The atrial fibrillation burden during the blanking period is predictive of time to recurrence after catheter ablation

© 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Objective: This study aimed to assess whether atrial fibrillation (AF) occurrence or its corresponding daily mean burden (in minutes/day) during the mid to late blanking period after pulmonary vein isolation (PVI), predicts AF recurrence. Methods: Analysis of consecutive first PVI ablation patients undergoing prolonged electrocardiogram (ECG) monitoring during the second and third months after PVI. The clinical variables, total AF burden, and their relationship with time to recurrence were studied. Results: 477 patients with a mean age of 56.9 (SD = 12.3) years (63.7 % male; 71.7 % paroxysmal AF), from which 317 (66.5 %) had an external event recorder between 30 and 90 days after ablation. Median follow-up of 16.0 (P 25:12.0: P 75:33.0) months, 177 (37 %) patients had an AF recurrence, with 106 (22.2 %) having the first episode after 12 months of follow-up. In the group of patients with an event recorder, 80 (25.2 %) had AF documented during the blanking period. Multivariable analysis showed that AF during the blanking period was associated with a 4-fold higher risk of recurrence (HR: 3.98; 95 %CI: 2.95-5.37), and, compared to patients in sinus rhythm, those with an AF burden ≥ 23 min/day had an approximately 7-fold higher risk of recurrence (HR estimate: 6.79; 95 %CI: 4.56-10.10). Conclusions: The probability of experiencing AF recurrence can be predicted by atrial tachyarrhythmia episodes during the second and third months after PVI. Atrial arrhythmias burden > 23 min/day has a high predictive ability for recurrence.info:eu-repo/semantics/publishedVersio

Estratégia Nacional para a Medicina Genómica - PT_MedGen: desafios e prioridades

Documento preparado pela Comissão nomeada pelo Despacho n.º 5135/2021, de 20 de maio do SEAS (Diário da República n.º 98/2021, Série II de 2021-05-20, pp 107-108): Fernando de Almeida, Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. – Presidente da Comissão; Astrid Moura Vicente, Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. – Coordenadora da Comissão e responsável pelo GT Doenças Complexas; Patrícia Calado, Agência de Investigação Clínica e Inovação Biomédica – Cocoordenadora da Comissão e responsável pelo GT Comunicação; Manuel Santos, Universidade de Aveiro, GenomePT – Responsável pelo GT Boas práticas de Sequenciação; Ana Sofia Carvalho, ICBAS - Instituto de ciências Biomédicas Abel Salazar, Universidade do Porto - Responsável pelo GT Questões Éticas, Legais e Sociais; Cíntia Águas, Membro do GT Questões Éticas, Legais e Sociais; Cátia Sousa Pinto, Serviços Partilhados do Ministério da Saúde E.P.E. – Responsável pelo GT Dados de Saúde; Mário Jorge Gaspar da Silva, Instituto Superior Técnico, Universidade de Lisboa; BioData.pt – Responsável pelo GT Interoperabilidade de Partilha de Dados; Ana Portugal Melo, BioData.pt - Membro do GT Interoperabilidade de Partilha de Dados; Mónica Duarte Correia de Oliveira, Instituto Superior Técnico, Universidade de Lisboa – Responsável pelo GT Economia da Saúde; Joana Feijó, Health Cluster Portugal – Responsável pelo GT Indústria e Setor Privado; Laura Vilarinho, Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. – Responsável pelo GT Doenças Raras; Carla Oliveira, I3S - Instituto de Investigação e Inovação, Universidade do Porto – Responsável pelo GT Cancro.Com os contributos adicionais de: Ana Berta Sousa, Centro Hospitalar Universitário de Lisboa Norte; Ana Fortuna, Centro Hospitalar Universitário do Porto; Gabriela Sousa, Instituto Português de Oncologia de Coimbra; Guiomar Oliveira, Centro Hospitalar Universitário de Coimbra; João Paulo Oliveira, Centro Hospitalar Universitário de São João; Jorge Pinto Basto, Colégio da Especialidade de Genética Médica da Ordem dos Médicos; Jorge Saraiva, Centro Hospitalar Universitário de Coimbra; Margarida Venâncio, Centro Hospitalar Universitário de Coimbra; Patrícia Dias, Centro Hospitalar Universitário de Lisboa Norte; Sérgio Sousa, Centro Hospitalar Universitário de Coimbra.À Comissão compete a definição de roadmap para o planeamento e implementação da Estratégia Nacional para a Medicina Genómica, que apoiará a contribuição de Portugal na iniciativa 1+MG.O presente documento visa propor o conceito e as linhas de ação prioritárias da Estratégia Nacional para a Medicina Genómica (PT_MedGen). O documento baseia-se na auscultação de alguns dos principais stakeholders nacionais, representados na Comissão nomeada pelo Despacho n.o 5135/2021 coordenada pelo INSA, e ainda na consulta de outras entidades e peritos de relevância. A estratégia PT_MedGen tem a meta global de criar infraestruturas e processos que permitam a adoção de abordagens de medicina personalizada na prática clínica, a par com a contribuição para a iniciativa 1+MG. Esta estratégia promoverá ainda a investigação, a inovação, a competitividade e a internacionalização, permitindo a criação de conhecimento e valor significativos na área da saúde.info:eu-repo/semantics/publishedVersio

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Síndrome de bronquiolite obliterante após o transplante pulmonar : factores de risco

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014Lung transplantation is a valid therapeutic option in selected patients with end stage lung disease. Long-term survival is limited by the development of chronic rejection manifested as Bronchiolitis Obliterans Syndrome (BOS), which is the main cause of death after the first year post-transplant. An effective treatment for this syndrome has not yet been found. Thus, the mitigation of the impact of BOS on mortality requires, probably, the modification/elimination of the predisposing factors. This paper proposes, precisely, to review and identify the factors that confer increased risk of BOS, based on the highest and most current evidence available. Several factors have been implicated in the development of BOS. This review supports the sight that acute rejection, lymphocytic bronchiolitis, HLA mismatch, primary graft dysfunction, gastroesophageal reflux, pre-transplant soluble CD30 plasma concentration greater than 20 U / mL and TARC serum levels less than 325 pg / mL during the first month post-transplant are significant risk factors for BOS. Inflammatory conditions (such as infection), hypogammaglobulinemia, autoimmunity, genetic susceptibility, unilateral transplantation and certain donor factors also seem to play a role in predisposition to BOS.A transplantação pulmonar é uma opção terapêutica válida em doentes seleccionados com doença pulmonar terminal. A sobrevida a longo-prazo é limitada pelo desenvolvimento de rejeição crónica, sob a forma de Síndrome de Bronquiolite Obliterante (SBO), que constitui a principal causa de morte após o primeiro ano pós-transplante. Ainda não foi encontrado um tratamento eficaz para este síndrome. Assim, a minoração do impacto do SBO sobre a mortalidade requer, provavelmente, a modificação/eliminação dos factores predisponentes. Este trabalho propõe-se, justamente, a rever e identificar os factores que conferem maior risco de SBO, com base na maior e mais actual evidência disponível. Vários factores têm sido implicados no desenvolvimento de SBO. Esta revisão bibliográfica suporta a visão de que a rejeição aguda, a bronquiolite linfocítica, a incompatibilidade HLA, a disfunção primária do enxerto, o refluxo gastro-esofágico, a concentração plasmática pré-transplante de CD30 solúvel superior a 20 U/mL e os níveis séricos de TARC inferiores a 325 pg/mL durante o primeiro mês pós-transplante constituem factores de risco significativos para SBO. Parece, também, existir um papel das condições inflamatórias (como as infecções), da hipogamaglobulinemia, da autoimunidade, da susceptibilidade genética, do transplante unilateral e de certos factores do dador na predisposição ao SBO

Effects of melatonin on ovarian follicles

Objective: To evaluate the histomorphometry and expression of Ki-67 and c-kit in ovarian follicles of pinealectomized or melatonin-treated pinealectomized rats.Study design: Forty adult rats were randomly divided into four groups of 10 animals: Group I - control; Group II - sham-pinealectomized; Group III - pinealectomized (Px), and Group IV - Px treated with melatonin (10 mu g/night, per animal). After two months' treatment, on the night of proestrous, the animals were placed in metabolic cages for night urine collection and subsequent measurement of 6-sulfatoxymelatonin (6-SMT). the rats were anesthetized, blood samples were taken for estrogen and progesterone determinations, and they were then euthanized. the ovaries were dissected out for further histological and immunohistochemical analyses. Data were first submitted to analysis of variance (ANOVA) complemented with the Tukey-Kramer test for multiple comparisons (P < 0.05).Results: the urinary levels of 6-SMT and serum progesterone were lower in the Px group (GIII). Exogenous melatonin treatment restored both blood melatonin and 6-SMT urinary levels. the histomorphometric data in Group III revealed a significant increase of degenerating antral and nonantral follicles with regard to the other groups. in addition no corpora lutea were observed in this group. No significant differences were noticed regarding the number of corpora lutea among the other groups (I, II and IV), but the number of cells and the thickness of the theca interna of Px animals (Group III) were higher than in the other groups. Conversely, the density of progesterone receptors (fmol/g) in the ovaries of Group III was significantly lower than in the other groups.Conclusion: Our data indicate that melatonin exerts a role on the maintenance of a proper follicular function, and is thus important for ovulation and progesterone production. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)São Paulo Fed Univ UNIFESP, Dept Gynecol, BR-04038031 São Paulo, BrazilUniv São Paulo, Fac Med, Gynecol Div, Dept Obstet & Gynecol, BR-05403000 São Paulo, BrazilUniv São Paulo, Inst Biomed Sci, Dept Pharmacol, BR-05508900 São Paulo, BrazilSão Paulo Fed Univ EPM UNIFESP, Dept Morphol & Genet, BR-04023009 São Paulo, BrazilSão Paulo Fed Univ UNIFESP, Dept Gynecol, BR-04038031 São Paulo, BrazilSão Paulo Fed Univ EPM UNIFESP, Dept Morphol & Genet, BR-04023009 São Paulo, BrazilFAPESP: 2006/60412-7FAPESP: 2007/54398-4Web of Scienc

Laryngeal chondrosarcoma – Ten years of experience

AbstractIntroductionLaryngeal involvement by cartilaginous tumors is rare. However, although accounting for only 1% of laryngeal tumor pathology, they are the most frequently occurring non-epithelial neoplasms. The most probable location is the endolaryngeal surface of the cricoid cartilage. Their symptoms are variable, depending on the size and location, and may include hoarseness, stridor, and dyspnea. Treatment is based on surgical excision. Some centers take into account the degree of differentiation and whether it is a case of relapse when deciding to perform a radical resection.AimTo evaluate this disease in a sample of the Portuguese population.MethodsA review of the medical records from 2002 to 2012 by assessment of clinical processes was performed. Data on demographics, clinical treatments, and outcomes were collected.ResultsSix patients were included in the study. Five of them underwent total laryngectomy, and in one case, partial excision of the thyroid cartilage was performed. None of the patients had either metastases or tumor-related death.ConclusionLaryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, with favorable prognosis, and metastases rarely occur. The main concern regards their propensity to relapse

Effects of melatonin on ovarian follicles

Objective: To evaluate the histomorphometry and expression of Ki-67 and c-kit in ovarian follicles of pinealectomized or melatonin-treated pinealectomized rats. Study design: Forty adult rats were randomly divided into four groups of 10 animals: Group I – control; Group II – sham-pinealectomized; Group III – pinealectomized (Px), and Group IV – Px treated with melatonin (10 mg/night, per animal). After two months’ treatment, on the night of proestrous, the animals were placed in metabolic cages for night urine collection and subsequent measurement of 6-sulfatoxymelatonin (6-SMT). The rats were anesthetized, blood samples were taken for estrogen and progesterone determinations, and they were then euthanized. The ovaries were dissected out for further histological and immunohistochemical analyses. Data were first submitted to analysis of variance (ANOVA) complemented with the Tukey–Kramer test for multiple comparisons (P < 0.05). Results: The urinary levels of 6-SMT and serum progesterone were lower in the Px group (GIII). Exogenous melatonin treatment restored both blood melatonin and 6-SMT urinary levels. The histomorphometric data in Group III revealed a significant increase of degenerating antral and nonantral follicles with regard to the other groups. In addition no corpora lutea were observed in this group. No significant differences were noticed regarding the number of corpora lutea among the other groups (I, II and IV), but the number of cells and the thickness of the theca interna of Px animals (Group III) were higher than in the other groups. Conversely, the density of progesterone receptors (fmol/g) in the ovaries of Group III was significantly lower than in the other groups. Conclusion: Our data indicate that melatonin exerts a role on the maintenance of a proper follicular function, and is thus important for ovulation and progesterone production.FAPESP - 2006/60412-7FAPESP - 2007/54398-

Clinical outcome of a single procedure cryoballoon ablation for the treatment of atrial fibrillation: A real-world multicenter experience in Portugal

Background: Cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) has been growing as an alternative technique, not only in patients with paroxysmal atrial fibrillation (PAF) but also in persistent atrial fibrillation (AF). Cryoballoon ablation has demonstrated encouraging acute and mid-term results. However, data on long-term follow-up of CB-based PVI are scarce. Objective: We sought to examine efficacy, safety, and long-term outcomes of CBA in PAF and persistent AF in four Portuguese centers. Methods: All patients that were treated with the cryoballoon catheter according to routine practices with a second-generation 28-mm CB in four centers were included. This was a retrospective, non-randomized analysis. Patients were followed-up for >12 months and freedom from atrial arrhythmias (AA) was evaluated at the end of follow-up. Results: Four hundred and six patients (57.7 ± 12.4 years, 66% men) participated. AF was paroxysmal in 326 patients (80.2%) and persistent in 80 (19.7%). The mean procedure time duration was 107.7 ± 50.9 min, and the fluoroscopy time was 19.5 ± 9.7 min. Procedural/periprocedural complications occurred in 30 cases (7.3%), being transient phrenic nerve palsy the most frequent incident (2 out of 3 complications). Anatomic variations of the PV were present in 16.1% of cases. At a mean follow-up of 22.0 ± 15.0 months, 310 patients (76.3%) remained in stable sinus rhythm, with at least one AF episode recurrence documented in 98 cases (24.1%). The recurrence rate was 20.5% in the PAF group and 37.8% in the persistent AF group. Conclusion: In this multicenter experience, a single CBA procedure resulted in 75.9% freedom from AF at a 22-month follow-up. This technique was demonstrated to be a safe and effective option in experienced centers for the treatment of PAF and PersAF. Resumo: Introdução: Observa-se um crescimento progressivo na utilização do cateter de balão de CrioEnergia (CBC) para isolamento das veias pulmonares (IVP), não apenas em doentes com fibrilhação auricular paroxística (FAParox), mas também com fibrilhação auricular persistente (FAPers). Esta tecnologia tem apresentado resultados – a curto e a médio prazo – encorajadores. No entanto, ainda há escassez de dados sobre o acompanhamento de longo prazo do IVP baseado em CBC. Objetivo: Procurámos examinar a eficácia, segurança e os resultados clínicos a longo prazo da ablação com CBC em doentes com FAParox e FAPers nos procedimentos realizados em quatro centros portugueses. Métodos: Foram incluídos todos os doentes submetidos a ablação com CBC de 28 mm de segunda geração, em quatro centros de eletrofisiologia. Esta foi uma análise retrospetiva e não randomizada. Os doentes foram acompanhados por um período >12 meses, tendo sido avaliada a presença de taquiarrimtias auriculares (TA) nesse período, bem como a ocorrência de complicações do procedimento. Resultados: Nesta análise, foram incluídos 406 (57,7 ± 12,4 anos, 66% homens). Nestes, observou-se que a FA era paroxística em 326 doentes (80,2%) e persistente em 80 (19,7%). O tempo médio de procedimento foi de 107,7 ± 50,9 minutos e o tempo de fluoroscopia de 19,5 ± 9,7 minutos. Ocorreram complicações no procedimento/periprocedimento em 30 casos (7,3%), sendo a paralisia do nervo frénico o incidente mais frequente (2 de 3 complicações). Observaram-se variações anatómicas das VPs em 16,1% dos casos. Em um seguimento médio de 22,0 ± 15,0 meses, 310 doentes (76,3%) permaneceram em ritmo sinusal estável, sendo documentado, pelo menos um episódio de FA em 98 casos (24,1%). A taxa de recorrência foi de 20,5% no grupo FAParox e 37,8% no grupo FAPers. Conclusão: Nesta experiência multicêntrica, um único procedimento com CBC resultou em 75,9% de ausência de FA em 22 meses de acompanhamento. Essa técnica demonstrou ser uma opção segura e eficaz em centros experientes no tratamento da FAParox e FAPers