Low risk of haematomas with intramuscular vaccines in anticoagulated patients: a systematic review with meta-analysis

© The Author(s). 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Introduction: The summary of product characteristics of vaccines administered intramuscularly, including the vaccine for coronavirus SARS-CoV-2 (COVID-19) and Influenza, warned for risks of bleeding in patients treated with oral anticoagulants. We aimed to estimate the incidence of major bleeding events in this setting and to compare these risks against other vaccination routes. Methods: This systematic review included all prospective and retrospective studies enrolling anticoagulated patients that received intramuscular vaccination, published until December 2020 in CENTRAL, MEDLINE and EMBASE. The outcomes of interest were major bleeding and haematoma related with vaccination. The incidence of the outcomes was estimated through a random-effects meta-analysis using the Freeman-Turkey transformation. The results are expressed in percentages, with 95%-confidence intervals (95%CI), limited between 0 and 100%. When studies compared intramuscular vaccination vs. other route, the data were compared and pooled using random-effects meta-analysis. Risk ratios (RR) with 95%CI were reported. Results: Overall 16 studies with 642 patients were included. No major bleeding event was reported. The pooled incidence of haematomas following vaccination (mostly against Influenza) in patients treated with oral anticoagulants (mostly warfarin; no data with DOACs / NOACs) was 0.46% (95%CI 0-1.53%). Three studies evaluated the intramuscular vs. subcutaneous route of vaccination. Intramuscular vaccines did not increase the risk of haematoma (RR 0.53, 95%CI 0.10-2.82) compared with subcutaneous route. Conclusions: Intramuscular vaccination in anticoagulated patients is safe with very low incidence of haematomas and the best available evidence suggests that using the intramuscular route does not increase the risk of haematomas compared with the subcutaneous route.info:eu-repo/semantics/publishedVersio

Letter to the editor : the role of medical students in the COVID-19 pandemic in Portugal

Copyright © Ordem dos Médicos 2020A pandemia de COVID-19 teve um impacto profundo na sociedade portuguesa, que se mobilizou para evitar o colapso do Serviço Nacional de Saúde (SNS). Como estudantes de Medicina, não podíamos ficar de braços cruzados enquanto os nossos professores, colegas seniores de profissão, se debatiam contra este inimigo invisível. Sentíamos que era nosso dever agir. Esta atitude inconformista resultou em várias iniciativas por todo o País.info:eu-repo/semantics/publishedVersio

Profiling of lung microbiota discloses differences in adenocarcinoma and squamous cell carcinoma

The lung is a complex ecosystem of host cells and microbes often disrupted in pathological conditions. Although bacteria have been hypothesized as agents of carcinogenesis, little is known about microbiota profile of the most prevalent cancer subtypes: adenocarcinoma (ADC) and squamous cell carcinoma (SCC). To characterize lung cancer (LC) microbiota a first a screening was performed through a pooled sequencing approach of 16S ribosomal RNA gene (V3-V6) using a total of 103 bronchoalveaolar lavage fluid samples. Then, identified taxa were used to inspect 1009 cases from The Cancer Genome Atlas and to annotate tumor unmapped RNAseq reads. Microbial diversity was analyzed per cancer subtype, history of cigarette smoking and airflow obstruction, among other clinical data. We show that LC microbiota is enriched in Proteobacteria and more diverse in SCC than ADC, particularly in males and heavier smokers. High frequencies of Proteobacteria were found to discriminate a major cluster, further subdivided into well-defined communities’ associated with either ADC or SCC. Here, a SCC subcluster differing from other cases by a worse survival was correlated with several Enterobacteriaceae. Overall, this study provides first evidence for a correlation between lung microbiota and cancer subtype and for its influence on patient life expectancy.We would like to thank all patients for donating their samples and for collaborating in this study. IPATIMUP integrates the i3S Research Unit, which is partially supported by the Portuguese Foundation for Science and Technology (FCT). This work was supported by the Portuguese Foundation for Science and Technology (FCT), financed by the European Social Funds (COMPETE-FEDER) and National Funds through the FCT (projects PEstC/SAU/LA0003/2013 and POCI-01-0145-FEDER-007274, fellowships SFRH/BPD/77646/2011 and SFRH/BPD/120777/2016 to S.G. and P.I.M., respectively, grant PTDC/BEXGMG/0242/2012 to S.S. and by Programa Operacional Regional do Norte (ON.2 – O Novo Norte and Norte 2020), through FEDER funds under the Quadro de Referência Estratégico Nacional (QREN; projects NORTE-07-0162-FEDER-00018 and NORTE-070162-FEDER-000067, and NORTE-01-0145-FEDER-000029)

Influenza vaccination reduces all-cause mortality in patients with heart failure : a systematic review and meta-analysis of observational studies

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020Introdução: A insuficiência cardíaca (IC) é uma doença associada a mortalidade, morbilidade e impacto económico significativos, apesar dos progressos terapêuticos das últimas décadas. As infeções com vírus influenza são um desencadeante importante da descompensação da IC crónica, e estudos recentes mostram que a vacinação contra este vírus diminui a mortalidade cardiovascular em doentes com doença coronária. Atualmente, várias organizações e guidelines recomendam a vacinação em doentes com IC, apesar da escassa evidência dos efeitos da vacina sobre outcomes importantes para esta população. Para avaliar esta associação, realizámos uma revisão sistemática com meta-análise de estudos observacionais, comparando a mortalidade por todas as causas em doentes com IC vacinados e não vacinados contra o vírus influenza. Métodos: dois investigadores recolheram estudos de doentes com IC que comparavam doentes vacinados e não vacinados na MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Health Technology Assessment (Maio 2018). Realizou-se uma meta-análise de random-effects para estimar o RR com intervalos de confiança a 95% e avaliou-se a heterogeneidade com recurso ao teste I2. Foi ainda realizada uma sub-análise de acordo com o tempo de avaliação da mortalidade por todas as causas. Resultados: incluíram-se 4 estudos de coorte (com 16 108 doentes com IC). A vacinação associou-se a uma diminuição do risco de mortalidade (RR = 0.77; 95%CI [0.71-0.84]; I2 = 0%). Na sub-análise esta diminuição do risco verificou-se em todas as categorias: intra-hospitalar/30 dias (RR= 0.55, 95%CI [0.37-0.82], I2 = 0%), 1 ano (RR= 0.75, 95%CI [0.68-0.84], I2 = 0%), 2 anos (RR= 0.82, 95%CI [0.70-0.96], apenas um estudo) e 4 anos (RR= 0.78, 95%CI [0.66-0.91], I2 = 0%). Reportaram-se ainda outcomes secundários, incluindo informação de 2 estudos adicionais. Conclusões: a vacinação contra o vírus influenza diminui o risco de mortalidade por todas as causas em doentes com IC.Background: Heart failure (HF) is a disease still associated with significant mortality, morbidity and economic burden, in spite of the progression of treatments in recent decades. Influenza infections are an important trigger for the exacerbation of chronic HF and recent studies show that influenza vaccination reduces the cardiovascular mortality in patients with coronary heart disease. Currently, several organizations and guidelines recommend the administration of the influenza vaccine in patients with HF despite the insufficient evidence of the effects of influenza vaccination on important outcomes in this population. To evaluate this association we conducted a systematic review with meta-analysis of observational studies comparing the all-cause mortality in vaccinated and non-vaccinated HF patients. Methods: Two reviewers searched for studies evaluating influenza vaccination with no vaccination control group in patients with HF in MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Health Technology Assessment (May 2018). We performed a random effects meta-analysis to estimate pooled RR with 95% confidence intervals. Heterogeneity was evaluated using the I2 test and a subanalysis was conducted according to time of the all-cause mortality assessment. Results: 4 cohort studies evaluating 16 108 HF patients were included in the meta-analysis. Influenza vaccination was associated with a decreased risk of all-cause mortality (RR = 0.77; 95%CI [0.71-0.84]; I2 = 0%). In the subanalysis, the decreased risk was observed and statistically significant in all categories: in-hospital/30 days (RR= 0.55, 95%CI [0.37-0.82], I2 = 0%), 1 year (RR= 0.75, 95%CI [0.68-0.84], I2 = 0%), 2 years (RR= 0.82, 95%CI [0.70-0.96], only one study) and 4 years all-cause mortality (RR= 0.78, 95%CI [0.66-0.91], I2 = 0%). Secondary outcomes were reported in a qualitative analysis, including information from 2 additional studies. Conclusions: influenza vaccination decreases the risk of all-cause mortality in patients with HF

Influenza vaccination in patients with heart failure : a systematic review and meta-analysis of observational studies

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE: Despite the progression of treatments over decades, heart failure (HF) is a disease with high morbidity, mortality and economic burden. Influenza infection is an important trigger for cardiovascular (CV) events, including HF. Influenza vaccination has been seen to reduce the risk of CV mortality in patients with coronary disease, but the effect in patients with HF is still unclear. Therefore, we conducted a systematic review to evaluate the effect of influenza vaccination in the morbimortality of patients with HF. METHODS: MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Technology Assessment and PsycINFO databases (December 2018) were searched for longitudinal studies evaluating influenza vaccination compared with a non-vaccination control group in patients with HF. The risk of bias was assessed according to the ROBINS-I tool. We performed a random-effects meta-analysis to estimate the pooled HRs with 95% CIs, and heterogeneity was evaluated using the I2 statistics. RESULTS: Six cohort studies evaluating 179 158 patients with HF were included in the meta-analysis. Influenza vaccination was associated with a lower risk of all-cause mortality (HR=0.83; 95% CI 0.76 to 0.91; I2=75%). The effect of the influenza vaccination was not statistically significant in a pooled analysis of CV mortality (HR=0.92, 95% CI 0.73 to 1.15; 2 studies) and of all-cause hospitalisations (HR=1.01, 95% CI 0.92 to 1.11; 2 studies). The majority of outcomes in the included studies had a serious risk of bias and almost all evaluated outcomes had very low Grading of Recommendation, Assessment, Development and Evaluation (GRADE) evidence. CONCLUSIONS: Influenza vaccination was associated with a significant decrease in all-cause mortality risk in patients with HF.info:eu-repo/semantics/publishedVersio

The association of influenza infection and vaccine with myocardial infarction: systematic review and meta-analysis of self-controlled case series

© 2019 Informa UK Limited, trading as Taylor & Francis GroupIntroduction: Influenza vaccination may be beneficial in coronary disease patients; however the infection and vaccination are associated with acute inflammation, a trigger of cardiovascular events. We aimed to review the risk of myocardial infarction (MI) associated with Influenza infection and the safety of vaccination in self-controlled case series (SCCS).Methods: We performed a systematic review with meta-analysis of SCCS studies to evaluate the risk of MI associated with Influenza infection/vaccination. Database search was performed in August/2018. The data were reported using the incident rate ratio (IRR) and 95% confidence interval (95%CI).Results: three studies for Influenza infection and two studies for Influenza vaccination were eligible. The risk of MI following an Influenza infection was significantly increased in the first 3 days (IRR 5.79; 95%CI: 3.59-9.38) and between 4-7 days (IRR 4.52; 95%CI: 2.80-7.32). In the first 4 weeks following the Influenza vaccination, there was a significant decrease of MI risk (IRR 0.84, 95%CI: 0.78-0.91).Conclusions: Short-term MI risk in Influenza infection is significantly increased, with a low-to-moderate confidence in the pooled evidence. The Influenza vaccine was safe regarding the short-term risk for MI, and the risk reduction is possibly related to a healthy period bias.info:eu-repo/semantics/publishedVersio

Comparative analysis of the bronchoalveolar microbiome in Portuguese patients with different chronic lung disorders.

The lung is inhabited by a diverse microbiome that originates from the oropharynx by a mechanism of micro-aspiration. Its bacterial biomass is usually low; however, this condition shifts in lung cancer (LC), chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). These chronic lung disorders (CLD) may coexist in the same patient as comorbidities and share common risk factors, among which the microbiome is included. We characterized the microbiome of 106 bronchoalveolar lavages. Samples were initially subdivided into cancer and non-cancer and high-throughput sequenced for the 16S rRNA gene. Additionally, we used a cohort of 25 CLD patients where crossed comorbidities were excluded. Firmicutes, Proteobacteria and Bacteroidetes were the most prevalent phyla independently of the analyzed group. Streptococcus and Prevotella were associated with LC and Haemophilus was enhanced in COPD versus ILD. Although no significant discrepancies in microbial diversity were observed between cancer and non-cancer samples, statistical tests suggested a gradient across CLD where COPD and ILD displayed the highest and lowest alpha diversities, respectively. Moreover, COPD and ILD were separated in two clusters by the unweighted UniFrac distance (P value = 0.0068). Our results support the association of Streptoccocus and Prevotella with LC and of Haemophilus with COPD, and advocate for specific CLD signatures

Profiling of lung microbiota discloses differences in adenocarcinoma and squamous cell carcinoma

We would like to thank all patients for donating their samples and for collaborating in this study. IPATIMUP integrates the i3S Research Unit, which is partially supported by the Portuguese Foundation for Science and Technology (FCT). This work was supported by the Portuguese Foundation for Science and Technology (FCT), financed by the European Social Funds (COMPETE-FEDER) and National Funds through the FCT (projects PEstC/SAU/LA0003/2013 and POCI-01-0145-FEDER-007274, fellowships SFRH/BPD/77646/2011 and SFRH/BPD/120777/2016 to S.G. and P.I.M., respectively, grant PTDC/BEXGMG/0242/2012 to S.S. and by Programa Operacional Regional do Norte (ON. 2 - O Novo Norte and Norte 2020), through FEDER funds under the Quadro de Referencia Estrategico Nacional (QREN; projects NORTE-07-0162-FEDER-00018 and NORTE-070162-FEDER-000067, and NORTE-01-0145-FEDER-000029).The lung is a complex ecosystem of host cells and microbes often disrupted in pathological conditions. Although bacteria have been hypothesized as agents of carcinogenesis, little is known about microbiota profile of the most prevalent cancer subtypes: adenocarcinoma (ADC) and squamous cell carcinoma (SCC). To characterize lung cancer (LC) microbiota a first a screening was performed through a pooled sequencing approach of 16S ribosomal RNA gene (V3-V6) using a total of 103 bronchoalveaolar lavage fluid samples. Then, identified taxa were used to inspect 1009 cases from The Cancer Genome Atlas and to annotate tumor unmapped RNAseq reads. Microbial diversity was analyzed per cancer subtype, history of cigarette smoking and airflow obstruction, among other clinical data. We show that LC microbiota is enriched in Proteobacteria and more diverse in SCC than ADC, particularly in males and heavier smokers. High frequencies of Proteobacteria were found to discriminate a major cluster, further subdivided into well-defined communities’ associated with either ADC or SCC. Here, a SCC subcluster differing from other cases by a worse survival was correlated with several Enterobacteriaceae. Overall, this study provides first evidence for a correlation between lung microbiota and cancer subtype and for its influence on patient life expectancy.publishersversionpublishe