Browsing by Author "Torres, A."
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- The effects of topical antibiotics on eradication and acquisition of third-generation cephalosporin and carbapenem-resistant Gram-negative bacteria in ICU patients; a post hoc analysis from a multicentre cluster-randomized trialPublication . Plantinga, N.L.; Wittekamp, B.H.J.; Brun-Buisson, C.; Bonten, M.J.M.; Cooper, B.S.; Coll, P.; Lopez-Contreras, J.; Mancebo, J.; Wise, M.P.; Morgan, M.P.G.; Depuydt, P.; Boelens, J.; Dugernier, T.; Verbelen, V.; Jorens, P.G.; Verbrugghe, W.; Malhotra-Kumar, S.; Damas, P.; Meex, C.; Leleu, K.; van den Abeele, A.M.; Esteves, F.; de Matos, A.F.G.P.; Torres, A.; Méndez, S.F.; Gomez, A.V.; Tomic, V.; Sifrer, F.; Tello, E.V.; Ramos, J.R.; Aragao, Irene; Santos, C.; Sperning, R.H.M.; Coppadoro, P.; Nardi, G.Objectives: The aim was to quantify the effects of selective digestive tract decontamination (SDD) consisting of a mouth paste and gastro-enteral suspension, selective oropharyngeal decontamination with a mouth paste (SOD) and 1-2% chlorhexidine (CHX) mouthwash on eradication and acquisition of carriage of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) and carbapenem-resistant Gram-negative bacteria (CR-GNB) in Intensive Care Unit (ICU) patients. Methods: This was a nested cohort study within a cluster-randomized cross-over trial in six European countries and 13 ICUs with 8665 patients. Eradication and acquisition during ICU stay of 3GCR-E and CR-GNB were investigated separately in the rectum and respiratory tract for the three interventions and compared with standard care (SC) using Cox-regression competing events analyses. Results: Adjusted cause specific hazard ratios (CSHR) for eradication of rectal carriage for SDD were 1.76 (95% CI 1.31-2.36) for 3GCR-E and 3.17 (95% CI 1.60-6.29) for CR-GNB compared with SC. For the respiratory tract, adjusted CSHR for eradication of 3GCR-E were 1.47 (0.98-2.20) for SDD and 1.38 (0.92-2.06) for SOD compared with SC, and for eradication of CR-GNB these were 0.77 (0.41- 1.45) for SDD and 0.81 (0.44-1.51) for SOD, compared with SC. Adjusted CSHRs for acquisition of rectal carriage during SDD (compared with SC) were 0.51 (0.40-0.64) for 3GCR-E and of 0.56 (0.40-0.78) for CR-GNB. Adjusted CSHRs for acquiring respiratory tract carriage with 3GCR-E compared with SC were 0.38 (0.28-0.50) for SDD and 0.55 (0.42-0.71) for SOD, and for CR-GNB 0.46 (0.33-0.64) during SDD and 0.60 (0.44-0.81) during SOD, respectively. SOD was not associated with eradication or acquisition of 3GCR-E and CR-GNB in the rectum. Conclusions: Among mechanically ventilated ICU patients, SDD was associated with more eradication and less acquisition of 3GCR-E and CR-GNB in the rectum than SC. SDD and SOD were associated with less acquisition of both 3GCR-E and CR-GNB than SC in the respiratory tract.
- The EMBARC European Bronchiectasis Registry: protocol for an international observational studyPublication . Chalmers, J.; Aliberti, S.; Polverino, E.; Vendrell, M.; Crichton, M.; Loebinger, M.; Dimakou, K.; Clifton, I.; van der Eerden, M.; Rohde, G.; Murris-Espin, M.; Masefield, S.; Gerada, E.; Shteinberg, M.; Ringshausen, F.; Haworth, C.; Boersma, W.; Rademacher, J.; Hill, A.; Aksamit, T.; O'Donnell, A.; Morgan, L.; Milenkovic, B.; Tramma, L.; Neves, J.; Menendez, R.; Paggiaro, P.; Botnaru, V.; Skrgat, S.; Wilson, R.; Goeminne, P.; De Soyza, A.; Welte, T.; Torres, A.; Elborn, J.; Blasi, F.Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies. The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration) registry is a prospective, pan-European observational study of patients with bronchiectasis. The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of: 1) a clinical history consistent with bronchiectasis; and 2) computed tomography demonstrating bronchiectasis. Core exclusion criteria are: 1) bronchiectasis due to known cystic fibrosis; 2) age <18 years; and 3) patients who are unable or unwilling to provide informed consent. The study aims to enrol 1000 patients by April 2016 across at least 20 European countries, and 10 000 patients by March 2020. Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high-quality longitudinal data on outcomes, treatment patterns and quality of life. Data from the registry will be available in the form of annual reports. and will be disseminated in conference presentations and peer-reviewed publications. The European Bronchiectasis Registry aims to make a major contribution to understanding the natural history of the disease, as well as guiding evidence-based decision making and facilitating large randomised controlled trials.
- Tuberculose e cancro – pior que um só dois!Publication . Couto, C.; Balona, F.; Sampaio, M.J.; Torres, A.; Pinto, A.; Ferreira, A.RESUMO Introdução: A tuberculose é um problema de saúde global e crescente. A doença pulmonar primária é a forma mais comum de apresentação da tuberculose activa. A tuberculose esquelética é pouco comum e representa 10 a 20% das formas extrapulmonares no doente imunocompetente. Quando existe imunossupressão, esta forma é mais frequente podendo estar presente, de modo isolado ou em associação com tuberculose pulmonar, em quase metade dos casos. A sua apresentação clínica é inespecífi ca e o diagnóstico diferencial inclui diversas patologias, sendo essencial um elevado índice de suspeição. Caso clínico: Os autores apresentam o caso clínico de uma criança com tumor de Wilms, em tratamento com quimioterapia, que desenvolveu tuberculose óssea. Discussão: Salienta-se a importância do diagnóstico diferencial da tuberculose com doença oncológica (primária ou secundária), a limitação dos métodos imagiológicos, a importância da confirmação diagnóstica através de estudos histopatológicos e microbiológicos, e a necessidade de um plano terapêutico adequado e o mais precoce possível. ABSTRACT Introduction: Tuberculosis is a global and growing health problem. Primary pulmonary disease is the most common form of presentation of active tuberculosis. The skeletal tuberculosis is uncommon and represents 10 to 20% of extrapulmonary disease in immunocompetent individuals. In immunosupressed patients, bone involvement is more common, either singly or in association with pulmonary tuberculosis, reaching half of the cases. Its clinical presentation is nonspecific and the differential diagnosis includes several pathologies, therefore a high index of suspicion is required. Case report: The authors report the clinical case of a child with Wilms’ tumor who was diagnosed with bone tuberculosis during the treatment of nephroblastoma. Discussion: It is emphasized the importance of differential diagnosis of tuberculosis with malignancy (primary or secondary), the limitation of imaging methods, the importance of diagnostic confi rmation by histopathological and microbiological studies, and the need for an appropriate treatment plan and as early as possible.