Analysis of Scientific Publication Profile in Anesthesiology - Journal and Congress of the Portuguese Society of Anesthesiology, 2014

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Crazy? Not Really! A Brainstorming on Ideas to Change Anesthesia Practice on the Next Ten Years

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Characterization of all Surgical Specimens Provided by a Portuguese Department of Ophthalmology over a 13 Year Period

INTRODUCTION: We intend to evaluate clinically, topographically and morphologically all surgical specimens sent by the Department of Ophthalmology of Hospital de Braga to the Department of Pathology of the same hospital. MATERIAL AND METHODS: Two hundred and fifty eight surgically obtained specimens, from the Department of Ophthalmology of Hospital de Braga, analyzed in the Department of Pathology, from January 2002 to June 2015, were characterized. Data was arranged according to year, age, sex, topography and morphological diagnosis according to the SNOMED® coding system. RESULTS: Mean age at time of diagnosis was 54.6 years old; 52.3% were male subjects. The number of specimens was relatively stable until the year 2010, with a significant increase between 2011 and 2013. Most specimens sent corresponded to eyelid (54.7%), followed by conjunctiva (26.7%); the most common pathological diagnosis was malignant epithelial lesions (22.48%), followed by melanocytic tumours (22.09%) and benign epithelial lesions (17.05%). DISCUSSION: The results are distinct from previous publications presumably because of differences between the populations submitted to analysis. CONCLUSION: This is the first indexed publication characterizing surgical specimens from a Department of Ophthalmology in Portugal; moreover, it also includes an extensive review of global epidemiological data about ophthalmic surgical specimens.info:eu-repo/semantics/publishedVersio

Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia

Statin-ezetimibe combinations are a potentially advantageous therapeutic option for high-risk patients who need additional lowering of low-density lipoprotein cholesterol (LDL-C). These combinations may overcome some of the limitations of statin monotherapy by blocking both sources of cholesterol. Recently, a fixed-dose combination with atorvastatin, one of the most extensively studied statins, was approved and launched in several countries, including the USA. Depending on atorvastatin dose, this combination provides LDL-C reductions of 50-60%, triglyceride reductions of 30-40%, and high-density lipoprotein cholesterol (HDL-C) increases of 5-9%. Studies comparing the lipid-lowering efficacy of the atorvastatin-ezetimibe combination with the alternatives of statin dose titration or switching to a more potent statin consistently showed that combination therapy provided greater LDL-C reduction, translating into a greater proportion of patients achieving lipid goals. Simvastatin-ezetimibe combinations have been shown to reduce the incidence of major atherosclerotic events in several clinical settings to a magnitude that seems similar to that observed with statins for the same degree of absolute LDL-C lowering. The atorvastatin-ezetimibe combination has also been shown to induce the regression of coronary atherosclerosis measured by intravascular ultrasound in a significantly greater proportion of patients than atorvastatin alone. Atorvastatin-ezetimibe combinations are generally well tolerated. Previous concerns of a possible increase in the incidence of cancer with ezetimibe were dismissed in large trials with long follow-up periods. In this paper, we examine the rationale for an atorvastatin-ezetimibe combination, review the evidence supporting it, and discuss its potential role in the management of dyslipidemia.info:eu-repo/semantics/acceptedVersio

Metabolic Activity in the Visceral and Subcutaneous Adipose Tissues by FDG-PET/CT in Obese Patients

INTRODUCTION: The emerging role of the 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in the study of the metabolic activity and inflammation in adipose tissue indicates that it might be a reliable tool to complement the risk stratification in obesity. The aims of this study were the evaluation of 18F-fluorodeoxyglucose uptake by visceral adipose tissues and subcutaneous adipose tissues and to determine eventual differences in patients with and without obesity. MATERIAL AND METHODS: Retrospective study of adult patients who underwent whole body 18F-fluorodeoxyglucose-positron emission tomography/ computed tomography scanning between July and August of 2016. STATISTICAL ANALYSIS: SPSS™ software v.20. Statisticalsignificance: p < 0.05. RESULTS: We assessed fluorodeoxyglucose-positron emission tomography/computed tomography scans from 156 patients (58.3% of males) with a mean age of 61.0 ± 14.1 years. Half of the patients had a body mass index ≥ 25.0 kg/m2 and 15.4% (n = 24) were obese. In both groups, the mean 18F-fluorodeoxyglucose uptake was higher in visceral adipose tissues. There were no differences in 18F-fluorodeoxyglucose uptake in visceral adipose tissues between the groups. Obese patients had lower density of adipose tissue,both in subcutaneous adipose tissues and in visceral adipose tissues. Abdominal circumference and density of visceral adipose tissueshad a positive predictive value in the mean 18F-fluorodeoxyglucose uptake in visceral adipose tissues. Discussion: Through a non-invasive test, this study demonstrated a significant higher metabolic activity in visceral adipose tissues in both obese and non-obese patients. According to our results, abdominal circumference was an important determinant in 18F-fluorodeoxyglucose uptake in visceral adipose tissues. We also demonstrated that obese patients had differences in adipose tissue quality. CONCLUSION: Our findings reinforce the importance of the adipose tissue quality and distribution for metabolic risk stratification.info:eu-repo/semantics/publishedVersio

Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

BACKGROUND: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. OBJECTIVE: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. METHODS: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. RESULTS: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. CONCLUSIONS: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.info:eu-repo/semantics/publishedVersio

Preventing infections in an ageing population: new nano/microcarriers for antibacterial coatings

Infection diseases are responsible for high mortality and morbidity in the elderly, with the treatment of a single resistant infection being extremely costly due to the extended hospitalization periods and additional treatment costs. Contaminated surfaces are associated with the spread of pathogenic microorganisms, being a dangerous transmission route in hospital settings, where the incidence of antimicrobial-resistant infections has reached alarming levels. Surfaces coated with antimicrobial agents have allowed the production of safe surfaces that can prevent the spread of microorganisms, with silver nanoparticles (AgNPs) being widely used due to their broad spectrum of bioactivity. Nevertheless, the colloidal instability of AgNPs and adverse effects on living organisms have driven the search for materials able to stabilize and control silver release. Vaterite CaCO3 crystals have extensively been studied as drug carriers due to their facile synthesis, biocompatibility, porous structure and pH-sensitive properties. The work presented in this thesis aims to develop hybrids composed of vaterite and AgNPs for antibacterial coatings. The work focuses on the stabilization of AgNPs, the mechanisms of AgNPs loading and release, the design of antibacterial coatings and the antimicrobial activity of the developed materials against Escherichia coli, methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, three bacteria responsible for numerous nosocomial infections. Five different capping agents were tested as stabilizing agents for AgNPs: trisodium citrate (Citrate), polyvinylpyrrolidone (PVP), dextran (Dex), diethylaminoethyl–dextran (DexDEAE) and carboxymethyl–dextran (DexCM). The results showed that the capping agents substantially impact the antibacterial activity of the AgNPs. The AgNPs coated with the Dex and DexCM presented the best antibacterial activity due to their better stability which resulted in the release of more silver ions, better interactions with the bacteria and diffusion into the biofilms. The stabilized AgNPs were then loaded into vaterite via co-precipitation in order to protect, store and control their release, resulting in CaCO3/AgNPs hybrids composed of up to 4% weight content of nanoparticles. The loading mechanism was well-described by the Langmuir adsorption model. The dissolution of CaCO3 was found to be the primary release mechanism at acid pH, while at neutral and basic pH the recrystallisation into non-porous calcite was responsible for the release of AgNPs. The pH-dependent release was then effectively regulated with poly(4-styrenesulfonic acid) to achieve a burst and sustained release. The antibacterial studies demonstrated that the hybrids protect the AgNPs without affecting their antibacterial activity. Coatings of CaCO3/AgNPs hybrids were designed by a simple drop-casting technique. PVP and mucin were used as additives to control the hybrids distribution, ensure coating mechanical integrity, and prevent the undesired release of AgNPs. Strong antibacterial performance was demonstrated at surface concentration of hybrids between 15 and 30 μg/cm2. The in vitro cytotoxicity studies demonstrated that the hybrids at bactericidal concentrations do not affect the viability of human cells, and in some cases, even decrease the toxicity of AgNPs. The findings presented in this thesis open new ways to stabilise, protect, store and release AgNPs, shedding light on the release mechanisms of AgNPs from vaterite and helping to foresee the release profiles of other active agents. The developed coating also demonstrates the enormous potential of the hybrids as active components for antibacterial surfaces, crucial to tackling the current antimicrobial resistance crisis