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1. Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in a Tertiary Level Hospital in Portugal

Author: Joana Vieira de Melo, Rita Valsassina, Ana Margarida Garcia, Tiago Silva, Catarina Gouveia, and Maria João Brito
Subjects: Tertiary Care Centers, Portugal, SARS-CoV-2, Child, Preschool, Humans, COVID-19, General Medicine, Child, Systemic Inflammatory Response Syndrome
Abstract: Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe manifestation of coronavirus disease 2019 (COVID-19). The aim of this study was to describe the characteristics of children with MIS-C admitted to a pediatric tertiary hospital in Portugal.Observational descriptive study of MIS-C patients admitted between April 2020 and April 2021. Demographic and clinical characteristics, diagnostic tests, and treatment data were collected. The diagnosis of MIS-C was based on the World Health Organization and Centers for Disease Control and Prevention criteria.We reported 45 children with MIS-C. The median age was seven years (IQR 4 - 10 years) and 60.0% were previously healthy. SARS-CoV-2 infection was confirmed in 77.8% by RT-PCR or antibody testing for SARS-CoV-2, and in 73.3%, an epidemiological link was confirmed. All the patients had a fever and organ system involvement: hematologic (100%), cardiovascular (97.8%), gastrointestinal (97.8%), mucocutaneous (86.7%), respiratory (26.7%), neurologic (15.6%), and renal (13.3%) system. Neurological (p = 0.035) and respiratory (p = 0.035) involvement were observed in patients with a more severe presentation. There was a significant difference of medians when comparing disease severity groups, namely in the values of hemoglobin (p = 0.015), lymphocytes (p = 0.030), D-dimer (p = 0.019), albumin (p0.001), NT-proBNP (p = 0.005), ferritin (p = 0.048), CRP (p = 0.006), procalcitonin (p = 0.005) and IL-6 (p = 0.002). From the total number of children, 93.3% received intravenous immunoglobulin, 91.1% methylprednisolone, and one patient (2.2%) received anakinra. Thirteen patients (28.8%) required intensive care and there were no deaths. Of the 21 patients evaluated, 90.4% had reduction of exercise capacity and of the 15 patients who underwent cardiac magnetic resonance, 53.3% had sequelae of cardiac injury.We observed a large spectrum of disease presentation in a group of patients where most were previously healthy. A small percentage of patients (28.9%) had a severe presentation of the disease. MIS-C is a challenge in current clinical practice and its diagnosis requires a high level of clinical suspicion as the timely initiation of therapy is essential to prevent complications. However, there is no scientific consensus on the treatment and follow-up of these patients.Introdução: A síndrome inflamatória multissistémica em crianças (MIS-C) é uma manifestação rara, mas grave da doença por coronavírus 2019 (COVID-19). Este estudo teve como objetivo descrever as características de crianças com MIS-C internadas num hospital pediátrico terciário em Portugal. Material e Métodos: Estudo observacional e descritivo de doentes com MIS-C internados de abril de 2020 a abril de 2021. Analisaram-se dados demográficos, clínicos, exames de diagnóstico e terapêutica. O diagnóstico baseou-se nos critérios da Organização Mundial de Saúde e Centers for Disease Control and Prevention. Resultados: Foram identificadas 45 crianças, com mediana de idades de sete anos (AIQ 4 - 10 anos) sendo 60,0% previamente saudáveis. A infeção por SARS-CoV-2 foi confirmada por RT-PCR ou serologia em 77,8% dos doentes e 73,3% tinham link epidemiológico. Todos os casos cursaram com febre e envolvimento multiorgânico: hematológico (100%), cardiovascular (97,8%), gastrointestinal (97,8%), mucocutâneo (86,7%), respiratório (26,7%), neurológico (15,6%) e renal (13,3%). O envolvimento neurológico (p = 0,035) e respiratório (p = 0,035) ocorreu nos doentes mais graves. Houve uma diferença significativa das medianas quando comparados grupos de gravidade da doença, nomeadamente nos valores de hemoglobina (p = 0,015), linfócitos (p = 0,030), D-dímeros (p = 0,019), albumina (p0,001), NT-proBNP (p = 0,005), ferritina (p = 0,048), pCr (p = 0,006), procalcitonina (p = 0,005) e IL-6 (p = 0,002). Destas crianças, 93,3% realizaram imunoglobulina intravenosa, 91% metilprednisolona e um (2,2%) realizou anakinra. Treze doentes (28,8%) necessitaram de cuidados intensivos e não se registaram óbitos. Dos 21 doentes avaliados seis meses após a alta, 90,4% apresentaram diminuição da tolerância ao esforço e 8/15 (53,3%) lesão cardíaca persistente. Conclusão: Observámos um amplo espectro de apresentação da doença num grupo de doentes previamente saudável, na sua maioria. Uma pequena percentagem de pacientes (28,9%) teve uma apresentação grave da doença. O diagnóstico da MIS-C é um desafio na prática clínica atual e requer um elevado nível de suspeição pois o início atempado de terapêutica é fundamental para prevenir complicações. No entanto, não existe ainda consenso científico sobre a melhor terapêutica e seguimento destes doentes.
Published: 2022
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2. Hysteroscopic Findings Related with the Assessment and Treatment of Uterine Florid Cystic Endosalpingiosis: A Case Report and Review of All the Published Cases

Author: Pedro Tiago Silva, Raquel Machado-Neves, Catarina Peixinho, João Bernardes, Ana Catarina Silva, and Teresina Amaro
Subjects: Infertility, medicine.medical_specialty, Hysteroscopy, Diagnosis, Differential, Pregnancy, medicine, Endometrial Polyp, Humans, Fallopian Tubes, medicine.diagnostic_test, Cysts, business.industry, Pelvic pain, General Medicine, Fallopian Tube Diseases, Middle Aged, medicine.disease, Leiomyoma, medicine.anatomical_structure, Endosalpingiosis, Uterine Neoplasms, Female, Radiology, medicine.symptom, Presentation (obstetrics), business, Fallopian tube
Abstract: Endosalpingiosis is a rare benign condition characterized by the presence of tubal epithelium outside the Fallopian tube. The clinical presentation of endosalpingiosis is nonspecific, and the diagnosis is typically incidental in women undergoing surgery for pelvic pain, infertility, urinary symptoms, or a pelvic mass. It can only be confirmed with histopathological examination.We report the first case of uterine florid cystic endosalpingiosis, with unusual hysteroscopic findings. We reviewed all the published cases of uterine florid cystic endosalpingiosis and their clinical presentation including hysteroscopic characteristics. It is a rare benign condition, with only 32 cases described in the literature. This is the first hysteroscopic description of this condition to be made.The patient first underwent a hysteroscopy and a leiomyoma resection when she was 51 years old. At 55, she went through another hysteroscopy, and a polypoid lesion was excised. A third hysteroscopy, one year later, revealed a new polypoid lesion in a similar location. After the initial incisions, this polypoid lesion disappeared. By decreasing the intrauterine pressure, it became visible again, corresponding histologically to an endometrial polyp with tubal metaplasia. At last, she underwent a laparoscopic hysterectomy with a final histopathological diagnosis of uterine florid cystic endosalpingiosis.Florid cystic endosalpingiosis is a rare condition that may be associated with several bizarre hysteroscopic findings.Introdução: A endossalpingiose é uma condição benigna rara caracterizada pela presença de epitélio tubário fora da trompa de Falópio. A apresentação clínica da endossalpingiose é inespecífica e o diagnóstico é geralmente incidental em mulheres submetidas a cirurgia por dor pélvica, infertilidade, sintomas urinários ou massa pélvica. O diagnostico só pode ser confirmado com exame histopatológico. Caso Clínico: Relatamos o primeiro caso de endosalpingiose cística florida uterina, no qual se encontrou achados histeroscópicos incomuns. Foram revistos todos os casos publicados de endosalpingiose cística florida uterina e suas apresentações clínicas, incluindo características histeroscópicas. Trata-se de uma condição benigna rara, com apenas 32 casos descritos na literatura. Apresentamos a primeira descrição histeroscópica desta patologia. Discussão: A doente foi submetida a uma primeira histeroscopia e resseção de leiomioma aos 51 anos de idade. Com 55, realizou uma nova histeroscopia e removeu uma lesão polipóide. Uma terceira histeroscopia, um ano depois, revelou uma nova lesão polipóide num local semelhante. Após as incisões iniciais, essa lesão polipóide desapareceu. Ao diminuir a pressão intrauterina, tornou-se visível novamente, correspondendo histologicamente a um pólipo endometrial com metaplasia tubária. A doente foi submetida a uma histerectomia laparoscópica com diagnóstico histopatológico final de endosalpingiose cística florida uterina. Foram revistos todos os casos publicados de endosalpingiose cística florida uterina e suas apresentações clínicas, incluindo características histeroscópicas. Conclusão: A endosalpingiose cística florida uterina é uma condição rara que pode estar associada a achados histeroscópicos bizarros.
Published: 2021
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3. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira 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Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, 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Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020
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4. Current state of antimicrobial stewardship and organ transplantation in Spain

Author: Jose Tiago Silva and José María Aguado
Subjects: Antimicrobial Stewardship, Transplantation, Infectious Diseases, Anti-Infective Agents, Ciprofloxacin, Spain, Vancomycin, Cirugía, Humans, Meropenem, Organ Transplantation, Microbiología médica, Anti-Bacterial Agents
Abstract: Introduction: Solid-organ transplantation (SOT) remains the best therapeutic option for end-stage organ disease. Regrettably, SOT recipients are disproportionately affected by nosocomial infections produced by multidrug-resistant (MDR) microorganisms and antimicrobial adverse events. Both have a negative impact on the patient´s outcome. Methods: Description of data concerning the antimicrobial stewardship program (ASP) in SOT recipients of the University Hospital “12 de Octubre”, and review of other Spanish ASPs. Results: From May 2017 to December 2021, the ASP issued 2.785 recommendations. Approximately, 4.9% were aimed at improving the antimicrobial treatment administered to SOT recipients. Treatment discontinuation or change to a better therapeutic regimen was recommended in 51.8% and 26.3% of cases, respectively. The acceptance rate of the recommendations was close to 92%. Between June 2015 and March 2016, a quasi-experimental study consisting of a joint ASP and hospital-acquired infection control (HAIC) initiative, which included kidney transplant recipients, reported a significant reduction in the consumption of meropenem, vancomycin and ciprofloxacin, and a reduction in the incidence of global bacterial infections, upper urinary tract infections, and cystitis. Although Spain has several robust regional ASPs (e.g., VINCat and PIRASOA), data specifically concerning SOT patients is lacking. Conclusion: ASP coupled with HAIC programs have proven to be effective in SOT, and should be implemented in centers that perform transplantation. Since data is scarce, Spanish centers which have ASP should report their experience in SOT. Understanding the efficacy and safety of the Spanish ASP´s intervention in the SOT population is essential and deserves further study.
Published: 2022
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5. Implementation of a program to improve influenza vaccination rates among medical students: a comparative study involving two university affiliated hospitals

Author: José María Aguado, Francisco López-Medrano, María Asunción Pérez-Jacoiste Asín, Pilar Arrazola, Jaime Coderch-Carretero, Miguel Saro-Buendía, Mario Fernández-Ruiz, Daniel García-Ruiz de Morales, Ángel Marrero-Sánchez, Guillermo Chiara-Graciani, and José Tiago Silva
Subjects: Pharmacology, medicine.medical_specialty, Students, Medical, Attitude of Health Personnel, business.industry, Health Personnel, Vaccination, 030231 tropical medicine, Immunology, virus diseases, digestive system diseases, Hospitals, University, 03 medical and health sciences, Cross-Sectional Studies, 0302 clinical medicine, Influenza Vaccines, Family medicine, Influenza, Human, Humans, Immunology and Allergy, Medicine, 030212 general & internal medicine, business, Research Paper
Abstract: Background and objectives: Influenza vaccination rates among medical students (MSs) are below the standards recommended in hospitals where influenza vaccination is not mandatory. We carried out a comparative study in two Spanish university hospitals to reassert this fact and evaluated the impact on vaccination rates of a specific program aimed at promoting influenza vaccination among MSs. Methods: A descriptive cross-sectional study was performed describing influenza vaccination rates and motivations for vaccination during the 2017/18 campaign among MSs in two hospitals affiliated to the same university. We subsequently performed a community-based intervention study during the 2018/19 campaign evaluating the impact of a strategy for promoting influenza vaccination, comparing the hospital where the intervention took place (hospital A) with the one where it did not take place (hospital B). Results: During de 2017/18 campaign the overall influenza vaccination rate was 44.8%, with no differences between hospitals A and B (difference: 3.9%; 95% CI: −4.36–12.16; p-value = .4). During the 2018/19 campaign, vaccination rate increased to 76.4% in hospital A, with significant differences compared with the previous campaign in the same hospital (29.8%; OR 5.00; 95% CI: 3.14–8.3; p-value = .0001) and with that observed in hospital B in the same campaign (21.1%; 95% CI: 13.38–28.82; p-value
Published: 2021
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6. Cefiderocol, a new antibiotic against multidrug-resistant Gram-negative bacteria

Author: José Tiago Silva and Francisco López-Medrano
Subjects: Adult, Microbiology (medical), Siderophore, carbapenemases, medicine.drug_class, Antibiotics, Cephalosporin, extended-spectrum beta-lactamases, multidrug-resistant Gram-negative bacteria, Microbiology, Update on Antimicrobial Pharmacotherapy, Drug Resistance, Multiple, Bacterial, Gram-Negative Bacteria, medicine, Extracellular, Humans, Cefiderocol, Pharmacology, biology, business.industry, Bacterial pneumonia, General Medicine, Periplasmic space, Acinetobacter, medicine.disease, biology.organism_classification, Anti-Bacterial Agents, Cephalosporins, Gram-Negative Bacterial Infections, business, Bacteria
Abstract: Cefiderocol is a novel catechol-substituted siderophore cephalosporin that binds to the extracellular free iron, and uses the bacterial active iron transport channels to penetrate in the periplasmic space of Gram-negative bacteria (GNB). Cefiderocol overcomes many resistance mechanisms of these bacteria. Cefiderocol is approved for the treatment of complicated urinary tract infections, hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia in the case of adults with limited treatment options, based on the clinical data from the APEKS-cUTI, APEKS-NP and CREDIBLE-CR trials. In the CREDIBLE-CR trial, a higher all-cause mortality was observed in the group of patients who received cefiderocol, especially those with severe infections due to Acinetobacter spp. Further phase III clinical studies are necessary in order to evaluate cefiderocol´s efficacy in the treatment of serious infections.
Published: 2021
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7. Prevention and therapy of viral infections in patients with solid organ transplantation

Author: José Tiago Silva, José María Aguado, and Mario Fernández-Ruiz
Subjects: 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Epstein-Barr Virus Infections, Herpesvirus 4, Human, Opportunistic infection, viruses, 030106 microbiology, Population, Congenital cytomegalovirus infection, Disease, medicine.disease_cause, Virus, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, education, education.field_of_study, business.industry, Organ Transplantation, medicine.disease, Antimicrobial, Herpes simplex virus, Pharmaceutical Preparations, Virus Diseases, business, Solid organ transplantation
Abstract: Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. The number of SOT procedures has been steadily increasing worldwide during the past decades. This trend has been accompanied by the continuous incorporation of new antimicrobial drugs and by the refinement of strategies aimed at minimizing the risk of opportunistic infection. Nonetheless, viral infections, which can occur at any stage of the post-transplant period, remain a clinical challenge that negatively impacts both patient and graft outcomes. This review offers an overview of the most relevant viral infections in the SOT population, with a focus on herpesviruses (cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, and herpes simplex virus 1 and 2) and polyomaviruses (human BK polyomavirus). In addition, the currently recommended prophylactic and treatment approaches are summarized, as well as the new antiviral agents in different phases of clinical development.
Published: 2021
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8. Eradication of Staphylococcus aureus Post-Sternotomy Mediastinitis Following the Implementation of Universal Preoperative Nasal Decontamination With Mupirocin: An Interrupted Time-Series Analysis

Author: José Tiago Silva, María Ruiz-Ruigómez, Laura Corbella, Mario Fernández-Ruiz, Francisco López-Medrano, Isabel Rodríguez-Goncer, Victoria Benito-Arnaiz, Esther Viedma, Manuel Lizasoain, José Luis Pérez-Vela, María Jesús López-Gude, Emilio Renes Carreño, María Ángeles Orellana, Rafael San-Juan, José M. Cortina-Romero, José María Aguado, Consuelo A. Gotor-Pérez, and David Lora
Subjects: Microbiology (medical), Staphylococcus aureus, medicine.medical_specialty, Mupirocin, 030204 cardiovascular system & hematology, Preoperative care, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, Humans, Surgical Wound Infection, 030212 general & internal medicine, Risk factor, Decontamination, business.industry, Incidence (epidemiology), Odds ratio, Staphylococcal Infections, medicine.disease, Sternotomy, Mediastinitis, Confidence interval, Anti-Bacterial Agents, Infectious Diseases, chemistry, Carrier State, Cohort, business
Abstract: Background Although presurgical nasal decontamination with mupirocin (NDM) has been advocated as a measure for preventing postsurgical mediastinitis (PSM) due to Staphylococcus aureus, this strategy is not universally recommended due to lack of robust supporting evidence. We aimed to evaluate the role of preoperative NDM in the annual incidence of S. aureus PSM at our institution. Methods An interrupted time-series analysis, with an autoregressive error model, was applied to our single-center cohort by comparing preintervention (1990–2003) and postintervention (2005–2018) periods. Logistic regression was performed to analyze risk factors for S. aureus PSM. Results 12 236 sternotomy procedures were analyzed (6370 [52.1%] and 5866 [47.9%] in the pre- and postintervention periods, respectively). The mean annual percentage adherence to NDM estimated over the postintervention period was 90.2%. Only 4 of 127 total cases of S. aureus PSM occurred during the 14-year postintervention period (0.68/1000 sternotomies vs 19.31/1000 in the preintervention period; P Conclusions Our experience suggests the implementation of preoperative NDM significantly reduces the incidence of S. aureus PSM.
Published: 2021
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9. Percutaneous treatment of an intraorbital arteriovenous malformation using a transvenous approach: A case report

Author: Renata Caroline Ferreira Gomes, Alexandre Amaral Yung, François Dantas, Róberti Uili Rodrigues Firmino, George Ac Mendes, Tiago Silva e Carvalho, and Rogério Zenóbio Darwich
Subjects: Intracranial Arteriovenous Malformations, Chemosis, medicine.medical_specialty, Percutaneous, business.operation, Ophthalmoparesis, Arteriovenous Malformations, 03 medical and health sciences, 0302 clinical medicine, Occlusion, medicine, Humans, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, Arteriovenous malformation, Digital subtraction angiography, medicine.disease, Embolization, Therapeutic, Cerebral Angiography, AV shunt, 030221 ophthalmology & optometry, Cavernous Sinus, Radiology, medicine.symptom, business, Transorbital, Superior ophthalmic vein, 030217 neurology & neurosurgery
Abstract: Intraorbital arteriovenous malformations (AVMs) are extremely rare, and their actual prevalence is unknown. There is no consensus regarding the best treatment options, and the treatment is usually challenging, involving endovascular and other surgical procedures. Herein, we report the case of a patient diagnosed with an intraorbital AVM, presenting with thrombosis and hemorrhage, with rapidly progressive proptosis, chemosis, ophthalmoparesis, and vision loss. Treatment was performed with a transorbital puncture targeting a venous aneurysm of the superior ophthalmic vein, and closure of the AVM was possible with the use of coils and Onyx. We obtained anatomical occlusion of the lesion, and the patient showed progressive improvement of chemosis, vision acuity, and ophthalmoparesis. At six-month’ follow-up, only mild proptosis was noted, and a control digital subtraction angiography confirmed complete closure of the AVM, with no residual lesion. To date, this is the first case of an intraorbital AVM treated with transorbital direct puncture.
Published: 2021
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10. Ex-vivo Surgical Repair of a Renal Artery Aneurysm with Kidney Autotransplantation

Author: Artur Tiago Silva, Luis G. Pedro, Gonçalo Sobrinho, and Augusto Ministro
Subjects: renal artery/surgery, medicine.medical_specialty, medicine.medical_treatment, lcsh:Medicine, Kidney, Transplantation, Autologous, aneurysm/surgery, Renal Artery, Aneurysm, medicine.artery, medicine, Humans, cardiovascular diseases, Right Renal Artery, Renal artery, Aged, Computed tomography angiography, Surgical repair, lcsh:R5-920, medicine.diagnostic_test, business.industry, lcsh:R, General Medicine, medicine.disease, Kidney Transplantation, Autotransplantation, Surgery, medicine.anatomical_structure, Hypertension, cardiovascular system, Female, lcsh:Medicine (General), business, Ex vivo
Abstract: Renal artery aneurysms are rare. They are most commonly degenerative, congenital or due to medial fibroplasia. Proximal aneurysms can be repaired by endovascular and in-situ surgical techniques. However, aneurysms of the distal renal artery and its branches require ex-vivo surgical repair, also known as auto-transplantation: the kidney is removed, dissected and reconstructed in cold ischemia, and put back in place. A 69-year-old woman, with hypertension, presented with bilateral renal artery aneurysms with a diameter of 3.4 cm on the right kidney and 1 cm on the left kidney. The right renal artery aneurysm, which was due to medial fibroplasia, was successfully repaired using the ex-vivo surgical technique. Patency was confirmed by postoperative computed tomography angiography.
Published: 2020
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11. DNA Methylation and Transcriptomic Features are Preserved Throughout Disease Recurrence and Chemoresistance in High Grade Serous Ovarian Cancers

Author: Nicole Gull, Michell Jones, Pei-Chen Peng, Simon Coetzee, Tiago Silva, Jasmine Plummer, Alberto Reyes, Brian Davis, Stephanie Chen, Kate Lawrenson, Jenny Lester, Christine Walsh, Bobbie Rimel, Andrew Li, Ilana Cass, Yonatan Berg, John Paul Govindavari, Joanna Rutgers, Benjamin Berman, Beth Karlan, and Simon Gayther
Subjects: Ovarian Neoplasms, Cancer Research, Oncology, Drug Resistance, Neoplasm, Humans, Female, DNA Methylation, Neoplasm Recurrence, Local, Transcriptome
Abstract: Background Little is known about the role of global DNA methylation in recurrence and chemoresistance of high grade serous ovarian cancer (HGSOC). Methods We performed whole genome bisulfite sequencing and transcriptome sequencing in 62 primary and recurrent tumors from 28 patients with stage III/IV HGSOC, of which 11 patients carried germline, pathogenic BRCA1 and/or BRCA2 mutations. Results Landscapes of genome-wide methylation (on average 24.2 million CpGs per tumor) and transcriptomes in primary and recurrent tumors showed extensive heterogeneity between patients but were highly preserved in tumors from the same patient. We identified significant differences in the burden of differentially methylated regions (DMRs) in tumors from BRCA1/2 compared to non-BRCA1/2 carriers (mean 659 DMRs and 388 DMRs in paired comparisons respectively). We identified overexpression of immune pathways in BRCA1/2 carriers compared to non-carriers, implicating an increased immune response in improved survival (P = 0.006) in these BRCA1/2 carriers. Conclusion These findings indicate methylome and gene expression programs established in the primary tumor are conserved throughout disease progression, even after extensive chemotherapy treatment, and that changes in methylation and gene expression are unlikely to serve as drivers for chemoresistance in HGSOC.
Published: 2022
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12. Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study

Author: Laura Corbella, Mario Fernández-Ruiz, María Ruiz-Ruigómez, Isabel Rodríguez-Goncer, José Tiago Silva, Pilar Hernández-Jiménez, Francisco López-Medrano, Manuel Lizasoain, Jennifer Villa, Octavio Carretero, José María Aguado, and Rafael San-Juan
Subjects: Microbiology (medical), General Medicine, Microbial Sensitivity Tests, Prognosis, Hospitals, beta-Lactamases, Anti-Bacterial Agents, Klebsiella Infections, Cohort Studies, Klebsiella pneumoniae, Infectious Diseases, Carbapenem-Resistant Enterobacteriaceae, Bacterial Proteins, Sepsis, Humans, Retrospective Studies
Abstract: To describe the determinants of outcome of infections due to oxacillinase-48 (OXA-48) carbapenemase-producing Klebsiella pneumoniae (OXA-48-Kp).A retrospective cohort study of 117 episodes of OXA-48-Kp infection were conducted. Multivariate Cox models identified factors predicting 14-day clinical response and 30-day all-cause mortality.A total of 77 (65.8%) isolates were susceptible to imipenem/meropenem. The 14-day clinical response and 30-day mortality rates were 41.9% and 28.2%. Catheter-related bloodstream infection (adjusted hazard ratio [aHR]: 8.33; 95% confidence interval [95%CI]: 3.19-21.72; P-value0.001), urinary tract infection (aHR: 3.04; 95%CI: 1.39-6.66; P-value = 0.006) and early appropriate treatment (aHR: 1.77; 95%CI: 0.97-3.22; P-value = 0.064) predicted clinical response, whereas severe sepsis had a deleterious impact (aHR: 0.22; 95%CI: 0.10-0.50; P-value0.001). Lower respiratory tract infection (aHR: 6.58; 95%CI: 2.83-15.29; P-value0.001) and bloodstream infection (aHR: 2.33; 95%CI: 1.05-5.15; P-value = 0.037) were associated with 30-day mortality, whereas definitive therapy including ≥1 active agent (aHR: 0.26; 95%CI: 0.11-0.63; P-value = 0.003) and source control (aHR: 0.35; 95%CI: 0.14-0.91; P-value = 0.030) were protective. Combination therapy did not seem to be associated with better outcomes.Appropriate antimicrobial treatment was protective for 30-day mortality in OXA-48-Kp infections. Carbapenems are usually active, whereas combination therapy appeared not to confer additional benefit.
Published: 2021

13. Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation

Author: José María Aguado, José Tiago Silva, Rafael San-Juan, and Mario Fernández-Ruiz
Subjects: Opinion Review, Graft Rejection, medicine.medical_specialty, medicine.medical_treatment, Antitubercular Agents, Disease, Liver transplantation, Lower risk, Mycobacterium tuberculosis, End Stage Liver Disease, Postoperative Complications, Latent Tuberculosis, Risk Factors, Internal medicine, medicine, Isoniazid, Humans, Latent tuberculosis infection, Disease burden, Latent tuberculosis, biology, business.industry, Incidence, Gastroenterology, General Medicine, medicine.disease, biology.organism_classification, bacterial infections and mycoses, Allografts, Transplantation, Treatment Outcome, Drug-induced liver graft injury, Liver, Chemical and Drug Induced Liver Injury, business, Immunosuppressive Agents, medicine.drug, Fluoroquinolones
Abstract: Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection, particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis. Active tuberculosis (TB) after SOT is a significant cause of morbidity and mortality. Most cases of posttransplant TB are secondary to reactivation of latent tuberculosis infection (LTBI) due to the effects of long-term immunosuppressive therapy. Risk minimization strategies have been developed to diagnose LTBI and initiate treatment prior to transplantation. Isoniazid with vitamin B6 supplementation is the treatment of choice. However, liver transplantation (LT) candidates and recipients have an increased risk of isoniazid-induced liver toxicity, leading to lower treatment completion rates than in other SOT populations. Fluoroquinolones (FQs) exhibit good in vitro antimycobacterial activity and a lower risk of drug-induced liver injury than isoniazid. In the present review, we highlight the disease burden posed by posttransplant TB and summarize the emerging clinical evidence supporting the use of FQs for the treatment of LTBI in LT recipients and candidates.
Published: 2019

14. A comparison of isokinetic rotator cuff performance in wheelchair basketball athletes vs. non-athletes with spinal cord injury

Author: Marcelo Riberto, Felipe de Souza Serenza, Tiago Silva Santana, Lucas Sartori Manoel, and Poliane Silva Freitas
Subjects: Adult, 030506 rehabilitation, medicine.medical_specialty, Adolescent, Shoulders, Wheelchair basketball, Basketball, Rotator Cuff, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Humans, Medicine, Rotator cuff, Spinal cord injury, Spinal Cord Injuries, Research Articles, biology, Shoulder Joint, business.industry, Athletes, FORÇA MUSCULAR, Middle Aged, medicine.disease, biology.organism_classification, Cross-Sectional Studies, medicine.anatomical_structure, Wheelchairs, Neurology (clinical), 0305 other medical science, business, human activities, 030217 neurology & neurosurgery
Abstract: OBJECTIVES: This study aimed to compare the isokinetic peak torque and, secondarily, other parameters of the rotator cuff in the shoulders of paraplegic wheelchair basketball athletes and non-athletes controls. DESIGN: Cross-sectional study. METHODS: Thirty-six complete spinal cord injured individuals aged between 18 and 45 years performed an isokinetic evaluation of peak torque, power, and work exerted by the rotator cuff muscle group, in a Biodex System. All Concentric isokinetic tests were performed in the seated position with the shoulder at a 45° abduction from the scapular plane and flexed at 30° to the frontal plane. Subjects completed five repetitions at 60°/s and 180°/s, and ten repetitions at 300°/s, bilaterally, with an interval of one minute between each series. Statistical analysis (t-test, P
Published: 2019
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15. The Unlicensed and Off-label Prescription of Medications in General Paediatric Ward: An Observational Study

Author: Lucian de Souza, Clarissa Gutierrez Carvalho, Alícia Dorneles Dornelles, Lisiane Hoff Calegari, Tiago Silva Tonelli, and Patrícia Ebone
Subjects: Male, Pediatrics, medicine.medical_specialty, formulation, Off-label use, paediatric pharmacology, Article, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, International literature, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Practice Patterns, Physicians', Medical prescription, Child, Prospective cohort study, paediatric medication, Inpatients, prescription, Off-label, business.industry, prescribing, Infant, Off-Label Use, University hospital, hospital pharmacology, Cross-Sectional Studies, Prescriptions, Child, Preschool, unlicensed, Pediatrics, Perinatology and Child Health, Female, Observational study, Winter season, business
Abstract: Background: Unlicensed (UL) and Off-label (OL) prescription of medications is common in paediatrics and does not constitute negligent practice since there is often no approved alternative according to FDA bulary. Aim: The study aimed to determine the current frequency of UL and OL prescriptions in children from one month to 12 years of age in a Paediatric Inpatient Unit (PIU). Methods: This is an observational, prospective study, reviewing the prescriptions of all patients admitted to the PIU in a university hospital in a single week in August 2014 and a single week in January 2015. Results: We included 157 patients of median age 18 months and median length of stay 24 days. There were 1,328 prescription items (average of 8.4 items/patient) and only two patients without UL/OL use. During the winter season (August), 27% of prescriptions were classified as UL and 44.6% as OL, and during summer (January), 29.6% as UL and 45.1% as OL. We identified 188 medications, of which the most prescribed were paracetamol (11%) and dipyrone (9.5%). The most frequent OL classification was regarding drug formulation (15.8%). In the winter week, the most frequent reasons for admission were respiratory (44%), followed by other clinical causes (CC) (17.3%), while in the summer week, they were CC (26.3%), followed by surgical and gastrohepatic (23.7%). Conclusion: The OL prescription of medicines for children in Brazil is in accordance with the international literature. The higher prevalence of OL due to formulation found in this study is related to the use of formulations other than those used by the FDA.
Published: 2019
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16. A short course of antibiotic treatment is safe after catheter withdrawal in catheter-related bloodstream infections due to coagulase-negative staphylococci

Author: Mario Fernández-Ruiz, Laura Corbella, José Tiago Silva, Pilar Hernández-Jiménez, María Ruiz-Ruigómez, Francisco López-Medrano, Iván Martínez-Redondo, Rafael San-Juan, Raúl Recio, José María Aguado, and María Ángeles Orellana
Subjects: Adult, Coagulase, Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Time Factors, Adolescent, Staphylococcus, 030106 microbiology, Bacteremia, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Internal medicine, medicine, Central Venous Catheters, Humans, Endocarditis, Septic thrombophlebitis, 030212 general & internal medicine, Risk factor, Child, Device Removal, Aged, Retrospective Studies, Aged, 80 and over, Proportional hazards model, business.industry, Hazard ratio, cons, General Medicine, Middle Aged, Staphylococcal Infections, medicine.disease, Anti-Bacterial Agents, Catheter, Treatment Outcome, Infectious Diseases, Catheter-Related Infections, Propensity score matching, Female, business
Abstract: CoNS is the main cause of catheter-related bloodstream infections (CRBSI). Current guidelines recommend catheter withdrawal followed by antibiotics for at least 5 days. We aimed to assess the efficacy and safety of a shorter course of antibiotherapy in patients with CoNS CRBSI. All proven cases of CoNS CRBSI at our institution (Jan 12/Dec 17) were retrospectively analysed. Comparison of clinical characteristics and outcomes between patients receiving a short (SC ≤ 3 days) versus long antibiotic course (LC > 3 days) was performed. Cox regression models predicting the risk for complications (including propensity score [PS] for treatment assignment as covariate) were designed to adjust baseline differences among both treatment groups. A total of 79 cases were included. Most patients (75.9%) showed clinical response at day 7 after catheter removal. Complications occurred in 3.8% (three cases of septic thrombophlebitis) with no cases of endocarditis. Microbiological relapse (MR) occurred in 13 patients (16.5%). SC and LC were administered to 25 (31.6%) and 54 (68.4%) patients, respectively, with no significant differences in MR-free survival between SC and LC groups (87.8 vs 86.3%; P = 0.6). In PS-adjusted Cox regression analyses, a tunnelled catheter as the source of CRBSI was the only independent risk factor for MR (hazard ratio, 5.71; 95% confidence interval, 1.6–21) whereas the duration of therapy had no apparent impact. Shortening antibiotic therapy to ≤ 3 days is not associated with a poorer outcome or a greater risk of MR in patients with CoNS CRBI with catheter withdrawal.
Published: 2019
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17. Enabling Early Obstructive Sleep Apnea Diagnosis With Machine Learning: Systematic Review

Author: Pedro Pereira Rodrigues, Daniela Santos, Pedro Amorim, Matilde Monteiro-Soares, and Tiago Silva Martins
Subjects: Adult, Machine Learning, Sleep Apnea, Obstructive, Polysomnography, Humans, Bayes Theorem, Health Informatics, Neural Networks, Computer
Abstract: Background American Academy of Sleep Medicine guidelines suggest that clinical prediction algorithms can be used to screen patients with obstructive sleep apnea (OSA) without replacing polysomnography, the gold standard. Objective We aimed to identify, gather, and analyze existing machine learning approaches that are being used for disease screening in adult patients with suspected OSA. Methods We searched the MEDLINE, Scopus, and ISI Web of Knowledge databases to evaluate the validity of different machine learning techniques, with polysomnography as the gold standard outcome measure and used the Prediction Model Risk of Bias Assessment Tool (Kleijnen Systematic Reviews Ltd) to assess risk of bias and applicability of each included study. Results Our search retrieved 5479 articles, of which 63 (1.15%) articles were included. We found 23 studies performing diagnostic model development alone, 26 with added internal validation, and 14 applying the clinical prediction algorithm to an independent sample (although not all reporting the most common discrimination metrics, sensitivity or specificity). Logistic regression was applied in 35 studies, linear regression in 16, support vector machine in 9, neural networks in 8, decision trees in 6, and Bayesian networks in 4. Random forest, discriminant analysis, classification and regression tree, and nomogram were each performed in 2 studies, whereas Pearson correlation, adaptive neuro-fuzzy inference system, artificial immune recognition system, genetic algorithm, supersparse linear integer models, and k-nearest neighbors algorithm were each performed in 1 study. The best area under the receiver operating curve was 0.98 (0.96-0.99) for age, waist circumference, Epworth Somnolence Scale score, and oxygen saturation as predictors in a logistic regression. Conclusions Although high values were obtained, they still lacked external validation results in large cohorts and a standard OSA criteria definition. Trial Registration PROSPERO CRD42021221339; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221339
Published: 2022
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18. Microbiome and oral squamous cell carcinoma: a possible interplay on iron metabolism and its impact on tumor microenvironment

Author: Svetoslav Nanev Slavov, Gabriela Marcelino Pereira de Souza, Rafael dos Santos Bezerra, Maria Jara Montibeller, Carlos Alberto Oliveira de Biagi, Guilherme Taborda Ribas, Humberto Miguel Garay-Malpartida, Daisy Obispo Achallma, Ellen Gomes Alves, Caroline Fabiane Granatto, Camila Margalho Braga, Rodrigo Alex Arthur, David Livingstone Alves Figueiredo, Raphael de Andrade Morraye, Luan Henrique Burda da Silva, Natália de Melo Nasser Fava, João Valentini Neto, Igor Henrique Sanches, Charlie Felipe Liberati da Silva, João Paulo Bianchi Ximenez, Glauco Vinicius Nestor dos Santos, Bruna Laís Merlin, Karen Flaviane Assis Andrade, Summer Course, Tiago Silva da Costa, Monique Schreiner, Jessica Moraes Malheiros, Valquiria do Carmo Alves Martins, Diana Estefania Ramos, Wilson A. Silva, Jhefferson Barbosa Guimaraes, Ulisses Costa Terin, Univ Fed Rio Grande do Sul, Universidade de São Paulo (USP), Reg Blood Ctr Ribeirao Preto, Inst Canc Res IPEC, Univ Estadual Centro Oeste, Universidade Estadual Paulista (Unesp), Univ Paulista, Univ Fed Parana, Univ Fed Amapa, Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA), FARVET, Univ San Martin de Porres, Para State Univ, Fundacao Ctr Controle Oncol Estado Amazonas, Universidade Federal de Goiás (UFG), and Blood Ctr Ribeirao Preto
Subjects: medicine.medical_specialty, Alcohol Drinking, Clinical Microbiology - Research Paper, Iron, Functional pathways prediction, Electronic Nicotine Delivery Systems, medicine.disease_cause, Microbiology, Ferric Compounds, 03 medical and health sciences, Medical microbiology, Haemophilus, Media Technology, medicine, Prevotella, Tumor Microenvironment, Humans, Microbiome, TABAGISMO, Cigarette, 030304 developmental biology, Iron(III) transport system, 0303 health sciences, Tumor microenvironment, biology, 030306 microbiology, Campylobacter, Microbiota, biology.organism_classification, stomatognathic diseases, Fusobacterium, Oral squamous cell carcinoma, Cancer research, Carcinoma, Squamous Cell, Mouth Neoplasms, Oral Microbiome, Alcohol, Precancerous Conditions
Abstract: Made available in DSpace on 2021-06-25T15:05:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-18 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) There is increasing evidence showing positive association between changes in oral microbiome and the occurrence of oral squamous cell carcinoma (OSCC). Alcohol- and nicotine-related products can induce microbial changes but are still unknown if these changes are related to cancerous lesion sites. In an attempt to understand how these changes can influence the OSCC development and maintenance, the aim of this study was to investigate the oral microbiome linked with OSCC as well as to identify functional signatures and associate them with healthy or precancerous and cancerous sites. Our group used data of oral microbiomes available in public repositories. The analysis included data of oral microbiomes from electronic cigarette users, alcohol consumers, and precancerous and OSCC samples. An R-based pipeline was used for taxonomic and functional prediction analysis. The Streptococcus spp. genus was the main class identified in the healthy group. Haemophilus spp. predominated in precancerous lesions. OSCC samples revealed a higher relative abundance compared with the other groups, represented by an increased proportion of Fusobacterium spp., Prevotella spp., Haemophilus spp., and Campylobacter spp. Venn diagram analysis showed 52 genera exclusive of OSCC samples. Both precancerous and OSCC samples seemed to present a specific associated functional pattern. They were menaquinone-dependent protoporphyrinogen oxidase pattern enhanced in the former and both 3 ',5 '-cyclic-nucleotide phosphodiesterase (purine metabolism) and iron(III) transport system ATP-binding protein enhanced in the latter. We conclude that although precancerous and OSCC samples present some differences on microbial profile, both microbiomes act as iron chelators-like potentially contributing to tumor growth. Univ Fed Rio Grande do Sul, Fac Dent, Prevent & Community Dent Dept, BR-90035003 Porto Alegre, RS, Brazil Univ Sao Paulo, Fac Med Ribeirao Preto, Postgrad Program Clin Oncol Stem Cells & Cell The, BR-14049900 Ribeirao Preto, SP, Brazil Reg Blood Ctr Ribeirao Preto, Natl Inst Sci & Technol Stem Cell & Cell Therapy, Ctr Cell Based Therapy CEPID FAPESP, Mol Genet & Bioinfonnat Lab MGBL, Rua Tenente Catao Roxo 2501, BR-14049900 Ribeirao Preto, SP, Brazil Univ Sao Paulo, Ribeirio Preto Med Sch, Dept Genet, BR-14049900 Ribeirao Preto, SP, Brazil Univ Sao Paulo, Luiz de Queiroz Coll Agr, Dept Entomol & Acarol, BR-13418900 Piracicaba, SP, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, BR-14049900 Ribeirao Preto, SP, Brazil Univ Sao Paulo, Sch Publ Hlth, Dept Nutr, BR-01246904 Sao Paulo, SP, Brazil Univ Sao Paulo, Sao Carlos Sch Engn, Dept Hydraul & Sanitat, BR-13563120 Sao Carlos, SP, Brazil Inst Canc Res IPEC, BR-85015430 Guarapuava, PR, Brazil Univ Estadual Centro Oeste, Dept Med, BR-85015430 Guarapuava, PR, Brazil Sao Paulo State Univ, Sch Pharmaceut Sci, Dept Food & Nutr, Araraquara, SP, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Biochem & Immunol, Ribeirao Preto, SP, Brazil Univ Paulista, Inst Hlth Sci, Undergrad Biol Sci, Ribeirao Preto, SP, Brazil Univ Fed Parana, Grad Program Bioinformat Profess & Technol Educ S, Curitiba, Parana, Brazil Univ Fed Amapa, Dept Biol Sci & Hlth, Macapa, AP, Brazil Embrapa Southeast Livestock EMBRAPA, Sao Paulo, Brazil FARVET, Labs Invest & Desarrollo, Chincha Alta, Ica, Peru Univ San Martin de Porres, Ctr Invest Genet & Biol Mol CIGBM, Lima, Peru Para State Univ, Grad Program Parasit Biol Amazon, Belem, Para, Brazil Para State Univ, Inst Technol, Dept Elect & Biomed Engn, Belem, Para, Brazil Fundacao Ctr Controle Oncol Estado Amazonas, Dept Educ & Res, Manaus, Amazonas, Brazil Univ Fed Goias, Inst Pathol Trop & Publ Hlth, Goiania, Go, Brazil Univ Sao Paulo, Sch Dent Ribeirao Preto, Dept Oral Maxillofacial Surg & Periodontol, Ribeirao Preto, SP, Brazil Univ Sao Paulo, Sch Arts Sci & Humanities, Sao Paulo, Brazil Blood Ctr Ribeirao Preto, Ctr Cell Based Therapy CEPID FAPESP, Mol Genet & Bioinformat Lab MGBL, Rua Tenente Catao Roxo 2501, BR-14051140 Ribeirao Preto, SP, Brazil Sao Paulo State Univ, Sch Pharmaceut Sci, Dept Food & Nutr, Araraquara, SP, Brazil CNPq: 465539/2014-9 FAPESP: 2013/08135-2 FAPESP: 17/23205-8 FAPESP: 19/08528-0
Published: 2021

19. EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT FOR POSTCARDIOTOMY SHOCK: SINGLE CENTER EXPERIENCE

Author: Manuela, Silva, Carolina, Rodrigues, Tiago, Silva, Pedro, Coelho, Nuno, Banazol, Rui, Rodrigues, Paulo, Franco, and José, Fragata
Subjects: Adult, Male, Cardiopulmonary Bypass, Infant, Hemorrhage, Middle Aged, Extracorporeal Membrane Oxygenation, Child, Preschool, Heart Transplantation, Humans, Female, Child, Aged, Retrospective Studies
Abstract: We aim to report our experience on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy shock (PCS).Single center, retrospective study of all patients on VA-ECMO for PCS, from November 2006 to July 2019. Pediatric and adult patients were analysed separately. Primary outcomes were survival to discharge and one-year survival.Twenty-nine patients were included. Pediatric group (group PED) (62%, n=18): mean age 1,3±2,1 years and 39% male. Adults (group AD) (38%, n=11): mean age 55,6±15,9 years and 64% male. Indications in group PED were complex congenital heart surgery (94%) and heart transplant (6%), with 27% being reoperations; in group AD valvular surgery (45%), aortic surgery (21%), coronary artery bypass grafting (18%) and pulmonary endarterectomy (9%); 45% were reoperations. ECMO support was initiated intraoperatively due to failure to wean from cardiopulmonary bypass in 28% of group PED and 73% of group AD. Central cannulation was performed in all pediatric patients and 82% adults. Bleeding was the most common complication in both groups (group PED 39%, group AD 45%). Mean ECMO support time was respectively 6,2±4,9 and 6,2± 3,6 days for group PED and group AD. Weaning rate was 44% in group PED (with 2 patients bridged to LVAD) and 45% in group AD. Survival to discharge as well as one-year survival were both 28% in group PED and 18% in group AD.Despite low survival and high complication rates, VA ECMO support provides a survival benefit in refractory cases, with a dismal prognosis, that would otherwise die.
Published: 2021

20. Health status after invasive or conservative care in coronary and advanced kidney disease

Author: Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic, Spertus J.A., Jones P.G., Maron D.J., Mark D.B., O'Brien S.M., Fleg J.L., Reynolds H.R., Stone G.W., Sidhu M.S., Chaitman B.R., Chertow G.M., Hochman J.S., Bangalore S, and ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic
Subjects: Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract: BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of
Published: 2020

21. Combination therapy with tocilizumab and corticosteroids for aged patients with severe COVID-19 pneumonia: a single-center retrospective study

Author: Octavio Carretero, Carlos Lage Gómez, Borja de Miguel, Héctor Bueno, Eduardo Gutiérrez, Joaquin Martinez-Lopez, Julia Origüen, Rafael San Juan, José L. Pablos, Guillermo Chiara-Graciani, José María Aguado, José Tiago Silva, Mercedes Catalán, Hernando Trujillo, Daniel García-Ruiz de Morales, Cristina de la Calle, María Asunción Pérez-Jacoiste Asín, Rocío García-García, Carlos Lumbreras, José Manuel Caro, Antonio Lalueza, Mar Ripoll, Miguel Saro-Buendía, Guillermo Maestro de la Calle, Estela Paz-Artal, Angel Sevillano, Fernando Aguilar, Mario Fernández-Ruiz, Ángel Marrero-Sánchez, and Francisco López-Medrano
Subjects: 0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Combination therapy, Secondary infection, 030106 microbiology, Infectious and parasitic diseases, RC109-216, Single Center, immunomodulation, Antibodies, Monoclonal, Humanized, Gastroenterology, Methylprednisolone, Article, corticosteroids, 03 medical and health sciences, chemistry.chemical_compound, tocilizumab, 0302 clinical medicine, Tocilizumab, Internal medicine, medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, therapy, business.industry, SARS-CoV-2, Hazard ratio, COVID-19, Retrospective cohort study, General Medicine, Odds ratio, Middle Aged, mortality, Confidence interval, COVID-19 Drug Treatment, Infectious Diseases, chemistry, outcome, Drug Therapy, Combination, Female, business, medicine.drug
Abstract: BackgroundThe role of combination immunomodulatory therapy with systemic corticosteroids and tocilizumab (TCZ) for aged patients with COVID-19-associated cytokine release syndrome remains unclear.MethodsWe conducted a retrospective single-center study including consecutive patients ≥65 years that developed severe COVID-19 between March 3 and May 1, 2020 and were treated with corticosteroids at various doses (methylprednisolone [0.5 mg/Kg/12 hours to 250 mg/24 hours]), either alone (“CS group”) or associated to intravenous tocilizumab (400-600 mg, one to three doses) (“CS-TCZ group”). Primary outcome was all-cause mortality by day +14, whereas secondary outcomes included mortality by day +28 and clinical improvement (discharge and/or a ≥2-point decrease on a six-point ordinal scale) by day +14. Propensity score (PS)-based adjustment and inverse probability of treatment weights (IPTW) were applied.ResultsOverall, 181 and 80 patients were included in the CS and CS-TCZ groups. All-cause 14-day mortality was lower in the CS-TCZ group, both in the PS-adjusted (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.17 – 0.68;P-value = 0.002) and IPTW-weighted models (odds ratio [OR]: 0.38; 95% CI: 0.21 – 0.68;P-value = 0.001). This protective effect was also observed for 28-day mortality (PS-adjusted HR: 0.38; 95% CI: 0.21 – 0.72;P-value = 0.003). Clinical improvement by day +14 was higher in the CS-TCZ group in the IPTW analysis only (OR: 2.26; 95% CI: 1.49 – 3.41;P-value ConclusionsThe combination of corticosteroids and TCZ was associated with better outcomes among patients ≥65 years with severe COVID-19.
Published: 2021

22. [Invasive fungal infection over the last 30 years]

Author: José Tiago, Silva, Isabel, Ruiz-Camps, and José María, Aguado
Subjects: Antifungal Agents, Mycoses, Mucorales, Humans, Scedosporium, Invasive Fungal Infections
Abstract: Clinical mycology is in continuous development. The appearance of new clinical guidelines has made it possible to improve the approach to opportunistic fungal infections, especially in immunosuppressed patients (oncohematological and/or transplant recipients). At the same time, the development of new diagnostic tools and new antifungals with a greater spectrum of action and fewer side effects have led to faster diagnoses and treatments that are more effective. Along with these advances, there has been a change in the epidemiology of invasive fungal infection (IFI), with the appearance of new patients (e.g., COPD, liver cirrhosis, post-influenza) and new microorganisms (Candida auris, Lomentospora prolificans, mucorales), and resistant fungi (isolates of Aspergillus resistant to azoles) which the clinician must take into account when choosing the treatment of a patient with an IFI. In this paper we will briefly review the advances in recent decades and the emerging problems.
Published: 2021

23. Reactivation of latent infections in solid organ transplant recipients from sub-Saharan Africa: What should be remembered?

Author: Paolo Grossi, Mario Fernández-Ruiz, José Tiago Silva, Beatriz Prista-Leão, Lurdes Santos, Pilar Hernández-Jiménez, Francisco López-Medrano, José María Aguado, and Alessandra Mularoni
Subjects: 030230 surgery, Cyclospora cayetanensis, Strongyloides stercoralis, Serology, 03 medical and health sciences, 0302 clinical medicine, Solid organ transplantation, parasitic diseases, Medicine, media_common.cataloged_instance, Animals, Humans, European union, Intestinal Diseases, Parasitic, Evaluation, Africa South of the Sahara, Schistosoma, media_common, Transplantation, biology, Sub-Saharan Africa, business.industry, Leishmaniasis, Organ Transplantation, biology.organism_classification, medicine.disease, Reactivation, Parasitic diseases, Transplant Recipients, Latent infection, Latent Infection, Intestinal Diseases, Parasitic, Immunology, 030211 gastroenterology & hepatology, business, Malaria
Abstract: International migration from Sub-Saharan African countries to the European Union and the United States has significantly increased over the past decades. Although the vast majority of these immigrants are young and healthy people, a minority can be affected by chronic conditions eventually leading to solid organ transplantation (SOT). Importantly, these candidates can bear geographically restricted fungal and parasitic latent infections that can reactivate after the procedure. An appropriate evaluation before transplantation followed by treatment, whenever necessary, is essential to minimize such risk, as covered in the present review. In short, infection due to helminths (Schistosoma spp. and Strongyloides stercoralis) and intestinal protozoa (Entamoeba histolytica, Giardia lamblia or Cyclospora cayetanensis) can be diagnosed by multiple direct stool examination, serological assays and stool antigen testing. Leishmaniasis can be assessed by means of serology, followed by nucleic acid amplification testing (NAAT) if the former test is positive. Submicroscopic malaria should be ruled out by NAAT. Screening for Histoplasma spp. or Cryptococcus spp. is not routinely indicated. Consultation with an Infectious Diseases specialist is recommended in order to adjust preemptive treatment among Sub-Saharan African SOT candidates and recipients.
Published: 2021

24. Experience With Moxifloxacin for the Treatment of Latent Tuberculosis Infection in Liver Transplantation: A Single-Center Prospective Study

Author: Mario Fernández-Ruiz, Pilar Hernández-Jiménez, Álvaro García-Sesma, Alberto Marcacuzco, Felix Cambra, Jorge Calvo, Carlos Lumbreras, Carlos Jiménez, Iago Justo, Francisco López-Medrano, Carmelo Loinaz, Alejandro Manrique, José María Aguado, Oscar Caso, Rafael San Juan, and José Tiago Silva
Subjects: Transplantation, medicine.medical_specialty, Hepatology, Latent tuberculosis, business.industry, medicine.medical_treatment, Moxifloxacin, Antitubercular Agents, Mycobacterium tuberculosis, Liver transplantation, Single Center, medicine.disease, Liver Transplantation, Latent Tuberculosis, Internal medicine, medicine, Humans, Surgery, Prospective Studies, business, Prospective cohort study, medicine.drug
Published: 2020

25. What is the role of smartphones on physical activity promotion? A systematic review and meta-analysis

Author: Marcelo Cozzensa da Silva, Natan Feter, Eduardo Lucia Caputo, and Tiago Silva dos Santos
Subjects: Adult, Male, medicine.medical_specialty, Health (social science), media_common.quotation_subject, Psychological intervention, Physical activity, MEDLINE, Health Promotion, PsycINFO, 03 medical and health sciences, 0302 clinical medicine, Promotion (rank), Surveys and Questionnaires, Humans, Medicine, 030212 general & internal medicine, Exercise, Aged, media_common, Motivation, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Middle Aged, Actigraphy, Meta-analysis, Physical therapy, Female, Smartphone, 0305 other medical science, business, Cell Phone
Abstract: To identify and evaluate the effect of interventions that used cell phones as a means to promote physical activity (PA).The databases searched were MedLine/PubMed, Scopus, SPORTDiscus, PsycINFO, Science Direct, Lilacs, and SciELO. After removing duplicates, applying exclusion criteria, and checking the reference lists, 45 studies were reviewed. The Downs and Black (DB) scale measured methodological quality, and a random effect model was used to compute the meta-analysis of PA by the reported unit (minutes per day or steps per day), delivery agent (application (APP), SMS, or other), and PA measurement (questionnaire, accelerometer, pedometer).Mobile phone-based PA interventions were efficient in increasing both minutes [10.49; CI (3.37-17.60); p = 0.004] and steps per day [735.17; CI (227.72-1242.61); p = 0.005] in adults when compared to baseline. Furthermore, APP-based interventions were able to increase the number of steps (p = 0.04) and minutes per day of PA (p = 0.04) in adults. Also, 85% of included manuscripts were classified as moderate- to high-quality articles.Mobile phone-based PA interventions, inclusive those delivery by APP, were effective to increase minutes and steps per day in adults.
Published: 2019
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26. Risk factors for the development of invasive aspergillosis after kidney transplantation: Systematic review and meta-analysis

Author: María Asunción Pérez-Jacoiste Asín, Dimitrios P. Kontoyiannis, Mario Fernández-Ruiz, José María Aguado, Francisco López-Medrano, José Tiago Silva, and Rafael San Juan
Subjects: Graft Rejection, medicine.medical_specialty, medicine.medical_treatment, Disease, 030230 surgery, Aspergillosis, Diabetic nephropathy, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Immunology and Allergy, Medicine, Humans, Pharmacology (medical), Kidney transplantation, Transplantation, business.industry, Odds ratio, medicine.disease, Kidney Transplantation, Meta-analysis, Hemodialysis, business, Invasive Fungal Infections, Cohort study
Abstract: To investigate risk factors for invasive aspergillosis (IA) after kidney transplantation (KT), we conducted a systematic search in PubMed and EMBASE to identify studies published until June 2020. We included case-control or cohort design studies comprising KT recipients with a diagnosis of IA, defined according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria, and assessed risk factors for the development of IA. Random-effect models meta-analysis served to pool data. We identified eleven case-control studies (319 IA cases and 835 controls). There was an increased risk of IA among recipients with underlying chronic lung diseases (odds ratio [OR] = 7.26; 95% confidence interval [CI] = 1.05-50.06) and among those with diabetic nephropathy (OR = 1.65; 95% CI = 1.10-2.48). Requiring posttransplant hemodialysis (OR = 3.69; 95% CI = 2.13-6.37) or surgical reintervention (OR = 6.28; 95% CI = 1.67-23.66) were also associated with an increased risk. Moreover, a positive link was identified between IA and posttransplant bacterial infection (OR = 7.51; 95% CI = 4.37-12.91), respiratory tract viral infection (OR = 7.75; 95% CI = 1.60-37.57), cytomegalovirus infection or disease (OR = 2.67; 95% CI = 1.12-6.32), and acute graft rejection (OR = 3.01; 95% CI = 1.78-5.09). In contrast, receiving a kidney from a living donor was associated with a reduced risk (OR = 0.65; 95% CI = 0.46-0.93). KT recipients that accumulate several of these conditions should be closely monitored and a low threshold of suspicion for IA should be maintained. Future studies should explore the benefit of mold-active prophylaxis to this subgroup of KT recipients at highest risk.
Published: 2020

27. Multidrug-resistant Gram-negative infection in solid organ transplant recipients

Author: Mario Fernández-Ruiz, José María Aguado, and José Tiago Silva
Subjects: 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, 030106 microbiology, Antibiotics, Drug resistance, Targeted therapy, Immunocompromised Host, 03 medical and health sciences, Risk Factors, Drug Resistance, Multiple, Bacterial, Internal medicine, Humans, Medicine, Contraindication, business.industry, Organ Transplantation, Guideline, Transplant Recipients, Multiple drug resistance, Transplantation, Infectious Diseases, Practice Guidelines as Topic, Gram-Negative Bacterial Infections, business, Solid organ transplantation
Abstract: Purpose of review Solid organ transplantation (SOT) is the best therapeutic option for both acute and chronic end-stage diseases. The development of more potent and safer immunosuppressants and the improvement of prophylactic practices have significantly diminished the morbidity and mortality associated with rejection and opportunistic infections. However, infections produced by multidrug-resistant (MDR) Gram-negative bacilli (GNB) have recently emerged as a significant threat. Recent findings The Spanish Society of Transplantation (SET), the Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA-SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI) have recently published their recommendations concerning the management of MDR GNB infections in SOT recipients. We review this guideline, and also the most recent available evidence, focusing on donor-derived infections, colonized recipients and therapeutic approaches. Summary Overall, donor and recipient colonization is associated with an increased risk of infection by MDR GNB, although none of these circumstances constitutes an absolute contraindication to transplantation. SOT recipients with risk factors for MDR GNB infection should receive an empirical treatment which includes potentially active antibiotics. Targeted therapy should be adjusted according to antimicrobial susceptibility testing and severity of infection.
Published: 2018
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28. Oophoropexy to the Round Ligament after Recurrent Adnexal Torsion

Author: Ana Catarina Silva, Pedro Tiago Silva, Inês Sarmento Gonçalves, Gisela Fornelos, Joana Sampaio, and Joana Félix
Subjects: Adult, Torsion Abnormality, medicine.medical_specialty, Round Ligaments, round ligament, laparoscopy, Asymptomatic, 03 medical and health sciences, Gynecologic Surgical Procedures, 0302 clinical medicine, Recurrence, Oophoropexy, medicine, Humans, Laparoscopy, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, Round Ligament, business.industry, Adnexal Torsion, Ovary, Obstetrics and Gynecology, Gynecology and obstetrics, musculoskeletal system, Polycystic ovary, oophoropexy, Surgery, gynecological emergency, medicine.anatomical_structure, Adnexal Diseases, 030220 oncology & carcinogenesis, Adnexal torsion, Ligament, RG1-991, Female, medicine.symptom, business
Abstract: Recurrent adnexal torsion is a rare gynecological emergency. We report a case of recurrent ipsilateral adnexal torsion in a woman with polycystic ovaries, previously submitted to a laparoscopic plication of the utero-ovarian ligament. Due to the recurrence after the plication of the utero-ovarian ligament, the authors performed a laparoscopic oophoropexy to the round ligament, which is an underreported procedure. The patient was asymptomatic for 1 year, after which she had a new recurrence and needed a unilateral laparoscopic adnexectomy. Since then, she regained the quality of life without any gynecological symptoms.Oophoropexy to the round ligament may be considered when other techniques fail or, perhaps, as a first option in selected cases of adnexal torsion, as it may allow the prevention of recurrence without increasing morbidity while preserving the adnexa.A torção anexial recorrente é uma emergência ginecológica rara. Os autores descrevem um caso de torsão anexial unilateral recorrente em uma paciente com síndrome de ovário policístico, previamente submetida a plicatura do ligamento utero-ovárico por laparoscopia. Nesta circunstância, os autores decidiram realizar uma ooforopexia laparoscópica ao ligamento redondo, uma técnica pouco descrita na literatura. A paciente manteve-se assintomática durante 1 ano, período após o qual teve nova recorrência, tendo-se decidido realizar uma anexectomia laparoscópica unilateral. Desde então, ela recuperou a qualidade de vida sem qualquer sintoma ginecológico.A ooforopexia ao ligamento redondo é uma técnica que deverá ser considerada quando outras falham e, em casos selecionados de torsão anexial recorrente, poderá ser considerada a primeira abordagem, para prevenir a recorrência e preservar o anexo.
Published: 2018

29. Effectiveness of ceftazidime-avibactam for the treatment of infections due to Pseudomonas aeruginosa

Author: Laura Corbella, Jorge Boán, Rafael San-Juan, Mario Fernández-Ruiz, Octavio Carretero, David Lora, Pilar Hernández-Jiménez, María Ruiz-Ruigómez, Isabel Rodríguez-Goncer, José Tiago Silva, Francisco López-Medrano, Manuel Lizasoain, Jennifer Villa, Jose Manuel Caro-Teller, and José M. Aguado
Subjects: Microbiology (medical), Drug Combinations, Infectious Diseases, Pseudomonas aeruginosa, Humans, Pseudomonas Infections, Pharmacology (medical), Microbial Sensitivity Tests, General Medicine, Azabicyclo Compounds, Ceftazidime, Anti-Bacterial Agents, Retrospective Studies
Abstract: Clinical experience with ceftazidime-avibactam (CAZ-AVI) for treatment of infections due to multidrug or extremely resistant (MDR/XDR) Pseudomonas aeruginosa (P. aeruginosa) is limited.A retrospective cohort study was conducted on patients with MDR/XDR P. aeruginosa infections treated with CAZ-AVI. The primary outcome was clinical cure by day 14, evaluated by logistic regression adjusted for the propensity score to receive CAZ-AVI as combination therapy. Secondary outcomes were 30-day all-cause mortality, 90-day recurrence, emerging CAZ-AVI resistance, and safety of therapy.Sixty-one first episodes of MDR/XDR P. aeruginosa infection were included. The most common source was lower respiratory tract infection (34.4%), 14.8% episodes developed bloodstream infection and 50.8% had sepsis at presentation. Ceftazidime-avibactam therapy was initiated at a median of 7.0 (interquartile range [IQR]: 3.5-12.0) days from symptom onset; it was used as combined therapy in 29 (47.5%) episodes. Clinical cure rate by day 14 was 54.1% and predictors of response were days to source control (adjusted odds ratio [aOR]: 0.84; 95% confidence interval [CI]: 0.72-0.98; P = 0.024), days until the initiation of CAZ-AVI therapy (aOR: 0.65; 95% CI: 0.49-0.86; P = 0.003), age (aOR: 1.07; 95% CI: 0.99-1.15; P = 0.066) and CAZ-AVI combination therapy (aOR: 0.02; 95% CI: 0.01-0.38; P = 0.009). Rates of 30-day all-cause mortality and 90-day recurrence were 13.1% and 12.5%, respectively. Emergence of drug resistance to CAZ-AVI was not detected. Treatment-related adverse events occurred in three episodes (4.9%).CAZ-AVI constitutes a valid alternative for the treatment of infections due to MDR/XDR P. aeruginosa.
Published: 2022
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30. Functioning metastasis from adrenocortical carcinoma

Author: Clara Cunha, Sara Donato, Tiago Silva, and Valeriano Leite
Subjects: Fluorodeoxyglucose F18, Positron-Emission Tomography, Adrenocortical Adenoma, Adrenocortical Carcinoma, Humans, Adrenalectomy, Female, General Medicine, Middle Aged, Adrenal Cortex Neoplasms
Abstract: Recurrence of Cushing’s syndrome due to functional metastasis from adrenocortical carcinoma (ACC) after adrenalectomy is extremely rare. We describe a case of a 56-year-old woman who presented with Cushing’s syndrome due to an ACC. Abdominal CT showed a heterogeneous left adrenal tumour of 8 cm as well as a right adrenal nodule with 3 cm. An 18F-fluorodeoxyglucose positron emission tomography-CT (18F-FDG/CT PET) revealed an increased uptake of both adrenal lesions (maximum standardised uptake values, 17.7 and 10.4 for left and right adrenal lesions, respectively). Patient underwent bilateral adrenalectomy with R0 resection. Pathological examination revealed a left ACC with a Weiss’ score of 7, Ki67 10%, stage II European Network for the Study of Adrenal Tumours and a right adrenal adenoma. After surgery, clinical improvement was noted. Two months later, she noticed recurrence of hypercortisolism and multiple liver and lung metastasis were demonstrable, without evidence of local recurrence on the 18F-FDG/CT PET and abdominal MRI.
Published: 2022
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31. Covid-19 during pregnancy: A case series from an universally tested population from the north of Portugal

Author: Catarina Peixinho, Mariana Dória, Pedro Tiago Silva, Ana Mesquita Varejão, and Mafalda Laranjo
Subjects: Adult, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Population, Article, Betacoronavirus, Young Adult, COVID-19 Testing, Infectious Epidemiology, Pregnancy, Obstetrics and Gynaecology, Humans, Medicine, Pregnancy Complications, Infectious, education, Pandemics, Series (stratigraphy), education.field_of_study, Portugal, Clinical Laboratory Techniques, SARS-CoV-2, business.industry, COVID-19, Obstetrics and Gynecology, medicine.disease, Reproductive Medicine, Female, Coronavirus Infections, business, Demography
Published: 2020
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32. Estresse ocupacional de enfermeiros do Serviço De Atendimento Móvel de Urgência

Author: Tiago Silva Vaz, Luciana Neves da Silva Bampi, Rayanne da Silva Queiroz, Alessandra Ferreira Araujo, Caio Cesar de Olivera Cabral, and Luiza Helena Brito Calasans
Subjects: Male, Emergency Medical Services, Estresse Ocupacional, Nurses, Enfermagem em Emergência, Burnout, Emergency Nursing, Occupational safety and health, Servicios Médicos de Urgencia, Saúde do Trabalhador, Occupational Stress, Surveys and Questionnaires, Emergency medical services, Workplace, Burnout, Professional, General Nursing, Enfermería de Urgencia, 030504 nursing, lcsh:Nursing, enfermeiros, estresse ocupacional, Job satisfaction, Female, 0305 other medical science, Psychology, Emergency nursing, Adult, medicine.medical_specialty, SAMU, Job Satisfaction, 03 medical and health sciences, Social support, medicine, Humans, saúde do trabalhador, Occupational Health, lcsh:RT1-120, 030505 public health, business.industry, Social Support, enfermagem em emergência, Enfermeros, Enfermeiros, Cross-Sectional Studies, Family medicine, Estrés Laboral, Salud Laboral, samu, Observational study, Occupational stress, business
Abstract: Objective: To evaluate stress, and to associate it with sociodemographic and clinical aspects of nurses from the Mobile Emergency Care Service. Method: This is an observational, cross-sectional and quantitative study conducted with 123 nurses, who answered a questionnaire to assess sociodemographic and clinical variables, and the Job Stress Scale, which evaluates stress in the workplace. Results: The results indicated that most of them were women, 20 to 40 years old, married, without another employment bond and with specialization course. They had low control and low demand at work and performed a passive work. Women reported passive work and high stress levels, while men were equally divided in active and passive work with low stress levels. Conclusion: Passive work is harmful to health and it is related to lack of autonomy, decision-making, and social support. It may lead to reduced ability to solve problems faced in daily work routine. RESUMEN Objetivo: evaluar el estrés y asociar los aspectos sociodemográficos y clínicos de los enfermeros que trabajan en el Atendimiento Móvil de Emergencias. Método: Este fue un estudio observacional, transversal y cuantitativo realizado con 123 enfermeros, que respondieron un cuestionario para conocer las variables sociodemográficas y clínicas, y la Job Stress Scale. Resultados: Los resultados indicaron que la mayoría eran mujeres, de 20 a 40 años, sin ninguna otra relación laboral ni especialización. Tenían bajo control y baja demanda en el trabajo y realizaron un trabajo considerado pasivo. Las mujeres reportaron trabajo pasivo y desgaste elevado, mientras que los hombres se dividieron entre trabajo activo y pasivo con desgaste bajo. Conclusión: el trabajo pasivo es perjudicial para la salud y está relacionado con la falta de autonomía y el poder de decisión. Puede llevar a una capacidad reducida para producir soluciones a los problemas que se enfrentan en el trabajo diario. RESUMO Objetivo: Avaliar o estresse, associando-o aos aspectos sociodemográficos e clínicos de enfermeiros do Serviço de Atendimento Móvel de Urgências. Método: Trata-se de estudo observacional, transversal e quantitativo, realizado com 123 enfermeiros, que responderam a um questionário, para conhecer variáveis sociodemográficas e clínicas. Foi utilizada a Job Stress Scale, que avalia o estresse no trabalho. Resultados: Os resultados indicaram que a maioria eram mulheres, de 20 a 40 anos, casadas, sem outro vínculo empregatício e com especialização. Possuíam baixo controle, baixa demanda no trabalho e executavam trabalho considerado passivo. As mulheres referiram trabalho passivo e alto desgaste, enquanto os homens dividiram-se igualmente entre o perfil ativo e passivo com baixo desgaste. Conclusão: O trabalho passivo é nocivo à saúde e está relacionado à falta de autonomia, de poder de decisão e de suporte social. Pode conduzir à redução da capacidade de produzir soluções para os problemas enfrentados no cotidiano laboral.
Published: 2020

33. And then there were none

Author: J, Tiago Silva, C, Mejía-Chew, A, Spec, J M, Aguado, and F, López-Medrano
Subjects: Lung Diseases, Clinical-Pathological Conference, Humans, Female, Aged, Mycobacterium avium-intracellulare Infection
Published: 2019

34. Peripherally inserted central venous catheter placed and maintained by a dedicated nursing team for the administration of antimicrobial therapy vs. another type of catheter: a retrospective case-control study

Author: Almudena Lagares-Velasco, José Tiago Silva, Francisco López-Medrano, M. Dolores Pérez-Cárdenas, José María Aguado, Gema González-Monterrubio, and Mario Fernández-Ruiz
Subjects: 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Catheterization, Central Venous, medicine.medical_treatment, 030106 microbiology, Peripherally-inserted central venous catheter, 03 medical and health sciences, 0302 clinical medicine, Nursing, Anti-Infective Agents, Acute care, Indwelling catheter, Catheterization, Peripheral, Medicine, Central Venous Catheters, Humans, 030212 general & internal medicine, Retrospective Studies, business.industry, Case-control study, Control subjects, Antimicrobial, Catheter, Case-Control Studies, business, Central venous catheter
Abstract: Data concerning the use of peripherally inserted central catheters (PICC) for the administration of intravenous (IV) antimicrobials in the acute care setting is scarce.We performed a single-center retrospective case-control study (1:1). Case subjects were defined as patients who received IV antimicrobial treatment through a PICC line placed and maintained by specifically trained nurses (PICC group). Control subjects were defined as patients who received antimicrobial therapy by a peripheral or a central venous catheter (CVC) (control group). Control subjects were matched by type of antimicrobial, causative microorganism of the infection that was being treated and duration of treatment. An event leading to undesired catheter removal (ELUCR) was defined as any circumstance which lead to the removal of the indwelling catheter other than the completion of the scheduled course of antimicrobial therapy.The study included 50 patients in each group. The total follow-up time was 1376 catheter-days for the PICC group and 1362 catheter-days for the control group. We observed a significantly lower incidence of ELUCR in the PICC group (0.2 versus 7.7 events per 100 catheter-days; P0.001). When the incidence of ELUCR was analyzed according to the duration of indwelling catheterisation for each type of catheter (divided into one-week intervals), differences between both groups were also significant (P-values≤0.001 for the first three weeks of treatment). During the second week of IV treatment, only one patient in the PICC group (2.1%) developed an ELUCR compared to 19 (38.8%) in the control group (P0.001).A PICC placed and maintained by a dedicated nursing team is an excellent alternative to peripheral venous catheters or CVCs for administrating antimicrobial therapy for both short and long periods of treatment.
Published: 2019

35. Clinical examination remains crucial to the correct diagnosis: a case of severe peripheral oedema referred for investigation of heart failure

Author: Andrew Ludman, Lyndsey Phelps, Siddhartha Mengi, and Tiago Silva Carvalho da Silva
Subjects: 0301 basic medicine, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Peripheral edema, Physical examination, Vena Cava, Inferior, Disease, 030105 genetics & heredity, Inferior vena cava, New onset, Diagnosis, Differential, Heart Neoplasms, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Medicine, Humans, Heart Atria, Diagnostic Errors, Physical Examination, Aged, 80 and over, Heart Failure, medicine.diagnostic_test, business.industry, Liver Neoplasms, General Medicine, medicine.disease, digestive system diseases, Reminder of Important Clinical Lesson, medicine.vein, Hepatocellular carcinoma, Heart failure, cardiovascular system, Radiology, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Hepatocellular carcinoma (HCC) uncommonly metastasises to the heart. We present a case of new onset bilateral leg swelling and suspected right heart failure in a previously fit and healthy man, which on further investigation revealed a new diagnosis of HCC with extension into the inferior vena cava and right atrium. This case highlights the importance of considering alternative possibilities when physical examination does not match the initial clinical diagnosis. The management approach was for best supportive care in view of extensive metastatic disease.
Published: 2019

36. The Impact of Electronic Obstetric Records Using the ObsCare Software on Scientific Production

Author: Ana Margarida, Pereira, Priscila Alves, Maranhão, Tiago, Silva-Costa, and Ricardo J, Cruz-Correia
Subjects: Obstetrics, Portugal, Hospital Information Systems, Electronic Health Records, Humans, Software, Systematic Reviews as Topic
Abstract: To compare the characteristics of scientific publications performed in hospitals that used with those that didn't use an obstetric electronic health record (EHR).This study included two reviews (A and B). Review A was an exploratory analysis of all 100 abstracts presented at the Scientific Meeting of the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, in November 2017. Review B was a systematic review of studies in obstetrics, performed in Portugal and published between 2016-18 and indexed in PubMed. In both reviews, the included papers/abstracts were divided into two groups: from hospitals that used ObsCareIn both reviews, the sample size was significantly higher in hospitals from the ObsCare group. In review B, the length of the study period was also significantly longer in ObsCare group; no significant difference was found in review A.Publications from hospitals that used an obstetric specific EHR (ObsCare), included a higher number of patients and longer study periods.
Published: 2019

37. From ObsCare Software to an OpenEHR Platform: Modelling Obstetric Archetypes

Author: Priscila A, Maranhão, Ana Margarida, Pereira, Gustavo, Bacelar-Silva, Duarte, Gonçalves-Ferreira, Pedro, Vieira-Marques, Tiago, Silva-Costa, and Ricardo J, Cruz-Correia
Subjects: Obstetrics, Infant, Newborn, Electronic Health Records, Humans, Female, Software
Abstract: Electronic health records (EHRs) are important tools to facilitate communication between care providers and to improve clinical research. In obstetrics they became essential. The ObsCare software was created to answer to the need for an EHR with specific obstetric features. The present study aimed to develop openEHR-archetypes capable of representing an ObsCare® EHR form and to create an openEHR-template using the developed archetypes.The study was performed in four phases: 1) selection and description of the ObsCare form; 2) Clinical Knowledge Manager (CKM) analysis; 3) modelling of the archetypes; 4) creation and testing of the template.One openEHR-archetype - Newborn summary - was modelled to assemble the following three clinical concepts that were not represented in CKM: hours of life, "Examination of newborn movements" and "Examination of reflexes". Finally, an openEHR-template was built and automatically converted into an EHR by VCIntegrator.Considering the potential to improve clinical research, we believe that more obstetric-gynecologic clinical statements should be modelled into openEHR.
Published: 2019

38. Post-transplant monitoring of NK cell counts as a simple approach to predict the occurrence of opportunistic infection in liver transplant recipients

Author: Luis M. Allende, C. Jimenez, Francisco López-Medrano, Iago Justo, Mario Fernández-Ruiz, José María Aguado, Felix Cambra, R. San Juan, José Tiago Silva, and Estela Paz-Artal
Subjects: Male, Opportunistic infection, Lymphocyte, medicine.medical_treatment, Cytomegalovirus, Opportunistic Infections, 030230 surgery, Liver transplantation, 03 medical and health sciences, 0302 clinical medicine, Monitoring, Immunologic, Predictive Value of Tests, Risk Factors, medicine, Humans, Lymphocyte Count, Prospective Studies, Aged, Immunity, Cellular, Transplantation, Receiver operating characteristic, business.industry, Proportional hazards model, Hazard ratio, Middle Aged, Flow Cytometry, medicine.disease, Lymphocyte Subsets, Liver Transplantation, Killer Cells, Natural, Infectious Diseases, medicine.anatomical_structure, Peripheral blood lymphocyte, Cytomegalovirus Infections, Immunology, Female, business, CD8, Follow-Up Studies, 030215 immunology
Abstract: BACKGROUND Monitoring of peripheral blood lymphocyte subpopulation (PBLS) counts might be useful for estimating the risk of infection after liver transplantation (LT). METHODS We prospectively measured total lymphocyte and PBLS counts at baseline and post-transplant months 1 and 6 in 92 LT recipients. PBLS were enumerated by single-platform 6-color flow cytometry technology. Areas under receiver operating characteristic (ROC) curves were used to evaluate the accuracy of different PBLS for predicting cytomegalovirus (CMV) disease and overall opportunistic infection (OI). Adjusted hazard ratios (aHRs) for both outcomes were estimated by Cox regression. RESULTS After a median follow-up of 730.0 days, 29 patients (31.5%) developed 38 episodes of OI (including 22 episodes of CMV disease). The counts of CD3(+) , CD4(+) , and CD8(+) T cells, and CD56(+) CD16(+) natural killer (NK) cells at month 1 were significantly lower in patients subsequently developing OI. The NK cell count was the best predictive parameter (area under ROC curve for predicting CMV disease: 0.78; P-value = 0.001). Patients with an NK cell count
Published: 2016
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39. Galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive aspergillosis in non-hematological patients

Author: E. Venanzi, J.J. Cabanillas, Julio García-Rodríguez, Pilar Martín-Dávila, José Tiago Silva, R. García-Luján, Mario Fernández-Ruiz, D. Benito, F. Lazaro, E. Gomez Garcia de la Pedrosa, Jesús Fortún, José María Aguado, F. Castaño, I. Quiles, and Santiago Moreno
Subjects: Adult, Male, 0301 basic medicine, Microbiology (medical), Pathology, medicine.medical_specialty, Neutropenia, 030106 microbiology, Aspergillosis, Sensitivity and Specificity, Gastroenterology, Article, Mannans, Immunocompromised Host, Pulmonary Disease, Chronic Obstructive, Young Adult, 03 medical and health sciences, Galactomannan, chemistry.chemical_compound, Internal medicine, Humans, Medicine, In patient, Retrospective Studies, Invasive Pulmonary Aspergillosis, COPD, medicine.diagnostic_test, business.industry, Galactose, Retrospective cohort study, Middle Aged, respiratory system, University hospital, medicine.disease, respiratory tract diseases, Infectious Diseases, Bronchoalveolar lavage, chemistry, Spain, Population study, Female, business, Bronchoalveolar Lavage Fluid
Abstract: Summary Background The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established. Methods We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded. Results A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPD patients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively). Conclusions In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions.
Published: 2016
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40. Detection of Epstein-Barr virus DNAemia after lung transplantation and its potential relationship with the development of post-transplant complications

Author: M. A. Pérez-Jacoiste Asín, Francisco López-Medrano, V. Pérez-González, José María Aguado, Tamara Ruiz-Merlo, José Tiago Silva, Mario Fernández-Ruiz, María Dolores Folgueira, Rodrigo Alonso-Moralejo, A. De Pablo-Gafas, and Rafael San-Juan
Subjects: Adult, Male, Epstein-Barr Virus Infections, Herpesvirus 4, Human, medicine.medical_specialty, Opportunistic infection, medicine.medical_treatment, Opportunistic Infections, 030230 surgery, Real-Time Polymerase Chain Reaction, Gastroenterology, Cohort Studies, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Internal medicine, medicine, Humans, Lung transplantation, Viremia, Epstein–Barr virus infection, Aged, Retrospective Studies, Immunosuppression Therapy, Transplantation, Surrogate endpoint, business.industry, Incidence, Incidence (epidemiology), Hazard ratio, Immunosuppression, Middle Aged, medicine.disease, Infectious Diseases, DNA, Viral, Immunology, Female, 030211 gastroenterology & hepatology, business, Biomarkers, Follow-Up Studies, Lung Transplantation
Abstract: BACKGROUND Recent studies suggest that Epstein-Barr virus DNAemia (EBVd) may act as a surrogate marker of post-transplant immunosuppression. This hypothesis has not been tested so far in lung transplant (LT) recipients. METHODS We included 63 patients undergoing lung transplantation at our center between October 2008 and May 2013. Whole blood EBVd was systematically assessed by real-time polymerase chain reaction assay on a quarterly basis. The occurrence of late complications (overall and opportunistic infection [OI] and chronic lung allograft dysfunction [CLAD]) was analyzed according to the detection of EBVd within the first 6 months post transplantation. RESULTS Any EBVd was detected in 30 (47.6%) patients. Peak EBVd was higher in patients with late overall infection (2.23 vs. 1.73 log10 copies/mL; P = 0.026) and late OI (2.39 vs. 1.74 log10 copies/mL; P = 0.004). The areas under receiver operating characteristic curves for predicting both events were 0.806 and 0.871 respectively. The presence of an EBVd ≥2 log10 copies/mL during the first 6 months post transplantation was associated with a higher risk of late OI (adjusted hazard ratio [aHR] 7.92; 95% confidence interval [CI] 2.10-29.85; P = 0.002). Patients with detectable EBVd during the first 6 months also had lower CLAD-free survival (P = 0.035), although this association did not remain statistically significant in the multivariate analysis (aHR 1.26; 95% CI 0.87-5.29; P = 0.099). CONCLUSIONS Although preliminary in nature, our results suggest that the detection of EBVd within the first 6 months after transplantation is associated with the subsequent occurrence of late OI in LT recipients.
Published: 2016
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41. Infectious Complications Following Small Bowel Transplantation

Author: Carlos Lumbreras, Jorge Calvo-Pulido, G. Prieto-Bozano, José Tiago Silva, J. Maria Aguado, Manuel López-Santamaría, Mario Fernández-Ruiz, Carlos Jiménez-Romero, Francisco López-Medrano, Rafael San-Juan, B. Fernández-Caamaño, and Elena Resino-Foz
Subjects: Adult, Graft Rejection, Male, medicine.medical_specialty, Opportunistic infection, medicine.medical_treatment, Opportunistic Infections, 030230 surgery, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Internal medicine, Intestine, Small, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Renal replacement therapy, Child, Retrospective Studies, Cause of death, Transplantation, business.industry, Incidence, Incidence (epidemiology), Graft Survival, Hazard ratio, Retrospective cohort study, Prognosis, medicine.disease, Surgery, Intestinal Diseases, Mycoses, Child, Preschool, Female, 030211 gastroenterology & hepatology, business, Complication, Follow-Up Studies
Abstract: Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a retrospective analysis of all patients undergoing SBT from 2004 to 2013 in Spain. Sixty-nine patients underwent a total of 87 SBT procedures (65 pediatric, 22 adult). The median follow-up was 867 days. Overall, 81 transplant patients (93.1%) developed 263 episodes of infection (incidence rate: 2.81 episodes per 1000 transplant-days), with no significant differences between adult and pediatric populations. Most infections were bacterial (47.5%). Despite universal prophylaxis, 22 transplant patients (25.3%) developed cytomegalovirus disease, mainly in the form of enteritis. Specifically, 54 episodes of opportunistic infection (OI) occurred in 35 transplant patients. Infection was the major cause of mortality (17 of 24 deaths). Multivariate analysis identified retransplantation (hazard ratio [HR]: 2.21; 95% confidence interval [CI]: 1.02-4.80; p = 0.046) and posttransplant renal replacement therapy (RRT; HR: 4.19; 95% CI: 1.40-12.60; p = 0.011) as risk factors for OI. RRT was also a risk factor for invasive fungal disease (IFD; HR: 24.90; 95% CI: 5.35-115.91; p
Published: 2016
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42. [Tennis racket sign: A complicated case of pulmonary tuberculosis]

Author: Sérgio, Alves, Diana, Póvoas, and Tiago, Silva
Subjects: Adolescent, Humans, Female, Tomography, X-Ray Computed, Tuberculosis, Pulmonary
Published: 2018

43. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Intracellular signaling pathways: tyrosine kinase and mTOR inhibitors)

Author: J. W. de Fijter, M. Reinwald, Nicolas J. Mueller, Paolo Grossi, Mario Fernández-Ruiz, José Tiago Silva, J. Fortún, Christian Garzoni, José María Aguado, University of Zurich, and Reinwald, M
Subjects: Microbiology (medical), mTOR inhibitors, 610 Medicine & health, Communicable Diseases, 2726 Microbiology (medical), 10234 Clinic for Infectious Diseases, Idelalisib, Immunocompromised Host, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, BCR-ABL kinase inhibitors, Humans, Medicine, Bruton's tyrosine kinase, 030212 general & internal medicine, Protein Kinase Inhibitors, Clinical Trials as Topic, Janus kinase inhibitors, biology, business.industry, Venetoclax, TOR Serine-Threonine Kinases, Ibrutinib, Cancer, 2725 Infectious Diseases, General Medicine, Protein-Tyrosine Kinases, medicine.disease, Small-molecule inhibitors, Biological Therapy, Dasatinib, Infectious Diseases, chemistry, 030220 oncology & carcinogenesis, Immunology, biology.protein, Janus kinase, business, Infection, Tyrosine kinase, Signal Transduction, medicine.drug
Abstract: Background The present review is part of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biologic therapies. Aims To review, from an infectious diseases perspective, the safety profile of therapies targeting different intracellular signaling pathways and to suggest preventive recommendations. Sources Computer-based Medline searches with MeSH terms pertaining to each agent or therapeutic family. Content Although BCR-ABL tyrosine kinase inhibitors modestly increase the overall risk of infection, dasatinib has been associated with cytomegalovirus and hepatitis B virus reactivation. BRAF/MEK kinase inhibitors do not significantly affect infection susceptibility. The effect of Bruton tyrosine kinase inhibitors (ibrutinib) among patients with B-cell malignancies is difficult to distinguish from that of previous immunosuppression. However, cases of Pneumocystis jirovecii pneumonia (PCP), invasive fungal infection and progressive multifocal leukoencephalopathy have been occasionally reported. Because phosphatidylinositol-3-kinase inhibitors (idelalisib) may predispose to opportunistic infections, anti-Pneumocystis prophylaxis and prevention strategies for cytomegalovirus are recommended. No increased rates of infection have been observed with venetoclax (antiapoptotic protein Bcl-2 inhibitor). Therapy with Janus kinase inhibitors markedly increases the incidence of infection. Pretreatment screening for chronic hepatitis B virus and latent tuberculosis infection must be performed, and anti-Pneumocystis prophylaxis should be considered for patients with additional risk factors. Cancer patients receiving mTOR inhibitors face an increased incidence of overall infection, especially those with additional risk factors (prior therapies or delayed wound healing). Implications Specific preventive approaches are warranted in view of the increased risk of infection associated with some of the reviewed agents.
Published: 2018

44. Mycobacterium abscessuspulmonary infection complicated with vertebral osteomyelitis in a heart transplant recipient: case report and literature review

Author: Rafael San-Juan, Juan F. Delgado, Maria J. Ruiz-Cano, José María Aguado, Mario Fernández-Ruiz, José Tiago Silva, and Francisco López-Medrano
Subjects: medicine.medical_specialty, Pulmonary infection, Disease, Mycobacterium abscessus, Heart transplant recipient, Mycobacterium, Immunocompromised Host, Risk Factors, Clarithromycin, Humans, Medicine, Vertebral osteomyelitis, Respiratory Tract Infections, Aged, Transplantation, biology, business.industry, Osteomyelitis, bacterial infections and mycoses, biology.organism_classification, medicine.disease, Anti-Bacterial Agents, Surgery, Treatment Outcome, Infectious Diseases, Heart Transplantation, bacteria, Female, Solid organ transplantation, business
Abstract: Infections produced by Mycobacterium abscessus are emerging in immunosuppressed patients, such as solid organ transplant recipients. We report the first case, to our knowledge, of a vertebral osteomyelitis caused by M. abscessus in a heart transplant recipient, and review the risk factors, manifestations, and therapeutic approaches to this uncommon disease.
Published: 2015
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45. [Invasive aspergillosis in solid organ transplantation]

Author: José Tiago, Silva, Julián, Torre-Cisneros, and José María, Aguado
Subjects: Intestines, Male, Antifungal Agents, Postoperative Complications, Pyridines, Nitriles, Aspergillosis, Humans, Organ Transplantation, Middle Aged, Triazoles, Invasive Fungal Infections
Abstract: Solid organ transplant (SOT) recipients have a high risk for developing invasive fungal infections (IFI). Treatment is difficult due to the interaction between the antifungal and immunosuppressant drugs, as well as the risk of hepatotoxicity and kidney failure associated with voriconazole and amphotericinB, respectively. Isavuconazole is a new antifungal triazole agent with excellent oral bioavailability, predictable and linear pharmacokinetics, good tolerance and low adverse effects. It has been approved for the treatment of invasive aspergillosis and mucormycosis. A review is presented of the reported experience in the use of isavuconazole in SOT. According to the published studies, isavuconazole has a significantly lower risk of interaction with tacrolimus, and is less hepatotoxic than voriconazole. Nevertheless, there is a significant variability between patients, and between each type of SOT. Isavuconazole reduces the side effects associated with the treatment of IFI in SOT. It would be of great interest the implementation of future clinical trials with isavuconazole for the treatment and/or prophylaxis of IFI in these patients.
Published: 2018

46. Experience with leflunomide as treatment and as secondary prophylaxis for cytomegalovirus infection in lung transplant recipients: A case series and review of the literature

Author: Rafael San-Juan, José Tiago Silva, Rodrigo Alonso-Moralejo, Francisco López-Medrano, Mario Fernández-Ruiz, José María Aguado, María Dolores Folgueira, Alicia de Pablo-Gafas, V. Pérez-González, and Patricia Brañas
Subjects: Foscarnet, Ganciclovir, Adult, Male, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Cytomegalovirus, Viremia, 030230 surgery, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Internal medicine, medicine, Secondary Prevention, Lung transplantation, Humans, Adverse effect, Leflunomide, Aged, Retrospective Studies, Transplantation, business.industry, virus diseases, Immunosuppression, Middle Aged, medicine.disease, Prognosis, Rheumatoid arthritis, Cytomegalovirus Infections, Female, business, Immunosuppressive Agents, medicine.drug, Follow-Up Studies, Lung Transplantation
Abstract: Background Data concerning the use of leflunomide-a drug approved for rheumatoid arthritis with in vitro anticytomegalovirus (CMV) activity-in lung transplant (LT) recipients are scarce. Aims To report the use of leflunomide in LT recipients diagnosed with CMV infection/disease. Material and methods We performed a single-center retrospective study including LT recipients who received leflunomide for CMV infection or as secondary prophylaxis after viremia clearance. We also conducted a full systematic PubMed search until June 30, 2017. Results We identified 5 LT recipients in our center plus 7 patients reported in the literature. All patients had previously received ganciclovir (GCV) and foscarnet (FOS), with drug-induced adverse effects described in 6 recipients (50%). Antiviral resistance mutations were observed in 8 patients (66.7%). Leflunomide was prescribed for CMV infection in 9 of 12 patients (75%) and as secondary prophylaxis in 3 patients (25%). Initial decrease of CMV viremia after starting leflunomide was observed in 7 of 9 recipients (77.7%), although this response was only transient in 2 patients. Long-term suppression of CMV viremia was reported in 7 of 12 patients (58.3%). In 3 recipients (25%), leflunomide was discontinued due to adverse effects. Discussion Our study has some limitations, such as the small number of patients included, its retrospective nature, and absence of leflunomide drug monitoring in serum. Notwithstanding, in our experience, leflunomide proved to be particularly effective as an anti-CMV secondary prophylaxis treatment and for clearing low-grade viremia. Moreover, leflunomide combined with a short course of GCV or intravitreal FOS also proved to be very effective in some patients. Conclusion Leflunomide, alone or in combination, could be an effective treatment in selected LT recipients with GCV-resistant CMV infection and as secondary prophylaxis. Further studies are necessary.
Published: 2017

47. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [II]: agents targeting interleukins, immunoglobulins and complement factors)

Author: Alexandre Dumusc, Esther Benamu, Josef S Smolen, José Tiago Silva, Leonard H. Calabrese, José María Aguado, Mario Fernández-Ruiz, Xavier Mariette, and Kevin L. Winthrop
Subjects: Microbiology (medical), Brodalumab, Immunoglobulins, Meningococcal Vaccines, Antibodies, Monoclonal, Humanized, Communicable Diseases, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Ustekinumab, medicine, Humans, 030212 general & internal medicine, Molecular Targeted Therapy, 030203 arthritis & rheumatology, Clinical Trials as Topic, Latent tuberculosis, business.industry, Interleukins, Interleukin-17, Antibodies, Monoclonal, General Medicine, Complement System Proteins, Eculizumab, medicine.disease, Rilonacept, Biological Therapy, Ixekizumab, Infectious Diseases, Immunology, Chemoprophylaxis, Communicable Disease Control, Secukinumab, Dermatologic Agents, business, medicine.drug
Abstract: Background The present review is part of the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies. Aims To review, from an Infectious Diseases perspective, the safety profile of agents targeting interleukins, immunoglobulins and complement factors and to suggest preventive recommendations. Sources Computer-based MEDLINE searches with MeSH terms pertaining to each agent or therapeutic family. Content Patients receiving interleukin-1 (IL-1) -targeted (anakinra, canakinumab or rilonacept) or IL-5-targeted (mepolizumab) agents have a moderate risk of infection and no specific prevention strategies are recommended. The use of IL-6/IL-6 receptor-targeted agents (tocilizumab and siltuximab) is associated with a risk increase similar to that observed with anti-tumour necrosis factor-α agents. IL-12/23-targeted agents (ustekinumab) do not seem to pose a meaningful risk of infection, although screening for latent tuberculosis infection may be considered and antiviral prophylaxis should be given to hepatitis B surface antigen-positive patients. Therapy with IL-17-targeted agents (secukinumab, brodalumab and ixekizumab) may result in the development of mild-to-moderate mucocutaneous candidiasis. Pre-treatment screening for Strongyloides stercoralis and other geohelminths should be considered in patients who come from areas where these are endemic who are receiving IgE-targeted agents (omalizumab). C5-targeted agents (eculizumab) are associated with a markedly increased risk of infection due to encapsulated bacteria, particularly Neisseria spp. Meningococcal vaccination and chemoprophylaxis must be administered 2–4 weeks before initiating eculizumab. Patients with high-risk behaviours and their partners should also be screened for gonococcal infection. Implications Preventive strategies are particularly encouraged to minimize the occurrence of neisserial infection associated with eculizumab.
Published: 2017

48. Health communication by virtual environments: an experience report

Author: Mônica Beatriz Ortolan, Libardi, Júlia Maria de Oliveira, Duarte, Josilene Albino de Freitas, Lima, Sandra de Nazaré Costa, Monteiro, Tiago Silva, Vaz, and Zelinda, Torri
Subjects: Health Communication, Virtual Reality, Humans, Social Media
Abstract: to report an experience of health communication with a strategy based on hosting health videos in a virtual environment.a video sharing site (YouTube), accessible websites, and tools to facilitate the execution of tasks (applications) were used to report a health education experience based on the hosting of videos addressing the subjects of cardiopulmonary resuscitation, airway obstruction by foreign bodies, and hemorrhages.in 17 months, there were 31,727 views for the resuscitation and the obstruction videos, which were accessed by people from 69 countries, especially Brazil and the United States; the videos about hemorrhages had 5,400 views, by viewers from the same countries.the use of communication by hosting health videos in a virtual environment impacts on popular education significantly.relatar a experiência da estratégia de comunicação em saúde por meio de hospedagem de vídeos de saúde em um ambiente virtual.relato de experiência com educação em saúde por hospedagem de vídeos nos temas reanimação cardiopulmonar, obstrução da via aérea por corpos estranhos e hemorragias, utilizando páginas da internet (site) de compartilhamento de vídeos (YouTube), páginas acessíveis na internet (websites) e ferramentas para melhorarem tarefas (aplicativos).em dezessete meses, houve 31.727 visualizações para os temas de reanimação e obstrução, onde sessenta e nove países acessaram os vídeos, com destaque para Brasil e Estados Unidos; os vídeos de hemorragias tiveram 5.400 visualizações, pelos mesmos países.a utilização da comunicação por meio de hospedagem de vídeos de saúde em um ambiente virtual é de extrema importância para educação popular.relatar la experiencia de la estrategia de comunicación en salud través del hospedaje de videos de salud en un ambiente virtual.relato de experiência com educación em salud por hospedaje de vídeos en temas de reanimación cardiopulmonar, obstrucción de la vía aérea por cuerpo extraño y sangría, usando páginas de Internet (sites) de compartir videos (YouTube), páginas acessibles en Internet (websites) y herramientas para mejorar las tareas (aplicaciones).en diecisiete meses, hubo 31.727 visualizaciones para los temas de reanimación y obstrucción, donde sesenta y nueve países accedieron a los videos, con destaque para Brasil y Estados Unidos; los videos de hemorragias tuvieron 5.400 visualizaciones, por los mismos países.la utilización de la comunicación por medio de hospedaje de videos de salud en un ambiente virtual es de extrema importancia para la educación popular.
Published: 2017

49. Diverticulitis

Author: J Tiago, Silva, Francisco, López-Medrano, and José M, Aguado
Subjects: Humans, General Medicine, Diverticulitis, Diverticulitis, Colonic
Published: 2019
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50. Molecular detection of human adenovirus in sediment using a direct detection method compared to the classical polyethylene glycol precipitation

Author: Sabrina Esteves de Matos Almeida, Rodrigo Staggemeier, Tiago Silva, Fernando Rosado Spilki, Tatiana Moraes da Silva Heck, and Marina Bortoluzzi
Subjects: Geologic Sediments, Chromatography, Adenoviruses, Human, Direct method, Extraction (chemistry), Sediment, Polyethylene glycol, Biology, Real-Time Polymerase Chain Reaction, Virology, Soil, chemistry.chemical_compound, Real-time polymerase chain reaction, chemistry, Reagent, DNA, Viral, PEG ratio, Nucleic acid, Humans
Abstract: Various effective methods have been developed to measure the concentration of viruses in sediment samples. However, there is need to standardize less laborious and simpler techniques. The objective of the present study was to compare two different methods to measure the concentration of viruses in soil samples. The use of polyethylene glycol (PEG) was compared with a direct extraction of viral nucleic acids from the samples diluted in modified Eagle's minimal essential medium (E-MEM). The presence of adenovirus in the samples was detected by real-time quantitative polymerase chain reaction (qPCR). Only six samples (30%) were positive for adenovirus when PEG technique was used. The direct method showed 16 (80%) samples positive for adenovirus. Therefore, direct detection (i.e. without previous concentration) demonstrated a higher rate of detection, better effectiveness, and shorter execution time. Furthermore, direct detection uses reagents that are often readily available in virology laboratories. Thus, it is an attractive alternative to other methods of detection of virus particles in sediments.
Published: 2015
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