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Objective: To evaluate the performance of the No-Apnea score, a simplified screening instrument for obstructive sleep apnea (OSA), by gender. Methods: This was a cross-sectional study including adults undergoing full polysomnography. The No-Apnea model comprises two items (neck circumference and age) with a total score of 0 to 9. The severity of OSA was categorized, on the basis of the apnea-hypopnea index, as any (≥ 5 events/h), moderate-to-severe (≥ 15 events/h), or severe (≥ 30 events/h). The performance of the No-Apnea instrument was assessed by determining the area under the (ROC) curve (AUC) and by constructing contingency tables. Results: We evaluated a total of 6,606 adults (53.8% men). For categorizing the level of OSA severity, the No-Apnea score had a sensitivity of 83.9-93.0% and a specificity of 57.3-35.2%. At all OSA severity levels, the No-Apnea score exhibited higher sensitivity and lower specificity in men than in women. The No-Apnea score proved to be an appropriate screening model for patients in general or when separated by gender or severity of OSA (AUC > 0.7 for all). The discriminatory power of the No-Apnea score to predict any, moderate-to-severe, and severe OSA was similar between genders (p = 0.109, p = 0.698, and p = 0.094, respectively). Conclusions: In a sample of adults referred to the sleep laboratory, there was no significant difference between men and women in terms of the discriminatory power of the No-Apnea instrument in for screening for OSA severity. RESUMO Objetivo: Avaliar o desempenho do escore No-Apnea, um instrumento simplificado para a triagem da apneia obstrutiva do sono (AOS), relacionado ao gênero. Métodos: Estudo transversal incluindo indivíduos adultos submetidos à polissonografia completa. O No-Apnea é um modelo contendo dois itens (circunferência do pescoço e idade) com uma pontuação total de 0 a 9. A gravidade da AOS foi baseada no índice de apneia-hipopneia ≥ 5 eventos/h (qualquer AOS), ≥ 15 eventos/h (AOS moderada/grave) e ≥ 30 eventos/h (AOS grave). O desempenho do No-Apnea foi avaliado pela área sob a curva (ASC) ROC e tabelas de contingência. Resultados: No total, 6.606 adultos (53,8% homens) foram avaliados. No geral, para a triagem dos diferentes níveis de gravidade de AOS, o No-Apnea teve sensibilidade variando de 83,9% a 93,0% e especificidade variando de 57,3% a 35,2%. Em todos os níveis de gravidade da AOS, o No-Apnea exibiu maior sensibilidade e menor especificidade nos homens que nas mulheres. O No-Apnea mostrou ser um adequado modelo de triagem para os pacientes em geral ou quando separados por gênero ou gravidade da AOS (ASC > 0,7 para todos). A capacidade discriminatória do No-Apnea em predizer qualquer AOS, AOS moderada/grave e AOS grave foi semelhante entre os sexos (p = 0,109, p = 0,698 e p = 0,094, respectivamente). Conclusões: Em uma amostra de indivíduos adultos encaminhados para laboratório do sono, o No-Apnea apresentou discriminação similar para a triagem de AOS de acordo com sua gravidade em mulheres e homens.

Introduction: Despite several screening tools for obstructive sleep apnoea (OSA), it remains largely underdiagnosed. Aims and objectives: To develop a simple model that includes only objective items for OSA screening in adults and then to compare its performance with STOP-Bang and No-SAS models. Methods: A cross-sectional study was designed (n=1,320 patients). Area under the curve (AUC) and 2x2 contingency tables were used to obtain its performance. Results: The “No-Apnoea” was developed with two variables: neck circumference (in cm) was scored as 1 (37.0-39.9), 2 (40.0-42.9) or 3 points (≥43.0), while the age (in years) was scored as 1 (30-49) or 2 points (≥50); reaching a score of 0-5 points. We used the cut-points ≥2, ≥3, and ≥4 to classify patients at high-risk of having any OSA (OSA≥5), moderate/severe OSA (OSA≥15), and severe OSA (OSA≥30), respectively. The AUCs obtained for screening of OSA≥5, OSA≥15, and OSA≥30 were: 0.744, 0.725, and 0.734; respectively. Based on AUCs, its performance did not show statistically significant differences compared to STOP-Bang or No-SAS for screening of OSA≥5, OSA≥15, and OSA≥30. For screening of OSA≥5, No-Apnoea showed the highest sensitivity (91.7%), while No-SAS had the highest specificity (60.1%) and STOP-Bang had the highest accuracy (78.8%). For screening of OSA≥15 and of OSA≥30, STOP-Bang showed the highest sensitivity (93.8% and 98.2%), the lowest specificity (30.4% and 25.5%), and the lowest accuracy (64.8% and 50.6%); respectively. For screening of OSA≥30, No-Apnoea showed the highest accuracy (70.2%) vs. 58.5% (No-SAS) and 50.6% (STOP-Bang). Conclusions: The No-Apnea, a very practical model, seems to be a useful tool for OSA screening.

Introduction: Silicosis is a less frequent disease with indication for lung transplantion (LT) known for being a challenging surgery with difficult pneumectomy and surgical complications. Objectives: Comparative analysis of survival and complications after LT for silicosis and other interstitial diseases. Methods: Retrospective analysis of patients (pts) who underwent single LT (SLT) between 2010 and 2015. Mann-Whitney and chi-squared tests were used. Results: Were evaluated 43 pts: 5 silicosis and 38 other interstitial lung diseases (ILD) -hypersensitivity pneumonitis (45%, n=17), idiopathic pulmonary fibrosis (21%, n=8) and others (34%, n=13). All the pts with silicosis were male, average age of 48y, mean FVC of 2273mL (57%) and FEV1 of 1808mL (57%). The ILD group (n=38) had 53% females (n=20), mean age of 53y, FVC of 1582mL (48%) and FEV1 of 1326mL (48%). For the ILD group the 3-month survival was 95% and at 1 year 85% while the pts with silicosis had a 1-year survival of 100%. There was an increased use of blood components (80% vs 53%), ECMO support (40% vs 18%) and an increase average ischemic time (415 vs 352min) in silicosis. Also, there was an increase in primary graft dysfunction (40 vs 32%) but no increase in surgical complications. Both the post-operative FVC (2498mL/66% vs 2104mL/65%) and FEV1 (1735mL/57% vs 1619mL/56%) were improved in silicosis but not statistically significant. Conclusions: Although the number of pts is small, we demonstrated that in spite of the challenging surgical technique and worse operative conditions of LT in pts with silicosis, this group have a similar survival and perioperative complications after LT.

Introduction and Objectives: Cardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20–30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke. Methods: The CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011.The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers. Results: We studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009). Conclusions: Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity. Resumo: Introdução e objetivos: A cardioembolia representa uma das causas mais frequentes de lesões cerebrovasculares isquémicas, com prevalência estimada de 20-30% e implicações terapêuticas diretas que obrigam à sua correta avaliação. Apesar de a validação das escalas de risco cardioembólico (CHADS2 e, mais recentemente, CHA2DS2-VASc) em populações heterogéneas de doentes com fibrilhação furicular, desconhece-se ainda a sua validade em contexto de prevenção secundária cerebrovascular.É objetivo deste trabalho estudar a sensibilidade e especificidade diferencial das escalas de risco cardioembólico como preditoras de fonte cardioembólica documentada por ecocardiograma transesofágico (ETE) numa população de doentes com AVC isquémico. Métodos: Aplicámos as escalas CHADS2 e CHA2DS2-VASc a todos os doentes internados por evento cerebrovascular isquémico na Unidade de AVC/Enfermaria de Neurologia de um hospital central português com diagnóstico de fibrilhação auricular (prévio ou obtido durante/após o internamento), que realizaram ETE entre janeiro e agosto de 2011.Definimos como presença de fonte cardioembólica a observação em ETE de autocontraste espontâneo na aurícula e apêndice auricular esquerdo ou trombos nas cavidades cardíacas esquerdas. Resultados: Analisámos 94 doentes, 66,0% do sexo masculino, idade média: 64,4 anos (desvio padrão: 14,2). Foi detetada fonte cardioembólica em 20 doentes. A análise de curva Receiver Operating Characteristic (ROC) identifica como preditores de fonte cardioembólica pontuação CHADS2 ≥ 4; sensibilidade: 75,0%, especificidade: 66,0%, p = 0,014 e pontuação CHA2DS2-VASc ≥ 5; sensibilidade: 83,3%, especificidade: 58,0%, p = 0,009. Conclusões: Ambas as escalas apresentam sensibilidade significativa como preditoras de risco cardioembólico em contexto de prevenção secundária cerebrovascular. A escala CHA2DS2-VASc possui uma sensibilidade superior à CHADS2, sendo, no entanto, menos específica. Keywords: Stroke, Atrial fibrillation, Thromboembolism, Echocardiography, Anticoagulation, Palavras-chave: Acidente vascular cerebral, Fibrilhação auricular, Tromboembolismo, Ecocardiografia, Anticoagulação

Introduction: Obstructive sleep apnoea (OSA) is a very common disorder associated with several risk factors. Aims and objectives: To determine the role of age on the prevalence and severity assessment of OSA. Methods: Cross-sectional study of Brazilian adult patients referred for full polysomnography [PSG] from January/2010 to December/2015. The OSA diagnosis was obtained with an apnoea/hypopnoea index (AHI) ≥ 5.0/h, while moderate/severe OSA was diagnosed with AHI ≥ 15.0/h. Age was evaluated in four different groups: 18-39 (group A), 40-59 (group B), 60-79 (group C), and ≥ 80 years (group D). Results: A total of 17,926 patients (58.9% men) were evaluated, with mean ± SD body-mass index (BMI) of 30.0 ± 6.8 Kg/m 2 and mean age of 45.9 ± 14.5 years. Overall OSA prevalence was 75.2%, while moderate/severe OSA prevalence was 52.5%. The OSA prevalence enlarged with aging (groups A to D): 62.2%, 80.6%, 86.9%, and 87.6%, respectively (p 2 , 30.2 ± 6.4 Kg/m 2 , 28.9 ± 5.3 Kg/m 2 , and 27.2 ± 4.6 Kg/m 2 , respectively (p Conclusions: Aging was associated with an increase in both prevalence and severity of OSA. However, this increase was not accompanied by BMI, since its values decreased as raising the age group, showing that BMI decreases in importance with aging.

Introduction: Chronic respiratory diseases lead to a limited life expectancy and poor quality of life, which amounts to considerable suffering for patients and their families. Providing high quality end-of-life care should be a main concern in any respiratory ward. Aims: To identify interventions (pharmacological, non-pharmacological, invasive or palliative) provided to terminal respiratory patients in their last 72 hours of life. Methods: Retrospective, descriptive analysis of patients with chronic respiratory disease deceased in our unit over the last 2 years. Results: During this period, 54 patients were assessed. The most common primary diagnosis were cancer (39%) and chronic obstructive pulmonary disease (26%). The most frequent cause of admission was dyspnoea (67%). More than 50% of patients underwent noninvasive ventilation, only 3 of which with a clearly palliative intent. 37% (n=20) of patients were referred to the hospital Palliative Care Team; in 9 cases this was done in the last 72 hours of life. The numeric pain scale was applied daily and most of them registered some relief: 29 patients were treated with strong opioids, 16 had breakthrough analgesic and in 9 patients was used palliative sedation. Dyspnoea was still not routinely assessed by standardized measurement scale. Few patients had clearly stated an advanced care plan treatment, namely concerning decisions not-to intubate. Conclusions: There are still difficulties in recognising proximity to end-of-life, mainly in a non-oncologic setting. While focused on a curative-restorative medicine, we miss opportunities for Palliative Care integration. We need to improve our competences in such matters to alleviate the suffering of our patients and their families.

Introduction: Obstructive sleep apnoea (OSA) is a very prevalent disorder and a large proportion of individuals with OSA, mostly women, remain undiagnosed. Several risk factors have been identified in OSA development such as age and male gender, but undoubtedly, obesity is the most acknowledged. Aims and objectives: To compare the role of age, body mass index (BMI) and neck circumference (NC) on the prevalence and severity of OSA among genders. Methods: Retrospective study of consecutive Brazilian patients referred for in-lab polysomnography (January to December/2014). The ROC curve was employed to evaluate discriminatory power of age, BMI, and NC for diagnosis and severity assessment of OSA. Results: We evaluated 3,397 adult patients, 58.1% men, with mean (SD) age of 59.0 (14.4) years, BMI 29.4 (6.3) Kg/m 2 , and NC 39.2 (4.5) cm. Men were younger and had a larger NC than women (p Conclusions: We found significant differences between men and women with OSA. We believe such differences should be taken into account in our clinical practice, and that special attention should be give to aging in women.

Introduction: Lung transplant (LT) is therapeutic option for patients (pts) with end-stage lung disease. However it is still associated with many complications, namely airway complications (AC). Recently, a grading system for central AC after lung transplantation was published, known as the MDS classification – corresponding to macroscopic aspect (M), diameter (D) and appearance of the sutures (S) of the anastomosis. Objectives: Compare the anastomosis diameter according to MDS classification assessed with bronchofibroscopy (BF) and multiplanar reconstructed thoracic computed tomography (CT) in a series of pts submitted to LT in our center between Jan/2012 and Dec/2014. Methods: Retrospective analysis of BF reports and correspondent CT images (max 30 days difference). The anastomosis diameter was classified according to MDS classification as D0: normal to fixed reduction up to 33%; D1: malacia greater than 50%; D2: stenosis from 33% to 66% and D3: stenosis greater than 66%. Results: One hundred and thirty exams (performed 15 days to 34 months after LT) were analyzed and the results were as in table 1. No significant correlation between BF and CT results was found. Moreover, when compared to BF (gold standard), the CT sensitivity in the assessment of significant stenosis (D1 – D3) was 17% and specificity 86%. Conclusions: BF remains an indispensable technique in the evaluation of airway complications in LT. However, due to his high specificity, CT can be useful in diagnosing significant stenosis.

Resumo: Introdução e objetivos: A cardioembolia representa uma das causas mais frequentes de lesões cerebrovasculares isquémicas, com prevalência estimada de 20-30% e implicações terapêuticas diretas que obrigam à sua correta avaliação. Apesar de a validação das escalas de risco cardioembólico (CHADS2 e, mais recentemente, CHA2DS2-VASc) em populações heterogéneas de doentes com fibrilhação furicular, desconhece-se ainda a sua validade em contexto de prevenção secundária cerebrovascular.É objetivo deste trabalho estudar a sensibilidade e especificidade diferencial das escalas de risco cardioembólico como preditoras de fonte cardioembólica documentada por ecocardiograma transesofágico (ETE) numa população de doentes com AVC isquémico. Métodos: Aplicámos as escalas CHADS2 e CHA2DS2-VASc a todos os doentes internados por evento cerebrovascular isquémico na Unidade de AVC/Enfermaria de Neurologia de um hospital central português com diagnóstico de fibrilhação auricular (prévio ou obtido durante/após o internamento), que realizaram ETE entre janeiro e agosto de 2011.Definimos como presença de fonte cardioembólica a observação em ETE de autocontraste espontâneo na aurícula e apêndice auricular esquerdo ou trombos nas cavidades cardíacas esquerdas. Resultados: Analisámos 94 doentes, 66,0% do sexo masculino, idade média: 64,4 anos (desvio padrão: 14,2). Foi detetada fonte cardioembólica em 20 doentes. A análise de curva Receiver Operating Characteristic (ROC) identifica como preditores de fonte cardioembólica pontuação CHADS2 ≥ 4; sensibilidade: 75,0%, especificidade: 66,0%, p = 0,014 e pontuação CHA2DS2-VASc ≥ 5; sensibilidade: 83,3%, especificidade: 58,0%, p = 0,009. Conclusões: Ambas as escalas apresentam sensibilidade significativa como preditoras de risco cardioembólico em contexto de prevenção secundária cerebrovascular. A escala CHA2DS2-VASc possui uma sensibilidade superior à CHADS2, sendo, no entanto, menos específica. Abstract: Introduction and objectives: Cardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20-30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke. Methods: The CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011.The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers. Results: We studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009). Conclusions: Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity. Palavras-chave: Acidente vascular cerebral, Fibrilhação auricular, Tromboembolismo, Ecocardiografia, Anticoagulação, Keywords: Stroke, Atrial fibrillation, Thromboembolism, Echocardiography, Anticoagulation

This presentation focuses on an ongoing project which aims at the creation of a large lexical database of Portuguese multiword (MW) units, automatically extracted through the analysis of a balanced 50 million word corpus, statistically interpreted with lexical association measures and validated by hand. This database covers different types of MW units, like named entities, and lexical associations ranging from sets of favoured co-occurring forms to strongly lexicalized expressions. This new resource has a two-fold objective: to be an important research tool which supports the development of MW units typologies; to be of major help in developing and evaluating language processing tools able of dealing with MW expressions.