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Background and objectives: Coronary artery disease is a common health problem. The aim of this study was to evaluate the prognosis impact on mortality of the variation of hemoglobin (Hb) levels during hospitalization time. Methods: The retrospective observational study included 2640 patients admitted for acute coronary syndrome in a single coronary care unit from May 2004 until June 2013. The primary endpoint was all cause of death at 1 year of follow up time, and secondary endpoint was all cause of death at 2 years of the follow up time. Results: Four groups were created according to the quartiles of Hb variation (admission Hb minus lowest Hb value) during the hospitalization time: group 1: ≥2.1 g/dL with 627 patients; group 2: >1.1 and 0.3 and ≤1.1 g/dL with 686 patients and group 4: ≤0.3 g/dL with 661 patients. A total of 84 patients (3.2%) died during the first year of the follow up. More patients died in group 1 and 4 (6.4% vs 3.7% vs 3.7% vs 6.8%, Log-Rank = 0.023). At 2 years of follow-up, the results were similar, with higher mortality in group 4 (7.3% vs 4.3% vs 4.6% vs 9.2%, Log-Rank = 0.003). Multivariate analysis showed that Hb variation >1.1 was an independent predictor of mortality (hazard ration = 0309 95% confidence interval, 0.136–0.702; P = 0.005). Conclusion: The patients with the lower baseline hemoglobin and the variability of Hb highest than 1.1 mg/dL had the worse prognosis with high mortality rate during the follow up time.

Determining how intra-specific genetic diversity is apportioned among natural populations is essential for detecting local adaptation and identifying populations with inherently low levels of extant diversity which may become a conservation concern. Sequence polymorphism at two adaptive loci (MHC DRA and DQB) was investigated in long-finned pilot whales (Globicephala melas) from four regions in the North Atlantic and compared with previous data from New Zealand (South Pacific). Three alleles were resolved at each locus, with trans-species allele sharing and higher levels of non-synonymous to synonymous substitution, especially in the DQB locus. Overall nucleotide diversities of 0.49 ± 0.38% and 4.60 ± 2.39% were identified for the DRA and DQB loci, respectively, which are relatively low for MHC loci in the North Atlantic, but comparable to levels previously described in New Zealand (South Pacific). There were significant differences in allele frequencies within the North Atlantic and between the N...

The coastal preferences of harbour porpoise (Phocoena phocoena) intensify their exposure to human activities. The harbour porpoise Iberian population is presently very small and information about the threats it endures is vital for the conservation efforts that are being implemented to avoid local extinction. The present study explored the possible relation between the accumulation of trace elements by porpoises and their sex, body length, nutritional state, presence of parasites and gross pathologies. The concentrations of arsenic (As), cadmium (Cd), copper (Cu), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), zinc (Zn) and selenium (Se) were evaluated in 42 porpoises stranded in Portugal between 2005 and 2013. Considering European waters, porpoises stranded in Portugal present the highest Hg concentrations and the lowest Cd concentrations, which may reflect dietary preferences and the geographic availability of these pollutants. While no effect of sex on trace element concentrations was detected, there was a positive relationship between porpoise body length and the concentration of Cd, Hg and Pb. Animals in worse nutritional condition showed higher levels of Zn. Harbour porpoises with high parasite burdens showed lower levels of Zn and As in all analysed tissues and also lower levels of renal Ni, while those showing gross pathologies presented higher Zn and Hg levels. This is the first data on the relationship between trace elements and health-related variables in porpoises from southern European Atlantic waters, providing valuable baseline information about the contamination status of this vulnerable population.

Lattice corneal dystrophy gelsolin type was first described in 1969 by Jouko Meretoja, a Finnish ophthalmologist. It is caused by an autosomal dominant mutation in gelsolin gene resulting in unstable protein fragments and amyloid deposition in various organs. The age of onset is usually after the third decade of life and typical diagnostic triad includes progressive bilateral facial paralysis, loose skin, and lattice corneal dystrophy. We report a case of a 53-year-old female patient referred to our Department of Ophthalmology by severe dry eye and incomplete eyelid closure. She had severe bilateral facial paresis, significant orbicularis, and perioral sagging as well as hypoesthesia of extremities and was diagnosed with Meretoja's syndrome at the age of 50, confirmed by the presence of gelsolin mutation. At our observation she had bilateral diminished tear film break-up time and Schirmer test, diffuse keratitis, corneal opacification, and neovascularization in the left eye. She was treated with preservative-free lubricants and topical cyclosporine, associated with nocturnal complete occlusion of both eyes, and underwent placement of lacrimal punctal plugs. Ocular symptoms are the first to appear and our role as ophthalmologists is essential for the diagnosis, treatment, and monitoring of ocular alterations in these patients. info:eu-repo/semantics/publishedVersion

O objetivo deste estudo foi avaliar o estado da referenciação de crianças à especialidade hospitalar de oftalmologia, no Centro Hospitalar do Porto, analisando os motivos de referenciação, patologias diagnosticadas, eficácia dessa referenciação e o impacto visual nas crianças. Método: Estudo retrospetivo e descritivo dos processos clínicos das crianças com idade menor ou igual a 10 anos, referenciadas à consulta de oftalmologia pediátrica entre julho de 2011 e julho de 2012. Resultados: Um total de 649 crianças foi referenciado, tendo sido os motivos mais frequentes a suspeita de estrabismo em 41,9% dos casos, rastreio de patologia oftalmológica em 22,6% e suspeita de baixa acuidade visual (AV) em 15,2%. Das crianças referenciadas por suspeita de estrabismo confirmou-se o diagnóstico em 40,8% dos casos (média das idades 4,5±2,2 anos), sendo que 16,8% das crianças referenciadas por outros motivos apresentavam também estrabismo. No total, 62,3% foram classificados como endotropias e 32,3% como exotropias. Das crianças referenciadas por suspeita de baixa AV, confirmou-se o diagnóstico em 39% dos casos e a principal causa de diminuição da AV foram as ametropias (52% dos casos). Das crianças referenciadas por outros motivos, 13,3% apresentavam diminuição mensurável da AV e 20% tinham ametropias potencialmente ambliogénicas. Apenas 40% das crianças referenciadas por suspeita de baixa AV apresentavam registo de AV no pedido de referenciação. Foi diagnosticada ambliopia em 20,1% de todas as crianças observadas. Discussão: Os problemas que mais frequentemente motivaram a referenciação para oftalmologia pediátrica foram a suspeita de estrabismo e de diminuição da AV. No entanto, confirmou-se o diagnóstico em menos de metade das crianças referenciadas e uma percentagem significativa dos casos diagnosticados foi referenciado por outro motivo. A média das idades de diagnóstico de estrabismo foi tardia e a percentagem de ambliopia elevada. Este estudo reforça a importância da realização do exame oftalmológico de rastreio nos cuidados de saúde primários e o seu impacto na referenciação, diagnóstico e tratamento atempado destas patologias em idade pediátrica The aim of this study was to evaluate the current state of the referral of children to the specialty of Ophthalmology at our Hospital-Centro Hospitalar do Porto, analyzing the reasons for referral, diagnosed diseases, effectiveness of referral and the visual impact on children. Methods: Retrospective and descriptive study of medical records of children aged ≤10 years-old referred to the Pediatric Ophthalmology Clinic, between July 2011 and July 2012. Results: A total of 649 children were referred and the most frequent reasons included suspected strabismus in 41.9%, screening for ocular pathology in 22.6%, and suspected low visual acuity (VA) in 15.2% of the cases. Amongst children referred for suspected strabismus, the diagnosis was confirmed in 40.8% of the cases (mean age of 4.5±2.2 years); 16.8% of children referred for other reasons also had strabismus. 62.3% were classified as esotropias and 32.3% as exotropias. Amongst the children referred for suspected low VA, the diagnosis was confirmed in 39% of the cases, and the main cause were ametropias (52% of cases). Of the children referred for other reasons, 13.3% had a measurable decrease in AV and 20% had potentially amblyogenic ametropias. Only 40% of the children referred by suspected low VA had a VA evaluation in the referral request. Amblyopia was diagnosed in 20.1% of all children observed. Discussion: The problems that most frequently motivated referral for pediatric ophthalmology were the suspicion of strabismus and of decreased VA. However, the diagnosis was confirmed in less than half of the referred children, and a significant percentage of diagnosed cases was referred for another reason. The mean age of diagnosis of strabismus was late, and the percentage of amblyopia was high. This study reinforces the importance of conducting ophthalmologic screening in primary health care, and its impact on a timely referral, diagnosis and treatment of these pediatric diseases

Acknowledgements. Cetacean samples were collected under the auspices of stranding monitoring programs run by the Sociedade Portuguesa de Vida Selvagem, the Coordinadora para o Estudio dos Mamiferos Marinos (supported by the regional government Xunta de Galicia), the UK Cetacean Strandings Investigation Programme and the Scottish Agriculture College Veterinary Science Division (jointly funded by Defra and the Devolved Governments of Scotland and Wales), the Marine Mammals Research Group of the Institute of Marine Research (Norway), the Museum of Natural History of the Faroe Islands and the International Fund for Animal Welfare Marine Mammal Rescue and Research Program (USA). The authors thank all the members of these institutions and organizations for their assistance with data and sample collection. S.S.M., P.M.F. and M.F. were supported by PhD grants from the Fundacao para a Ciencia e Tecnologia (POPH/FSE ref SFRH/BD/ 38735/ 2007, SFRH/BD/36766/2007 and SFRH/BD/30240/ 2006, respectively). A.L. was supported by a postdoctoral grant from the Fundacao para a Ciencia e Tecnologia (ref SFRH/BPD/82407/2011). The work related to strandings and tissue collection in Portugal was partially supported by the SafeSea project EEAGrants PT 0039 (supported by Iceland, Liechtenstein and Norway through the EEA Financial Mechanism), the MarPro project Life09 NAT/PT/000038 (funded by the European Union program LIFE+) and the project CetSenti FCT RECI/AAG-GLO/0470/2012 (FCOMP- 01-0124-FEDER-027472) (funded by the program COMPETE and the Fundacao para a Ciencia e Tecnologia). G.J.P. thanks the University of Aveiro and Caixa Geral de Depositos (Portugal) for financial support. The authors acknowledge the assistance of the chemical analysts at Marine Scotland Science with the fatty acid analysis.

Interactions between cetaceans and the purse-seine fishery operating along the whole Portuguese continental coast were studied based on on-board observations from 2010 to 2011. Cetacean presence and mortality were estimated and characteristics under which interactions were most likely to occur were identified. Observations were made on 163 fishing trips (0.7% of the average annual number of fishing trips) and 302 fishing operations/hauls. Cetaceans were present during 16.9% of fishing events; common dolphins (Delphinus delphis) accounted for 96% of occurrences, mostly overnight in summer and early autumn. Regression models showed that cetacean presence during a fishing set was significantly (p < 0.05) associated with sardine catches, effort, and latitude/longitude. Encirclement and mortality occurred in 2.3 and 1.0% of fishing events, respectively. Encircled species were the common dolphin, bottlenose dolphin (Tursiops truncatus), and harbour porpoise (Phocoena phocoena), but only common dolphin showed mortality (three individuals); raised to fleet level, estimated total mortality rates of common dolphins were 69 (95% CI 37–110) in the north and 91 (95% CI 55–165) in the south for 2010 and 78 (95% CI 47–140) in the south only for 2011. The estimated annual mortality rate due to purse seining is 113 (95% CI 3–264) common dolphins, which is ∼0.63% of the current most optimistic estimate of population size for the Portuguese fishing area (SCANS II). The wide confidence limits, as well as variation between years, reflect low observer coverage, emphasizing the need for increased monitoring to cover gaps in the spatial and seasonal distribution of observer effort and provide reliable estimates of bycatch.

In order to improve our knowledge on the feeding ecology of long-finned pilot whales (Globicephala melas) in Northeast Atlantic waters, skin samples of 68 long-finned pilot whales stranded in Northwest Iberia (n = 22) and Scotland (n = 46) were analysed using stable isotopes of δ13C and δ15N. Isotopic mixing models were applied to obtain a quantitative estimate of the proportion of the main prey species in the diet of pilot whales. Stable isotope analysis revealed that 57.8–73.8% of the diet in Northwest Iberia consisted in curled octopus (Eledone cirrhosa), followed by European flying squid (Todarodes sagittatus), while in Scotland the predominant prey species was either Histioteuthis sp. or T. sagittatus, depending of the trophic enrichment factor applied. These results are generally in accordance with previous stomach content studies; however, the isotopic analysis may provide new information regarding key prey species and habitat use that could be missed or underestimated if only stomach contents analysis were used. Additionally, considering that the Atlantic Coast of Iberia was responsible for 95% of the landings of the main prey consumed by pilot whales in this area, between 2000 and 2010, these data provide trophic baseline information to be taken into account in fishery impact assessment studies and management decisions.

Purpose: To evaluate the anatomical and functional results of patients who underwent pars plana vitrectomy for perforating eye injuries as well as to analyze the benefit of the chorioretinectomy procedure. Methods: Retrospective and descriptive study of 24 eyes of 22 patients with perforating eye injuries operated on at the Centro Hospitalar do Porto between January 2006 and December 2012. Results: An early vitrectomy was accomplished in 67% of the eyes and a delayed vitrectomy in 33% of the eyes. A concomitant chorioretinectomy was carried out in 78%. Final proliferative vitreoretinopathy (PVR) was found in 11%. The anatomical success was 83%. At the final follow-up, 78% had best-corrected visual acuity equal to or superior to 5/200. Of the eyes that underwent early vitrectomy, 58% regained a visual acuity of 40/200 or better, versus 17% of the cases that underwent delayed vitrectomy. Conclusion: Early vitrectomy with prophylactic chorioretinectomy seems to be an effective approach to prevent PVR and improve the visual outcome and globe survival in perforating injuries.

Competition with fisheries and incidental capture in fishing gear are the major current threats for seabirds at sea. Fishing is a traditional activity in Portugal and is mainly composed of a great number of small vessels. Given the lack of knowledge on effects of the Portuguese fishing fleet on seabird populations, bycatch was assessed in mainland coastal waters for 2010–2012. Interviews and on-board data were divided into 5 strata, according to fishing gear: Bottom trawling, Bottom longline, Purse seine, Beach seine, Polyvalent ( ≥ 12 m) and Polyvalent ( 12 m). Polyvalent included Setnets, Traps and Demersal longlines. Overall, 68 birds were recorded to be bycaught. The average catch per unit effort (CPUE) was 0.05 birds per fishing event. Polyvalent ( 12 m), Polyvalent ( ≥ 12 m) and Purse seiners had the biggest seabird bycatch rates, with 0.5 (CPUE=0.1), 0.11 (CPUE=0.05) and 0.2 (CPUE=0.11) birds per trip, respectively. Within Polyvalent gear, Setnets captured the largest diversity of seabird species (CPUE=0.06), while Demersal longline had the highest CPUE (0.86). Northern gannet was the most common bycaught species. Although more observation effort is required, our results suggest that substantial numbers of Balearic shearwater might be bycaught annually, mainly in Purse seine and Setnets.

Introduction and objectives Hyperglycemia at admission seems to identify a subgroup of patients with acute coronary syndromes with poorer outcome. The aim of this study was to evaluate the impact of the glycemic variation during hospitalization in long-term mortality in nondiabetic patients. Methods Retrospective study of 2043 consecutive patients without known diabetes mellitus admitted for acute coronary syndrome in a single coronary care unit from May 2007 through August 2013. The population was divided in quartiles regarding glycemia at admission (≤ 90 mg/dL, n = 374; 90-140 mg/dL, n = 1307; 141-180 mg/dL, n = 230; ≥ 181 mg/dL, n = 111) and the mortality rate quantified for patients with glycemic variation above/below the mean for their respective quartile. The median follow-up was about 1200 days. Results The all-cause mortality during follow-up was significantly and successively higher in the upper quartiles (9.1%, 9.7%, 13.5% and 18.9%; P = .007). Multivariate regression analysis showed that hyperglycemia at admission (≥ 181 mg/dL) was a strong independent predictor of mortality during follow-up (hazard ratio = 1.74; 95% confidence interval, 1.07-2.8; P = .027). In the fourth quartile (≥ 181 mg/dL), the mortality is higher in patients with higher variations of glycemia (37.5% vs 8.5%; P Conclusions Hyperglycemia at admission is a predictor of all-cause mortality in our population. The mortality is higher in patients with higher glycemic variations. More studies are needed to confirm these data.

Resumen Introduccion y objetivos La hiperglucemia al ingreso parece identificar a un subgrupo de pacientes con sindromes coronarios agudos que muestran una peor evolucion clinica. El objetivo de este estudio es evaluar la influencia de la variacion de la glucemia durante la hospitalizacion en la mortalidad a largo plazo de los pacientes no diabeticos. Metodos Estudio retrospectivo de 2.043 pacientes consecutivos sin diabetes mellitus conocida que ingresaron por un sindrome coronario agudo en una misma unidad coronaria entre mayo de 2007 y agosto de 2013. La poblacion se dividio en cuartiles en funcion de los valores de glucemia al ingreso (≤ 90 mg/dl, n = 374; 90-140 mg/dl, n = 1.307; 141-180 mg/dl, n = 230; ≥ 181 mg/dl, n = 111) y se determino la tasa de mortalidad de los pacientes con variaciones de la glucemia por encima o por debajo de la media de su respectivo cuartil. La mediana de seguimiento fue de aproximadamente 1.200 dias. Resultados La mortalidad por cualquier causa durante el seguimiento fue sucesiva y significativamente mayor en los cuartiles superiores (el 9,1, el 9,7, el 13,5 y el 18,9%; p = 0,007). El analisis de regresion multivariable puso de manifiesto que la hiperglucemia al ingreso (≥ 181 mg/dl) es un potente factor independiente predictivo de la mortalidad durante el seguimiento (hazard ratio = 1,74; intervalo de confianza del 95%, 1,07-2,8; p = 0,027). En el cuarto cuartil (≥ 181 mg/dl), la mortalidad fue superior entre los pacientes con mayores variaciones de la glucemia (el 37,5 frente al 8,5%; p Conclusiones La hiperglucemia al ingreso es un factor predictivo de la mortalidad por cualquier causa en nuestra poblacion. La mortalidad es mas elevada entre los pacientes con mayores variaciones de la glucemia. Se necesitan mas estudios para confirmar estos datos.

The Balearic shearwater Puffinus mauretanicus is one of the most threatened seabirds in the world. To evaluate the abundance and distribution of Balearic Shearwaters in Portuguese Continental Shelf Waters, during the post-breeding period when migrating birds are outside the Mediterranean Sea, we conducted 5 aerial surveys between 2010 and 2014 (21 survey days covering 62,716 km2). Following a line transect method, observers recorded a total of 181 Balearic Shearwaters sightings. Using Distance sampling software, we estimated an overall species abundance (2010–2014) of 10,182, ranging between 2338 in 2010 and 23,221 individuals in 2012. During the 2012 post-breeding period, the Portuguese Continental Shelf Waters were used by up to 96.8% of the latest migratory population assessment. Considering Balearic Shearwater estimates per sampling block, there was a preference for the North and Center sectors of the Portuguese coast (respectively, 7058 and 1366 individuals) where several SPAs were already designated. We computed the annual and overall habitat predictive models for Balearic Shearwaters using a maximum entropy algorithm on MaxEnt software. In all models, the Balearic shearwater distribution was best predicted by mean chlorophyll concentration. Balearic Shearwaters are mostly present in shallow shelf and coastal waters particularly in the widest portions of the continental shelf. These areas are strongly influenced by upwelling, which concurs with the chlorophyll concentration being the most important predicting variable. Portuguese Continental Shelf Waters are one of the most important post-breeding grounds to the Balearic Shearwater, Portuguese Wildlife Society and projects SafeSea EEA-Grants, FAME (Proj. 2009-1/089) and European Commission’s Life Programme (MarPro NAT/PT/00038). This study was also partly supported by the Portuguese Foundation for Science and Technology (FCT) with Grants SFRH/ BD/30240/2006 to M. Ferreira and SFRH/BD/32841/2006 to P. C. Rodrigues. C. Eira is supported by FCT through CESAM UID/AMB/50017/2013 co-funded by FCT/MEC and FEDER, within PT2020 and Compete 2020 and S. Monteiro is financed by a Grant (BPD/0043/AMB/50017) from UID/AMB/50017/2013. This work was also partially supported by the strategic programme UID/BIA/04050/2013 (POCI-01-0145-FEDER-007569) funded by FCT and by ERDF (COMPETE2020). The authors thank observers and airplane pilots who contributed to this work, info:eu-repo/semantics/publishedVersion

Pollution is among the most significant threats that endanger sea turtles worldwide. Waters off the Portuguese mainland are acknowledged as important feeding grounds for juvenile loggerheads. However, there is no data on trace element concentrations in marine turtles occurring in these waters. We present the first assessment of trace element concentrations in loggerhead turtles (Caretta caretta) occurring off the coast of mainland Portugal. Also, we compare our results with those from other areas and discuss parameters that may affect element concentrations. Trace element concentrations (As, Cd, Cu, Pb, Mn, Hg, Ni, Se, Zn) were determined in kidney, liver and muscle samples from 38 loggerheads stranded between 2011 and 2013. As was the only element with higher concentrations in muscle (14.78 μg g-1ww) than in liver or kidney. Considering non-essential elements, Cd presented the highest concentrations in kidney (34.67 μg g-1) and liver (5.03 μg g-1). Only a weak positive link was found between renal Cd and turtle size. Inter-elemental correlations were observed in both liver and kidney tissues. Hepatic Hg values (0.30 ± 0.03 μg g-1) were higher than values reported in loggerheads in the Canary Islands but lower than in Mediterranean loggerheads. Cd concentrations in the present study were only exceeded by values found in turtles from the Pacific. Although many endogenous and exogenous parameters related with complex life cycle changes and wide geographic range may influence trace element accumulation, the concentrations of Cd are probably related to the importance of crustaceans in loggerhead diet in the Portuguese coast., Sociedade Portuguesa de Vida Selvagem for their assistance with data and sample collection and the staff at the Centres Científics i Tècnics of the Universitat de Barcelona. The authors also thank the Oceanário de Lisboa for their support. LN, MF and AM were supported by the Portuguese Foundation for Science and Technology (FCT) grants (SFRH/BD/51416/2011, SFRH/BD/30240/2006, SFRH/BPD/64889/2009, respectively). Also, LN, SM and CE were supported by CESAMUID/AMB/50017/2013 (FCT) co-funded by FCT/MEC and FEDER, within PT2020 and Compete 2020. Sample collection was partially supported by Project LIFE MarPro (Life09 NAT/PT/000038) co-funded by the European Commission and Project CetSenti RECI/AAG-GLO/0470/2012 (FCOMP-01-0124-FEDER- 027472), FCT/MCTES (PIDDAC) and FEDER - COMPETE (POFC), info:eu-repo/semantics/publishedVersion

ACKNOWLEDGEMENTS We wish to express our gratitude to all Galician and Portuguese fishers that took part in the survey for sharing their time and information with us. We would also like to acknowledge the support of the Galician Council for Rural and Marine Affairs (Conselleria do Medio Rural e do Mar, Xunta de Galicia), namely the cooperation of the fisheries´ observers (Luis Perez Miser, Francisco Jose Lopez, Juan Chapela Portela, Felix Barreiro, Candido Aguiar Couto, Jose Maria Garcia Rozamontes, Jose Manuel Garrido Vispo, Jose Manuel Perez Veres, Javier Garcia Romero, Juan Gonzalez Perez), the coordinators (Ricardo Arnaiz Ibarrondo, Francisco Filgueira Rodriguez) and the staff (Manuel Garcia Tasende, Jorge Ribo Landin, Jose Manuel Campelos Alvarez) of the Technical Unit for Inshore Fisheries. Furthermore, we would like to thank Baltasar Patino and Gersom Costas for provision of background information and logistical support, and Juan Santos and Edward Morgan, for assisting with the interviewing. Interviews in Galicia were carried out in the framework of the project ECOSUMMER (ECOsystem approach to Sustainable Managament of the Marine Environment and its living Resource) with EU funding (projects MEXC-CT-2006-042337 and MEST-CT-2005-020501). The interview survey in Portugal was conducted under the SafeSea Project (Sustainable local fisheries and promotion of a safe sea for cetaceans) and supported by the EEA Grants programme (EEA Financial Mechanism 2004-2009). SG was also funded by the German Academic Exchange Service (DAAD) and the Fundacao para a Ciencia e a Tecnologia (FCT). MBS participation was part of the EU FP7 grant MYFISH (no. 289257) and the LOTOFPEL project (Plan Nacional de I + D + I, CTM 2010-16053). The Whalewatch Project was financed by the Xunta de Galicia (programme PEME I+D e I+D SUMA).

Purpose: The aim of this paper was to report the outcomes of prophylactic chorioretinectomy in open-globe injuries where a foreign body penetrated the choroid or perforated the globe. Methods: We conducted a retrospective, consecutive, noncomparative, and descriptive study of patients registered in the ocular trauma database between January 2006 and December 2014, who underwent vitrectomy with chorioretinectomy. Results: Thirty-six patients (33 male, 3 female) with a mean age of 40 years and a median of follow-up of 13 months were included. Twenty-one cases had penetrating globe injuries with an intraocular foreign body and 15 cases had perforating globe injuries. A concomitant chorioretinectomy was performed in all eyes, although it was only partial in 8 eyes. At the end of follow-up, proliferative vitreoretinopathy (PVR) rates were 6.5%, anatomical success was 80.6%, and the globe survival rate was 96.8%. Conclusion: Prophylactic chorioretinectomy is a surgical procedure that may decrease posttraumatic PVR, thus improving final visual acuity and increasing globe survival rates.

© The Author(s), 2019. Article reuse guidelines: sagepub.com/journalspermissions, Background: A new approach to address focal vitreomacular adhesion in patients with diabetic macular edema may control and stabilize diabetic macular edema with fewer antivascular endothelial growth factor injections. Objectives: The aim of this study was to demonstrate that diabetic macular edema can be improved by inducing the release of a vitreomacular adhesion, with less than 2500μm, with enzymatic vitreolysis. Methods: From a retrospective analysis of clinical records from patients with diabetic retinopathy, patients with diabetic macular edema and vitreomacular adhesion

Resumo: A diabetes mellitus tipo 2 é actualmente reconhecida como um importante factor de risco de morbilidade e mortalidade cardiovascular, particularmente em doentes admitidos com síndromes coronárias agudas (SCA). Apesar dos recentes avanços do diagnóstico, estratificação de risco e tratamento destas entidades clínicas, a sua associação no mesmo doente continua a representar um prognóstico sombrio. O objectivo deste artigo é sistematizar a caracterização e abordagem da diabetes no contexto das SCA, em termos de diagnóstico, estratificação de risco e prognóstico a curto e longo prazo, visando desta forma contribuir para a disseminação das boas práticas clínicas na abordagem da diabetes no âmbito das SCA.A diabetes é importante factor de risco cardiovascular, sendo os diabéticos uma relevante população no contexto das SCA. Estratégias como a revascularização precoce e completa, o recurso à insulinoterapia intensiva aguda, à realização sistemática de PTGO em doentes sem diagnóstico prévio de diabetes e um enfoque particular na identificação e mitigação de comorbilidades e factores de risco, complementados por uma terapêutica antidiabética, antitrombótica e anti-isquémica optimizadas e o recurso frequente à reabilitação cardíaca e à promoção multidisciplinar da compliance terapêutica e de estilos de vida saudáveis são traves mestras de uma estratégia bem sucedida para a optimização do prognóstico das SCA no contexto de diabetes. Abstract: Type 2 diabetes is currently recognized as an important risk factor for cardiovascular morbidity and mortality, particularly in patients admitted with acute coronary syndromes (ACS). The aim of this paper is to characterize, in a sistematic way, how to approach diabetes and ACS, regarding prognosis, risk stratification and short and long-term prognosis, therefore contributing to improve good clinical practices regarding diabetes and ACS.Diabetes is an important crdiovascular risk factor, being diabetics an inportant ACS subpopulation. A comprehensive diabetes and ACS management, including early and complete revascularization, sistematic OGTT peformance in patients lacking a previous diagnosis of diabetes and a particular focus on identifying and decreasing comorbidities and risk factors, as well as in optimizing antidiabetic, antithrombotic and anti-ischemic medication, using cardiac rehabilitation and the multidisciplinary promotion of therapeutic compliance and healthy lifestyles are key factors in a successful strategy to optimize prognosis of ACS in diabetics. Palavras-chave: Síndromes coronárias agudas, Diabetes mellitus, Diagnóstico, Prognóstico, Keywords: Acute coronary syndromes, Diabetes, Diagnosis, Outcome

Hereditary transthyretin (TTR)V30M-associated amyloidosis is an autosomal dominant inherited disorder caused by an amino acid substitution of methionine for valine at position 30 of TTR, a transpor...

Natural risks have attracted much interest, not only within the academic community but also within the government policies of land management, all over the world. Some manifestations of natural hazards correspond to major disasters, which has greatly contributed to highlight the need to study the distribution of dangerous phenomena and the vulnerability of populations, in order to achieve more effective management of the territories. Cape Verde, in the history of its existence, has been suffering the adverse effects of risk events, especially crises of drought, with different intensities over time. In fact, the Cape Verde archipelago was affected by a wide variety of natural hazards, many of them being due to its geographical position and its climatic conditions, with strong irregularity in rainfall. Not only the risk of drought are intrinsic to this position, but also other climatic risks such as desertification, accelerated soil erosion, flash floods, mass movements and storms, with a very damaging impact on the population.Along with this high intrinsic hazard, there is a significant increase of vulnerability, particularly in the expanding urban areas, what drives an increased risk in the territory of Cape Verde.The population of major cities, especially of the capital (Praia) experienced a very rapid growth in recent years. This growth has been fueled by both internal migration (rural exodus and migration from other islands) and external, from neighboring countries in West Africa. This rapid population growth in the capital has not been accompanied by political and /or housing programs which can provide an effective response to demand. Consequence is the proliferation of spontaneous neighborhoods in the suburbs of the capital, where the buildings appear overnight, without obeying any kind of planning and not endowed with infrastructure.These quarters of illegal and spontaneous occupation, located mostly in areas of high risk (especially in riverbeds and steep slopes), are occupied mainly by a population of very low income. In this work, we intend to present some case studies, such as the quarters of Santa Rosa, Jamaica and Achada Grande Frente.

Introduction: Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events, particularly in the context of stable heart disease treated by percutaneous coronary intervention. Objective: To stratify medium-term prognosis of an acute coronary syndrome (ACS) population by platelet aggregation. Methods: We performed a prospective longitudinal study of 70 patients admitted for an ACS between May and August 2009. Platelet function was assessed by ADP-induced platelet aggregation using a commercially available kit (Multiplate® analyzer) at discharge. The primary endpoint was a combined outcome of mortality, non-fatal myocardial infarction, or unstable angina, with a median follow-up of 136.0 (79.0–188.0) days. Results: The median value of platelet aggregation was 16.0 U (11.0–22.5 U) with a maximum of 41.0 U and a minimum of 4.0 U (normal value according to the manufacturer: 53–122 U). After ROC curve analysis with respect to the combined endpoint (AUC 0.72), we concluded that a value of 18.5 U conferred a sensitivity of 75.0% and a specificity of 68% to that result. We therefore created two groups based on that level: group A – platelet aggregation

Background: Clopidogrel requires oxidation dependent on the cytochrome P450 enzyme 2C19 (CYP2C19) to form its active metabolite. The importance of loss-of-function alleles (particularly CYP2C19*2, 681G>A) in poor platelet response to clopidogrel is well recognized. Objective: To investigate the prevalence and prognostic impact of the CYP2C19*2 allele in a local acute coronary syndrome (ACS) population. Methods: We performed a prospective, longitudinal study of 95 patients admitted for an ACS between March and October 2009 to a single coronary care unit. Patients aged under 75 who survived hospital stay and for whom clopidogrel was prescribed were included. At discharge, CYP2C19 was genotyped using a commercially available kit. Patients were divided into two groups: Group A (non-carriers, normal metabolizers, CYP2C19*1/*1), n = 69; and Group B (carriers, slow metabolizers, CYP2C19*2/*1 or *2/*2), n = 26. The primary endpoint was a combined outcome of cardiovascular death, non-fatal myocardial infarction or re-admission for unstable angina; median follow-up was 136.0 (79.0–188.0) days. Results: The median age of the population was 62.0 (51.0–68.0) years, and 83.2% were male. The CYP2C19*2 (A) allele had a frequency of 14.2%. There were no differences between the groups with respect to demographic data or history of cardiovascular disease. Coronary anatomy, left ventricular ejection fraction and renal function were also similar. The groups were also homogenous with respect to GRACE risk score (118.0 (95.0–136.5) vs. 115.0 (96.0–133.0), p = 0.68), medical treatment and percutaneous revascularization during hospital stay. Event-free survival was higher for Group A (94.0% vs. 75.0%, log-rank p = 0.010). Three readmissions for MI were documented, all in the slow metabolizers group. Conclusion: In our ACS population, the CYP2C19*2 allele was a medium-term prognostic marker. Resumo: Introdução: Polimorfismos no complexo enzimático P450, como CYP2C19*2, 681G>A parecem estar na base de fraca resposta ao clopidogrel. Objectivo: Caracterizar a prevalência e o impacto prognóstico do alelo CYP2C19*2(A) numa população local de doentes com síndrome coronária aguda (SCA). População e métodos: Estudo longitudinal, prospectivo, de 95 doentes admitidos por SCA entre Março e Outubro de 2009. Foram incluídos doentes com idade inferior a 75 anos, que sobreviveram à hospitalização, e que tiveram alta medicados com clopidogrel. Foi determinado o genótipo do alelo CYP2C19 no momento da alta hospitalar. Foram criados dois grupos; grupo A (metabolizadores normais, CYP2C19 *1/*1) n = 69 e grupo B (metabolizadores lentos, CYP2C19 *2/*1 ou *2/*2) n = 26. No seguimento foi analisado um resultado combinado de morte cardiovascular, enfarte agudo do miocárdio não fatal, e readmissão por angina instável (tempo mediano de seguimento: 136 (79–188) dias. Resultados: A idade mediana da população era de 62,0 (51,0–68,0) anos, e 83,2% eram do género masculino. O alelo CYP2C19*2(A) teve uma frequência de 14,2%. Não existiram diferenças entres os grupos relativamente a dados demográficos, e antecedentes cardiovasculares. A anatomia coronária, a fracção de ejecção ventricular esquerda e a função renal eram semelhantes. Os grupos eram também homogéneos relativamente ao score GRACE (118,0 (95,0–136,5) versus 115,0 (96,0–133,0), p = 0,68), tratamento médico e taxa de revascularização percutânea durante hospitalização. No final do seguimento clínico a sobrevida livre de eventos foi superior para o grupo A (94,0% versus 75,0%, log rank p = 0,010). Foram documentadas três readmissões por enfarte agudo do miocárdio, todas no grupo B. Conclusões: Na população referida, o alelo CYP2C19*2 (A) foi um marcador de prognóstico a médio prazo. Keywords: CYP2C19*2, Clopidogrel, Acute coronary syndromes, Prognosis, Palavras-chave: CYP2C19*2, Clopidogrel, Síndrome coronária aguda, Prognóstico

Resumo: Introdução: Permanecem dúvidas sobre o impacto prognóstico a longo prazo da pressão telediastólica do ventrículo esquerdo (PTDVE) no contexto de uma síndrome coronária aguda (SCA). Objectivo: Caracterizar a PTDVE e o seu impacto prognóstico numa população de doentes com SCA e fracção de ejecção ventricular esquerda (FEVE) ≥ a 40%. População e métodos: Estudo prospectivo, longitudinal e contínuo de 1329 doentes admitidos (n = 489) numa unidade de cuidados intensivos coronários entre 2004 e 2006. Foram seleccionados os doentes submetidos a uma estratégia invasiva, no qual foi determinada a PTDVE, com FEVE ≥ 40%. A população foi divida em três grupos: A — PTDVE ≤ 19 mmHg (n = 186); grupo B — PTDVE > 19 ≤ 27 mmHg (n = 172) e; grupo C — PTDVE > 27 mmHg (n = 131). O resultado primário desta análise foi a readmissão por insuficiência cardíaca congestiva (ICC) no ano seguinte à SCA. Resultados: A PTDVE média da população foi de 22,8 mmHg ± 7,8 mmHg. Os grupos eram homogéneos entre si no que disse respeito ao género, idade, factores de risco cardiovascular, história cardiovascular e medicação prévia à admissão. Quanto maior a PTDVE maior a probabilidade de uma admissão por enfarte agudo do miocárdio com supradesnivelamento do segmento ST (35,4 versus 45,9 versus 56,7%, p 40% were excluded (n = 489). The population was divided into three groups: A — LVEDP ≤19 mmHg (n = 186); B — LVEDP >19 and ≤27 mmHg (n = 172); and C — LVEDP >27 mmHg (n = 131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission. Results: Mean LVEDP was 22.8 ± 7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p

Introduction: There is still debate concerning the impact of left ventricular end-diastolic pressure (LVEDP) on long-term prognosis after an acute coronary syndrome (ACS). Objective: To assess LVEDP and its prognostic implications in ACS patients with left ventricular ejection fraction (LVEF) ≥40%. Methods: We performed a prospective, longitudinal study of 1329 ACS patients from a single center between 2004 and 2006. LVEDP was assessed at the beginning of the coronary angiogram. Patients with LVEF >40% were included (n = 489). The population was divided into three groups: A — LVEDP ≤19 mmHg (n = 186); B — LVEDP >19 and ≤27 mmHg (n = 172); and C — LVEDP >27 mmHg (n = 131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission. Results: Mean LVEDP was 22.8 ± 7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p 19 ≤ 27 mmHg (n = 172) e ; grupo C — PTDVE > 27 mmHg (n = 131). O resultado primário desta análise foi a readmissão por insuficiência cardíaca congestiva (ICC) no ano seguinte à SCA. Resultados: A PTDVE média da população foi de 22,8 mmHg ± 7,8 mmHg. Os grupos eram homogéneos entre si no que disse respeito ao género, idade, factores de risco cardiovascular, história cardiovascular e medicação prévia à admissão. Quanto maior a PTDVE maior a probabilidade de uma admissão por enfarte agudo do miocárdio com supradesnivelamento do segmento ST (35,4 versus 45,9 versus 56,7 %, p

Introduccion y objetivos. El pronostico y el tratamiento en el hospital de los pacientes con sindrome coronario agudo (SCA) y antecedentes de cirugia de bypass coronario (CABG) es motivo de controversia. El objetivo de este estudio es caracterizar a los pacientes con SCA que tienen antecedentes de CABG y comparar su evolucion intrahospitalaria y extrahospitalaria con la de los pacientes sin antecedentes de CABG. Metodos. Estudio prospectivo observacional continuo de 1.495 ingresos consecutivos por SCA en una misma unidad coronaria, con un seguimiento medio de 19 meses. Se dividio a los pacientes en dos grupos: grupo A (n = 73) con CABG previa y grupo B (n = 1.223) sin CABG previa. Resultados. Los pacientes del grupo A eran con mayor frecuencia varones (el 86,3 frente al 69,1%; p = 0,002), tenian antecedentes mas frecuentes de diabetes mellitus, infarto de miocardio previo e insuficiencia cardiaca. Los pacientes del grupo B tenian mas infartos agudos de miocardio con elevacion del ST, una fraccion de eyeccion mas alta (53% [47%-60%] frente a 50% [42%-55%]; p < 0,01) y valores superiores de concentracion maxima de troponina I. No se observaron diferencias en cuanto al uso de una estrategia invasiva. Por lo que respecta a la medicacion, los pacientes del grupo B tenian una mayor probabilidad de recibir doble tratamiento antiagregante al alta. No se observaron diferencias significativas en cuanto a la mortalidad hospitalaria (el 9,5 frente al 5,9%; p = 0,2) ni en la mortalidad a 1 mes, 6 meses o 1 ano (el 9,8 frente al 9,1%; log-rank test, p = 0,87), y la ausencia acumulativa de eventos adversos cardiovasculares mayores fue tambien similar en ambos grupos. Los antecedentes de CABG se asociaron a una mayor frecuencia de reingresos por angina inestable (el 11,3 frente al 3,1%; p < 0,01). Conclusiones. En nuestra poblacion con SCA, el antecedente de CABG no influyo de manera significativa en la evolucion a corto y medio plazo en cuanto a la mortalidad por cualquier causa o eventos adversos cardiovasculares mayores.

Introduccion y objetivos Evaluar la relacion entre la magnitud de la variacion de la glucemia durante la hospitalizacion y la mortalidad hospitalaria y a largo plazo y otras variables de valoracion posteriores al alta, en dos poblaciones con sindrome coronario agudo: pacientes con o sin diagnostico previo de diabetes. Metodos Estudiamos a 1.210 pacientes ingresados por sindrome coronario agudo entre mayo de 2004 y julio de 2007. Dividimos la poblacion en dos subgrupos: pacientes con un diagnostico previo de diabetes (n = 386) y pacientes no diabeticos (n = 824). Cada una de estas subpoblaciones se dividio en cuatro grupos, segun los cuartiles de variacion de la glucemia: diabeticos (Q1 Resultados En los pacientes diabeticos no hubo relacion alguna entre la magnitud de variacion de la glucemia y las variables de valoracion intrahospitalarias y posteriores al alta. En los no diabeticos, no se observaron diferencias significativas en cuanto a la morbimortalidad hospitalaria, pero si hubo diferencias estadisticamente significativas en el seguimiento clinico. Tras un analisis de regresion multiple, el cuartil Q4 frente al Q1, la edad ≥ 70 anos y los antecedentes previos de tratamiento con antiagregantes plaquetarios o con inhibidores de la enzima de conversion de angiotensina fueron factores predictivos independientes para las variables de valoracion posteriores al alta en el grupo no diabetico. Conclusiones En los pacientes con sindrome coronario agudo no diabeticos, la magnitud de variacion de la glucemia durante la hospitalizacion es un factor predictivo independiente y potente de las variables de valoracion posteriores al alta.

Ventricular dysfunction in acute coronary syndrome (ACS) patients is a recognized predictor of in-hospital and post-discharge morbidity and mortality. Recently, hyperglycemia at admission has been considered as an important marker of poor in-hospital prognosis.To characterize an ACS population and to identify independent predictors of one-year mortality.This study included 1179 consecutive patients admitted to a single coronary care unit for acute coronary syndrome between May 2004 and December 2006. Patients were followed up for 12 months after ACS.In our population, 70.9% of patients were male, with a mean age of 66.6+/-12.5 years; 15.7% were admitted by unstable angina, 44.7% by non-ST elevation myocardial infarction and 38.5% by ST elevation myocardial infarction; 16% of patients had left ventricular systolic dysfunction during the index admission. In-hospital mortality was 3.5% and complications occurred in 5.6% of patients. Mortality rate at 1-year of follow-up was 8.8% and rehospitalization rate for heart failure was 5.5%. After multivariate regression analysis, left ventricular systolic dysfunction [odds ratio (OR): 3.58; confidence interval (CI): 1.57-8.16], glycemia at admission137 mg/dl (OR: 3.58; CI: 1.52-8.47) and age65 years (OR: 2.67; CI: 1.08-6.59) were independent predictors of 1-year mortality.In this population, hyperglycemia at admission was an independent predictor of 1-year mortality, with a predictive value equivalent to that of left ventricular systolic dysfunction. This fact, never before described, emphasizes the importance of metabolic abnormalities and their control in the prognosis of ACS patients.

An 80-year old woman was admitted to the emergency room due to severe dyspnea. She had no known history of cardiovascular disease, but in last month she complained to increasing fatigue and shortness of breath. Physical examination was notable for diffuse lungs crackles. The heart sounds were normal and no murmur could be heard. The 12-lead electrocardiogram demonstrated sinus rhythm with non-specific ST-segment changes. The chest radiograph showed congested lung and there was also a round shadow behind the heart (figure 1-A). The patient was admitted to Cardiology department for further investigation. Figure 1 A) The chest radiography showed congested lung and a round shadow behind the heart; B) Transthoracic echocardiography showing echolucent mass severely compressing the left atrium; C) Spiral computed tomography of thorax showed a large hiatus hernia with ... In the next day, a two-dimension transthoracic echocardiography was performed and showed normal left ventricular function, no valvular disease, but the left atrium was severely compressed by an extrinsic amorphous, echolucent mass (Figure 1-B). Spiral computed tomography of thorax showed a large hiatus hernia with intrathoracic extension (Figure 1-C). The hernia was located behind the left atrium causing anterior shift of the heart. The intrathoracic migration of a large part of the stomach was confirmed by upper gastrointestinal barium examination, which was performed after consulting a surgeon, to further assess the extent of the hernia and the potential need for surgical treatment. In the first few months, the patient was successfully treated with conservative measures, but the symptoms returned and she was admitted again with acute pulmonary edema. One week later, the corrective surgery was performed and the patient had no further recurrence of acute pulmonary edema in the subsequent 6 months. In the light of these knowledges, FFR might be a useful tool to evaluate moderate coronary lesions with regard to revascularization appropriateness.

Problem Statement: Depression is a serious health problem among adolescents, which may be associated with poor psychosocial functioning. Maltreatment is a risk factor for the development of depression in adolescence.Research Questions: The relationship between maltreatment and psychosocial functioning and the role that psychosocial functioning has in the relation between maltreatment and depressive symptomatology are underexplored in the literature.Purpose of the Study: The aims of this study are to explore the moderating effect of psychosocial functioning in the relationship between maltreatment experience and depressive symptomatology, and their relation to socio-demographic variables. The sample consists of 170 adolescents (between 14-17 years, mostly female).Research Methods: Two self-report questionnaires were used: the Childhood Trauma Questionnaire (Bernstein, Fink, 2004 Pereira Matos, 2011) to evaluate the maltreatment experience and the Children’s Depression Inventory (Kovacs, 1992 Marujo, 1994) to measure the level of depression. To assess the psychosocial functioning of adolescents was applied the Adolescent Longitudinal Interval Follow-Up Evaluation (Matos Costa, 2011).Findings: As expected the maltreatment experience was associated with depressive symptomatology. Emotional abuse and neglect were the best predictors of depressive symptoms.Conclusions: These results emphasize the impact that maltreatment experiences can have on the development of depression among adolescents. This risk factor, mainly its emotional dimension, is an important variable to consider in the development of prevention and treatment programs for depression.

Problem Statement: Depression in adolescence has a lasting, devastating nature, and affects different areas of functioning, resulting in significant psychosocial limitations. Poor interpersonal relations have been increasingly associated with depressive symptoms.Research Questions: Negative familial interactions are a vulnerability factor to depression but more research is needed to identify dimensions of parent-child relationships that are relevant to the development of depressive symptomatology.Purpose of the Study: This study aimed to test the moderating effect of psychosocial functioning in the relationship between the quality of interpersonal relationships and depressive symptoms.Research Methods: The sample consisted of 170 adolescents, with 13-17 years. The following instruments were used: CDI, (Kovacs, 1985 Marujo, 1994), QRI - Quality of Relationships Inventory, Pierce, Sarason Sarason, 1991 Neves Pinheiro 2006). To evaluate adolescent psychosocial functioning was used the semi-structured interview Adolescent-Longitudinal Interval Follow-up (Keller et al., 1993 Portuguese version: Matos Costa, 2011).Findings: A relationship was found between poor interpersonal relationships and depressive symptomatology. The dimensions of support and depth in the relationships with mother and father were protective factors against the development of depression in adolescence. The conflict dimension was associated with higher levels of depressive symptoms.Conclusions: The present results suggest that the implementation of intervention programs designed to improve the quality of familial relationships will be beneficial to adolescents’ psychosocial functioning and to the prevention of the onset of depressive symptoms.

Both the conservation status of bottlenose dolphins (Tursiops truncatus) (Habitats Directive 92/43/CEE, Annex II) and the Marine Strategy Framework Directive demand for data on their ecology and anthropogenic threats. To evaluate the bottlenose dolphin's toxicological status in continental Portugal, several trace elements (As, Cd, Cu, Hg, Mn, Ni, Pb, Se, Zn) were determined in 25 stranded individuals. The potential effect of sex, body length and stranding location on trace element concentrations was analysed. In the present study, bottlenose dolphins presented high mercury levels, only exceeded by animals from the Mediterranean and Adriatic seas. Only essential elements were influenced by dolphin sex, whereas Cd, Hg and Pb bioaccumulated in larger dolphins, and hepatic Hg and Cd concentrations were higher in the northwest coast of continental Portugal. The location effect may relate to variations in bottlenose diet and trace element availability, according to the proximity to anthropogenic sources in the Atlantic Iberian coast.

Background: Cardiovascular disease (CVD) is the leading cause of death in patients with diabetes. The presence of type 2 diabetes mellitus (T2DM) puts the patients with and without history of myocardial infarction at risk for significant cardiovascular risk. Objective: To evaluate the prognostic impact of the time of duration and metabolic control of T2DM in a population hospitalized for acute coronary syndrome. Methods: Retrospective study of 731 consecutive patients admitted for acute coronary syndrome from May 2007 to August 2013. Patients were stratified into: Group 1 (n=297) with known diabetes mellitus (DM) (prior to hospitalization) and hemoglobin A1c (HbA1c)

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There is little previous information on feeding habits of long-finned pilot whales (Globicephala melas) in the northeast Atlantic. The present study analyzed stomach contents of pilot whales stranded in Portugal (n = 6), Galicia (northwest Spain) (n = 32), and Scotland (United Kingdom) (n = 10), from 1990 to 2011. These animals ranged from 213 to 555 cm in length (24 females, 19 males and 5 of unknown sex). The main prey identified were cephalopods of the families Octopodidae and Ommastrephidae, the former being numerically more important in Iberia (Portugal and Galicia) and the latter more important in Scotland, with Iberian whales also showing a more diverse diet. Multivariate analysis revealed evidence of geographical and seasonal variation in diet. Generalized Additive Modeling results indicated that more octopus (Eledone cirrhosa) were eaten in Iberia than in Scotland, more in the first half of the year, and more in larger whales. Numbers of ommastrephid squids in the stomach decreased over the study period and varied with season and whale length. This study confirms cephalopods as the main prey of pilot whales, as previously reported, although our results also suggest that, in the northeast Atlantic, ommastrephid squid are largely replaced as the main prey by octopods at lower latitudes.

Purpose.To report the treatment outcome of photodynamic therapy with verteporfin (PDT) for exudative retinal detachment (RD) associated with diffuse choroidal hemangioma in Sturge-Weber syndrome (SWS).Methods.An interventional case report of a 10-year-old girl with SWS who developed an exudative RD (visual acuity hand motions) that was treated with PDT. She was treated with a first session of multispot PDT. Posteriorly, a choroidotomy for drainage of subretinal fluid was created, combined with an intravitreal injection of gas (SF6) and cryoapplication. Finally, a second session of PDT was applied.Results.Subretinal fluid resolved over a period of one year and visual acuity increased to 20/125.Conclusions.PDT is an effective therapeutic option for exudative RD associated with diffuse choroidal hemangioma.

Although the proven efficacy of evidence-based therapy in patients with cardiovascular diseases, the recommendations are not always instituted. We aimed to analyse the compliance of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients with treatment guidelines and to assess the impact of these measures in hospital death during the index hospitalization.All consecutive patients (pts) included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between January 1, 2002 and August 31, 2011 were analysed. Compliance with Guidelines for the management of NSTE-ACS was evaluated with a 6-point therapeutic score (ThSc), comprising the treatment with: aspirin, clopidogrel, heparin, beta-blocker, angiotensin-converting enzyme inhibitor and statin. One point was assigned for each drug prescribed and zero if not given. The total therapeutic compliance was defined as ThSc =6 points.The final analysis comprised 14,276 pts (67.1% male; mean age 67.6±12.3 years), most of them admitted with non-ST elevation myocardial infarction (77.4%). The mean value of ThSc was 4.9±1.1 and total compliance occurred in 36.7% pts. Centres with percutaneous coronary intervention (PCI) capacity had a statistically significant higher ThSc (5.0±1.0 vs. 4.8±1.1, P0.001) and were associated with higher total compliance [OR 1.53, 95% confidence intervals (CI), 1.42-1.65, P0.001]. In-hospital mortality was 2.4% (354 deaths). Compared to pts who died, the survivors had a higher ThSc (4.9±1.1 vs. 4.2±1.3, P0.001) and this score was independently associated with lower risk of in-hospital mortality (OR 0.70, 95% CI, 0.64-0.77, P0.001). Receiver operating characteristics curve analysis showed a good accuracy of ThSc for the occurrence of in-hospital mortality with the area under the curve (AUC) 0.82 (95% CI, 0.80-0.84, P0.001), sensitivity 71.6% and specificity 78.0%. Age, peripheral artery disease, Killip-Kimball classI, electrocardiogram (ECG) with ST-segment depression and positive troponin were other independent predictors of in-hospital mortality.In the present study, patients with NSTE-ACS who received medications recommended by guidelines had better in-hospital outcomes. These findings highlight the need to clarify the clinical recommendations and to develop approaches for quality improvement in this subset of patients.

Type 2 diabetes is currently recognized as an important risk factor for cardiovascular morbidity and mortality, particularly in patients admitted with acute coronary syndromes (ACS). The aim of this paper is to characterize, in a systematic way, how to approach diabetes and ACS, regarding prognosis, risk stratification and short and long-term prognosis, therefore contributing to improve good clinical practices regarding diabetes and ACS. Diabetes is an important cardiovascular risk factor, being diabetics an important ACS subpopulation. A comprehensive diabetes and ACS management, including early and complete revascularization, systematic OGTT performance in patients lacking a previous diagnosis of diabetes and a particular focus on identifying and decreasing comorbidities and risk factors, as well as in optimizing antidiabetic, antithrombotic and anti-ischemic medication, using cardiac rehabilitation and the multidisciplinary promotion of therapeutic compliance and healthy lifestyles are key factors in a successful strategy to optimize prognosis of ACS in diabetics.

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FUNDAMENTO: Há falta de dados sobre o impacto prognóstico da pressão diastólica final do ventrículo esquerdo (PDFVE) sobre as síndromes coronarianas agudas (SCA). OBJETIVO: Avaliar a PDFVE e suas implicações prognósticas em pacientes com SCA. MÉTODOS: Estudo prospectivo, longitudinal e contínuo de 1.329 pacientes com SCA de um único centro, realizado entre 2004 e 2006. A função diastólica foi determinada através da PDFVE. A população foi dividida em dois grupos: Grupo A - PDFVE < 26,5 mmHg (n = 449); Grupo B - PDFVE > 26,5 mmHg (n = 226). RESULTADOS: Não houve diferenças significantes entre os grupos em relação aos fatores de risco para doença cardiovascular, histórico médico e terapia médica durante a admissão. Nos pacientes do grupo A, a SCA sem elevação do segmento ST foi mais frequente, bem como angiogramas coronários normais. A mortalidade hospitalar foi similar entre os grupos, mas a sobrevida de um ano foi maior entre os pacientes do grupo A (96,9 vs 91,2%, log rank p = 0,002). Em um modelo multivariado de regressão de Cox, uma PDFVE > 26,5 mmHg (RR 2,45, IC95% 1,05 - 5,74) permaneceu um preditor independente para mortalidade de um ano, quando ajustado para idade, fração de ejeção sistólica do VE, SCA com elevação do segmento ST, pico da troponina, glicemia na admissão hospitalar e diuréticos após 24 horas. Além disso, uma PDFVE > 26,5 mmHg foi um preditor independente de uma futura rehospitalização por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSÃO: Em nossa população selecionada, a PDFVE apresentou uma influência prognóstica significante. BACKGROUND: Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE: To assess LVEDP and its prognostic implications in ACS patients. METHODS: Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP > 26.5 mmHg (n = 226). RESULTS: There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP > 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP > 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION: In our selected population, LVEDP had a significant prognostic influence. FUNDAMENTO: Hay falta de datos sobre el impacto pronóstico de la presión diastólica final del ventrículo izquierdo (PDFVI) sobre los síndromes coronarios agudos (SCA). OBJETIVO: Evaluar la PDFVI y sus implicaciones pronósticas en pacientes con SCA. MÉTODOS: Estudio prospectivo, longitudinal y continuo de 1.329 pacientes con SCA de un único centro, realizado entre 2004 y 2006. La función diastólica fue determinada a través de la PDFVI. La población fue dividida en dos grupos: Grupo A - PDFVI < 26,5 mmHg (n = 449); Grupo B - PDFVI > 26,5 mmHg (n = 226). RESULTADOS: No hubo diferencias significativas entre los grupos en relación a los factores de riesgo para enfermedad cardiovascular, historia médica y terapia médica durante la admisión. En los pacientes del grupo A, la SCA sin elevación del segmento ST fue más frecuente, así como angiogramas coronarios normales. La mortalidad hospitalaria fue similar entre los grupos, pero la sobrevida de un año fue mayor entre los pacientes del grupo A (96,9 vs 91,2%, log rank p = 0,002). En un modelo multivariado de regresión de Cox, una PDFVI > 26,5 mmHg (RR 2,45, IC95% 1,05 -5,74) permaneció un predictor independiente para mortalidad de un año, cuando fue ajustado para edad, fracción de eyección sistólica del VI, SCA con elevación del segmento ST, pico de la troponina, glicemia en la admisión hospitalaria y diuréticos después de 24 horas. Además de eso, una PDFVI > 26,5 mmHg fue un predictor independiente de una futura rehospitalización por IC congestiva (RR 6,65 IC95% 1,74 - 25,5). CONCLUSIÓN: En nuestra población seleccionada, la PDFVI presentó una influencia pronóstica significativa.

People with diabetes are at increased risk for heart failure (HF), major adverse cardiovascular events (MACE) and death following acute coronary syndromes (ACS). It is important to recognize the most powerful predictors of these events after an ACS as early as possible, in order to address them more aggressively. This is particularly important considering that various studies have shown that this population is undertreated in the setting of ACS.To characterize a diabetic population presenting with ACS and to determine independent predictors of HF, MACE and mortality on follow-up.This was a longitudinal, observational, retrospective study including 471 consecutive diabetic patients, both previously known and newly diagnosed, hospitalized for ACS in a single center between May 2004 and December 2006. A mean 12-month follow-up was conducted. Cox regression analysis was used to determine the independent predictors of HF, MACE and mortality on follow-up, divided into different periods--1 month, 6 months and 1 year.Of the overall diabetic population, 67.3% were male and mean age was 69 +/- 11 years. Mean glomerular filtration rate (GFR) was 62 +/- 22 ml/min and mean left ventricular ejection traction (LVEF) was 50%. diagnosis on admission was ST-elevation myocardial infarction (STEMI) in 31.3%, non-ST elevation myocardial infarction (NSTEMI) in 50.1%, unstable angina (UA) in 14.3% and ACS with left bundle branch block or pacemaker in 4.2%. Cardiac catheterization was performed in 55.6% of the patients during the index hospitalization. Mortality during hospitalization and at 1 year was 6.4% and 10.4%, respectively. The one-year MACE rate was 20.4% and hospitalization for HF occurred in 10.1% of the patients. The independent predictors of HF at 1 year were blood glucose on admission184.5 mg/dl, GFR63.8 ml/min, LVEF46.5% and NSTEMI, while predictors of mortality were LVEF40.5% and Killip class on admissionI. Blood glucose on admission130.5 mg/dl and LVEF49.5% were independent predictors of MACE, whereas cardiac catheterization was a protective factor.Following ACS diabetic patients have high rates of mortality, HF and MACE. The low rate of invasive strategy may contribute to this situation. HF during hospitalization, whether by low LVEF or Killip classI, and higher blood glucose on admission were powerful predictors of poorer outcome. Moreover, the use of recommended cardiovascular agents and procedures were protective factors. These findings suggest that diabetic patients should not be excluded from recommended cardiovascular interventions. Efforts should be made to identify these high-risk patients as early as possible in order to manage them carefully and aggressively to improve their poor prognosis.

Age is an important prognostic factor in acute coronary syndromes (ACS). An invasive strategy has been shown to benefit many non-ST elevation ACS populations; however, there is some controversy regarding patients who are more susceptible to procedure-related complications, such as the elderly, an under-represented population in the studies on this subject.We aimed to compare the in-hospital and long-term prognosis of elderly patients with non-ST elevation ACS treated with either invasive procedures or a conservative strategy, and to characterize the patients selected for an early invasive approach.This observational, longitudinal, prospective and continuous study included 307 patients aged over 75 years consecutively admitted for non-ST elevation ACS. They were divided into two groups, according to the approach adopted: Group A (n=91)--patients treated with an early invasive strategy; and Group B (n=216)--patients treated conservatively. The median clinical follow-up was 18 months.The subjects who were treated invasively were younger (79.8 +/- 3.2 vs. 81.4 +/- 3.9 years, p0.001) and more often male (63.7 vs. 50.9%, p = 0.04), had a higher incidence of previous coronary artery disease, were more often treated with clopidogrel, and had a longer hospital stay (5.8 +/- 3.1 vs. 4.9 +/- 2.6 days, p = 0.01). Patients managed conservatively presented higher Killip class, and were more often treated with diuretics during hospitalization. The group treated by an invasive approach presented a higher incidence of in-hospital complications (13.6 vs. 4.9%, p = 0.009), but there were no significant differences in mortality rates. Multivariate analysis showed that an invasive strategy was an independent predictor of in-hospital morbidity (OR = 3.55). In follow-up, rates of MACE (56.3 vs. 33.3%, p = 0.002) and death (32.5 vs. 13.8%, p = 0.007) were higher in the group that received conservative treatment, and an invasive strategy was a protective factor against MACE; the strongest predictor of mortality was left ventricular ejection fraction50%.Although an invasive strategy was associated with increased in-hospital complications, it was shown to confer a better long-term prognosis. These data show that age should not be the only criterion in selecting patients for an invasive strategy and favor early adoption of this approach in the elderly.

Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events.We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFRor = 60 ml/min (group A) and eGFR60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population.Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p0.001, and 76.2 vs. 86.2%, p0.001, respectively). Multivariate analysis showed that eGFR of30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71).We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented.

To evaluate the impact of admission glycaemia on short-term and long-term prognosis in diabetic and non-diabetic patients admitted for acute coronary syndromes (ACS), and to identify the independent predictors of post-ACS mortality in this population.This study included 1149 consecutive patients admitted to a single coronary care unit for ACS between May 2004 and December 2006. Our population was divided into four groups according to the quartiles of glycaemia at admission [Q15.77 mmol/l, Q2 (5.77-7.0) mmol/l, Q3 (7.0-9.22) mmol/l and Q4or =9.22 mmol/l]. Diabetic (n = 396) and non-diabetic (n = 753) subgroups were then separately analysed.Hyperglycaemia at admission was associated with worse cardiovascular risk profile, high levels of necrosis and inflammation biomarkers and low left ventricle ejection fraction. Considering overall population, in-hospital, 30-day and 3-year mortalities were higher in more elevated glycaemia quartiles. In diabetic patients, there were no significant differences in mortality among glycaemia quartiles; however, in non-diabetic group higher admission glucose levels were associated with successively higher in-hospital and 3-year mortalities. After multivariate regression analysis, glycaemia at admissionor =5.77 mmol/l, ageor =72 years, Killip class1 and troponin Ior =6.0 ng/ml were independent predictors of in-hospital mortality.This study suggests that, in a broad ACS population, hyperglycaemia at admission is a short-term and long-term bad prognosis marker, particularly in non-diabetic patients, being a strong independent predictor of in-hospital mortality.

Mestrado Integrado em Medicina Master Degree in Medicine