Screening diabetic retinopathy, a major cause of blindness, is time-consuming for ophthalmologist... more Screening diabetic retinopathy, a major cause of blindness, is time-consuming for ophthalmologists and has some constrains in achieving full coverage and attendance. The handheld fundus camera EyeFundusScope was recently developed to expand the scale of screening, drawing on images acquired in primary care and telescreening made by ophthalmologists or a computer-aided diagnosis (CADx) system. This study aims to assess the diagnostic accuracy of the interpretation of images captured using EyeFundusScope and perform its technical evaluation, including image quality, functionality, usability, and acceptance in a real-world clinical setting. Physicians and nurses without training in ophthalmology will use EyeFundusScope to take pictures of the retinas of patients with diabetes and the images will be classified for the presence or absence of diabetic retinopathy and image quality by a panel of ophthalmologists. A subgroup of patients will also be examined with the reference standard tabl...
The diagnostic gold standard to screen diabetic retinopathy is a visual analysis of eye fundus fo... more The diagnostic gold standard to screen diabetic retinopathy is a visual analysis of eye fundus for identification of microvascular lesions.1 In telescreening, high quality of eye fundus photographs is essential to adequately identify disease.2 However, studies on the agreement between ophthalmologists in classifying image quality and its impact on the reliability of diabetic retinopathy diagnosis are scarce3,4 and inexistent, respectively. In this cross-sectional study, two ophthalmologists (a retina specialist and a general ophthalmologist) blindly and independently classified 350 eye fundus images randomly selected from the Kaggle database containing 53571 images of subjects with diabetes5 using a web annotation tool. After excluding 55 images for being considered not classifiable due to insufficient quality for diagnosis, 295 images were classified for diabetic retinopathy, referable diabetic retinopathy, and maculopathy, as displayed in Table 1. As in the current clinical practice, image quality classification was performed based on non-defined and subjective criteria and diabetic retinopathy was graded using the modified version6 of the International Clinical Disease Severity Scale (ICDSS). Overall agreement, positive and negative specific agreement proportions, and Cohen’s Kappa coefficient (к), with the respective 95% confidence intervals (CIs) were calculated. Interrater agreement for diabetic retinopathy, maculopathy and referral cases were 85% [95% confidence interval (CI) 73%-97%], 96% (95% CI 72%-100%) and 94% (95% CI 75%100%), respectively. Ophthalmologists showed considerably higher agreement in excluding diabetic retinopathy, referable diabetic retinopathy and maculopathy, than in identifying them [proportion of agreement of 91% (95% CI 79%-100%) vs 56% (95% CI 44%-68%), 98% (95% CI 74%-100%) vs 56% (95% CI 32%-80%) and 97% (95% CI 78%-100%) vs 57% (95% CI 38%-76%), respectively]. Kappa coefficients obtained for diabetic retinopathy were 0.49 (95% CI 0.37-0.61), for maculopathy 0.54 (95% CI 0.30-0.78) and for referral cases 0.54 (95% CI 0.35-0.73). From clinical perspective, these results are of concern, suggesting that there is considerable variability in the interpretation of disease findings in images. For image quality, proportion of agreement was 58% (95% CI 51%-65%) and kappa value 0.27 (95% CI 0.20-0.34), suggesting different understandings of image quality requirements for a proper diagnosis. Good or excellent image quality improved both interrater reliability and agreement for the identification of disease [with к value raising from 0.49 to 0.62 (95% CI 0.40-0.73) and proportion of agreement from 50% (95% CI 43%-57%) to 64% (95% CI 57%-71%), p<0.05]. Our study highlighted that images classified by ophthalmologists as bad or fair quality were more likely to be classified as screen-positive for diabetic retinopathy, referable diabetic retinopathy and maculopathy, increasing the number of patients requiring further observation and the burden on screening programmes. Ensuring that only good or excellent quality images are sent to ophthalmologists may improve interrater agreement for disease exclusion. Future studies are needed to understand image quality as perceived by ophthalmologists and should be 1000418 DSTXXX10.1177/19322968211000418Journal of Diabetes Science and TechnologyRêgo et al letter2021
IntroductionRational prescribing for older adults is a challenge because they usually exhibit mul... more IntroductionRational prescribing for older adults is a challenge because they usually exhibit multimorbidity and multimedication. One available and reliable tool to tackle this issue consists of the Screening Tool of Older People’s Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START), which has been associated with improvements in clinical outcomes. Our goal here is to translate and validate the STOPP-START screening tool for use with Portuguese general practitioners/family physicians.Methods and analysisThe study will be conducted in four phases: phase I—translation of the STOPP-START screening tool to Portuguese; phase II—data collection of patient data; phase III—intrarater reliability and agreement study; and phase IV—inter-rater reliability and agreement study.Ethics and disseminationThis study was approved by the Ethics Committee of the Central Health Region of Portugal (where the study will take place). Every participant will sign a written consent...
European Journal of Gastroenterology & Hepatology, 2016
Esophagogastroduodenoscopy (EGD) is considered a very effective method to identify gastric cancer... more Esophagogastroduodenoscopy (EGD) is considered a very effective method to identify gastric cancer (GC). However, the existence of missed lesions has been frequently discussed. This systematic review and meta-analysis aimed at assessing the magnitude of missing GC diagnosis with EGD and its predictive factors. MEDLINE was searched to identify all studies assessing and reporting the proportion of missed GC diagnosis with EGD. Pooled proportion and negative predictive values were computed using the random-effects model and heterogeneity was assessed using the Cochrane Q-test and I. The studies included (n=22) were grouped by study design. The pooled negative predictive value was 99.7% (95% confidence interval 99.6-99.9%). Missed GCs proportion was 9.4% (95% confidence interval 5.7-13.1%), being 10.0% in studies including patients with negative EGD followed over time, 8.3% in studies including patients with GC, and 23.3% in studies evaluating the proportion of missed synchronous lesions. Mainly, missed cancers were located in the gastric body both in Eastern and in Western studies (39 and 47%, respectively). The majority of missed GCs were adenocarcinomas. Younger age (&lt;55 years), female sex, marked gastric atrophy, gastric adenoma or ulcer, and inadequate number of biopsy fragments were reported as predictive factors for diagnostic failure. EGD is a very effective method to rule out GC. However, missing GC with EGD is not uncommon, with one out of 10 cancers being potentially missed. Interestingly, lesions were more often missed in the body and therefore a more rigorous protocol for endoscopy and biopsy should be implemented worldwide.
Aim: We aimed to estimate and to compare the predictive value of available classification systems... more Aim: We aimed to estimate and to compare the predictive value of available classification systems that allowed a stratification of risk for amputation in patients with diabetic foot ulcer (DFU). Methods: A prospective cohort study is currently being conducted on a consecutive sample of patients presenting with DFU from 1 October 2009 to 31 March 2011 (n= 118) [mean age of 65 years (26-88); 65% male; 90% with diabetes type 2; mean diabetes duration of 18 years (2-42)]. To all patients different classification systems (Meggit-Wagner, University of Texas, Van Acker/Peter, SINBAD, DEPA and DUSS) were applied by a single observer using clinical data (previous foot complications, presence of ischemia, neuropathy or foot deformity, ulcer number, site, depth, area and active infection) and outcomes assessed (ulcer healing and amputation). Results: With a mean follow-up of 71 days (3-270d), 59% of patients enrolled presented with previous DFU or amputation. Neuropathy alone was observed is 4...
Objective: Pharyngocutaneous fistula is considered one of the major complications in the postoper... more Objective: Pharyngocutaneous fistula is considered one of the major complications in the postoperative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocutaneous fistula predictive factors and risk classifications. Methods: Research was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n = 846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded. Results: A total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumo...
The presence of lymph node (LN) metastasis is a key prognostic factor for gastric adenocarcinoma.... more The presence of lymph node (LN) metastasis is a key prognostic factor for gastric adenocarcinoma. However, even among patients without LN metastasis (N0), recurrence may occur. In some of these cases, occult tumor cells (OTC) are thought to play an important role. We aimed to determine the prevalence of OTC and its clinical relevance. We conducted a systematic review of studies in English published until September 2013 that addressed OTC prevalence and/or its clinical relevance. The studies were retrieved from the MEDLINE database. We included 42 studies. The most frequently used methods for detecting OTC were immunohistochemical examination (IHC) and/or polymerase chain reaction (PCR) with a wide range of markers. Using IHC for OTC detection, in patients and in LN, the prevalence varied from 9 to 88% and 0.4 to 42%, respectively. With PCR, it ranged from 17 to 46% in patients, and from 3 to 33% in LN. In the studies assessing the predictive role of OTC in gastric cancer recurrence ...
Introdução: A prevalência da Diabetes mellitus (DM) está a atingir um nível epidémico. A nível po... more Introdução: A prevalência da Diabetes mellitus (DM) está a atingir um nível epidémico. A nível podológico os indivíduos com diabetes apresentam um risco aumentado de ulceração e consequente amputação. O impacto de um controlo glicémico adequado na prevenção de complicações microvasculares tem sido exaustivamente estudado. No entanto, no que concerne à prevenção das complicações no pé do diabético, a evidência é escassa. Desenvolvemos um estudo de forma a avaliar a associação entre o valor da hemoglobina glicada (HbA1c) de base com a ocorrência de amputação podológica e o seu valor preditivo. Material e Métodos: Foi realizado um estudo de coorte prospectivo, entre 09/2009 e 07/2012, incluindo consecutivamente todos os indivíduos com DM, úlcera podológica activa e HbA1c disponível observados na consulta Multidisciplinar de Pé Diabético do CHVNG/ Espinho EPE. Foi analisada a associação entre a ocorrência de amputação e o valor da HbA1c, assim como o seu valor preditivo através na avali...
Purpose: We aim to validate and optimize the diabetic foot ulcer (DFU) development stratification... more Purpose: We aim to validate and optimize the diabetic foot ulcer (DFU) development stratification systems for the DFU healing prediction. With this study we intend to propose a system proved valid for DFU development prediction that, with the inclusion of few DFU related variables, can also accurately predict DFU healing. Methods: A prospective cohort study is currently being conducted on a consecutive sample of patients presenting with DFU from September 2009 until February 2012 and achieving outcome (healing, amputation or death) until March 2012 (n= 206) [mean age of 66 years (26-91); 66% male; 97% with diabetes type 2; mean diabetes duration of 17 years (1-49)]. It will be continued until August 2012. To all patients the DFU development risk stratification systems [American Diabetes Association (ADA), International Working Group on Diabetic Foot (IWGDF), Scottish Intercollegiate Guidelines Network (SIGN), University of Texas (UT) and Seattle Risk Score] were applied (collecting ...
Objectives: Diabetes mellitus is one of the most frequent metabolic disorders, with a prevalence ... more Objectives: Diabetes mellitus is one of the most frequent metabolic disorders, with a prevalence of 13.9% in the Oporto district in Portugal (our referral area). Diabetic foot is one of the major complications of this disease and causes a considerable burden in health care and patient well-being. Literature reports high rates of morbi-mortality associated with this condition. Therefore we considered essential to estimate the risk at 3 and 5 years of ulcer occurrence (1st or re-ulceration), amputation and death in a population of patients followed in our Diabetic Foot Outpatient Clinic as well as determine their causes and predictive variables. Material and method: A retrospective cohort study is being conducted including all patients recurring to our Diabetic Foot Outpatient Clinic from January 2002 until September 2012. Patients will be followed for at least 3 years or death. Those lost to follow-up will be excluded, as well as those with missing data apart from tunning fork exam (...
Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. ... more Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery. A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n=171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed. American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed. A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.
To validate and compare the existing systems developed to stratify subjects with diabetes and foo... more To validate and compare the existing systems developed to stratify subjects with diabetes and foot ulcer (DFU) by risk of consequent lower extremity amputation (LEA). We conducted a prospective cohort study on a consecutive series of patients (mean age 68 years, 64% being male) with DFU attending our Diabetic Foot Outpatient Clinic (n = 293) from 01/2010 to 03/2013. At baseline, participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics and systems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; composing variables were collected. Variables&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; predictive value and systems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; prognostic accuracy for overall and major LEA occurrence were assessed. During a median follow-up of 91 days (interquartile range of 98), DFU healed in 62% of subjects. Major LEA occurred in 7% and minor in 17%. Previous DFU, previous LEA, DFU area and gangrene were associated with overall LEA occurrence. Physical impairment was associated only with major LEA. Nephropathy, pulses number, DFU aetiology, depth and number were associated with both. For overall and major LEA prediction, systems typically presented sensitivity values ≥80% and negative likelihood ratios ≤ 0.5 for the highest risk group; area under the ROC curve ranged from 0.56 to 0.83 and positive likelihood ratios from 1.0 to 5.9. Positive predictive values were lower and negative predictive values tended to be higher when using only major LEA prediction as outcome. Systems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; stages, grades, scores and/or prognostics were generally associated with LEA, presenting overall substantial accuracy values. Nevertheless, great improvement is possible. A multicentre study validating and refining the existing systems is needed to improve clinical decision making in this area. This article is protected by copyright. All rights reserved.
Understanding the quality of diabetic foot care delivery is essential. The Eurodiale consortium a... more Understanding the quality of diabetic foot care delivery is essential. The Eurodiale consortium addressed subjects&amp;amp;#39; characteristics, diabetic foot ulcer prognostic predictors and clinical outcomes, in 10 European countries. We analyzed the results of a specialized Portuguese diabetic foot clinic at the light of the ones from Eurodiale.
Screening diabetic retinopathy, a major cause of blindness, is time-consuming for ophthalmologist... more Screening diabetic retinopathy, a major cause of blindness, is time-consuming for ophthalmologists and has some constrains in achieving full coverage and attendance. The handheld fundus camera EyeFundusScope was recently developed to expand the scale of screening, drawing on images acquired in primary care and telescreening made by ophthalmologists or a computer-aided diagnosis (CADx) system. This study aims to assess the diagnostic accuracy of the interpretation of images captured using EyeFundusScope and perform its technical evaluation, including image quality, functionality, usability, and acceptance in a real-world clinical setting. Physicians and nurses without training in ophthalmology will use EyeFundusScope to take pictures of the retinas of patients with diabetes and the images will be classified for the presence or absence of diabetic retinopathy and image quality by a panel of ophthalmologists. A subgroup of patients will also be examined with the reference standard tabl...
The diagnostic gold standard to screen diabetic retinopathy is a visual analysis of eye fundus fo... more The diagnostic gold standard to screen diabetic retinopathy is a visual analysis of eye fundus for identification of microvascular lesions.1 In telescreening, high quality of eye fundus photographs is essential to adequately identify disease.2 However, studies on the agreement between ophthalmologists in classifying image quality and its impact on the reliability of diabetic retinopathy diagnosis are scarce3,4 and inexistent, respectively. In this cross-sectional study, two ophthalmologists (a retina specialist and a general ophthalmologist) blindly and independently classified 350 eye fundus images randomly selected from the Kaggle database containing 53571 images of subjects with diabetes5 using a web annotation tool. After excluding 55 images for being considered not classifiable due to insufficient quality for diagnosis, 295 images were classified for diabetic retinopathy, referable diabetic retinopathy, and maculopathy, as displayed in Table 1. As in the current clinical practice, image quality classification was performed based on non-defined and subjective criteria and diabetic retinopathy was graded using the modified version6 of the International Clinical Disease Severity Scale (ICDSS). Overall agreement, positive and negative specific agreement proportions, and Cohen’s Kappa coefficient (к), with the respective 95% confidence intervals (CIs) were calculated. Interrater agreement for diabetic retinopathy, maculopathy and referral cases were 85% [95% confidence interval (CI) 73%-97%], 96% (95% CI 72%-100%) and 94% (95% CI 75%100%), respectively. Ophthalmologists showed considerably higher agreement in excluding diabetic retinopathy, referable diabetic retinopathy and maculopathy, than in identifying them [proportion of agreement of 91% (95% CI 79%-100%) vs 56% (95% CI 44%-68%), 98% (95% CI 74%-100%) vs 56% (95% CI 32%-80%) and 97% (95% CI 78%-100%) vs 57% (95% CI 38%-76%), respectively]. Kappa coefficients obtained for diabetic retinopathy were 0.49 (95% CI 0.37-0.61), for maculopathy 0.54 (95% CI 0.30-0.78) and for referral cases 0.54 (95% CI 0.35-0.73). From clinical perspective, these results are of concern, suggesting that there is considerable variability in the interpretation of disease findings in images. For image quality, proportion of agreement was 58% (95% CI 51%-65%) and kappa value 0.27 (95% CI 0.20-0.34), suggesting different understandings of image quality requirements for a proper diagnosis. Good or excellent image quality improved both interrater reliability and agreement for the identification of disease [with к value raising from 0.49 to 0.62 (95% CI 0.40-0.73) and proportion of agreement from 50% (95% CI 43%-57%) to 64% (95% CI 57%-71%), p<0.05]. Our study highlighted that images classified by ophthalmologists as bad or fair quality were more likely to be classified as screen-positive for diabetic retinopathy, referable diabetic retinopathy and maculopathy, increasing the number of patients requiring further observation and the burden on screening programmes. Ensuring that only good or excellent quality images are sent to ophthalmologists may improve interrater agreement for disease exclusion. Future studies are needed to understand image quality as perceived by ophthalmologists and should be 1000418 DSTXXX10.1177/19322968211000418Journal of Diabetes Science and TechnologyRêgo et al letter2021
IntroductionRational prescribing for older adults is a challenge because they usually exhibit mul... more IntroductionRational prescribing for older adults is a challenge because they usually exhibit multimorbidity and multimedication. One available and reliable tool to tackle this issue consists of the Screening Tool of Older People’s Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START), which has been associated with improvements in clinical outcomes. Our goal here is to translate and validate the STOPP-START screening tool for use with Portuguese general practitioners/family physicians.Methods and analysisThe study will be conducted in four phases: phase I—translation of the STOPP-START screening tool to Portuguese; phase II—data collection of patient data; phase III—intrarater reliability and agreement study; and phase IV—inter-rater reliability and agreement study.Ethics and disseminationThis study was approved by the Ethics Committee of the Central Health Region of Portugal (where the study will take place). Every participant will sign a written consent...
European Journal of Gastroenterology & Hepatology, 2016
Esophagogastroduodenoscopy (EGD) is considered a very effective method to identify gastric cancer... more Esophagogastroduodenoscopy (EGD) is considered a very effective method to identify gastric cancer (GC). However, the existence of missed lesions has been frequently discussed. This systematic review and meta-analysis aimed at assessing the magnitude of missing GC diagnosis with EGD and its predictive factors. MEDLINE was searched to identify all studies assessing and reporting the proportion of missed GC diagnosis with EGD. Pooled proportion and negative predictive values were computed using the random-effects model and heterogeneity was assessed using the Cochrane Q-test and I. The studies included (n=22) were grouped by study design. The pooled negative predictive value was 99.7% (95% confidence interval 99.6-99.9%). Missed GCs proportion was 9.4% (95% confidence interval 5.7-13.1%), being 10.0% in studies including patients with negative EGD followed over time, 8.3% in studies including patients with GC, and 23.3% in studies evaluating the proportion of missed synchronous lesions. Mainly, missed cancers were located in the gastric body both in Eastern and in Western studies (39 and 47%, respectively). The majority of missed GCs were adenocarcinomas. Younger age (&lt;55 years), female sex, marked gastric atrophy, gastric adenoma or ulcer, and inadequate number of biopsy fragments were reported as predictive factors for diagnostic failure. EGD is a very effective method to rule out GC. However, missing GC with EGD is not uncommon, with one out of 10 cancers being potentially missed. Interestingly, lesions were more often missed in the body and therefore a more rigorous protocol for endoscopy and biopsy should be implemented worldwide.
Aim: We aimed to estimate and to compare the predictive value of available classification systems... more Aim: We aimed to estimate and to compare the predictive value of available classification systems that allowed a stratification of risk for amputation in patients with diabetic foot ulcer (DFU). Methods: A prospective cohort study is currently being conducted on a consecutive sample of patients presenting with DFU from 1 October 2009 to 31 March 2011 (n= 118) [mean age of 65 years (26-88); 65% male; 90% with diabetes type 2; mean diabetes duration of 18 years (2-42)]. To all patients different classification systems (Meggit-Wagner, University of Texas, Van Acker/Peter, SINBAD, DEPA and DUSS) were applied by a single observer using clinical data (previous foot complications, presence of ischemia, neuropathy or foot deformity, ulcer number, site, depth, area and active infection) and outcomes assessed (ulcer healing and amputation). Results: With a mean follow-up of 71 days (3-270d), 59% of patients enrolled presented with previous DFU or amputation. Neuropathy alone was observed is 4...
Objective: Pharyngocutaneous fistula is considered one of the major complications in the postoper... more Objective: Pharyngocutaneous fistula is considered one of the major complications in the postoperative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocutaneous fistula predictive factors and risk classifications. Methods: Research was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n = 846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded. Results: A total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumo...
The presence of lymph node (LN) metastasis is a key prognostic factor for gastric adenocarcinoma.... more The presence of lymph node (LN) metastasis is a key prognostic factor for gastric adenocarcinoma. However, even among patients without LN metastasis (N0), recurrence may occur. In some of these cases, occult tumor cells (OTC) are thought to play an important role. We aimed to determine the prevalence of OTC and its clinical relevance. We conducted a systematic review of studies in English published until September 2013 that addressed OTC prevalence and/or its clinical relevance. The studies were retrieved from the MEDLINE database. We included 42 studies. The most frequently used methods for detecting OTC were immunohistochemical examination (IHC) and/or polymerase chain reaction (PCR) with a wide range of markers. Using IHC for OTC detection, in patients and in LN, the prevalence varied from 9 to 88% and 0.4 to 42%, respectively. With PCR, it ranged from 17 to 46% in patients, and from 3 to 33% in LN. In the studies assessing the predictive role of OTC in gastric cancer recurrence ...
Introdução: A prevalência da Diabetes mellitus (DM) está a atingir um nível epidémico. A nível po... more Introdução: A prevalência da Diabetes mellitus (DM) está a atingir um nível epidémico. A nível podológico os indivíduos com diabetes apresentam um risco aumentado de ulceração e consequente amputação. O impacto de um controlo glicémico adequado na prevenção de complicações microvasculares tem sido exaustivamente estudado. No entanto, no que concerne à prevenção das complicações no pé do diabético, a evidência é escassa. Desenvolvemos um estudo de forma a avaliar a associação entre o valor da hemoglobina glicada (HbA1c) de base com a ocorrência de amputação podológica e o seu valor preditivo. Material e Métodos: Foi realizado um estudo de coorte prospectivo, entre 09/2009 e 07/2012, incluindo consecutivamente todos os indivíduos com DM, úlcera podológica activa e HbA1c disponível observados na consulta Multidisciplinar de Pé Diabético do CHVNG/ Espinho EPE. Foi analisada a associação entre a ocorrência de amputação e o valor da HbA1c, assim como o seu valor preditivo através na avali...
Purpose: We aim to validate and optimize the diabetic foot ulcer (DFU) development stratification... more Purpose: We aim to validate and optimize the diabetic foot ulcer (DFU) development stratification systems for the DFU healing prediction. With this study we intend to propose a system proved valid for DFU development prediction that, with the inclusion of few DFU related variables, can also accurately predict DFU healing. Methods: A prospective cohort study is currently being conducted on a consecutive sample of patients presenting with DFU from September 2009 until February 2012 and achieving outcome (healing, amputation or death) until March 2012 (n= 206) [mean age of 66 years (26-91); 66% male; 97% with diabetes type 2; mean diabetes duration of 17 years (1-49)]. It will be continued until August 2012. To all patients the DFU development risk stratification systems [American Diabetes Association (ADA), International Working Group on Diabetic Foot (IWGDF), Scottish Intercollegiate Guidelines Network (SIGN), University of Texas (UT) and Seattle Risk Score] were applied (collecting ...
Objectives: Diabetes mellitus is one of the most frequent metabolic disorders, with a prevalence ... more Objectives: Diabetes mellitus is one of the most frequent metabolic disorders, with a prevalence of 13.9% in the Oporto district in Portugal (our referral area). Diabetic foot is one of the major complications of this disease and causes a considerable burden in health care and patient well-being. Literature reports high rates of morbi-mortality associated with this condition. Therefore we considered essential to estimate the risk at 3 and 5 years of ulcer occurrence (1st or re-ulceration), amputation and death in a population of patients followed in our Diabetic Foot Outpatient Clinic as well as determine their causes and predictive variables. Material and method: A retrospective cohort study is being conducted including all patients recurring to our Diabetic Foot Outpatient Clinic from January 2002 until September 2012. Patients will be followed for at least 3 years or death. Those lost to follow-up will be excluded, as well as those with missing data apart from tunning fork exam (...
Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. ... more Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery. A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n=171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed. American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed. A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.
To validate and compare the existing systems developed to stratify subjects with diabetes and foo... more To validate and compare the existing systems developed to stratify subjects with diabetes and foot ulcer (DFU) by risk of consequent lower extremity amputation (LEA). We conducted a prospective cohort study on a consecutive series of patients (mean age 68 years, 64% being male) with DFU attending our Diabetic Foot Outpatient Clinic (n = 293) from 01/2010 to 03/2013. At baseline, participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics and systems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; composing variables were collected. Variables&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; predictive value and systems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; prognostic accuracy for overall and major LEA occurrence were assessed. During a median follow-up of 91 days (interquartile range of 98), DFU healed in 62% of subjects. Major LEA occurred in 7% and minor in 17%. Previous DFU, previous LEA, DFU area and gangrene were associated with overall LEA occurrence. Physical impairment was associated only with major LEA. Nephropathy, pulses number, DFU aetiology, depth and number were associated with both. For overall and major LEA prediction, systems typically presented sensitivity values ≥80% and negative likelihood ratios ≤ 0.5 for the highest risk group; area under the ROC curve ranged from 0.56 to 0.83 and positive likelihood ratios from 1.0 to 5.9. Positive predictive values were lower and negative predictive values tended to be higher when using only major LEA prediction as outcome. Systems&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; stages, grades, scores and/or prognostics were generally associated with LEA, presenting overall substantial accuracy values. Nevertheless, great improvement is possible. A multicentre study validating and refining the existing systems is needed to improve clinical decision making in this area. This article is protected by copyright. All rights reserved.
Understanding the quality of diabetic foot care delivery is essential. The Eurodiale consortium a... more Understanding the quality of diabetic foot care delivery is essential. The Eurodiale consortium addressed subjects&amp;amp;#39; characteristics, diabetic foot ulcer prognostic predictors and clinical outcomes, in 10 European countries. We analyzed the results of a specialized Portuguese diabetic foot clinic at the light of the ones from Eurodiale.
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