Browsing by Issue Date, starting with "2021-01"
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- Spatial and Temporal Dynamics of Epileptic Activity at Sleep Onset in the Encephalopathy with Status Epilepticus During Slow Sleep (ESES) After Unilateral Thalamic LesionsPublication . Leal, AEncephalopathy with Status Epilepticus during slow Sleep (ESES) is a syndrome where neurocognitive impairment correlates with multifocal Electroencephalography (EEG) spikes increasing abruptly at sleep onset. Demonstration of a focal onset could provide important clues to unravel the mechanisms underlying the condition, but until know it has not been established.
- Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital ProjectPublication . Machado, A; Gomez, V; Panarra, A; Poças, J; Corte-Real, R; Peres, MJ; Nunes, BIntroduction: The project ‘Integrated Monitoring of Vaccines in Europe’ aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.
- 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.
- The Impact of Multidisciplinary Team Conferences in Urologic Cancer in a Tertiary HospitalPublication . Gil, M; Guerra, J; Andrade, V; Medeiros, M; Guimarães, T; Bernardino, R; Falcão, G; Calais da Silva, F; Campos Pinheiro, LPurpose: Multidisciplinary team (MDT) conferences are currently the standard of care in cancer patients' management. Despite evidence supporting benefits to the majority of malignancies, a paucity of data exists examining the impact in urinary and male genital cancers. This study aims to evaluate the impact of MDT conferences in urologic cancer practice. Methods: Clinical plans discussed in urologic MDT conferences in Centro Hospitalar Universitário de Lisboa Central between January 2019 and December 2019 were retrospectively analysed. Clinical plans were categorized as accepted, changed, rejected (cases that had to be re-presented to the MDT because of insufficient staging or administrative issues) or no plan. MDT conferences' impact was assessed according to type of consultation, referral medical specialty and primary tumour type. Results: 710 clinical plans were discussed at the MDT conferences. 61.8% were accepted, 10.6% were changed, 16.5% were rejected and 11.1% of cases referred to MDT discussion had no defined clinical plan. First consultations had a higher rate of accepted clinical plans (63.4%) versus subsequent consultations (56.4%). Referrals by the urology specialty had the highest rate of acceptances (64.3%). On the stratification by primary tumour site, testicular cancer had the highest acceptance rate (70.3%), whereas bladder cancer had the lowest (47.8%). Conclusions: MDT conferences had an important impact in the management of 38.2% of cases. Therefore, all patients with urologic malignancies should be referred to MDT review to ensure optimal clinical care.