Browsing by Author "Sousa, A"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in EuropePublication . Valverde, I; Singh, Y; Sanchez-de-Toledo, J; Theocharis, P; Chikermane, A; Di Filippo, S; Kuciñska, B; Mannarino, S; Tamariz-Martel, A; Gutierrez-Larraya, F; Soda, G; Vandekerckhove, K; Gonzalez-Barlatay, F; McMahon, C; Marcora, S; Napoleone, C; Duong, P; Tuo, G; Deri, A; Nepali, G; Ilina, M; Ciliberti, P; Miller, O; Iriart, X; Hubrechts, J; Kuipers, I; Sousa, A; Donti, A; Sharpe, A; Reinhardt, Z; Cairello, F; De Wolf, D; Vieira, M; Lazea, C; Gran, F; Medrano-Lopez, C; Ortiz-Garrido, A; Vukomanovic, V; Brent, B; Milanesi, O; Dewals, W; Manso, B; Valsangiacomo-Buchel, E; Francisco, A; Seghaye, MC; Loeckx, I; Rodriguez-Gonzalez, M; ReyGarcía, S; Ziesenitz, V; Bordin, G; Doros, G; Grangl, G; Fadl, S; Perminow, K; Centeno, F; Pinto, F; Niemelä, J; Kanthimathinathan, H; Randanne, P; Niszczota, C; Zuccotti, G; Gordillo, I; Obeyasekhara, M; Armstrong, C; Butler, K; Ciuffreda, M; Villar, AM; Pappula, N; Caorsi, R; Singh, D; Durairaj, S; McLeod, K; Calcagni, G; Quizad, Y; Gewillig, M; Kuijpers, T; Ataide, R; Fabi, M; Bharucha, T; Abbas, K; Magrass, S; Wong, J; Iacob, D; Balcells, J; GilVillanueva, N; Cuenca-Peiro, V; Cerovi, I; Sarfatt, A; Zaqout, M; Sanchez-Valderrabanos, E; Kelly-Geyer, J; Diogo, F; Cajgfinger, N; Françoise, M; Rueda-Nuñez, F; Gorenflo, M; Grison, A; Mihailov, D; Koestenberger, M; Alcalde, C; Trigo, C; Arola, A; Hanseus, KBackground: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. Methods: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. Results: A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (P<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. Conclusions: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.
- Ascertainment of Silent Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention (from the GLOBAL LEADERS Trial)Publication . Chang, CC; Spitzer, E; Chichareon, P; Takahashi, K; Modolo, R; Kogame, N; Tomaniak, M; Komiyama, H; Yap, SC; Hoole, SP; Gori, T; Zaman, A; Frey, B; Cruz Ferreira, R; Bertrand, OF; Koh, TH; Sousa, A; Moschovitis, A; van Geuns, RJ; Steg, PG; Hamm, C; Jüni, P; Vranckx, P; Valgimigli, M; Windecker, S; Serruys, PW; Soliman, O; Onuma, YQ-wave myocardial infarction (QWMI) comprises 2 entities. First, a clinically evident MI, which can occur spontaneously or be related to a coronary procedure. Second, silent MI which is incidentally detected on serial electrocardiographic (ECG) assessment. The prevalence of silent MI after percutaneous coronary intervention (PCI) in the drug-eluting stent era has not been fully investigated. The GLOBAL LEADERS is an all-comers multicenter trial which randomized 15,991 patients who underwent PCI to 2 antiplatelet treatment strategies. The primary end point was a composite of all-cause death or nonfatal new QWMI at 2-years follow-up. ECGs were collected at discharge, 3-month and 2-year visits, and analyzed by an independent ECG core laboratory following the Minnesota code. All new QWMI were further reviewed by a blinded independent cardiologist to identify a potential clinical correlate by reviewing clinical information. Of 15,968 participants, ECG information was complete in 14,829 (92.9%) at 2 years. A new QWMI was confirmed in 186 (1.16%) patients. Transient new Q-waves were observed in 28.5% (53 of 186) of them during the follow-up. The majority of new QWMI (78%, 146 of 186) were classified as silent MI due to the absence of a clinical correlate. Silent MI accounted for 22.1% (146 of 660) of all MI events. The prevalence of silent MI did not differ significantly between treatment strategies (experimental vs reference: 0.88% vs 0.98%, p = 0.5027). In conclusion, we document the prevalence of silent MI in an all-comers population undergoing PCI in this large-scale randomized trial.
- Endocardites. Uma Nova RealidadePublication . Robalo, M; Teixeira, H; Godinho, A; Sousa, A; Marcão, I
- Real-Word Effectiveness and Safety of Dimethyl Fumarate in a Multiple Sclerosis Portuguese PopulationPublication . Barros, A; Sequeira, J; Sousa, A; Parra, J; Brum, M; Pedrosa, R; Capela, CObjectives: The aim of this study was to evaluate postmarketing dimethyl fumarate (DMF) safety and effectiveness in a real-world population with relapsing-remitting multiple sclerosis (RRMS). Methods: This was a retrospective, single-center study with RRMS patients treated with DMF. Demographic, clinical, and imagiological characteristics were analyzed, including annualized relapse rate (ARR), Expanded Disability Status Scale, "No Evidence of Disease Activity 3," previous treatment, adverse events, treatment duration, and reason for discontinuation. We investigated which baseline variables were associated with clinical and radiological outcomes. Results: We included 176 patients (70.4% females) with a median on-treatment follow-up time of 25.5 months. In total, 139 patients received prior disease-modifying therapies, and 37 were treatment-naive. Annualized relapse rate decreased by 77.1% in the total population (P < 0.001) and also decreased in the naive, tolerability switch, and efficacy switch groups by 95.8%, 56.7%, and 76.6% (P < 0.001). No Evidence of Disease Activity 3 status after 12 months of DMF treatment was maintained in 69.2% patients. Thirty patients (17%) discontinued treatment because of adverse drug reactions, and 21 (11.9%) because of lack of effectiveness. The occurrence of first relapse during follow-up was associated with higher ARR in the year before DMF start (hazard ratio, 4.833; P < 0.001) and prior exposure to multiple sclerosis treatments (tolerability and efficacy switchers). Conclusions: In this real-world audit, DMF appeared to be effective and safe for RRMS. Additionally, the study suggested that naive patients strongly benefit from DMF, and DMF also improves ARR in patients who switched from injectable therapies due to tolerability and efficacy issues.
- Seroconversion Rate Following HBV Vaccination in Clinical Practice: The Role of Age and DMT TreatmentPublication . Faustino, P; Coutinho, M; Leitão, L; Capela, C; Brum, M; Parra, J; Sequeira, J; Barros, A; Araújo, C; Sousa, A; Ladeira, FHBV screening and immunization is recommended in all MS patients and is mandatory before the start of some DMT. However, studies evaluating the immune response to HBV vaccine in MS patients are scarce. We aimed to evaluate the seroprotection rate following HBV immunization in MS patients and to assess if older age and DMT-treatment influenced seroprotection. We conducted a cohort study between 2016 and 2020 and compared the immune response to HBV vaccine in MS patients under different DMTs and in patients 50 years old or younger and older than 50. We found that patients under non-injectable DMT presented lower rates of seroprotection comparing to patients under injectable DMT's or without treatment. In patients older than 50, although the seroprotection rate was similar to the remaining patients, the antibody anti-HBV surface antigen titers following HBV immunization were lower and patients were more likely to require a 4th dose of the vaccine to achieve seroprotection. Our findings highlight to need to consider HBV immunization in MS patients early in the disease course, in order to ensure a proper immune response to the vaccine.