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- Feedback based on experience sampling data: examples of current approaches and considerations for future researchPublication . Bartels, Sara Laureen; van Zelst, Catherine; Melo Moura, Bernardo; Daniëls, Naomi E.M.; Simons, Claudia J.P.; Marcelis, Machteld; Bos, Fionneke M.; Servaas, Michelle N.Methodologies such as the Experience Sampling Method (ESM) or Ecological Momentary Assessment allow the gathering of fine-graded, dynamic, personal data within a patient's daily life. Currently, it is studied whether feedback based on experience sampling data (ESM-based feedback) can be used as a clinical tool to inform shared decision-making in clinical practice. Although the potential of feedback is recognized, little is known on how to generate, use, and implement it. This article (i) presents n = 15 ongoing ESM projects within the Belgian-Dutch network for ESM research wherein ESM-based feedback is provided to various patient populations, and (ii) summarizes qualitative data on experiences with ESM-based feedback of researchers (n = 8) with extensive expertise with ESM (average of 10 years) involved in these ongoing studies. The following aspects appear to be of relevance when providing ESM-based feedback: training for healthcare professionals and researchers, the use of online interfaces and graphical visualizations to present data, and interacting with patients in a face-to-face setting when discussing the contextual relevance and potential implications. Prospectively, research may build on these aspects and create coherent consensus-based guidelines for the use of ESM-based feedback.
- Relation of gender to atherosclerotic plaque characteristics by differing angiographic stenosis severityPublication . Jonas, Rebecca; Patel, Toral; Crabtree, Tami R.; Jennings, Robert S.; Heo, Ran; Park, Hyung Bok; Marques, Hugo; Chang, Hyuk Jae; Stuijfzand, Wijnand J.; van Rosendael, Alexander R.; Choi, Jung Hyun; Doh, Joon Hyung; Her, Ae Young; Koo, Bon Kwon; Nam, Chang Wook; Shin, Sang Hoon; Cole, Jason; Gimelli, Alessia; Khan, Muhammad Akram; Lu, Bin; Gao, Yang; Nabi, Faisal; Al-Mallah, Mouaz H.; Nakazato, Ryo; Schoepf, U. Joseph; Driessen, Roel S.; Bom, Michiel J.; Thompson, Randall C.; Jang, James J.; Ridner, Michael; Rowan, Chris; Avelar, Erick; Généreux, Philippe; Knaapen, Paul; de Waard, Guus A.; Pontone, Gianluca; Andreini, Daniele; Bax, Jeroen J.; Choi, Andrew D.; Earls, James P.; Hoffmann, Udo; Min, James K.; Villines, Todd C.It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all of whom underwent coronary computed tomographic angiography and clinically indicated nonemergent invasive coronary angiography upon study enrollment. Index tests were interpreted by 2 blinded core laboratories, one of which performed quantitative coronary computed tomographic angiography using an artificial intelligence application to characterize and quantify APCs, including percent atheroma volume (PAV), low-density noncalcified plaque (LD-NCP), noncalcified plaque (NCP), calcified plaque (CP), lesion length, positive arterial remodeling, and high-risk plaque (a combination of LD-NCP and positive remodeling ≥1.10); the other classified lesions as obstructive (≥50% diameter stenosis) or nonobstructive (<50% diameter stenosis) based on quantitative invasive coronary angiography. The relation between APCs and angiographic stenosis was further examined by gender. The mean age of the study cohort was 64.4 ± 10.2 years (29.0% female). In patients with obstructive disease, men had more LD-NCP PAV (0.5 ± 0.4 vs 0.3 ± 0.8, p = 0.03) and women had more CP PAV (11.7 ± 1.6 vs 8.0 ± 0.8, p = 0.04). Obstructive lesions had more NCP PAV compared with their nonobstructive lesions in both genders, however, obstructive lesions in women also demonstrated greater LD-NCP PAV (0.4 ± 0.5 vs 1.0 ± 1.8, p = 0.03), and CP PAV (17.4 ± 16.5 vs 25.9 ± 18.7, p = 0.03) than nonobstructive lesions. Comparing the composition of obstructive lesions by gender, women had more CP PAV (26.3 ± 3.4 vs 15.8 ± 1.5, p = 0.005) whereas men had more NCP PAV (33.0 ± 1.6 vs 26.7 ± 2.5, p = 0.04). Men had more LD-NCP PAV in nonobstructive lesions compared with women (1.2 ± 0.2 vs 0.6 ± 0.2, p = 0.02). In conclusion, there are gender-specific differences in plaque composition based on stenosis severity.
- Correction to: Surgery of the primary tumor in patients with de novo metastatic breast cancer: a nationwide population-based retrospective cohort study in Belgium (Breast Cancer Research and Treatment, (2024), 203, 2, (351-363), 10.1007/s10549-023-07116-6)Publication . Brandão, Mariana; Martins-Branco, Diogo; Angelis, Claudia De; Vuylsteke, Peter; Gelber, Richard D.; Damme, Nancy Van; Walle, Lien van; Ferreira, Arlindo R.; Lambertini, Matteo; Poggio, Francesca; Verhoeven, Didier; Barbeaux, Annelore; Duhoux, Francois P.; Wildiers, Hans; Caballero, Carmela; Awada, Ahmad; Piccart-Gebhart, Martine; Punie, Kevin; Azambuja, Evandro deIn the original publication of the article, the following article note has been missed to include. “Mariana Brandão and Diogo Martins-Branco have contributed equally to this work.” The original article has been corrected.
- Catheter-related right atrial endocarditis in a dialysis patientPublication . Ribeiro, Maria Inês; D'Orey, Francisco; Sampaio, João Prosil; Santos, João Grade; Pereira, VeraHemodialysis catheters are frequently used for vascular access in end-stage chronic kidney disease patients lacking mature arteriovenous fistula. The incidence of infective endocarditis in hemodialysis patients is higher than in the general population and is associated with severe and potentially life-threatening complications. A high index of suspicion is imperative for early diagnosis and timely intervention to enhance the prognosis of this high-mortality condition. Imaging studies, like transthoracic and transesophageal echocardiography, are crucial for prompt diagnosis. We present a case of a 36-year-old woman undergoing hemodialysis, whose prolonged use of a permanent catheter led to the development of infective endocarditis complicated with septic pulmonary embolism. Our case report presents an example of right atrial endocarditis with a poor outcome due to delayed diagnosis.
- Multidisciplinary team care in pituitary tumoursPublication . Marques, Pedro; Sagarribay, Amets; Tortosa, Francisco; Neto, Lia; Ferreira, Joana Tavares; Subtil, João; Palha, Ana; Dias, Daniela; Sapinho, InêsThe optimal care for patients with pituitary tumours is best provided in a multidisciplinary and collaborative environment, which requires the contribution of multiple medical specialties working together. The benefits and advantages of the pituitary multidisciplinary team (MDT) are broad, and all relevant international consensus and guidelines in the field recommend that patients with pituitary tumours should always be managed in a MDT. Endocrinologists and neurosurgeons are normally the leading specialties within the pituitary MDT, supported by many other specialties with significant contributions to the diagnosis and management of pituitary tumours, including neuropathology, neuroradiology, neuro-ophthalmology, and otorhinolaryngology, among others. Here, we review the literature concerning the concepts of Pituitary MDT/Pituitary Tumour Centre of Excellence (PTCOE) in terms of their mission, goals, benefits, structure, proposed models of function, and barriers, and we also provide the views of different specialists involved in our Pituitary MDT.
- Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021Publication . GBD 2021 Nervous System Disorders Collaborators; Steinmetz, Jaimie D.; Seeher, Katrin Maria; Schiess, Nicoline; Nichols, Emma; Cao, Bochen; Servili, Chiara; Cavallera, Vanessa; Cousin, Ewerton; Hagins, Hailey; Moberg, Madeline E.; Mehlman, Max L.; Abate, Yohannes Habtegiorgis; Abbas, Jaffar; Abbasi, Madineh Akram; Abbasian, Mohammadreza; Abbastabar, Hedayat; Abdelmasseh, Michael; Abdollahi, Mohammad; Abdollahi, Mozhan; Abdollahifar, Mohammad Amin; Abd-Rabu, Rami; Abdulah, Deldar Morad; Abdullahi, Auwal; Abedi, Aidin; Abedi, Vida; Abeldaño Zuñiga, Roberto Ariel; Abidi, Hassan; Abiodun, Olumide; Aboagye, Richard Gyan; Abolhassani, Hassan; Aboyans, Victor; Abrha, Woldu Aberhe; Abualhasan, Ahmed; Abu-Gharbieh, Eman; Aburuz, Salahdein; Adamu, Lawan Hassan; Addo, Isaac Yeboah; Adebayo, Oladimeji M.; Adekanmbi, Victor; Adekiya, Tayo Alex; Adikusuma, Wirawan; Adnani, Qorinah Estiningtyas Sakilah; Adra, Saryia; Afework, Tsion; Afolabi, Aanuoluwapo Adeyimika; Afraz, Ali; Afzal, Saira; Aghamiri, Shahin; Agodi, Antonella; Bettencourt, Paulo J. G.Background: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. Methods: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. Findings: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. Interpretation: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. Funding: Bill & Melinda Gates Foundation.
- The association between alterations in motor and cognitive dimensions of schizophrenia-spectrum disorders: a systematic reviewPublication . Moura, Bernardo Melo; Madeira, Luís; Bakker, P. Roberto; Harten, Peter van; Marcelis, MachteldMotor and cognitive alterations in schizophrenia-spectrum disorders (SSD) share common neural underpinnings, highlighting the necessity for a thorough exploration of the connections between these areas. This relationship is crucial, as it holds potential significance in unraveling the underlying mechanisms of SSD pathophysiology, ultimately leading to advancements in clinical staging and treatment strategies. The purpose of this review was to characterize the relationship between different hyper and hypokinetic domains of motor alterations and cognition in SSD. We systematically searched the literature (PROSPERO protocol CRD42019145964) and selected 66 original scientific contributions for review, published between 1987 and 2022. A narrative synthesis of the results was conducted. Hyper and hypokinetic motor alterations showed weak to moderate negative correlations with cognitive function across different SSD stages, including before antipsychotic treatment. The literature to date shows a diverse set of methodologies and composite cognitive scores hampering a strong conclusion about which specific cognitive domains were more linked to each group of motor alterations. However, executive functions seemed the domain more consistently associated with parkinsonism with the results regarding dyskinesia being less clear. Akathisia and catatonia were scarcely discussed in the reviewed literature. The present review reinforces the intimate relationship between specific motor alterations and cognition. Identified gaps in the literature challenge the formulation of definitive conclusions. Nevertheless, a discussion of putative underlying mechanisms is included, prompting guidance for future research endeavors.
- Heart with Mozambique: a Portuguese contribution to the eradication of rheumatic heart diseasePublication . Almeida, Inês Grácio de; Esteves, Ana; Gil, Victor
- Therapeutical usefulness of PD-1/PD-L1 inhibitors in aggressive or metastatic pituitary tumoursPublication . Lopes-Pinto, Mariana; Lacerda-Nobre, Ema; Silva, Ana Luísa; Marques, PedroTherapeutic options for pituitary neuroendocrine tumours (PitNETs) refractory to temozolomide are scarce. Immune checkpoint inhibitors (ICIs), particularly inhibitors of the programmed cell death-1 (PD-1) pathway and its ligand (PD-L1), have been experimentally used in aggressive or metastatic PitNETs. We aimed to study the therapeutic usefulness of anti-PD-1 drugs in patients with aggressive or metastatic PitNETs. Published cases and case series involving patients with PitNETs treated with PD-1/PD-L1 inhibitors were reviewed. Demographic data, clinical–pathological features, previous therapies, drug dosage and posology, and the best radiological and biochemical responses, as well as survival data, were evaluated. We identified 29 cases of aggressive (n = 13) or metastatic (n = 16) PitNETs treated with PD-1/PD-L1 inhibitors. The hypersecretion of adrenocorticotropic hormone (ACTH) was documented in eighteen cases (62.1%), seven were prolactinomas (24.1%), and four were non-functioning PitNETs. All patients underwent various therapies prior to using ICIs. Overall, a positive radiological response (i.e., partial/complete radiological response and stable disease) was observed in eighteen of twenty-nine cases (62.1%), of which ten and four were ACTH- and prolactin-secreting PitNETs, respectively. Hormonal levels reduced or stabilised after using ICIs in 11 of the 17 functioning PitNET cases with available data (64.7%). The median survival of patients treated with ICIs was 13 months, with a maximum of 42 months in two ACTH-secreting tumours. Among 29 patients with PitNETs treated with PD-1/PD-L1 inhibitors, the positive radiological and biochemical response rates were 62.1% and 64.7%, respectively. Altogether, these data suggest a promising role of ICIs in patients with aggressive or metastatic PitNETs refractory to other treatment modalities.
- World Heart Federation cholesterol roadmap: the Portuguese casePublication . Abreu, Ana; Dores, Hélder; Gonçalves, Lino; Franco, Fátima; Silveira, Conceição; Proença, Gonçalo; Timóteo, Ana Teresa; Cardim, Nuno; Pedro, Mónica; Fiuza, Manuela; Ferreira, Daniel; Bento, Luísa; Patrício, Lino; Caldeira, Daniel; Baptista, Sérgio Bravo; Santos, José; Rocha, Evangelista; Raimundo, Anabela; Catarino, Carlos; Carrageta, Manuel; Mexia, Ricardo; Araújo, Francisco; Pereira, Hélder; Santos, Raul; Pinto, Fausto J.Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of premature death and disability; effective cardiovascular (CV) risk prevention is fundamental. The World Heart Federation (WHF) Cholesterol Roadmap provides a framework for national policy development and aims to achieve ASCVD prevention. At the invitation of the WHF, a group of experts from the Portuguese Society of Cardiology (SPC), addressed the cholesterol burden at nationally and discussed possible strategies to include in a Portuguese cholesterol roadmap. The literature review showed that the cholesterol burden in Portugal is high and especially uncontrolled in those with the highest CV risk. An infographic scorecard was built to include in the WHF collection, for a clear idea about CV risk and cholesterol burden in Portugal, which would also be useful for health policy advocacy. The expert discussion and preventive strategies proposal followed the five pillars of the WHF document: awareness improvement; population-based approaches for CV risk and cholesterol; risk assessment/population screening; system-level approaches; surveillance of cholesterol and ASCVD outcomes. These strategies were debated by all the expert participants, with the goal of creating a national cholesterol roadmap to be used for advocacy and as a guide for CV prevention. Several key recommendations were outlined: include all stakeholders in a multidisciplinary national program; create a structured activities plan to increase awareness in the population; improve the quality of continuous CV health education; increase the interaction between different health professionals and non-health professionals; increment the referral of patients to cardiac rehabilitation; screen cholesterol levels in the general population, especially high-risk groups; promote patient self-care, engage with patients’ associations; use specific social networks to spread information widely; create a national database of cholesterol levels with systematic registry of CV events; redefine strategies based on the evaluation of results; create and involve more patients’ associations – invert the pyramid order. In conclusion, ASCVD and the cholesterol burden remain a strong global issue in Portugal, requiring the involvement of multiple stakeholders in prevention. The Portuguese cholesterol roadmap can provide some solutions to help urgently mitigate the problem. Population-based approaches to improve awareness and CV risk assessment and surveillance of cholesterol and ASCVD outcomes are key factors in this change. A call to action is clearly needed to fight hypercholesterolemia and ASCVD burden.