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3. Streptococcus oralis Meningitis

Author

João Cardoso, David Ferreira, Rui Assis, Joana Monteiro, Inês Coelho, André Real, and Nuno Catorze

Subjects
streptococcus oralis, meningitis, oral hygiene, Medicine
Abstract

Streptococcus oralis is part of the normal flora of the oropharyngeal, nasal, gastrointestinal and genitourinary tracts. Classically, it shows low pathogenicity and virulence, but can very rarely cause meningitis in patients who have undergone dental procedures and have poor oral hygiene. The purpose of this report is to highlight the importance of considering S. oralis as a cause of meningitis in patients with poor oral hygiene. A 53-year-old man was admitted to the emergency department with high fever (39.4°C), headache and drowsiness. His mouth was unhygienic. He was diagnosed with meningitis and empiric antibiotics (ceftriaxone plus ampicillin) and dexamethasone were started. S. oralis was isolated from cerebrospinal fluid. Ampicillin and dexamethasone were stopped, while ceftriaxone was continued with full recovery of the patient.

Published
2021
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4. Envolvimento Gastrointestinal na Esclerose Sistémica

Author

André Real, Lara Adelino, Cristina Lopes, Isabel Almeida, António Marinho, and Carlos Vasconcelos

Subjects
Manifestações gastrointestinais, Envolvimento gastrointestinal, Esclerose Sistémica, Medicine, Internal medicine, RC31-1245
Abstract

Aproximadamente 70 a 90% dos doentes com Esclerose Sistémica apresentam envolvimento gastrointestinal e, em 10% dos casos, este envolvimento constitui a forma de apresentação de Esclerose Sistémica. Todo o trato gastrointestinal pode estar afectado sendo o esófago o órgão mais frequentemente descrito.

Published
2018
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5. Antibioterapia - uma análise retrospectiva de 3 anos

Author

André Real, Inês Coelho, Nuno Lopes, Ana Araújo, Tiago Pereira, Lucilia Pessoa, and Nuno Catorze

Subjects
Antibióticos, Microbiologia, Microorganismos multirresistentes, Medicine, Internal medicine, RC31-1245
Abstract

O ressurgimento de microorganismos multirresistentes resultantes do desadequado uso de antibióticos obrigam a um maior exercício na aplicabilidade de antibióticos face aos múltiplos padrões de resistências. O objetivo do trabalho foi analisar o consumo de antibióticos num hospital distrital, ao longo de 3 anos, e relacioná-lo com a microbiologia local e respectiva variabilidade durante os 3 anos. No período analisado, no Centro Hospitalar Médio Tejo (CHMT), assistiu-se a uma diminuição da utilização da Amoxicilina / Clavulanto contrapondo com o aumento da Piperacilina / Tazobactam, em sentido oposto à utilização de antibióticos na Unidade de Cuidados Intensivos (UCI). Contudo, tanto na UCI como no CHMT, observou-se um aumento dos microorganismos epidemiologicamente importantes face à evidente mudança de hábitos prescritivos.

Published
2017
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6. Whipple´s disease, a rare malabsorption syndrome of late diagnosis

Author

Raquel Batista, André Real, Jorge Nepomuceno, and Maria de Fátima Pimenta

Subjects
Enfermedad de Whipple, Síndrome de malabsorción, Tropheryma whipplei, Medicine, Internal medicine, RC31-1245
Abstract

Whipple´s disease is a rare, chronic bacterial illness with multisystemic involvement, caused by Tropheryma whipplei. Due to it´s multiform presentation and rarity it is often misdiagnosed. The standard method concerning diagnosis is the detection of PAS ( periodic acid- Shiff) positive macrophages in affected tissues.Immunohistochemical staining and PCR ( polymerase chain reaction) increase the sensitivity and specificity of conventional methods. Long term antibiotic therapy provides a favourable outcome in the majority of cases. The autors describe a case of a patient with Whipple´s disease in a progressive stage.

Published
2018
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7. Use of the House-Tree-Person Projective Drawings and Parental Styles Inventory in the Global Psychological Evaluation of Transgender Youth Who Seek Healthcare at the Gender Identity Program

Author

Bianca Machado Borba Soll, Angelo Brandelli Costa, Anna Martha Vaitses Fontanari, Ítala Raymundo Chinazzo, Dhiordan Cardoso da Silva, Karine Schwarz, Maiko Abel Schneider, Cesar Augusto Nunes Bridi Filho, Claudia Garcia de Garcia, André Real, Silza Tramontina, and Maria Inês Rodrigues Lobato

Subjects
psychological evaluation, parental styles, house-tree-person projective drawings, gender incongruence, gender dysphoria, transgender youth, Psychology, BF1-990
Abstract

The present study explores data collected in the psychological evaluation of transgender youth and their families who seek healthcare at the Gender Identity Program. Great psychosocial changes mark the transition from infancy to adulthood. Transgender youth may have these aspects of their developmental stage potentialized. A study was conducted with 23 transgender youth (mean age = 14 ± 2.38 years) and their caregivers. Eleven of the youngsters were assigned male at birth, while 12 were assigned female. The research protocol consisted of a survey and systematization of the data collected in the initial global psychological evaluation performed at the healthcare facility, including house-tree-person (HTP) projective drawings and the parental styles inventory. The present study aimed to explore the data collected during the psychological evaluation of youngsters diagnosed with gender incongruence, relating the HTP projective drawing technique to parental styles and gender trajectories. The results indicate two key points. One evidenced that parental styles could be either preventive or risk components in maintaining adequate socialization in these young people but not in affecting the level of gender dysphoria. The other was that coherence is introduced in the person’s perception of his or her projected self-image and his or her expressed gender as he/she becomes more comfortable in expressing his/her gender identity. Treating youngsters inherently brings ethical issues to clinical practice. Thus, global psychological evaluation tailored to this population is a fundamental resource that the psychology professional can use in consultations with youngsters because this tool brings a global understanding about the natural development cycle, facilitating the formulation of therapeutic conducts and exchanges within interdisciplinary transgender health care teams.

Published
2019
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8. Intra-Vesical Colistin for Pseudomonas aeruginosa Urinary Tract Infections

Author

Rui Encarnado Assis, Inês Coelho, André Real, Luís França, Ana Araújo, Tiago Pereira, and Nuno Catorze

Subjects
Colistin, Pseudomonas, multiple drug resistance, Medicine
Abstract

The numbers of multiple drug-resistant Gram-negative bacterial infections are rising worldwide. The threat is increased by the lack of new antibiotics, so clinicians are turning to older drugs previously abandoned due to their recognized toxicity, such as colistin. However, the need to avoid kidney toxicity from colistin has led to its topical use. We present the case of a patient with type I cardiorenal syndrome with cystitis due to multiple drug-resistant Pseudomonas aeruginosa who was successfully treated with intravesical instillation of colistin.

Published
2019
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9. Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus

Author

Fabio Ferreira da Cunha Brião, Marcio Leal Horta, Bernardo Lessa Horta, Guilherme Antônio Moreira de Barros, Ana Paula Behrensdorf, Ingrid Severo, Mariana Antunes Nunes, Roberta Boabaid, and André Real

Subjects
Droperidol, Morfina, Ondansetrón, Prurito, Inyección subaracnoidea, Anesthesiology, RD78.3-87.3
Abstract

BACKGROUND AND OBJECTIVES: The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus.METHODS: 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2 mg were randomized to receive, after the child's birth, metoclopramide 10 mg (Group I - control), droperidol 2.5 mg (Group II) or ondansetron 8 mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined.RESULTS: Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively.CONCLUSIONS: Ondansetron does not inhibit subarachnoid morphine-induced pruritus.

Published
2015
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10. The black fingers - Esclerose Sistémica Limitada

Author

André Real and Jorge Nepomuceno

Subjects
Esclerose Sistémica, CREST, Úlceras Digitais, Fenómeno de Raynaud, Iloprost, Medicine, Internal medicine, RC31-1245
Abstract

A Esclerose Sistémica (ES) é uma doença auto-imune sistémica que se caracteriza por fibrose e vasculopatia, com envolvimento multiorgânico de etiologia desconhecida. As manifestações clínicas são heterogéneas dependendo do órgão envolvido e pode haver maior predominância e/ou gravidade de algumas delas de acordo com o subtipo.

Published
2017
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12. Access to Intensive Care Unit Care for Elderly Patients with COVID-19 in Portugal

Author

André Borges, Rui Moreno, Guilherme Domingos, Filipe S. Cardoso, Ana C P Araujo, Nuno Germano, Isabel Botelho, André Real, Luís Bento, and R. A. Pereira

Subjects
medicine.medical_specialty, medicine.medical_treatment, Acesso a cuidados de saúde, elderly, law.invention, access to healthcare, symbols.namesake, Idosos, law, medicine, Fisher's exact test, Mechanical ventilation, business.industry, Health Policy, Incidence (epidemiology), lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Retrospective cohort study, lcsh:RA1-1270, Triage, Intensive care unit, portugal, covid-19, Emergency medicine, Cohort, symbols, Number needed to treat, Commentary, business
Abstract

The overstretched intensive care unit (ICU) capacity during the 2019 coronavirus disease (COVID-19) pandemic generated a debate about age being an important criterion for triaging patients with COVID-19 for ICU admission [1, 2]. In Portugal, as of April 30, 2020, there have been 24,987 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection (6,136 [24.5%] patients aged ≥70 years) and 1,007 individuals have died from COVID-19 (878 [87.2%] patients aged ≥70 years) [3, 4]. This was a multicenter retrospective cohort using data retrieved from the ICU databases. For comparisons between variables, we used χ2 or Fisher exact tests (SPSS V20; IBM Corp., North Castle, NY, USA). As of April 30, in 6 hospitals in Lisbon (catchment area of 1.2 million people), 95 (4.8% of a total of 1,988 cases) patients with COVID-19 pneumonia (nasal/pharynx swab or respiratory secretions with positive SARS-CoV2 by real-time polymerase chain reaction) were admitted to the ICU, with 39 (41.1%) patients aged ≥70 years. Overall, 94 (98.9%) patients required invasive mechanical ventilation (IMV). Among those aged ≥70 years, 38 (97.4%) patients required IMV and only 1 (2.6%) patient was managed solely with a high-flow nasal cannula. Overall, the mean (±SD) sequential organ failure assessment (SOFA) score on ICU admission was 7 (±3), and 16 (16.8%) patients did not survive the ICU stay. Four ICU (70.5% of the 95 patients included) were using the Clinical Frailty Scale to help triage patients with COVID-19 for ICU admission, with those having >6 points being generally declined for ICU care [5]. In 5 (12.8%) patients aged ≥70 years, do-not-resuscitate decisions were established during the ICU stay. In this cohort, patients aged ≥70 years were twice more likely to be admitted to the ICU than others (Table 1; RR = 2.14; 95% CI 1.44–3.18). Moreover, patients aged ≥70 years had access to IMV (RR = 0.97; 95% CI 0.93–1.03) and mean SOFA scores similar to those of others (8 vs. 7; RR = 1.38; 95% CI 0.47–4.07). However, patients aged ≥70 years were 6 times more likely to die in the ICU than others (RR = 6.22; 95% CI 1.90–20.39). Alternatively, of every 4 patients aged ≥70 years admitted to the ICU, 1 derived a survival benefit from ICU care (number needed to treat: 4; 95% CI 2–8). Our findings suggest that chronological age was not a limitative criterion for ICU admission in patients with COVID-19. More likely, clinicians pondered factors such as the number and severity of comorbidities, the presence and severity of frailty, and the number and severity of acute organ dysfunctions [5]. The following limitations warrant consideration. First, the COVID-19 incidence decreased a few weeks following the lockdown imposed by the Portuguese government on March 18 (from a peak of 1,516 cases on April 10 to 368 cases on April 30) [3]. Second, the peak ICU bed occupancy rate occurred on April 6 (60.1% of the total national capacity) [4]. Finally, data on comorbidities and patients declined for ICU admission were not captured and thus we could not weigh for those potential confounders. In conclusion, access to ICU care for elderly patients with COVID-19 may be preserved during the pandemic, especially if there is no strained ICU capacity. While patients aged ≥70 years may incur in a higher mortality, those selected by ICU clinicians may benefit from ICU care. Statement of Ethics Informed consent was waived due to the observational nature of this study. Conflicts of Interest Statement The authors have no conflict of interests to declare. Funding Sources The authors have no funding sources to declare. Author Contributions F.S.C., A.B., I.B., A.R., G.D., A.C.A., and R.P. collected the data. F.S.C. analyzed and interpreted the data. F.S.C. and A.B. drafted this paper. All of the authors read and approved the final version of this work.

Published
2020

13. What Changed Between the Peak and the Plateau Periods of the First COVID-19 Pandemic Wave? A Multicentric Portuguese Cohort Study in Intensive Care

Author

Diogo Lopes, L. Coelho, Camila Tapadinhas, Paulo Telles-Freitas, Pedro Póvoa, João Camões, Ana Valadas, Maria Ferreira da Silva, R. A. Pereira, Danay Perez, Raul Neto, Susana Cabral, João Gouveia, Renato Reis, João João Mendes, Nelson Cardoso, E. Molinos, Rogério C. Silva, João M. Ribeiro, Ana Lúcia Rios, Isabel Amorim Ferreira, Sara Ventura, Bruno Miguel Faria Do Vale, Ana L. P. Marques, Maria Inês Ribeiro, Maria Adão-Serrano, Ana Pinho Oliveira, José Pedro Cidade, Filipa Brás Monteiro, Mariana Cascão, Cleide Barrigoto, Luís Daniel Rodrigues Melo, Rita Alves, Rosa Cardiga, Luís Val-Flores, Tiago Ramires, Bruno Sarmento Banheiro, Flávio Marino, Ana Raquel Maia, Marta M. Sousa, Vitor Mendes, Tatiana Fonseca, Simão C Rodeia, Ana Cracium, Irene Aragão, André Real, and Susana M. Fernandes

Subjects
Geography, Plateau, geography.geographical_feature_category, Coronavirus disease 2019 (COVID-19), Intensive care, Pandemic, language, Portuguese, language.human_language, Demography, Cohort study
Abstract

BackgroundThe COVID-19 pandemic represented a challenge for intensive care units (ICU) with overwhelming demand, heterogenous outcomes and clinical practices. To improve care a profound knowledge on severe COVID-19 patients during different time points is crucial. This data is still scarce. We aimed to analyze and compare COVID-19 patient demographics, clinical management, and outcomes between two periods from the first pandemic wave.MethodsWe performed a multicentric ambispective cohort study including severe COVID-19 patients between March and August 2020 from 16 Portuguese ICUs. A peak and a plateau period were defined, corresponding to weeks 10-16 and 17-34 of the first pandemic wave. All patients had SARS-CoV-2 pneumonia diagnosis and complete hospital follow-up.ResultsWe included 541 adult patients with a median age of 65 [57-74] years and mostly male (71.2%). Severe acute respiratory distress syndrome developed in 63.9% of cases. Overall, 28-day mortality rate was 23.7% with age and SAPSII (both p

Published
2021

14. Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Author

Barbara Wanjiru Citarella, Christiana Kartsonaki, Elsa D. Ibáñez-Prada, Bronner P. Gonçalves, Joaquin Baruch, Martina Escher, Mark G. Pritchard, Jia Wei, Fred Philippy, Andrew Dagens, Matthew Hall, James Lee, Demetrios James Kutsogiannis, Evert-Jan Wils, Marília Andreia Fernandes, Bharath Kumar Tirupakuzhi Vijayaraghavan, Prasan Kumar Panda, Ignacio Martin-Loeches, Shinichiro Ohshimo, Arie Zainul Fatoni, Peter Horby, Jake Dunning, Jordi Rello, Laura Merson, Amanda Rojek, Michel Vaillant, Piero Olliaro, Luis Felipe Reyes, S.A. Moharam, Sabriya Abdalasalam, Alaa Abdalfattah Abdalhadi, Naana Reyam Abdalla, Walaa Abdalla, Almthani Hamza Abdalrheem, Ashraf Abdalsalam, Saedah Abdeewi, Esraa Hassan Abdelgaum, Mohamed Abdelhalim, Mohammed Abdelkabir, Israa Abdelrahman, Sheryl Ann Abdukahil, Lamees Adil Abdulbaqi, Salaheddin Abdulhamid, Widyan Abdulhamid, Nurul Najmee Abdulkadir, Eman Abdulwahed, Rawad Abdunabi, Ryuzo Abe, Laurent Abel, Ahmed Mohammed Abodina, Amal Abrous, Lara Absil, Kamal Abu Jabal, Nashat Abu Salah, Abdurraouf Abusalama, Tareg Abdallah Abuzaid, Subhash Acharya, Andrew Acker, Elisabeth Adam, Safia Adem, Manuella Ademnou, Francisca Adewhajah, Diana Adrião, Anthony Afum-Adjei Awuah, Melvin Agbogbatey, Saleh Al Ageel, Aya Mustafa Ahmed, Musaab Mohammed Ahmed, Shakeel Ahmed, Zainab Ahmed Alaraji, Abdulrahman Ahmed Elhefnawy Enan, Reham Abdelhamid Ahmed Khalil, Ali Mostafa Ahmed Mohamed Abdelaziz, Kate Ainscough, Eka Airlangga, Tharwat Aisa, Ali Aisha, Bugila Aisha, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Ernita Akmal, Chika Akwani, Eman Al Qasim, Ahmed Alajeeli, Ahmed Alali, Razi Alalqam, Aliya Mohammed Alameen, Mohammed Al-Aquily, Zinah A. Alaraji, Khalid Albakry, Safa Albatni, Angela Alberti, Osama Aldabbourosama, Tala Al-dabbous, Amer Aldhalia, Abdulkarim Aldoukali, Senthilkumar Alegesan, Marta Alessi, Beatrice Alex, Kévin Alexandre, Abdulrahman Al-Fares, Asil Alflite, Huda Alfoudri, Qamrah Alhadad, Hoda Salem Alhaddad, Maali Khalid Mohamed Abdalla Alhasan, Ahmad Nabil Alhouri, Hasan Alhouri, Adam Ali, Imran Ali, Maha TagElser Mohammed Ali, Syed Ali Abbas, Yomna Ali Abdelghafar, Naseem Ali Sheikh, Kazali Enagnon Alidjnou, Mahmoud Aljadi, Sarah Aljamal, Mohammed Alkahlout, Akram Alkaseek, Qabas Alkhafajee, Clotilde Allavena, Nathalie Allou, Lana Almasri, Abdulrahman Almjersah, Raja Ahmed Alqandouz, Walaa Alrfaea, Moayad Alrifaee, Rawan Alsaadi, Yousef Al-Saba'a, Entisar Alshareea, Eslam Alshenawy, Aneela Altaf, João Melo Alves, João Alves, Rita Alves, Joana Alves Cabrita, Maria Amaral, Amro Essam Amer, Nur Amira, Amos Amoako Adusei, John Amuasi, Roberto Andini, Claire Andrejak, Andrea Angheben, François Angoulvant, Sophia Ankrah, Séverine Ansart, Sivanesen Anthonidass, Massimo Antonelli, Carlos Alexandre Antunes de Brito, Ardiyan Apriyana, Yaseen Arabi, Irene Aragao, Francisco Arancibia, Carolline Araujo, Antonio Arcadipane, Patrick Archambault, Lukas Arenz, Jean-Benoît Arlet, Christel Arnold-Day, Lovkesh Arora, Rakesh Arora, Elise Artaud-Macari, Diptesh Aryal, Angel Asensio, Elizabeth A. Ashley, Muhammad Ashraf, Muhammad Sheharyar Ashraf, Abir Ben Ashur, Franklin Asiedu-Bekoe, Namra Asif, Mohammad Asim, Grace Assi, Jean Baptiste Assie, Amirul Asyraf, Fouda Atangana, Ahmed Atia, Minahel Atif, Asia Atif Abdelrhman Abdallahrs, Anika Atique, Moad Atlowly, AM Udara Lakshan Attanyake, Johann Auchabie, Hugues Aumaitre, Adrien Auvet, Abdelmalek Awad Ali Mohammed, Eyvind W. Axelsen, Ared Ayad, Ahmed Ayman Hassan Helmi, Laurène Azemar, Mohammed Azizeldin, Cecile Azoulay, Hakeem Babatunde, Benjamin Bach, Delphine Bachelet, Claudine Badr, Roar Bævre-Jensen, Nadia Baig, John Kenneth Baillie, J Kevin Baird, Erica Bak, Agamemnon Bakakos, Nazreen Abu Bakar, Hibah Bileid Bakeer, Ashraf Bakri, Andriy Bal, Mohanaprasanth Balakrishnan, Irene Bandoh, Firouzé Bani-Sadr, Renata Barbalho, Nicholas Yuri Barbosa, Wendy S. Barclay, Saef Umar Barnett, Michaela Barnikel, Helena Barrasa, Cleide Barrigoto, Marie Bartoli, Joaquín Baruch, Romain Basmaci, Muhammad Fadhli Hassin Basri, AbdAlkarim Batool, Denise Battaglini, Jules Bauer, Diego Fernando Bautista Rincon, Denisse Bazan Dow, Abigail Beane, Alexandra Bedossa, Ker Hong Bee, Husna Begum, Sylvie Behilill, Albertus Beishuizen, Aleksandr Beljantsev, David Bellemare, Anna Beltrame, Beatriz Amorim Beltrão, Marine Beluze, Nicolas Benech, Lionel Eric Benjiman, Suzanne Bennett, Luís Bento, Jan-Erik Berdal, Lamis Berdeweel, Delphine Bergeaud, Hazel Bergin, Giulia Bertoli, Lorenzo Bertolino, Simon Bessis, Sybille Bevilcaqua, Karine Bezulier, Amar Bhatt, Krishna Bhavsar, Isabella Bianchi, Claudia Bianco, Sandra Bichoka, Farah Nadiah Bidin, Felwa Bin Humaid, Mohd Nazlin Bin Kamarudin, Muhannud Binnawara, Zeno Bisoffi, Patrick Biston, Laurent Bitker, Mustapha Bittaye, Jonathan Bitton, Pablo Blanco-Schweizer, Catherine Blier, Frank Bloos, Mathieu Blot, Filomena Boccia, Laetitia Bodenes, Debby Bogaert, Anne-Hélène Boivin, Ariel Bolanga, Isabela Bolaños, Pierre-Adrien Bolze, François Bompart, Aurelius Bonifasius, Joe Bonney, Diogo Borges, Raphaël Borie, Hans Martin Bosse, Elisabeth Botelho-Nevers, Lila Bouadma, Olivier Bouchaud, Sabelline Bouchez, Damien Bouhour, Kévin Bouiller, Laurence Bouillet, Camile Bouisse, Latsaniphone Bountthasavong, Anne-Sophie Boureau, John Bourke, Maude Bouscambert, Aurore Bousquet, Marielle Boyer-Besseyre, Maria Boylan, Fernando Augusto Bozza, Axelle Braconnier, Cynthia Braga, Timo Brandenburger, Filipa Brás Monteiro, Luca Brazzi, Dorothy Breen, Patrick Breen, David Brewster, Kathy Brickell, Tessa Broadley, Helen Brotherton, Alex Browne, Nicolas Brozzi, Sonja Hjellegjerde Brunvoll, Marjolein Brusse-Keizer, Petra Bryda, Nina Buchtele, Polina Bugaeva, Marielle Buisson, Danilo Buonsenso, Erlina Burhan, Donald Buri, Aidan Burrell, Ingrid G. Bustos, Denis Butnaru, André Cabie, Susana Cabral, Joana Cabrita, Eder Caceres, Cyril Cadoz, Rui Caetano Garcês, Kate Calligy, Jose Andres Calvache, João Camões, Valentine Campana, Paul Campbell, Josie Campisi, Cecilia Canepa, Mireia Cantero, Janice Caoili, Pauline Caraux-Paz, Sheila Cárcel, Filipa Cardoso, Filipe Cardoso, Nelson Cardoso, Sofia Cardoso, Simone Carelli, Nicolas Carlier, Thierry Carmoi, Gayle Carney, Inês Carqueja, Marie-Christine Carret, François Martin Carrier, Ida Carroll, Gail Carson, Maire-Laure Casanova, Mariana Cascão, Siobhan Casey, José Casimiro, Bailey Cassandra, Silvia Castañeda, Nidyanara Castanheira, Guylaine Castor-Alexandre, Ivo Castro, Ana Catarino, François-Xavier Catherine, Paolo Cattaneo, Roberta Cavalin, Giulio Giovanni Cavalli, Alexandros Cavayas, Adrian Ceccato, Masaneh Ceesay, Shelby Cerkovnik, Minerva Cervantes-Gonzalez, Muge Cevik, Anissa Chair, Catherine Chakveatze, Adrienne Chan, Meera Chand, Jean-Marc Chapplain, Charlotte Charpentier, Julie Chas, Muhammad Mobin Chaudry, Jonathan Samuel Chávez Iñiguez, Anjellica Chen, Yih-Sharng Chen, Léo Chenard, Matthew Pellan Cheng, Antoine Cheret, Thibault Chiarabini, Julian Chica, Suresh Kumar Chidambaram, Leong Chin Tho, Catherine Chirouze, Davide Chiumello, Sung-Min Cho, Bernard Cholley, Danoy Chommanam, Marie-Charlotte Chopin, Yock Ping Chow, Ting Soo Chow, Nathaniel Christy, Hiu Jian Chua, Jonathan Chua, Jose Pedro Cidade, José Miguel Cisneros Herreros, Anna Ciullo, Jennifer Clarke, Rolando Claure-Del Granado, Sara Clohisey, Cassidy Codan, Caitriona Cody, Jennifer Coles, Megan Coles, Gwenhaël Colin, Michael Collins, Pamela Combs, Jennifer Connolly, Marie Connor, Anne Conrad, Elaine Conway, Graham S. Cooke, Hugues Cordel, Amanda Corley, Sabine Cornelis, Alexander Daniel Cornet, Arianne Joy Corpuz, Andrea Cortegiani, Grégory Corvaisier, Camille Couffignal, Sandrine Couffin-Cadiergues, Roxane Courtois, Stéphanie Cousse, Juthaporn Cowan, Rachel Cregan, Gloria Crowl, Jonathan Crump, Claudina Cruz, Marc Csete, Ailbhe Cullen, Matthew Cummings, Gerard Curley, Elodie Curlier, Colleen Curran, Paula Custodio, Ana da Silva Filipe, Charlene Da Silveira, Al-Awwab Dabaliz, John Arne Dahl, Darren Dahly, Umberto D'Alessandro, Peter Daley, Zaina Dalloul, Heidi Dalton, Jo Dalton, Seamus Daly, Juliana Damas, Joycelyn Dame, Cammandji Damien, Nick Daneman, Jorge Dantas, Frédérick D'Aragon, Gillian de Loughry, Diego de Mendoza, Etienne De Montmollin, Rafael Freitas de Oliveira França, Ana Isabel de Pinho Oliveira, Rosanna De Rosa, Cristina De Rose, Thushan de Silva, Peter de Vries, Jillian Deacon, David Dean, Alexa Debard, Bianca DeBenedictis, Marie-Pierre Debray, Nathalie DeCastro, William Dechert, Romain Decours, Eve Defous, Isabelle Delacroix, Alexandre Delamou, Eric Delaveuve, Karen Delavigne, Nathalie M. Delfos, Ionna Deligiannis, Andrea Dell'Amore, Christelle Delmas, Pierre Delobel, Corine Delsing, Elisa Demonchy, Emmanuelle Denis, Dominique Deplanque, Pieter Depuydt, Diane Descamps, Mathilde Desvallées, Santi Dewayanti, Pathik Dhangar, Alpha Diallo, Souleymane Taran Diallo, Sylvain Diamantis, André Dias, Fernanda Dias Da Silva, Rodrigo Diaz, Juan Jose Diaz, Priscila Diaz, Bakary K. Dibba, Kévin Didier, Jean-Luc Diehl, Wim Dieperink, Jérôme Dimet, Vincent Dinot, Fara Diop, Alphonsine Diouf, Yael Dishon, Cedric Djadda, Félix Djossou, Annemarie B. Docherty, Helen Doherty, Arjen M. Dondorp, Christl A. Donnelly, Yoann Donohue, Sean Donohue, Peter Doran, Céline Dorival, Eric D'Ortenzio, Yash Doshi, Phouvieng Douangdala, James Joshua Douglas, Renee Douma, Nathalie Dournon, Joanne Downey, Mark Downing, Thomas Drake, Aoife Driscoll, Ibrahim Kwaku Duah, Claudio Duarte Fonseca, Vincent Dubee, François Dubos, Audrey Dubot-Pérès, Alexandre Ducancelle, Toni Duculan, Susanne Dudman, Abhijit Duggal, Paul Dunand, Mathilde Duplaix, Emanuele Durante-Mangoni, Lucian Durham, III, Bertrand Dussol, Juliette Duthoit, Xavier Duval, Anne Margarita Dyrhol-Riise, Sim Choon Ean, Ada Ebo, Marco Echeverria-Villalobos, Michael Edelstein, Siobhan Egan, Linn Margrete Eggesbø, Khadeja Ehzaz, Carla Eira, Mohammed El Sanharawi, Marwan El Sayed, Mohammed Elabid, Mohamed Bashir Elagili, Subbarao Elapavaluru, Mohammad Elbahnasawy, Sohail Elboshra, Brigitte Elharrar, Jacobien Ellerbroek, Merete Ellingjord-Dale, Hamida ELMagrahi, Mohammad Muatasm Elmubark, Loubna Elotmani, Lauren Eloundou, Philippine Eloy, Basma Elshaikhy, Tarek Elshazly, Wafa Elsokni, Aml Ahmed Eltayeb, Iqbal Elyazar, Zarief Kamel Emad, Hussein Embarek, Isabelle Enderle, Tomoyuki Endo, Gervais Eneli, Chan Chee Eng, Ilka Engelmann, Vincent Enouf, Olivier Epaulard, Haneen Esaadi, Mariano Esperatti, Hélène Esperou, Catarina Espírito Santo, Marina Esposito-Farese, Rachel Essaka, Lorinda Essuman, João Estevão, Manuel Etienne, Anna Greti Everding, Mirjam Evers, Isabelle Fabre, Marc Fabre, Ismaila Fadera, Asgad Osman Abdalla Fadlalla, Amna Faheem, Arabella Fahy, Cameron J. Fairfield, Zul Fakar, Komal Fareed, Pedro Faria, Ahmed Farooq, Hanan Fateena, Mohamed Fathi, Salem Fatima, Karine Faure, Raphaël Favory, Mohamed Fayed, Niamh Feely, Jorge Fernandes, Susana Fernandes, François-Xavier Ferrand, Eglantine Ferrand Devouge, Joana Ferrão, Mário Ferraz, Benigno Ferreira, Isabel Ferreira, Bernardo Ferreira, Sílvia Ferreira, Nicolas Ferriere, Céline Ficko, Claudia Figueiredo-Mello, William Finlayson, Thomas Flament, Tom Fletcher, Aline-Marie Florence, Letizia Lucia Florio, Brigid Flynn, Deirdre Flynn, Jean Foley, Victor Fomin, Tatiana Fonseca, Patricia Fontela, Karen Forrest, Simon Forsyth, Denise Foster, Giuseppe Foti, Berline Fotso, Erwan Fourn, Robert A. Fowler, Marianne Fraher, Diego Franch-Llasat, Christophe Fraser, John F. Fraser, Marcela Vieira Freire, Ana Freitas Ribeiro, Craig French, Caren Friedrich, Ricardo Fritz, Stéphanie Fry, Nora Fuentes, Masahiro Fukuda, G. Argin, Valérie Gaborieau, Rostane Gaci, Massimo Gagliardi, Jean-Charles Gagnard, Amandine Gagneux-Brunon, Abdou Gai, Sérgio Gaião, Linda Gail Skeie, Adham Mohamed Galal Mohamed Ramadan, Phil Gallagher, Carrol Gamble, Yasmin Gani, Arthur Garan, Rebekha Garcia, Julia Garcia-Diaz, Esteban Garcia-Gallo, Navya Garimella, Denis Garot, Valérie Garrait, Basanta Gauli, Anatoliy Gavrylov, Alexandre Gaymard, Johannes Gebauer, Eva Geraud, Louis Gerbaud Morlaes, Nuno Germano, Malak Ghemmeid, Praveen Kumar Ghisulal, Jade Ghosn, Marco Giani, Tristan Gigante, Elaine Gilroy, Guillermo Giordano, Michelle Girvan, Valérie Gissot, Gezy Giwangkancana, Daniel Glikman, Petr Glybochko, Eric Gnall, Geraldine Goco, François Goehringer, Siri Goepel, Jean-Christophe Goffard, Jin Yi Goh, Brigitta Golács, Jonathan Golob, Kyle Gomez, Joan Gómez-Junyent, Marie Gominet, Alicia Gonzalez, Patricia Gordon, Isabelle Gorenne, Laure Goubert, Cécile Goujard, Tiphaine Goulenok, Margarite Grable, Jeronimo Graf, Edward Wilson Grandin, Pascal Granier, Giacomo Grasselli, Lorenzo Grazioli, Christopher A. Green, Courtney Greene, William Greenhalf, Segolène Greffe, Domenico Luca Grieco, Matthew Griffee, Fiona Griffiths, Ioana Grigoras, Albert Groenendijk, Fassou Mathias Grovogui, Heidi Gruner, Yusing Gu, Jérémie Guedj, Martin Guego, Anne-Marie Guerguerian, Daniela Guerreiro, Romain Guery, Anne Guillaumot, Laurent Guilleminault, Maisa Guimarães de Castro, Thomas Guimard, Marieke Haalboom, Daniel Haber, Ali Hachemi, Abdurrahman Haddud, Nadir Hadri, Wael Hafez, Fakhir Raza Haidri, Fatima Mhd Rida Hajij, Sheeba Hakak, Adam Hall, Sophie Halpin, Shaher Hamdan, Abdelhafeez Hamdi, Jawad Hameed, Ansley Hamer, Raph L. Hamers, Rebecca Hamidfar, Bato Hammarström, Naomi Hammond, Terese Hammond, Lim Yuen Han, Matly Hanan, Rashan Haniffa, Kok Wei Hao, Hayley Hardwick, Ewen M. Harrison, Janet Harrison, Samuel Bernard Ekow Harrison, Alan Hartman, Sulieman Hasan, Mohammad Ali Nabil Hasan, Mohd Shahnaz Hasan, Junaid Hashmi, Madiha Hashmi, Amoni Hassan, Ebtisam Hassanin, Muhammad Hayat, Ailbhe Hayes, Leanne Hays, Jan Heerman, Lars Heggelund, Ahmed Helmi, Ross Hendry, Martina Hennessy, Aquiles Rodrigo Henriquez-Trujillo, Maxime Hentzien, Diana Hernandez, Andrew Hershey, Liv Hesstvedt, Astarini Hidayah, Eibhlin Higgins, Rupert Higgins, Samuel Hinton, Hiroaki Hiraiwa, Haider Hirkani, Hikombo Hitoto, Antonia Ho, Yi Bin Ho, Alexandre Hoctin, Isabelle Hoffmann, Wei Han Hoh, Oscar Hoiting, Rebecca Holt, Jan Cato Holter, Juan Pablo Horcajada, Ikram Houas, Mabrouka Houderi, Catherine L. Hough, Stuart Houltham, Jimmy Ming-Yang Hsu, Jean-Sébastien Hulot, Abby Hurd, Iqbal Hussain, Aliae Mohamed Hussein, Mahmood Hussein, Fatima Ibrahim, Bashir Ibran, Samreen Ijaz, M. Arfan Ikram, Carlos Cañada Illana, Patrick Imbert, Muhammad Imran Ansari, Rana Imran Sikander, Hugo Inácio, Carmen Infante Dominguez, Yun Sii Ing, Mariachiara Ippolito, Vera Irawany, Sarah Isgett, Tiago Isidoro, Nadiah Ismail, Margaux Isnard, Mette Stausland Istre, Junji Itai, Daniel Ivulich, Danielle Jaafar, Salma Jaafoura, Hamza Jaber, Julien Jabot, Clare Jackson, Abubacarr Jagne, Stéphane Jaureguiberry, Denise Jaworsky, Florence Jego, Anilawati Mat Jelani, Synne Jenum, Ruth Jimbo-Sotomayor, Ong Yiaw Joe, Ruth Noemí Jorge García, Silje Bakken Jørgensen, Cédric Joseph, Mark Joseph, Swosti Joshi, Mercé Jourdain, Philippe Jouvet, Anna Jung, Hanna Jung, Dafsah Juzar, Ouifiya Kafif, Florentia Kaguelidou, Neerusha Kaisbain, Thavamany Kaleesvran, Sabina Kali, Karl Trygve Kalleberg, Smaragdi Kalomoiri, Muhammad Aisar Ayadi Kamaluddin, Armand Saloun Kamano, Zul Amali Che Kamaruddin, Nadiah Kamarudin, Kavita Kamineni, Darshana Hewa Kandamby, Kong Yeow Kang, Darakhshan Kanwal, Dyah Kanyawati, Mohamed Karghul, Pratap Karpayah, Todd Karsies, Daisuke Kasugai, Kevin Katz, Christy Kay, Lamees Kayyali, Seán Keating, Pulak Kedia, Andrea Kelly, Aoife Kelly, Claire Kelly, Niamh Kelly, Sadie Kelly, Yvelynne Kelly, Maeve Kelsey, Kalynn Kennon, Sommay Keomany, Maeve Kernan, Younes Kerroumi, Sharma Keshav, Shams Khail, Sarah Khaled, Imrana Khalid, Antoine Khalil, Irfan Khan, Quratul Ain Khan, Sushil Khanal, Abid Khatak, Krish Kherajani, Michelle E. Kho, Denisa Khoo, Ryan Khoo, Saye Khoo, Muhammad Nasir Khoso, Amin Khuwaja, Khor How Kiat, Yuri Kida, Peter Kiiza, Beathe Kiland Granerud, Anders Benjamin Kildal, Jae Burm Kim, Antoine Kimmoun, Detlef Kindgen-Milles, Nobuya Kitamura, Eyrun Floerecke Kjetland Kjetland, Paul Klenerman, Rob Klont, Gry Kloumann Bekken, Stephen R. Knight, Robin Kobbe, Paa Kobina Forson, Chamira Kodippily, Malte Kohns Vasconcelos, Sabin Koirala, Mamoru Komatsu, Franklina Korkor Abebrese, Volkan Korten, Stephanie Kouba, Mohamed Lamine Kourouma, Karifa Kourouma, Arsène Kpangon, Karolina Krawczyk, Ali Kredan, Vinothini Krishnan, Sudhir Krishnan, Oksana Kruglova, Anneli Krund, Pei Xuan Kuan, Ashok Kumar, Deepali Kumar, Ganesh Kumar, Mukesh Kumar, Dinesh Kuriakose, Ethan Kurtzman, Demetrios Kutsogiannis, Galyna Kutsyna, Ama Kwakyewaa Bedu-Addo, Sylvie Kwedi, Konstantinos Kyriakoulis, Marie Lachatre, Marie Lacoste, John G. Laffey, Nadhem Lafhej, Marie Lagrange, Fabrice Laine, Olivier Lairez, Sanjay Lakhey, Marc Lambert, François Lamontagne, Marie Langelot-Richard, Vincent Langlois, Eka Yudha Lantang, Marina Lanza, Cédric Laouénan, Samira Laribi, Delphine Lariviere, Stéphane Lasry, Sakshi Lath, Naveed Latif, Youssef Latifeh, Odile Launay, Didier Laureillard, Yoan Lavie-Badie, Andy Law, Cassie Lawrence, Teresa Lawrence, Minh Le, Clément Le Bihan, Cyril Le Bris, Georges Le Falher, Lucie Le Fevre, Quentin Le Hingrat, Marion Le Maréchal, Soizic Le Mestre, Gwenaël Le Moal, Vincent Le Moing, Hervé Le Nagard, Ema Leal, Marta Leal Santos, Biing Horng Lee, Heng Gee Lee, Su Hwan Lee, Jennifer Lee, Todd C. Lee, Yi Lin Lee, Gary Leeming, Bénédicte Lefebvre, Laurent Lefebvre, Benjamin Lefèvre, Sylvie LeGac, Merili-Helen Lehiste, Jean-Daniel Lelievre, François Lellouche, Adrien Lemaignen, Véronique Lemee, Anthony Lemeur, Gretchen Lemmink, Ha Sha Lene, Jenny Lennon, Rafael León, Marc Leone, Tanel Lepik, Quentin Lepiller, François-Xavier Lescure, Olivier Lesens, Mathieu Lesouhaitier, Amy Lester-Grant, Andrew Letizia, Sophie Letrou, Bruno Levy, Yves Levy, Claire Levy-Marchal, Katarzyna Lewandowska, Erwan L'Her, Gianluigi Li Bassi, Janet Liang, Ali Liaquat, Geoffrey Liegeon, Kah Chuan Lim, Wei Shen Lim, Chantre Lima, Bruno Lina, Lim Lina, Andreas Lind, Maja Katherine Lingad, Guillaume Lingas, Sylvie Lion-Daolio, Keibun Liu, Marine Livrozet, Patricia Lizotte, Antonio Loforte, Navy Lolong, Leong Chee Loon, Diogo Lopes, Dalia Lopez-Colon, Anthony L. Loschner, Paul Loubet, Bouchra Loufti, Guillame Louis, Silvia Lourenco, Lara Lovelace-Macon, Lee Lee Low, Marije Lowik, Jia Shyi Loy, Jean Christophe Lucet, Carlos M. Luna, Olguta Lungu, Miles Lunn, Liem Luong, Nestor Luque, Dominique Luton, Olavi Maasikas, Moïse Machado, Sara Machado, Gabriel Macheda, Mustafa Magzoub, Rafael Mahieu, Sophie Mahy, Ana Raquel Maia, Lars S. Maier, Oumou Maiga Ascofare, Mylène Maillet, Thomas Maitre, Nimisha Abdul Majeed, Maximilian Malfertheiner, Nadia Malik, Paddy Mallon, Fernando Maltez, Denis Malvy, Victoria Manda, Laurent Mandelbrot, Frank Manetta, Julie Mankikian, Edmund Manning, Aldric Manuel, Veronika Maráczi, Ceila Maria Sant′Ana Malaque, Flávio Marino, Samuel Markowicz, Ana Marques, Catherine Marquis, Laura Marsh, Brian Marsh, Megan Marshal, John Marshall, Celina Turchi Martelli, Dori-Ann Martin, Emily Martin, Guillaume Martin-Blondel, Alessandra Martinelli, F. Eduardo Martinez, Martin Martinot, Alejandro Martín-Quiros, Ana Martins, João Martins, Nuno Martins, Caroline Martins Rego, Gennaro Martucci, Olga Martynenko, Eva Miranda Marwali, Marsilla Marzukie, David Maslove, Sabina Mason, Sobia Masood, Fatma Masoud, Moise Massoma, Palmer Masumbe, Mohd Basri Mat Nor, Moshe Matan, Henrique Mateus Fernandes, Meghena Mathew, Christina Mathew, Mathieu Mattei, Laurence Maulin, Juergen May, Javier Maynar, Mayfong Mayxay, Thierry Mazzoni, Lisa Mc Sweeney, Colin McArthur, Naina McCann, Peter McCanny, Aine McCarthy, Anne McCarthy, Colin McCloskey, Rachael McConnochie, Sherry McDermott, Sarah E. McDonald, Aine McElroy, Samuel McElwee, Natalie McEvoy, Allison McGeer, Kenneth A. McLean, Paul McNally, Bairbre McNicholas, Edel Meaney, Cécile Mear-Passard, Maggie Mechlin, Nastia Medombou, Omar Mehkri, Ferruccio Mele, Luis Melo, Kashif Ali Memon, João João Mendes, Ogechukwu Menkiti, Kusum Menon, France Mentré, Alexander J. Mentzer, Emmanuelle Mercier, Noémie Mercier, Antoine Merckx, Mayka Mergeay-Fabre, Blake Mergler, António Mesquita, Roberta Meta, Osama Metwally, Agnès Meybeck, Dan Meyer, Alison M. Meynert, Vanina Meysonnier, Mehdi Mezidi, Céline Michelanglei, Isabelle Michelet, Efstathia Mihelis, Vladislav Mihnovit, Duha Milad Abdullah, Jennene Miller, Hugo Miranda-Maldonado, Nor Arisah Misnan, Nik Nur Eliza Mohamed, Nouralsabah Mohamed, Tahira Jamal Mohamed, Alaa Mohamed Ads, Ahmed Reda Mohamed Elsayed Abdelhalim, Libya Mohammed, Shrouk Fawze Mohammed Mostafa, Manahil Omer Abdelrahman Mohammedahmed, Omer Abdullah Mohammedelhassan, Asma Moin, Walaa Mokhtar, Elena Molinos, Brenda Molloy, Mary Mone, Agostinho Monteiro, Claudia Montes, Giorgia Montrucchio, Sarah Moore, Shona C. Moore, Lina Morales Cely, Marwa Morgom, Lucia Moro, Catherine Motherway, Ana Motos, Hugo Mouquet, Clara Mouton Perrot, Julien Moyet, Suleiman Haitham Mualla, Mohamed Muftah, Aisha Kalsoom Mufti, Ng Yong Muh, Mo'nes Muhaisen, Dzawani Muhamad, Jimmy Mullaert, Fredrik Müller, Karl Erik Müller, Daniel Munblit, Syed Muneeb Ali, Nadeem Munir, Laveena Munshi, Aisling Murphy, Patrick Murray, Marlène Murris, Srinivas Murthy, Himed Musaab, Alamin Mustafa, Mus'ab Mustafa, Dana Mustafa, Himasha Muvindi, Dimitra Melia Myrodia, Farah Nadia Mohd-Hanafiah, Behzad Nadjm, Dave Nagpal, Alex Nagrebetsky, Blanka Nagybányai-Nagy, Herwin Nanda Boudoin, Mangala Narasimhan, Nageswaran Narayanan, Prashant Nasa, Rashid Nasim Khan, Ahmad Nasrallah, Adel Gerges Nassif Metri, Alasdair Nazerali-Maitland, Nadège Neant, Holger Neb, Nikita Nekliudov, Matthew Nelder, Erni Nelwan, Raul Neto, Emily Neumann, Wing Yiu Ng, Pauline Yeung Ng, Anthony Nghi, Duc Nguyen, Orna Ni Choileain, Niamh Ni Leathlobhair, Nerissa Niba, Alistair D. Nichol, Prompak Nitayavardhana, Stephanie Nonas, Nurul Amani Mohd Noordin, Nurul Faten Izzati Norharizam, Anita North, Alessandra Notari, Mahdad Noursadeghi, Adam Nowinski, Saad Nseir, Leonard Numfor, Nurnaningsih Nurnaningsih, Dwi Utomo Nusantara, Elsa Nyamankolly, Anders Benteson Nygaard, Fionnuala O. Brien, Annmarie O. Callaghan, Annmarie O'Callaghan, Giovanna Occhipinti, Derbrenn OConnor, Max O'Donnell, Lawrence Ofori-Boadu, Tawnya Ogston, Takayuki Ogura, Tak-Hyuk Oh, Sophie O'Halloran, Katie O'Hearn, Sally-Ann Ohene, João Oliveira, Larissa Oliveira, Piero L. Olliaro, Cinderella Omar Rageh Elnaggar, Alsarrah Ali Mohammed Omer, Pierre Ondobo, David S.Y. Ong, Jee Yan Ong, Wilna Oosthuyzen, Anne Opavsky, Peter Openshaw, Saijad Orakzai, Claudia Milena Orozco-Chamorro, Jamel Ortoleva, Mohamed Osama Elsayed Soliman, Javier Osatnik, Linda O'Shea, Miriam O'Sullivan, Eman Othman, Siti Zubaidah Othman, Nadia Ouamara, Rachida Ouissa, Micheal Owusu, Ama Akyampomaa Owusu-Asare, Eric Oziol, Maïder Pagadoy, Justine Pages, Amanda Palacios, Massimo Palmarini, Giovanna Panarello, Hem Paneru, Lai Hui Pang, Mauro Panigada, Nathalie Pansu, Aurélie Papadopoulos, Rachael Parke, Melissa Parker, Jérémie Pasquier, Bruno Pastene, Fabian Patauner, Drashti Patel, Mohan Dass Pathmanathan, Luís Patrão, Patricia Patricio, Lisa Patterson, Rajyabardhan Pattnaik, Christelle Paul, Mical Paul, Jorge Paulos, William A. Paxton, Jean-François Payen, Sandra L. Peake, Kalaiarasu Peariasamy, Giles J. Peek, Florent Peelman, Nathan Peiffer-Smadja, Vincent Peigne, Mare Pejkovska, Paolo Pelosi, Ithan D. Peltan, Rui Pereira, Daniel Perez, Thomas Perpoint, Antonio Pesenti, Vincent Pestre, Lenka Petrou, Michele Petrovic, Ventzislava Petrov-Sanchez, Frank Olav Pettersen, Gilles Peytavin, Richard Odame Philips, Ooyanong Phonemixay, Soulichanya Phoutthavong, Michael Piagnerelli, Walter Picard, Olivier Picone, Maria de Piero, Djura Piersma, Carlos Pimentel, Raquel Pinto, Catarina Pires, Lionel Piroth, Ayodhia Pitaloka, Chiara Piubelli, Riinu Pius, Simone Piva, Laurent Plantier, Hon Shen Png, Julien Poissy, Ryadh Pokeerbux, Sergio Poli, Georgios Pollakis, Diane Ponscarme, Diego Bastos Porto, Andra-Maris Post, Douwe F. Postma, Pedro Povoa, Diana Póvoas, Jeff Powis, Sofia Prapa, Viladeth Praphasiri, Sébastien Preau, Christian Prebensen, Jean-Charles Preiser, Anton Prinssen, Gamage Dona Dilanthi Priyadarshani, Lucia Proença, Sravya Pudota, Bambang Pujo Semedi, Mathew Pulicken, Peter Puplampu, Gregory Purcell, Luisa Quesada, Vilmaris Quinones-Cardona, Else Quist-Paulsen, Mohammed Quraishi, Fadi Qutishat, Maia Rabaa, Christian Rabaud, Ebenezer Rabindrarajan, Aldo Rafael, Marie Rafiq, Abdelrahman Ragab, Mutia Rahardjani, Arslan Rahat Ullah, Ahmad Kashfi Haji Ab Rahman, Rozanah Abd Rahman, Fernando Rainieri, Giri Shan Rajahram, Pratheema Ramachandran, Nagarajan Ramakrishnan, José Ramalho, Ahmad Afiq Ramli, Blandine Rammaert, Grazielle Viana Ramos, Asim Rana, Rajavardhan Rangappa, Ritika Ranjan, Christophe Rapp, Aasiyah Rashan, Thalha Rashan, Ghulam Rasheed, Menaldi Rasmin, Indrek Rätsep, Cornelius Rau, Tharmini Ravi, Ali Raza, Andre Real, Stanislas Rebaudet, Sarah Redl, Brenda Reeve, Attaur Rehman, Muhammad Osama Rehman Khalid, Dag Henrik Reikvam, Renato Reis, Jonathan Remppis, Martine Remy, Hongru Ren, Hanna Renk, Anne-Sophie Resseguier, Matthieu Revest, Oleksa Rewa, Maria Ines Ribeiro, Antonia Ricchiuto, David Richardson, Denise Richardson, Laurent Richier, Siti Nurul Atikah Ahmad Ridzuan, Ana L. Rios, Asgar Rishu, Patrick Rispal, Karine Risso, Maria Angelica Rivera Nuñez, Chiara Robba, André Roberto, Stephanie Roberts, Charles Roberts, David L. Robertson, Olivier Robineau, Anna Roca, Ferran Roche-Campo, Paola Rodari, Simão Rodeia, Bernhard Roessler, Claire Roger, Pierre-Marie Roger, Roberto Roncon-Albuquerque, Jr., Mélanie Roriz, Manuel Rosa-Calatrava, Michael Rose, Dorothea Rosenberger, Andrea Rossanese, Matteo Rossetti, Patrick Rossignol, Carine Roy, Benoît Roze, Desy Rusmawatiningtyas, Clark D. Russell, Maeve Ryan, Steffi Ryckaert, Aleksander Rygh Holten, Isabela Saba, Sairah Sadaf, Musharaf Sadat, Valla Sahraei, Abdurraouf Said, Nadia Saidani, Pranya Sakiyalak, Fodé Bangaly Sako, Moamen Salah, Ali Alaa Salah Eldin Mohamed Abbas, Nawal Salahuddin, Leonardo Salazar, Jodat Saleem, Mohammed Saleh Alyasiri, Talat Ahmed Abu Salem, Gabriele Sales, Charlotte Salmon Gandonniere, Hélène Salvator, Dana Samardali, Shaden Samardali, Yehia Samir Shaaban Aly Orabi, Emely Sanchez, Olivier Sanchez, Kizy Sanchez de Oliveira, Angel Sanchez-Miralles, Vanessa Sancho-Shimizu, Gyan Sandhu, Zulfiqar Sandhu, Pierre-François Sandrine, Oana Săndulescu, Marlene Santos, Shirley Sarfo-Mensah, Bruno Sarmento Banheiro, Iam Claire E. Sarmiento, Benjamine Sarton, Ankana Satya, Sree Satyapriya, Rumaisah Satyawati, Egle Saviciute, Yen Tsen Saw, Justin Schaffer, Tjard Schermer, Arnaud Scherpereel, Marion Schneider, János Schnur, Stephan Schroll, Michael Schwameis, Gary Schwartz, Janet T. Scott, James Scott-Brown, Nicholas Sedillot, Tamara Seitz, Jaganathan Selvanayagam, Mageswari Selvarajoo, Malcolm G. Semple, Rasidah Bt Senian, Eric Senneville, Claudia Sepulveda, Filipa Sequeira, Tânia Sequeira, Ary Serpa Neto, Ellen Shadowitz, Syamin Asyraf Shahidan, Hamza Shahla, Laila Shalabi, Haitam Shames, Anuraj Shankar, Shaikh Sharjeel, Pratima Sharma, Catherine A. Shaw, Victoria Shaw, John Robert Sheenan, Dr. Rajesh Mohan Shetty, Rohan Shetty, Mohiuddin Shiekh, Nobuaki Shime, Keiki Shimizu, Sally Shrapnel, Shubha Kalyan Shrestha, Pramesh Sundar Shrestha, Hoi Ping Shum, Nassima Si Mohammed, Ng Yong Siang, Moses Siaw-Frimpong, Jeanne Sibiude, Bountoy Sibounheuang, Nidhal Siddig, Atif Siddiqui, Maqsood Ahmed Siddiqui, Louise Sigfrid, Fatoumata Sillah, Piret Sillaots, Catarina Silva, Maria Joao Silva, Rogério Silva, Benedict Sim Lim Heng, Wai Ching Sin, Dario Sinatti, Mahendra Singh, Punam Singh, Pompini Agustina Sitompul, Karisha Sivam, Vegard Skogen, Sue Smith, Benjamin Smood, Coilin Smyth, Morgane Snacken, Dominic So, Tze Vee Soh, Lene Bergendal Solberg, Joshua Solomon, Tom Solomon, Emily Somers, Agnès Sommet, Myung Jin Song, Rima Song, Tae Song, Jack Song Chia, Arne Søraas, Albert Sotto, Edouard Soum, Ana Chora Sousa, Marta Sousa, Maria Sousa Uva, Vicente Souza-Dantas, Mamadou Saliou Sow, Alexandra Sperry, Elisabetta Spinuzza, B. P. Sanka Ruwan Sri Darshana, Shiranee Sriskandan, Sarah Stabler, Thomas Staudinger, Stephanie-Susanne Stecher, Trude Steinsvik, Ymkje Stienstra, Birgitte Stiksrud, Eva Stolz, Amy Stone, Anca Streinu-Cercel, Adrian Streinu-Cercel, Geoff Strong, Ami Stuart, David Stuart, Richa Su, Decy Subekti, Gabriel Suen, Jacky Y. Suen, Prasanth Sukumar, Asfia Sultana, Charlotte Summers, Dubravka Supic, Deepashankari Suppiah, Magdalena Surovcová, Atie Suwarti, Andrey Svistunov, Sarah Syahrin, Augustina Sylverken, Konstantinos Syrigos, Jaques Sztajnbok, Konstanty Szuldrzynski, Shirin Tabrizi, Fabio S. Taccone, Lysa Tagherset, Shahdattul Mawarni Taib, Sara Taleb, Cheikh Talla, Jelmer Talsma, Renaud Tamisier, Maria Lawrensia Tampubolon, Kim Keat Tan, Yan Chyi Tan, Hiroyuki Tanaka, Taku Tanaka, Hayato Taniguchi, Huda Taqdees, Arshad Taqi, Coralie Tardivon, Yousef Tarek Kamal Mostafa, Ali Tarhabat, Pierre Tattevin, M Azhari Taufik, Hassan Tawfik, Tze Yuan Tee, João Teixeira, Sofia Tejada, Marie-Capucine Tellier, Sze Kye Teoh, Vanessa Teotonio, François Téoulé, Olivier Terrier, Nicolas Terzi, Hubert Tessier-Grenier, Adrian Tey, Alif Adlan Mohd Thabit, Anand Thakur, Zhang Duan Tham, Suvintheran Thangavelu, Elmi Theron, Vincent Thibault, Simon-Djamel Thiberville, Benoît Thill, Jananee Thirumanickam, Niamh Thompson, Shaun Thompson, Emma C. Thomson, David Thomson, Mathew Thorpe, Surain Raaj Thanga Thurai, Ryan S. Thwaites, Paul Tierney, Vadim Tieroshyn, Peter S. Timashev, Jean-François Timsit, Noémie Tissot, Fiona Toal, Jordan Zhien Yang Toh, Maria Toki, Kristian Tonby, Sia Loong Tonnii, Marta Torre, Antoni Torres, Margarida Torres, Rosario Maria Torres Santos-Olmo, Hernando Torres-Zevallos, Aboubacar Tounkara, Michael Towers, Fodé Amara Traoré, Tony Trapani, Cécile Tromeur, Ioannis Trontzas, Tiffany Trouillon, Jeanne Truong, Christelle Tual, Sarah Tubiana, Helen Tuite, Alexis F. Turgeon, Jean-Marie Turmel, Lance C.W. Turtle, Anders Tveita, Pawel Twardowski, Makoto Uchiyama, PG Ishara Udayanga, Andrew Udy, Roman Ullrich, Alberto Uribe, Asad Usman, Effua Usuf, Timothy M. Uyeki, Cristinava Vajdovics, Piero Valentini, Luís Val-Flores, Stijn Van de Velde, Marcel van den Berge, Machteld van der Feltz, Job van der Palen, Paul van der Valk, Nicky Van Der Vekens, Peter Van der Voort, Sylvie Van Der Werf, Laura van Gulik, Jarne Van Hattem, Carolien van Netten, Ilonka van Veen, Noémie Vanel, Henk Vanoverschelde, Michael Varrone, Shoban Raj Vasudayan, Charline Vauchy, Pavan Kumar Vecham, Shaminee Veeran, Aurélie Veislinger, Sebastian Vencken, Sara Ventura, Annelies Verbon, José Ernesto Vidal, César Vieira, Deepak Vijayan, Judit Villar, Pierre-Marc Villeneuve, Andrea Villoldo, Gayatri Vishwanathan, Benoit Visseaux, Hannah Visser, Chiara Vitiello, Manivanh Vongsouvath, Harald Vonkeman, Fanny Vuotto, Suhaila Abdul Wahab, Noor Hidayu Wahab, Nadirah Abdul Wahid, Marina Wainstein, Laura Walsh, Wan Fadzlina Wan Muhd Shukeri, Chih-Hsien Wang, Steve Webb, Katharina Weil, Tan Pei Wen, Hassi Wesam, Sanne Wesselius, T. Eoin West, Murray Wham, Bryan Whelan, Nicole White, Paul Henri Wicky, Aurélie Wiedemann, Surya Otto Wijaya, Keith Wille, Sue Willems, Bailey Williams, Patricia J. Williams, Virginie Williams, Jessica Wittman, Calvin Wong, Xin Ci Wong, Yew Sing Wong, Teck Fung Wong, Natalie Wright, Lim Saio Xian, Ioannis Xynogalas, Siti Rohani Binti Mohd Yakop, Masaki Yamazaki, Elizabeth Yarad, Yazdan Yazdanpanah, Nicholas Yee Liang Hing, Abdelrahman Yehia Mahmoud Abdelaal, Cécile Yelnik, Chian Hui Yeoh, Stephanie Yerkovich, Touxiong Yiaye, Toshiki Yokoyama, Hodane Yonis, Obada Yousif, Saptadi Yuliarto, Akram Zaaqoq, Marion Zabbe, Gustavo E. Zabert, Kai Zacharowski, Masliza Zahid, Maram Zahran, Nor Zaila Binti Zaidan, Maria Zambon, Miguel Zambrano, Alberto Zanella, Nurul Zaynah, Hiba Zayyad, Alexander Zoufaly, and David Zucman

Subjects
COVID-19, Non-respiratory symptoms, Respiratory symptoms, Risk factors, Mortality, Science (General), Q1-390, Social sciences (General), H1-99
Abstract

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Published
2024
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15. Antibioterapia - uma análise retrospectiva de 3 anos

Author

Tiago Pereira, Nuno Catorze, Inês Coelho, André Real, Nuno Lopes, Ana Araújo, and Lucilia Pessoa

Subjects
lcsh:Internal medicine, lcsh:R, Microbiologia, lcsh:Medicine, Microorganismos multirresistentes, Antibióticos, lcsh:RC31-1245
Abstract

O ressurgimento de microorganismos multirresistentes resultantes do desadequado uso de antibioticos obrigam a um maior exercicio na aplicabilidade de antibioticos face aos multiplos padroes de resistencias. O objetivo do trabalho foi analisar o consumo de antibioticos num hospital distrital, ao longo de 3 anos, e relaciona-lo com a microbiologia local e respectiva variabilidade durante os 3 anos. No periodo analisado, no Centro Hospitalar Medio Tejo (CHMT), assistiu-se a uma diminuicao da utilizacao da Amoxicilina / Clavulanto contrapondo com o aumento da Piperacilina / Tazobactam, em sentido oposto a utilizacao de antibioticos na Unidade de Cuidados Intensivos (UCI). Contudo, tanto na UCI como no CHMT, observou-se um aumento dos microorganismos epidemiologicamente importantes face a evidente mudanca de habitos prescritivos

Published
2017

16. Intra-Vesical Colistin for Pseudomonas aeruginosa Urinary Tract Infections

Author

Nuno Catorze, Luis França, André Real, Inês Coelho, Tiago Pereira, Rui Encarnado Assis, and Ana Araújo

Subjects
medicine.medical_specialty, medicine.drug_class, Polymyxin, Urinary system, Antibiotics, 030232 urology & nephrology, lcsh:Medicine, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Pseudomonas, Internal Medicine, medicine, biology, business.industry, Pseudomonas aeruginosa, Colistin, lcsh:R, Acinetobacter, biology.organism_classification, medicine.disease, Pneumonia, 030220 oncology & carcinogenesis, Anuria, medicine.symptom, business, multiple drug resistance, medicine.drug
Abstract

The numbers of multiple drug-resistant Gram-negative bacterial infections are rising worldwide. The threat is increased by the lack of new antibiotics, so clinicians are turning to older drugs previously abandoned due to their recognized toxicity, such as colistin. However, the need to avoid kidney toxicity from colistin has led to its topical use. We present the case of a patient with type I cardiorenal syndrome with cystitis due to multiple drug-resistant Pseudomonas aeruginosa who was successfully treated with intravesical instillation of colistin. LEARNING POINTS The case report is one of the few in the literature on the intravesical instillation of colistin to address lower urinary tract infection. Isolated intravesical colistin instillation was effective in a patient with anuria. Keywords: Colistin, Pseudomonas, multiple drug resistance INTRODUCTION Pseudomonas aeruginosa is a Gram-negative bacterium frequently associated with hospital-acquired infections and is one of the most frequent multiple-drug-resistant Gram-negative bacteria (MDR-GNB) encountered. It is often the agent behind ventilator-associated pneumonia and other hospital-acquired infections[1,2]. The emergence of MDR-GNB is posing a threat as they cause significant morbidity and mortality worldwide in the form of hospital-acquired infections and, increasingly, community-acquired infections in immunocompromised patients or patients with severe pulmonary or cardiovascular comorbidities[3]. However, few new antibiotics are available to combat these organisms, so clinicians are turning to older antibiotics such as colistin. Colistin is an antibiotic belonging to the polymyxin group which was discovered in 1949 by Koyama et al and made available in the form of a less toxic prodrug, colistimethate sodium. It was later largely abandoned due to its nephrotoxicity[4]. This toxicity together with the need to tackle MDR-GNB has led to topical routes of administration, such as intrathecal and intraventricular, as well as by inhalation. Instillation in the bladder for urinary tract infections (UTI) caused by Acinetobacter baumani has been reported to be effective[5,6]. However, there are few reports in the literature of its use against UTI due to P. aeruginosa[7]. This article describes the case of a patient with type I cardiorenal syndrome with anuria who developed cystitis due to MDR P. aeruginosa and was treated successfully with bladder instillation of colistin.

Published
2019

17. Intra-Vesical Colistin for

Author

Rui Encarnado, Assis, Inês, Coelho, André, Real, Luís, França, Ana, Araújo, Tiago, Pereira, and Nuno, Catorze

Subjects
Articles
Abstract

The numbers of multiple drug-resistant Gram-negative bacterial infections are rising worldwide. The threat is increased by the lack of new antibiotics, so clinicians are turning to older drugs previously abandoned due to their recognized toxicity, such as colistin. However, the need to avoid kidney toxicity from colistin has led to its topical use. We present the case of a patient with type I cardiorenal syndrome with cystitis due to multiple drug-resistantThe case report is one of the few in the literature on the intravesical instillation of colistin to address lower urinary tract infection.Isolated intravesical colistin instillation was effective in a patient with anuria.

Published
2018

18. Envolvimento Gastrointestinal na Esclerose Sistémica

Author

Carlos Vasconcelos, António Marinho, André Real, Cristina Lopes, Lara Adelino, and Isabel Almeida

Subjects
lcsh:Internal medicine, Manifestações gastrointestinais, lcsh:R, Envolvimento gastrointestinal, lcsh:Medicine, Esclerose Sistémica, lcsh:RC31-1245
Abstract

Aproximadamente 70 a 90% dos doentes com Esclerose Sistemica apresentam envolvimento gastrointestinal e, em 10% dos casos, este envolvimento constitui a forma de apresentacao de Esclerose Sistemica. Todo o trato gastrointestinal pode estar afectado sendo o esofago o orgao mais frequentemente descrito1,2,3,4.

Published
2018

19. Estágio na revista Anais de História de Além-mar

Author

Morgado, André Real

Subjects
Edição de Texto, Revistas Cientificas, Edição Científica
Abstract

Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Edição de Texto O presente relatório procura descrever o estágio por mim realizado na revista Anais de História de Além-Mar, entre os meses de Setembro e Dezembro de 2012. Além da descrição das actividades realizadas, procurei enquadrar a edição de revistas científicas no mundo mais vasto da edição, tentando analisar as suas particularidades e as suas dificuldades. Procurei ainda reflectir sobre o modelo editorial interno destas e o papel do editor científico enquanto peça fundamental na sua edição. Tentei ainda entender a função social destas publicações como meio de transmissão e difusão do conhecimento científico.

Published
2013

20. 'Via Verde' Coronary—Paradigm and paradoxes

Author

Nuno Catorze, André Real, and Sónia Gonçalves

Subjects
business.industry, Emergency Medicine, Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine, business, Epistemology
Published
2013

21. Comparação dos efeitos profiláticos do droperidol e do ondansetron sobre o prurido provocado pela morfina subaracnoidea

Author

Fabio Ferreira da Cunha Brião, Mariana Antunes Nunes, Marcio Leal Horta, Guilherme Antonio Moreira de Barros, Roberta Boabaid, Ana Paula Behrensdorf, Bernardo L. Horta, André Real, and Ingrid Berger Severo

Subjects
Gynecology, medicine.medical_specialty, Morphine, business.industry, Pruritus, Ondansetron, Morfina, Anesthesiology and Pain Medicine, Injeção subaracnoidea, Subarachnoid injection, medicine, Droperidol, business, medicine.drug, Prurido
Abstract

ResumoJustificativa e objetivosO efeito profilático do ondansetron sobre prurido provocado pela morfina subaracnoidea é controverso, enquanto evidências sugerem que o droperidol previne o prurido. O objetivo do presente trabalho é comparar o efeito do droperidol com o do ondansetron sobre o prurido provocado pela morfina subaracnoidea.Métodos180 pacientes ASA I ou II programadas para serem submetidas a cesarianas sob anestesia subaracnoidea à qual foram acrescentados 0,2mg de morfina foram divididas aleatoriamente para receber, logo após o nascimento da criança, 10mg de metoclopramida (grupo I – controle), 2,5mg de droperidol (grupo II),ou 8mg de ondansetron (grupo III). No período pós‐operatório as pacientes foram avaliadas quanto ao prurido (ausente, leve, moderado ou intenso) ou outros efeitos colaterais por observadores que não sabiam a alocação das pacientes. As pacientes também não sabiam da sua alocação. Os grupos foram comparados pela sua tendência a apresentar formas mais severas de prurido. Também determinamos o NNT.ResultadosAs pacientes alocadas para receber droperidol [Odds Ratio Proporcional: 0,45 (Intervalo de Confiança de 95% 0,23 – 0,88)] relataram menos prurido do que as que receberam metoclopramida. O efeito do ondansetron foi semelhante ao da metoclopramida [Odds Ratio Proporcional: 0,95 (Intervalo de Confiança de 95% 0,49 – 1,83)]. O NNT do droperidol foi 4,0 e o do ondansetron foi 14,7.ConclusõesO ondansetron não inibiu o prurido provocado pela morfina subaracnoidea.AbstractBackground and objectivesThe prophylactic effect of ondansetron on subarachnoid morphine‐induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine‐induced pruritus.Methods180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2mg were randomized to receive, after the child's birth, metoclopramide 10mg (Group I – control), droperidol 2.5mg (Group II) or ondansetron 8mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined.ResultsPatients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23‐0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49‐1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively.ConclusionsOndansetron does not inhibit subarachnoid morphine‐induced pruritus.

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22. Comparación de los efectos profilácticos del droperidol y del ondansetrón sobre el prurito provocado por la morfina subaracnoidea

Author

Ana Paula Behrensdorf, Ingrid Berger Severo, Marcio Leal Horta, Roberta Boabaid, Fabio Ferreira da Cunha Brião, Guilherme Antonio Moreira de Barros, André Real, Mariana Antunes Nunes, and Bernardo L. Horta

Subjects
Gynecology, medicine.medical_specialty, Ondansetrón, Morphine, business.industry, Pruritus, General Medicine, Ondansetron, Morfina, Prurito, Inyección subaracnoidea, Subarachnoid injection, medicine, Droperidol, business, medicine.drug
Abstract

ResumenJustificación y objetivosEl efecto profiláctico del ondansetrón sobre el prurito provocado por la morfina subaracnoidea es controvertido, mientras las evidencias nos muestran que el droperidol previene el prurito. El objetivo del presente trabajo es comparar el efecto del droperidol con el del ondansetrón sobre el prurito provocado por la morfina subaracnoidea.MétodosCiento ochenta pacientes ASA I o II programadas para someterse a cesáreas bajo anestesia subaracnoidea a la cual se le añadió 0,2mg de morfina fueron divididas aleatoriamente para recibir, inmediatamente después del nacimiento del niño, 10mg de metoclopramida (grupo i-control), 2,5mg de droperidol (grupo ii) u 8mg de ondansetrón (grupo iii). En el período postoperatorio las pacientes fueron evaluadas en cuanto al prurito (ausente, leve, moderado o intenso) u otros efectos colaterales por observadores que no sabían nada respecto de la ubicación de las pacientes. Las pacientes tampoco conocían su propia ubicación. Los grupos fueron comparados por su tendencia a presentar formas más severas de prurito. También se determinó el NNT.ResultadosLas pacientes aleatorizadas para recibir droperidol (odds ratio proporcional: 0,45 [intervalo de confianza del 95%: 0,23-0,88]) relataron menos prurito que las que recibieron metoclopramida. El efecto del ondansetrón fue similar al de la metoclopramida (odds ratio proporcional: 0,95 [intervalo de confianza del 95%: 0,49-1,83-+). El NNT del droperidol fue 4 y el del ondansetrón 14,7.ConclusionesEl ondansetrón no inhibió el prurito provocado por la morfina subaracnoidea.AbstractBackground and objectivesThe prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus.MethodsOne hundred eighty patients ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2mg were randomized to receive, after the child's birth, metoclopramide 10mg (Group I-control), droperidol 2.5mg (Group II) or ondansetron 8mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined.ResultsPatients assigned to receive droperidol (proportional odds ratio: 0.45 [95% confidence interval 0.23-0.88]) reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide (proportional odds ratio: 0.95 [95% confidence interval 0.49-1.83]). The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively.ConclusionsOndansetron does not inhibit subarachnoid morphine-induced pruritus.

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23. INVOLUÇÃO UTERINA, ATIVIDADE OVARIANA, PRIMEIRO CIO PÓS-PARTO E DISTÚRBIOS REPRODUTIVOS EM BÚFALAS

Author

Sebastião T. Rolim Filho, Haroldo Francisco L. Ribeiro, William Gomes Vale, Nayma da Silva Picanço, Elizabeth Machado Barbosa, Rafaela Nunes Ferreira, and André Reale Simões

Subjects
Amazônia, búfalos, eficiência reprodutiva, Agriculture, Animal culture, SF1-1100
Abstract

Objetivou-se com o presente estudo avaliar algumas características reprodutivas como a involução uterina, a atividade ovariana no pós-parto, o primeiro estro após o parto, e problemas reprodutivos em fêmeas bubalinas criadas no sistema misto (várzea e terra / pastagem artificial) em uma fazenda experimental do município de Belém , Pará, Brasil. Entre 2002 a 2005, um total de 167 períodos de pós-parto de 62 búfalas foram avaliados através de um exame clínico ginecológico e ultrassonografia. Os animais foram mantidos durante a estação chuvosa (janeiro-junho), em pastagens artificiais e, durante a estação seca (julho-dezembro), nas áreas de várzea, com excelente disponibilidade de pastagem. A retomada da atividade ovariana, verificada através da observação visual do primeiro estro do período do pós-parto, ocorreu em média 47,06 ± 25,66 dias, enquanto que a involução uterina verificada por palpação retal e exames ultrassonográficos foi de 27,5 ± 7,77 dias. O número de casos de abortamentos, retenção da placenta e morte embrionárias foram de 10 (5,90%), 13 (7,78%) e 14 (8,38%) casos, respectivamente, enquanto o número de casos de infecção uterina foi de 18 (10,7%). A presença de ovários não-funcionais no decorrer do período do pós-parto foi observado em 26 (15,56%) casos, tendo sido encontrados dois (1,19%) casos de hipoplasia do ovário, três (1,79%) casos de cistos ovarianos e dois (1,19%) casos de salpingite. PALAVRAS-CHAVE: Atividade ovariana, búfalos, cio pós-parto, distúrbios reprodutivos, eficiência reprodutiva.

Published
2011
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