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Predictors of Cognitive Stability or Decline During Aging: a Longitudinal Study in Primary Care.
Publication . Pavão Martins, Isabel; Maruta, Carolina; Morgado, Joana; Loureiro, Clara; Tavares, Joana; Freitas, Vanda; Lunet, Nuno; Viana, Pedro; Marques, Paulo
We aimed to identify the early predictors of cognitive decline, and primary care physicians' (PCP) ability to diagnose cognitively impaired subjects, in a cohort of individuals recruited in primary care centers. Independent adults, aged ≥50 years at inception, with an overall low level of education, undertook a prospective clinical and cognitive evaluation targeting memory, attention and executive functions. At follow-up subjects were classified as cognitively normal (CN) or impaired (CI). Of 275 subjects (70.4 ± 8.3 years old, 176 females, 7.5 ± 4.4 education, 162 with MRI), 31 (11.2%) presented CI 4.9 years later, the majority (64.5%) presenting subjective cognitive complaints. PCP could correctly identify 40% of CI individuals, particularly if they presented current cognitive complaints. Male sex (OR = 3.117; CI95%: 1.007-9.645), age (OR = 1.063; CI95%: 1.004-1.126) and baseline scores on TMT-B (OR = 0.225; CI95%: 0.073-0.688) and Vocabulary (OR = 0.940; 95% CI: 0.894-0.986) predicted CI. This study shows that measures indicating poor cognitive reserve and low executive performance (as shown by low vocabulary and executive test scores, respectively) can be early indicators of the risk of decline, stressing the role of cognitive assessment as part of prevention/early intervention programs. The results also underline the need to help PCP to improve the detection of subjects with cognitive decline.
Linking Sleep Disorders to Atrial Fibrillation: Pathways, Risks, and Treatment Implications.
Publication . Ferreira, Mónica; Oliveira, Mário; Laranjo, Sérgio; Rocha, Isabel
Sleep is a complex biobehavioural process essential for overall health, with various dimensions including duration, continuity, timing, and satisfaction. This study investigated the intricate relationships between common sleep disorders such as insomnia and obstructive sleep apnoea (OSA) and their impact on atrial fibrillation (AF), a prevalent arrhythmia with significant health implications. Using a comprehensive review of the current literature, this study examined the pathophysiological mechanisms linking sleep disorders to cardiovascular risks, focusing on autonomic nervous system disturbances, inflammation, and oxidative stress associated with OSA. These findings indicate that sleep disorders significantly elevate the risk of AF through mechanisms such as increased sympathetic activity and structural cardiac remodelling. Additionally, this study highlights the potential benefits of treating sleep disorders, particularly with continuous positive airway pressure (CPAP) therapy, in reducing AF recurrence and improving cardiovascular outcomes. This conclusion emphasises the importance of integrated therapeutic approaches that address both sleep disorders and AF to enhance patient outcomes and quality of life. Future research should explore these connections to develop more effective and holistic treatment strategies.
Characteristics and Outcomes of Cerebral Venous Thrombosis Associated With COVID-19.
Publication . Scutelnic, Adrian; van de Munckhof, Anita; Miraclin, Angel T; Aaron, Sanjith; Hameed, Sajid; Wasay, Mohammad; Grosu, Oxana; Krzywicka, Katarzyna; Sánchez van Kammen, Mayte; Lindgren, Erik; Moreira, Tiago; Acampora, Roberto; Negro, Alberto; Karapanayiotides, Theodoros; Yaghi, Shadi; Revert, Anna; Cuadrado Godia, Elisa; Garcia-Madrona, Sebastian; La Spina, Paolino; Grillo, Francesco; Giammello, Fabrizio; Nguyen, Thanh N; Abdalkader, Mohamad; Buture, Alina; Sofia Cotelli, Maria; Raposo, Nicolas; Tsivgoulis, Georgios; Candelaresi, Paolo; Ciacciarelli, Antonio; Mbroh, Joshua; Batenkova, Tatiana; Scoppettuolo, Pasquale; Zedde, Marialuisa; Pascarella, Rosario; Antonenko, Kateryna; Kristoffersen, Espen S; Kremer Hovinga, Johanna A; Jood, Katarina; Aguiar de Sousa, Diana; Poli, Sven; Tatlisumak, Turgut; Putaala, Jukka; Coutinho, Jonathan M; Ferro, José M; Arnold, Marcel; Heldner, Mirjam R
Introduction: Previous reports and meta-analyses derived from small case series reported a mortality rate of up to 40% in patients with coronavirus disease 2019 associated cerebral venous thrombosis (COVID-CVT). We assessed the clinical characteristics and outcomes in an international cohort of patients with COVID-CVT.
Patients and methods: This was a registry study of consecutive COVID-CVT patients diagnosed between March 2020 and March 2023. Data collected by the International Cerebral Venous Thrombosis Consortium from patients with CVT diagnosed between 2017 and 2018 served as a comparison. Outcome analyses were adjusted for age and sex.
Results: We included 70 patients with COVID-CVT from 23 hospitals in 15 countries and 206 controls from 14 hospitals in 13 countries. The proportion of women was smaller in the COVID-CVT group (50% vs 68%, p < 0.01). A higher proportion of COVID-CVT patients presented with altered mental state (44% vs 25%, p < 0.01), the median thrombus load was higher in COVID-CVT patients (3 [IQR 2-4] vs 2 [1-3], p < 0.01) and the length of hospital stay was longer compared to controls (11 days [IQR 7-20] vs 8 [4-15], p = 0.02). In-hospital mortality did not differ (5/67 [7%, 95% CI 3-16] vs 7/206 [3%, 2-7], aOR 2.6 [95% CI 0.7-9]), nor did the frequency of functional independence after 6 months (modified Rankin Scale 0-2; 45/58 [78%, 95% CI 65-86] vs 161/185 [87%, 81-91], aOR 0.5 [95% CI 0.2-1.02]).
Conclusion: In contrast to previous studies, the in-hospital mortality rate and functional outcomes during follow-up did not differ between COVID-CVT patients and the pre-COVID-19 controls.
Mordedura de Víbora Cornuda: Caso Clínico e Revisão de Abordagem Terapêutica
Publication . Gante, Cristiano; Watts Soares, Adriana; Brazete, João; Terceiro, Rafael; Rato, Fátima
A mordedura de víbora-cornuda (Vipera latastei), espécie endémica da Península Ibérica, provoca habitualmente toxicidade local e hematológica, podendo originar coagulopatia de consumo. Apresenta-se o caso de um homem de 39 anos mordido no quarto dedo da mão esquerda. A primeira dose de soro antiofídico (ViperFav®) foi administrada 10 horas após o incidente, com necessidade de duas doses adicionais por persistência de coagulopatia e trombocitopenia transitória. Implementaram-se medidas adjuvantes, cuja utilização e benefícios se encontram em discussão na comunidade médica: oxigenoterapia hiperbárica (10 sessões) e penso transdérmico de nitroglicerina para otimizar a perfusão local. A evolução foi favorável, com preservação da viabilidade digital e resolução laboratorial progressiva. Este caso evidencia a importância da administração precoce do antídoto, da vigilância hematológica contínua e o potencial benefício de integrar terapêuticas adjuvantes na prevenção de necrose e complicações sistémicas. A abordagem multidisciplinar permitiu a recuperação funcional completa sem sequelas.
Cancer Screening and Cancer Treatment in Kidney Transplant Recipients.
Publication . Bigotte Vieira, Miguel; Arai, Hiroyuki; Nicolau, Carla; Murakami, Naoka
As the population ages and post-transplant survival improves, pretransplant and post-transplant malignancy are becoming increasingly common. In addition, rapid advances in cancer therapies and improving outcomes prompt us to rethink pretransplant cancer-free wait time and screening strategies. Although kidney transplant recipients (KTRs) are at higher risk of developing cancer, epidemiological data on how to best screen and treat cancers in KTRs are incomplete. Thus, current recommendations are still largely on the basis of studies in the general population, and their validity in KTRs is uncertain. Kidney transplant candidates without prior cancer should be evaluated for latent malignancies even in the absence of symptoms. Conversely, individuals with a history of malignancy require thorough monitoring to detect potential recurrences or de novo malignancies. When treating KTRs with cancer, reducing immunosuppression can enhance antitumor immunity, yet this also increases the risk of graft rejection. Optimal treatment and immunosuppression management remains undefined. As the emergence of novel cancer therapies adds complexity to this challenge, individualized risk-benefit assessment is crucial. In this review, we discuss up-to-date data on pretransplant screening and cancer-free wait time, as well as post-transplant cancer screening, prevention strategies, and treatment, including novel therapies such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapies.