradient centrifugation (SLC) of fresh semen before cryopreservation on semen's microbial load (ML) and sperm cells kinetics after freezing-thawing. For that, one ejaculate was collected from 20 healthy stallions and split into control (C) samples (cryopreserved without previous SLC) and SLC samples (subjected to SLC). Semen cryopreservation was performed according to the same protocol in both groups. Microbial load of each microorganism species and total microbial load (TML) expressed in colony-forming units (CFU/mL) as well as frozen-thawed sperm kinetics were assessed in both groups. Additional analysis of the TML was performed, subdividing the frozen-thawed samples in "suitable" (total motility ≥ 30%) and "unsuitable" (total motility < 30%) semen for freezing programs, and comparing the C and SLC groups within these subpopulations. After thawing, SLC samples had less (P < 0.05) TML (88.65 × 10(2) ± 83.8 × 10(2) CFU/mL) than C samples (155.69 × 10(2) ± 48.85 × 10(2) CFU/mL), mainly due to a reduction of Enterococcus spp. and Bacillus spp. A relationship between post-thaw motility and SLC effect on ML was noted, as only in samples with more than 30% total motility was ML reduced (P < 0.05) by SLC (from 51.33 × 10(2) ± 33.26 × 10(2) CFU/mL to 26.68 × 10(2) ± 12.39 × 10(2) CFU/mL in "suitable" frozen-thawed semen vs. 240.90 × 10(2) ± 498.20 × 10(2) to 139.30 × 10(2) ± 290.30 × 10(2) CFU/mL in "unsuitable" frozen-thawed semen). The effect of SLC on kinetics of frozen-thawed sperm cells was negligible.
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Affiliation(s)
- T Guimarães
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Centro de Estudos de Ciência Animal (CECA/ICETA), University of Porto, Porto, Portugal
| | - G Lopes
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Centro de Estudos de Ciência Animal (CECA/ICETA), University of Porto, Porto, Portugal
| | - M Pinto
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal
| | - E Silva
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Centro de Investigação em Biodiversidade e Recursos Genéticos (CIBIO), University of Porto, Porto, Portugal
| | - C Miranda
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal
| | - M J Correia
- Fundação Alter Real, Alter do Chão, Portugal
| | - L Damásio
- Private Practitioner, Évora, Portugal
| | - G Thompson
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Centro de Investigação em Biodiversidade e Recursos Genéticos (CIBIO), University of Porto, Porto, Portugal
| | - A Rocha
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Centro de Estudos de Ciência Animal (CECA/ICETA), University of Porto, Porto, Portugal.
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Guimarães T, Miranda C, Pinto M, Silva E, Damásio L, Costa AL, Correia MJ, Duarte JC, Cosinha C, Lopes G, Thompson G, Rocha A. Effect of breeding activity on the microflora of the external genitalia and in the semen of stallions, and the relationship between micro-organisms on the skin and on the external genitalia. Reprod Domest Anim 2014; 49:926-33. [PMID: 25219398 DOI: 10.1111/rda.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022]
Abstract
A possible role of breeding activities in the composition of the microbial population in stallions' external genitalia (EG) and the relationship between micro-organisms colonizing the skin of the abdomen and the ones colonizing the EG have not been studied. In experiment 1, EG microbiological samples were collected from 41 stallions used for both natural cover and semen collection (BST) and from 18 non-breeding stallions (NBST). A higher (p < 0.05) frequency of isolation of potentially pathogenic species was found for BST. Age did not influence number of micro-organism species isolated both in BST and NBST. In experiment 2, the microbial content of the EG and semen was compared in 23 BST. Most micro-organisms isolated from the EG were present in semen, albeit with a numerically lower prevalence. In 7 stallions, six microbial species isolated from semen were absent from the EG cultures, suggesting contamination by the operator. In experiment 3, a numerically higher number of micro-organism species was isolated from the EG of 31 stallions, than from their skin of the ventral abdomen in contact with the penis or from the skin of the thorax. With the sole exception of Escherichia coli, potentially pathogenic bacteria were only isolated from the EG but not from the skin. Results suggest that breeding activity increased the number of species colonizing the EG; most species isolated from the EG were also found in semen even if with a lower frequency, and additional semen contamination seemed to occur during its manipulation. Many micro-organism species of the skin were also isolated from the penis, but independently of being or not in contact with the penis, skin did not seem to provide an adequate environment for the growth of potentially pathogenic bacteria that were isolated from EG, with the sole exception for E. coli.
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Affiliation(s)
- T Guimarães
- ICBAS, University of Porto, Porto, Portugal; Centro de Estudos de Ciência animal (CECA/ICETA), University of Porto, Porto, Portugal
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Freire M, Van Der Heijden I, do Prado G, Cavalcante L, Boszczowski I, Bonazzi P, Rossi F, Guimarães T, D'Albuquerque L, Costa S, Abdala E. Polymyxin use as a risk factor for colonization or infection with polymyxin-resistantAcinetobacter baumanniiafter liver transplantation. Transpl Infect Dis 2014; 16:369-78. [DOI: 10.1111/tid.12210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/22/2013] [Accepted: 11/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M.P. Freire
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - I.M. Van Der Heijden
- Microbiology Research Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - G.V.B. do Prado
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - L.S. Cavalcante
- Microbiology Research Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - I. Boszczowski
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - P.R. Bonazzi
- Liver and Gastrointestinal Transplant Division; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - F. Rossi
- Microbiology Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - T. Guimarães
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - L.A.C. D'Albuquerque
- Liver and Gastrointestinal Transplant Division; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - S.F. Costa
- Microbiology Research Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
- Department of Infectious Diseases; University of São Paulo School of Medicine; São Paulo Brazil
| | - E. Abdala
- Liver and Gastrointestinal Transplant Division; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
- Department of Infectious Diseases; University of São Paulo School of Medicine; São Paulo Brazil
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Guimarães T, Lopes G, Ferreira P, Leal I, Rocha A. Characteristics of stallion epididymal spermatozoa at collection and effect of two refrigeration protocols on the quality of the frozen/thawed sperm cells. Anim Reprod Sci 2012. [DOI: 10.1016/j.anireprosci.2012.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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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Boszczowski I, Nóbrega de Almeida Júnior J, Peixoto de Miranda EJ, Pinheiro Freire M, Guimarães T, Chaves CE, Cais DP, Strabelli TMV, Risek CF, Soares RE, Rossi F, Costa SF, Levin AS. Nosocomial outbreak of Pantoea agglomerans bacteraemia associated with contaminated anticoagulant citrate dextrose solution: new name, old bug? J Hosp Infect 2012; 80:255-8. [PMID: 22245117 DOI: 10.1016/j.jhin.2011.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 12/15/2011] [Indexed: 11/17/2022]
Abstract
We describe an outbreak investigation of Pantoea agglomerans bacteraemia associated with anticoagulant citrate-dextrose 46% (ACD) solution prepared in-house. A healthy man presented with septic shock during plasmapheresis for granulocyte donation. The solution used for priming and blood samples were sent for culture. Identification of the isolate to species level was performed by gyrB sequencing. Typing was performed by pulsed-field gel electrophoresis (PFGE). In total, eight cases were identified during a three-week period. P. agglomerans was also cultured from six ACD solution bags. Isolates from patients and ACD bags were identical by PFGE. All isolates were susceptible to ampicillin, cephazolin, gentamicin, ciprofloxacin, cefepime and imipenem.
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Affiliation(s)
- I Boszczowski
- Infection Control Department, Hospital das Clínicas, University of São Paulo, Brazil.
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Camacho EF, Boszczowski Í, Basso M, Jeng BCP, Freire MP, Guimarães T, Teixeira MJ, Costa SF. Infection rate and risk factors associated with infections related to external ventricular drain. Infection 2011; 39:47-51. [DOI: 10.1007/s15010-010-0073-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 12/13/2010] [Indexed: 11/29/2022]
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Paez J, Levin A, Fu L, Basso M, Fonseca G, Dulley F, Rossi F, Guimarães T, Costa S. Clusters of infection due to metallo-β-lactamase-producing Pseudomonas aeruginosa in stem cell transplant and haematology units. J Hosp Infect 2011; 77:76-7. [DOI: 10.1016/j.jhin.2010.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 08/31/2010] [Indexed: 10/18/2022]
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Santos L, Costa C, Pereira S, Koch M, Amaro T, Cardoso F, Guimarães T, Bento MJ, Lobo F, Pinto S, Lopes C. Neovascularisation is a prognostic factor of early recurrence in T1/G2 urothelial bladder tumours. Ann Oncol 2003; 14:1419-24. [PMID: 12954582 DOI: 10.1093/annonc/mdg377] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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: 11/15/2022] Open
Abstract
BACKGROUND Of patients with superficial bladder cancer, a group are still at risk of disease recurrence, progression and death from their cancer after curative treatment. Angiogenesis is a crucial pathogenic mechanism for this type of urothelial cell carcinoma (UCC), and is a potential therapeutic target. However, the selection of the appropriate patients remains a dilemma. PATIENTS AND METHODS Vascular endothelial growth factor (VEGF) expression and the presence of angiogenesis and occurrence of CD31, CD34, endoglin and factor VIII immunoexpression, were evaluated in 66 superficial papillary UCCs of the bladder and were correlated with classical histopathological factors and disease outcome. RESULTS VEGF immunoreactivity was observed in 100% of cases, and more intensely in the luminal surface. The presence of microvessel clusters independently of a fibrovascular core was observed in 22.7% of cases. Of these, the T1/G2 subgroup had an independent and significantly lower recurrence-free survival (P = 0.0002). CONCLUSIONS These results indicate that the presence of angiogenesis in tumour urothelium is a potential prognostic factor in superficial UCC, particularly in T1/G2 tumours, and may be used to select patients for anti-angiogenic treatments.
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Affiliation(s)
- L Santos
- Department of Surgical Oncology, Portuguese Institute of Oncology, Porto, Portugal.
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Winck JC, Delgado L, Vanzeller M, Guimarães T, Torres S, Sapage JM. Broncho-alveolar inflammation in cork worker's asthma. Allerg Immunol (Paris) 2002; 34:199-203. [PMID: 12134642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
UNLABELLED Suberosis is an occupational lung disease of cork workers associated with repeated exposure to mouldy cork dust in the cork industry, usually presenting as an interstitial lung disorder (Extrinsic Allergic Alveolitis). However, Occupational Asthma can also be associated with cork dust exposure and demonstrated by serial peak expiratory flow changes. AIM To investigate broncho-alveolar inflammation in patients with cork work-related occupational asthma, evaluated by Broncho-alveolar fluid cellular profiles and serial peak expiratory flow (PEF) rates monitoring. RESULTS We studied 14 patients with respiratory symptoms associated with occupational exposure in the cork industry. Positive PEF monitoring occurred in 7 cases (Occupational Asthma-OA), and in 7 (Non-occupational asthmatics-NOA) PEF records were negative. There were no differences in age, lung function (FEV1%, RV%), bronchial hyperresponsiveness, years of exposure, and atopy between the two patients groups. However, patients with work-related asthma had higher BAL eosinophil counts than NOA (1.9 +/- 2.6% versus 0.2 +/- 0.3%; p < 0.05, Wilcoxon test). CONCLUSIONS Cork worker's asthma, demonstrated by work related changes in serial PEF recordings, is associated with eosinophilic lung inflammation as described in other forms of occupational asthma.
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Affiliation(s)
- J C Winck
- Hospital de São João and Faculdade de Medicina-Universidade do Porto-4200 Porto, Portugal
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Guimarães T, Granato CF, Varella D, Ferraz ML, Castelo A, Kallás EG. High prevalence of hepatitis C infection in a Brazilian prison: identification of risk factors for infection. Braz J Infect Dis 2001; 5:111-8. [PMID: 11506773 DOI: 10.1590/s1413-86702001000300002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/22/2022] Open
Abstract
Hepatitis C virus (HCV) causes infectious hepatitis worldwide. It is transmitted mainly by blood products and sharing of intravenous paraphernalia during illicit drug use. High prevalence rates have been described among specific groups considered to be at higher risk for HCV infection, including prison inmates. The objectives of this study were: to determine the HCV seroprevalence among inmates of Casa de Detenção de São Paulo; to identify risk factors for HCV infection; and to compare the seroprevalence of HCV to other blood borne or sexually transmitted diseases. From December, 1993, to January, 1994, a total of 779 inmates were interviewed to collect information on sociodemographic status, sexual behavior, and past experience with illicit drugs. Blood samples were obtained from 756 inmates for serological tests. 310 (41%) blood samples were positive for anti-HCV, 425 (56.2%) were negative, and 21 (2.8%) showed indeterminate results. In this population, we found a seroprevalence of 13.7% for HIV, 3.3% for syphilis (VDRL), and 68.1% for hepatitis B virus previous infection. Four variables were each identified as associated with a positive anti-HCV serologic test: a positive VDRL (OR = 2.63 IC 95% 1.08 to 6.36); a time of current imprisonment longer than 130 months (OR = 2.44 IC 95% 1.04 to 5.71); previous incarceration at Casa de Detenção de São Paulo (OR = 1.73 IC 95% 1.19 to 2.52) and; illicit drug use before admission to the Casa de Detenção de São Paulo (OR = 1.64 IC 95% 1.15 to 2.33). The seroprevalence of HCV antibodies among the study population was high (41%), indeed, one of the highest clusters of HCV infection recorded until now. Four variables were each shown to be associated with HCV infection. The simultaneous presence of these 4 variables is associated with an 82% probability of being anti-HCV positive. Although risk factor analysis indicates most HCV infections occur prior to inprisonment, initiation of control measures to prevent continued transmission after incarceration should be done.
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Affiliation(s)
- T Guimarães
- Federal University of São Paulo, Medical College, São Paulo, SP, Brazil.
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Abstract
Suberosis is an occupational lung disorder of cork industry workers usually presenting as an extrinsic allergic alveolitis, but airway involvement in some cases makes the diagnostic approach complex. We assessed peak expiratory flow rates (PEF) in 17 cork workers with asthma symptoms that worsened at work, comparing three methods of PEF graph analysis. Complete agreement (three observers) was found in 12 of 17 cases (70.6%) with the visual inspection of mean daily values and in 11 of 17 cases (64.7%) with the minimum, maximum, and mean daily values (without any consensus in two cases). According to the mean PEF graph, there were eight positive readings (47%), five negative readings (29%), and four dubious readings (24%); with the other graphic analysis, two of the dubious cases were reclassified as negative. When we analyzed daily variability >20%, we found only three positive results, one of which was in absolute disagreement with the visual analysis. Our results suggest that it is possible to demonstrate occupational asthma in cork work exposure. The visual inspection of PEF monitoring shows a greater number of positive results than the index of daily variability; however, the latter may help to sort out dubious cases.
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Affiliation(s)
- J C Winck
- Pneumology Department, S. João Hospital and Porto Medical School, Portugal.
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Parente B, Barroso A, Conde S, Guimarães T, Seada J. A prospective study of gemcitabine and carboplatin as first-line therapy in advanced non-small cell lung cancer: toxicity of a three- versus a four-week schedule. Semin Oncol 2001; 28:10-4. [PMID: 11510028 DOI: 10.1053/sonc.2001.23804] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/11/2022]
Abstract
We evaluated the toxicity and activity of gemcitabine (Gemzar; Eli Lilly and Company, Indianapolis, IN) and carboplatin on a 3-week (trial A) versus a 4-week (trial B) schedule in patients with advanced/metastatic non-small cell lung cancer. Chemotherapy-naive patients in trial A received gemcitabine 1,000 mg/m(2) on days 1 and 8 plus carboplatin area under the curve of 5 on day 1, every 3 weeks. In trial B, patients received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 and carboplatin area under the curve of 6 on day 1, every 4 weeks. Thirty patients were enrolled in trial A and 28 in trial B. Patients received a total of 142 cycles in trial A and 134 in trial B. Despite more frequent treatment delays (82 cycles in trial B and 20 cycles in trial A), and dose reductions/omissions (mainly on day 15), gemcitabine mean dose intensities of both schedules were similar. The principal dose-limiting toxicity was grade 3/4 thrombocytopenia. Objective response rates were 40% in trial A and 68% in trial B (no complete response). Gemcitabine and carboplatin administered on days 1 and 8 every 3 weeks is associated with lower myelotoxicity than that of a 4-week schedule, although both schedules were active against non-small cell lung cancer. Semin Oncol 28 (suppl 10):10-14.
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Affiliation(s)
- B Parente
- Department of Pneumology, Centro Hospitalar de Vila Nova de Gaia, Portugal
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Guimarães T, Cardoso F, Amaro T, Vasconcelos A, Escobar C, Ferreira E. Pseudomyxoma peritonei (PMP): the Portuguese Institute of Oncology — Oporto Centre experience. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)80997-6] [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: 11/30/2022]
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Mayrink W, Pinto J, Da Costa C, Toledo V, Guimarães T, Genaro O, Vilela L. Short report: evaluation of the potency and stability of a candidate vaccine against American cutaneous leishmaniasis. Am J Trop Med Hyg 1999; 61:294-5. [PMID: 10463682 DOI: 10.4269/ajtmh.1999.61.294] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/07/2022] Open
Abstract
Availability of a safe, immunogenic, and affordable vaccine would represent the best strategy for control of cutaneous leishmaniasis (CL). Stability in field conditions is a essential property for any candidate vaccine. The stability and immunogenicity of three different preparations (thimerosal-preserved, autoclaved, and lyophilized) of a killed Leishmania amazonensis vaccine were assessed using fresh products and after 12 months of storage at 4 degrees C. Autoclaving was associated with a time-dependent decrease in the immunogenicity of the vaccine, as measured by the leishmanin skin test and production of interferon-gamma. These findings are of importance in the decision of which preparation of candidate killed CL vaccines should move to phase III trials.
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Affiliation(s)
- W Mayrink
- Departamento de Parasitologia, Instituto de Ciências Biológicas/Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Abstract
Few cases of AIDS associated to manifestations suggesting Behçet's syndrome have been reported. This case is of a young married woman who presented, during a period of 7 years, clinical manifestations consistent with the late diagnosis of Behçet's syndrome, when she developed recurrent lymphomonocytic meningoencephalitis. At this time, she was found to be infected by HIV-1. Immunosuppressive doses of glucocorticoid produced an unsatisfactory response and she evolved to death due to CNS toxoplasmosis. The latter diagnosis was presumed on the basis of magnetic resonance imaging findings and proved by necropsy after her third hospital stay. One of the factors hindering the appropriate diagnosis was the low level of CD4 and the CD4/CD8 ratio, sometimes observed in active Behçet's syndrome and higher than those observed in patients with this severe opportunistic infection. No information about the exact period of time she had been infected with HIV-1 is available. So, we do not know whether both diseases were overlooked, if the patient, infected by HIV-1, developed an unusual clinical feature consistent with Behçet's Behçet's syndrome, and subsequently evolved to AIDS.
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Affiliation(s)
- W H Chahade
- Department of Rheumatology, Hospital do Servidor Público Estadual de São Paulo, Brazil
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