15 research outputs found
Diagnosis and treatment of acute myocarditis in Portugal. Data from the national multicenter registry on myocarditis
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017.Introduction: The diagnosis of acute myocarditis (aMyo) needs a high level of suspicion. Cardiac magnetic resonance (CMR) may contribute to the diagnosis; but endomyocardial biopsy (EMB) is considered the gold standard, although used infrequently worldwide. Short-term course, albeit unpredictable is usually benign and treatment is mainly supportive.
Objectives: To assess the usual care attitudes regarding hospitalized patients (pts) with a diagnosis of aMyo in Portugal, report patient's clinical profiles and current therapeutic approaches, and assess the relevance of CMR to eventual changes in management and/or therapeutic decisions.
Methods: Prospective nationwide survey of admitted aMyo pts during a 2-year period (25.04.13â15). Electronic CRFs were completed with admission/discharge data, diagnostic tests, treatments and open-ended questions to evaluate physician's opinions and conclusions.
Results: 248 pts from 18 centers were included, 98% caucasian, 35±14 (18â84) years old, 83% male. A recent infectious disease was detected in 57.5% (upper respiratory tract in 71.2%) and 23% had been previously treated with antibiotics. On admission, presentation included angina-like thoracic pain (96%), non-CV symptoms- 58.4% (fever-71%, respiratory- 52.8%, GI- 28.1%), heart failure (HF)- 5.4% and cardiogenic shock- 0.8%; abnormal ECG - 82% (mostly ST elevation-78.5%); increased troponin levels in 95%; echo (in 94%pts) showed left ventricular dilatation (LVD) - 5.7%, segmental LV wall abnormalities (segmAbn) - 34%, reduced LV ejection fraction (RLVEF) - 21% and pericardial effusion (PE) - 11.7%. CMR (in 57%pts), didn't change the management in 70% of cases. Coronary angiography (in 40%) revealed significant CAD in 7.4%. EMB was diagnostic in the 2 pts in which was performed (due to severe progressive HF). Multiple viral serologies (in 32.4% pts) were conclusive in only 0.5%. Most pts were treated with NSAIDs, 39% received ACEi or ARB, 36% a beta-blocker (BB) and 8.4% diuretics; 3.4% needed inotropes. Only 1 death occurred (shock). At discharge, an abnormal ECG persisted in 64.4% of pts; echo (in 50.4%) showed LVD in 6%, segmAbn in 24.6%, RLVEF in 14.6% and PE in 10.2%. Most pts (88.2%) were discharged on NSAIDs, 37.6% on ACEi or ARB, 30.36% on BB, and 6.47% on diuretics. Final diagnosis was aMyo in 54.4% (probable/possible in 96.9% and definitive in only 3.1%) and myopericarditis in 45.6%. Diagnostic criteria were âclinicalâ in 96.4%, supported by lab results in 87.7% and ECG in 68.8%. Echo or CMR contribution in supporting âclinical diagnosisâ, was 38.3% and 48.6% respectively. Disease course was in most cases âmildâ (87%).
Conclusions: Echo and CMR were performed in most pts with aMyo but diagnosis remained mostly âclinicalâ according to treating physicians. EMB was very rarely performed. Treatment was largely empirical but an âoveruseâ of CV drugs and NSAIDs was observed.info:eu-repo/semantics/publishedVersio
Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts
Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1â15, 2002 (SOAP study, n = 3147), and May 8â18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1â7) days after admission in SOAP and 2 (1â6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies
Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000â2014 (CONCORD-3)
Background:
Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.
Methods:
We analyzed individual data for adults (15â99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000â2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.
Results:
The study included 556,237 adults. In 2010â2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%â38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000â2004 and 2005â2009. These improvements were more noticeable among adults diagnosed aged 40â70 years than among younger adults.
Conclusions:
To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines
Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000â14 (CONCORD-3) : analysis of individual data from 258 cancer registries in 61 countries
Background Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed
data for children (aged 0â14 years) and adults (aged 15â99 years) diagnosed with a haematological malignancy
during 2000â14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and
morphology, in young patients (aged 0â24 years).
Methods We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3
that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0â14 years),
adolescents (15â19 years), and young adults (20â24 years). We categorised leukaemia subtypes according to the
International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases
for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs,
using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by
country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age
survival estimates were standardised to the marginal distribution of young people with leukaemia included in the
analysis.
Findings 164563 young people were included in this analysis: 121328 (73·7%) children, 22963 (14·0%) adolescents, and
20272 (12·3%) young adults. In 2010â14, the most common subtypes were lymphoid leukaemia (28205 [68·2%] patients)
and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and
young adults for all leukaemias combined during 2010â14 varied widely, ranging from 46% in Mexico to more than
85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better
age-standardised survival (from 43% in Ecuador to â„80% in parts of Europe, North America, Oceania, and Asia) than
those with acute myeloid leukaemia (from 32% in Peru to â„70% in most high-income countries in Europe,
North America, and Oceania). Throughout 2000â14, survival from all leukaemias combined remained consistently
higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young
adults in most countries.
Interpretation This study offers the first worldwide picture of population-based survival from leukaemia in children,
adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower
survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators
of the quality of cancer management in this age group.peer-reviewe
Influence of CD4+/CD8+ratio on early age of stroke in persons living with HIV: a single university centre study in Portugal
Pais-de-Lacerda, A., Moreira, S., & Coelho, P. S. (2020). Influence of CD4+/CD8+ratio on early age of stroke in persons living with HIV: a single university centre study in Portugal. Journal Of The International Aids Society, 23(Sup. 7, SI), 71. [P069].authorsversionpublishe
Transcranial Doppler pulsatility index as a marker of endothelial dysfunction, especially useful when before persistently low CD4+/CD8+ratios
Pais-de-Lacerda, A., Lira, A., Soares, F., Badura, R., Valadas, E., Coelho, P. S., & Oliveira, V. (2020). Transcranial Doppler pulsatility index as a marker of endothelial dysfunction, especially useful when before persistently low CD4+/CD8+ratios. Journal Of The International Aids Society, 23(Sup. 7, SI), 72. [P071].authorsversionpublishe