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- Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancerPublication . Cabral, Francisco; Ramos, Paulo; Monteiro, Cecília; Casaca, Rui; Pinto, Iola; Abecasis, NunoIntroduction: The use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity. Methods: We retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded. The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups. Results: A total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old. The overall major surgical morbidity (Clavien-Dindo 3-5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p = 0.643). There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p = 0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p = 0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed. Conclusions: Perioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count. (C) 2020 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.
- An interactive dashboard for statistical analysis of intensive care unit COVID-19 dataPublication . Dias, Rúben; Ferreira, Artur; Pinto, Iola; Brás-Geraldes, Carlos; Von Rekowski, Cristiana; Bento, LuísCOVID-19 caused a pandemic, due to its ease of transmission and high number of infections. The evolution of the pandemic and its consequences for the mortality and morbidity of populations, especially the elderly, generated several scientific studies and many research projects. Among them, we have the Predictive Models of COVID-19 Outcomes for Higher Risk Patients Towards a Precision Medicine (PREMO) research project. For such a project with many data records, it is necessary to provide a smooth graphical analysis to extract value from it. Methods: In this paper, we present the development of a full-stack Web application for the PREMO project, consisting of a dashboard providing statistical analysis, data visualization, data import, and data export. The main aspects of the application are described, as well as the diverse types of graphical representations and the possibility to use filters to extract relevant information for clinical practice. Results: The application, accessible through a browser, provides an interactive visualization of data from patients admitted to the intensive care unit (ICU), throughout the six waves of COVID-19 in two hospitals in Lisbon, Portugal. The analysis can be isolated per wave or can be seen in an aggregated view, allowing clinicians to create many views of the data and to study the behavior and consequences of different waves. For instance, the experimental results show clearly the effect of vaccination as well as the changes on the most relevant clinical parameters on each wave. Conclusions: The dashboard allows clinicians to analyze many variables of each of the six waves as well as aggregated data for all the waves. The application allows the user to extract information and scientific knowledge about COVID-19’s evolution, yielding insights for this pandemic and for future pandemics.
- Complete pathological response (pCR) in gastroesophageal cancer: Correlation with metabolic responsePublication . Cabral, Francisco; Cruz, A.; Casaca, R.; Monteiro, C.; Ramos, P.; Pedro, C.; Brandão, F.; Fonseca, R.; Ratão, P.; Saldado, L.; Pinto, Iola; Abecasis, N.Purpose. - Neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with resectable esophageal or esophagogastric junctional (GEJ) (Siewert I) cancer is associated with long term overall survival benefits. Up to one third of all patients submitted to nCRT present pathological complete response (pCR). F-18-fluorodeoxyglucose positron emission tomography with CT (F-18-FDG PET-CT) is an important tool for assessing treatment response. Purpose was to assess retrospectively the power of F-18-FDG PET-CT in predicting pCR to evaluate the feasibility of a "watch and wait" approach. Patients and methods. - Retrospective analysis of a prospective database with esophageal or GEJ submitted to pre-operative chemoradiation. Pre and pos treatment F-18-FDG PET-CT were reviewed and classified using visual assessment and PERCIST criteria and the values of maximum standard uptake value were also recorded. Patients were classified as pCR or non-PCR. F-18-FDG PET-CT and pathological findings were compared against each other. Results. - Forty-three patients were included. The median age was 67 years and 90.7% were male. All patients underwent preoperative CRT and were evaluated with F-18-FDG PET-CT pre and post treatment. Transthoracic surgery was performed in all patients. Histological type was adenocarcinoma in 37% and squamous cell carcinoma in 58%. pCR was achieved in 56% of cases. Visual assessment of F-18-FDG PET-CT showed overall sensitivity 57.9%, specificity 62.5% and PERCIST criteria had 100% sensibility and 16.7% specificity. Conclusions. - F-18-FDG PET-CT is not an ideal predictor of pCR but if we use the PERCIST criteria we will have a high sensitivity and negative predictive value, avoiding false negative scans. (C) 2020 Societe francaise de radiotherapie oncologique (SFRO).
- Laboratory biomarkers associated to death in the first three COVID-19 waves in PortugalPublication . Von Rekowski, Cristiana; Fonseca, Tiago; Calado, Cecília; Bento, Luís; Pinto, Iola; Araújo, RúbenBesides the pandemic being over, new SARS-CoV-2 lineages, and sub-lineages, still pose risks to global health. Thus, in this preliminary study, to better understand the characteristics of COVID-19 patients and the effect of certain hematologic biomarkers on their outcome, we analyzed data from 337 patients admitted to the ICU of a single-center hospital in Lisbon, Portugal, in the first three waves of the pandemic. Most patients belonged to the second (40.4%) and third (41.2%) waves. The ones from the first wave were significantly older and relied more on respiratory techniques like invasive mechanic ventilation and extracorporeal membrane oxygenation. There were no significant differences between waves regarding mortality in the ICU. In general, non-survivors had worse laboratory results. Biomarkers significantly associated with death changed depending on the waves. Increased high-sensitivity cardiac troponin I results, and lower eosinophil counts were associated to death in all waves. In the second and third waves, the international normalized ratio, lymphocyte counts, and neutrophil counts were also associated to mortality. A higher risk of death was linked to increased myoglobin results in the first two waves, as well as increased creatine kinase results, and lower platelet counts in the third wave.
- The characteristics and laboratory findings of SARS-CoV-2 infected patients during the first three COVID-19 waves in Portugal – a retrospective single-center studyPublication . Von Rekowski, Cristiana; Fonseca, Tiago AH; Araújo, Rúben; Brás-Geraldes, Carlos; Calado, Cecília; Bento, Luís; Pinto, IolaBackground and Objectives: Given the wide spectrum of clinical and laboratory manifestations of the coronavirus disease 2019 (COVID-19), it is imperative to identify potential contributing factors to patients’ outcomes. However, a limited number of studies have assessed how the different waves affected the progression of the disease, more so in Portugal. Therefore, our main purpose was to study the clinical and laboratory patterns of COVID-19 in an unvaccinated population admitted to the intensive care unit, identifying characteristics associated with death, in each of the first three waves of the pandemic. Materials and Methods: This study included 337 COVID-19 patients admitted to the intensive care unit of a single-center hospital in Lisbon, Portugal, between March 2020 and March 2021. Comparisons were made between three COVID-19 waves, in the second (n = 325) and seventh (n = 216) days after admission, and between discharged and deceased patients. Results: Deceased patients were considerably older (p = 0.021) and needed greater ventilatory assistance (p = 0.023), especially in the first wave. Differences between discharged and deceased patients’ biomarkers were minimal in the first wave, on both analyzed days. In the second wave significant differences emerged in troponins, lactate dehydrogenase, procalcitonin, C-reactive protein, and white blood cell subpopulations, as well as platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios (all p < 0.05). Furthermore, in the third wave, platelets and D-dimers were also significantly different between patients’ groups (all p < 0.05). From the second to the seventh days, troponins and lactate dehydrogenase showed significant decreases, mainly for discharged patients, while platelet counts increased (all p < 0.01). Lymphocytes significantly increased in discharged patients (all p < 0.05), while white blood cells rose in the second (all p < 0.001) and third (all p < 0.05) waves among deceased patients. Conclusions: This study yields insights into COVID-19 patients’ characteristics and mortality-associated biomarkers during Portugal’s first three COVID-19 waves, highlighting the importance of considering wave variations in future research due to potential significant outcome differences.
- Trends in COVID-19 patient characteristics and mortality throughout the pandemic: insights from a portuguese single-centre studyPublication . Von Rekowski, Cristiana; Pinto, Iola; Henrique Fonseca, Tiago Alexandre; Araújo, Rúben Alexandre Dinis; Ferreira, Artur; Calado, Cecília; Bento, Luís; Domingues, Nuno; Tomar, Rajesh Singh; Mahamud, TosapornAs SARS-CoV-2 continues to circulate globally and new variants emerge, it remains relevant to gather data on the affected patients’ clinical characteristics and outcomes to understand how individual factors and public health measures affect prognosis. Thus, we analyzed data of 870 ICU patients admitted for COVID-19 across two distinct phases of the pandemic: before and after the introduction of immunization. Experimental results showed that vaccination significantly impacted patient demographics after the third wave, and that waves number two and three, dominated by the EU1 and Alpha variants, had higher mortality. Older age, the need for invasive mechanical ventilation, and hematologic cancer were significantly associated with an increased risk of death in the adjusted multivariable model (AUC: 0.778, 95% CI 0.746-0.810, p<0.001). As the pandemic progressed, while some public health interventions influenced the observed trends, individual patient characteristics had a more substantial impact on their outcome.