Centro Hospitalar Lisboa Norte

Abstract Background Around 15 to 30% of patients presenting without significant ST-segment elevation have an acutely occluded coronary artery. These patients have a worse prognosis, likely related to delayed revascularization. Purpose We aimed to test a novel artificial intelligence (AI) model designed to enhance the detection of these cases based on admission 12-lead electrocardiograms (ECGs). Methods A total of 658 ECGs from 398 patients admitted to the emergency department with suspected acute coronary syndrome (ACS) were retrospectively analyzed via the OMI AI ECG Model. The primary endpoint was the detection of occlusion myocardial infarction (OMI), defined as angiographic evidence of an acute culprit lesion with either 0-2 TIMI flow and positive troponin or TIMI 3 flow and significant troponin elevation (i.e. high-sensitivity troponin I ≥ 5000 ng/L). The model’s performance was compared with the current gold standard. Results In this initial test set, we identified 147 (36.9%) OMI cases. The OMI AI ECG Model achieved 72% accuracy (95% confidence interval (CI): 67.4–76.5), 44.2% sensitivity (95% CI: 37.2–51.6), 91.9% specificity (95% CI: 88.7-94.8), 79.6% PPV (95% CI: 71.9-86.6), NPV 69.8% (95% CI: 63.9-75.4), and a 0.422 Mathew’s correlation coefficient (MCC; 95% CI: 0.341-0.503), whereas the ST-segment elevation myocardial infarction (STEMI) criteria had 66.3% accuracy (95% CI: 61.0-71.3), 28.5% sensitivity (95% CI: 22.3-35.3), 93.2% specificity (95% CI: 90.1-96.1), 75.0% PPV (95% CI: 64.8-84.5), 64.6% NPV (95% CI: 58.6-70.4), and a 0.293 MCC (95% CI: 0.206-0.38)]. Demographic parameters, such as age and sex, did not impact model performance. Notably, within the patient group who underwent coronary angiography within 2 hours of admission, the model’s sensitivity increased to 81.2% (CI: 73.1-88.5), reflecting good model performance in acute/active case detection. Conclusion In this challenging all-comer suspect ACS cohort, the OMI AI ECG Model outperformed the STEMI criteria in active OMI detection, with about 1.5 times higher sensitivity, without compromising specificity. This tool may contribute to better patient triage and timely revascularization.

Chronic cough (CC, ≥8 weeks) affects >80% of the interstitial lung disease (ILD) population and is linked with disease progression and reduced quality of life. Yet, CC’s profile and factors influencing cough-related quality of life (CR-QoL) in ILD are unclear. This study identified factors associated with low CR-QoL in people with ILD and CC. Sociodemographic (age, sex) and clinical data (diagnosis, long-term oxygen therapy, lung function, medication) were collected. Dyspnoea and disease severity were rated with the modified Medical Research Council (mMRC) and the ILD – Gender, Age, Physiology and Comorbidities index (ILD-GAPC), respectively. CR-QoL was assessed with the Leicester Cough Questionnaire (LCQ). Individuals were grouped into low/worse (LCQ <17.05) and high/better (LCQ ≥17.05) CR-QoL. Group differences were analysed with Fisher’s/Mann-Whitney/t-tests, followed by logistic regression to identify factors associated with CR-QoL. Ninety-six individuals were included and 66% had low CR-QoL. People with low CR-QoL were younger, presented dust-related ILD (DR-ILD), lower disease severity and dyspnoea (Fig1). More dyspnoeic individuals (mMRC ≥2) were 8 times more likely to have low CR-QoL. Lower CR-QoL in ILD is linked to younger age, less disease severity, DR-ILD and dyspnoea. Our findings provide insights for the importance of dyspnoea when developing interventions targeting CR-QoL management in this population. <fig><object-id>erj;66/suppl_69/PA3018/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Background and aimsSevere aortic stenosis (AS) was traditionally managed with surgical aortic valve replacement (SAVR). Transcatheter aortic valve implantation (TAVI) emerged as a less invasive alternative, initially for high-risk patients. This meta-analysis evaluates the outcomes of TAVI in younger, low-risk patients, in whom SAVR is currently the gold standard.MethodsFollowing PRISMA guidelines, we systematically searched randomized controlled trials (RCTs) comparing TAVI with SAVR in younger (mean age <75 years) low-risk patients (STS score <4%) with severe AS. The primary endpoint was a composite of death or disabling stroke. Secondary endpoints included all-cause mortality, disabling stroke, atrial fibrillation (AF), permanent pacemaker implantation (PPI), bleeding, functional class (NYHA), and quality-of-life (KCCQ score) improvements.ResultsFour RCTs were included with 4,252 patients (2,125 TAVI and 2,127 SAVR). At a mean follow-up of 16 ± 5 months, TAVI showed a non-significant reduction in the composite of death or disabling stroke [2.8% vs. 5.1% risk ratio (RR) 0.98, 95% confidence interval (CI) (0.96–1.00), p = 0.11] and all-cause mortality [2.1% vs. 3.7%, RR 0.99, 95% CI (0.97–1.00), p = 0.15]. The incidence of disabling stroke was significantly lower in TAVI [0.9 vs. 2.1 RR 0.99, 95% CI (0.98–1.00), p < 0.01]. Hospital readmission [7.1% vs. 9.5% RR 0.97, 95% CI (0.96–0.99), p < 0.01] and bleeding rates [4.7% vs. 16%, RR 0.87, 95% CI (0.82–0.93), p < 0.01] were significantly lower in the TAVI group. Conversely, TAVI had a higher PPI rate [14% vs. 6%, RR 1.08, 95% CI (1.02–1.14), p < 0.01]. Faster symptomatic and quality-of-life improvements were sustained in the TAVI group.ConclusionsTAVI is a viable option for younger low-risk patients with severe AS, being non-inferior to SAVR in short-term outcomes. The benefits of TAVI include a lower risk of disabling stroke, hospital readmission, and bleeding, as well as quicker improvements in symptoms and quality of life. However, higher PPI rates require careful patient selection. The results support a tailored approach to TAVI in younger patients, with ongoing evaluation of long-term outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024559473, PROSPERO (CRD42024559473).

Introdução: A Organização Mundial de Saúde destaca que mais de 1 milhão de infeções sexualmente transmissíveis (IST) acontecem diariamente em todo o mundo, na maioria assintomáticas, e das 374 milhões de novas infeções que ocorrem a cada ano, apenas 1 em cada 4 são curáveis. A população migrante é identificada como um dos grupos populacionais mais vulneráveis à transmissão das IST. Objetivo: Mapear a evidência científica disponível relativa às IST em comunidades migrantes. Métodos: Realização de uma scoping review, de acordo com as orientações do Joanna Briggs Institute, com recurso à mnemónica PCC, tendo como participantes (P) “migrantes”, como conceito (C) “infeções”, e como contexto (C) “sexualmente transmissíveis”. A questão de pesquisa foi “qual a evidência publicada sobre infeções sexualmente transmissíveis em migrantes”. Resultados e Discussão: Os resultados identificados nas bases de dados (RCAAP 3, B-On 15, MedLine 2011, PubMed 44, CINAHL Ultimate 780) totalizaram 2853 estudos, e 21 foram incluídos nesta revisão após aplicação dos critérios de inclusão e exclusão. A ausência de conhecimentos sobre IST resultam da falta de esclarecimento e educação sexual. É proposta a sua implementação pelo(a) enfermeiro(a) e outros(as) profissionais da saúde, de forma cautelosa, humanizada e acolhedora, com a informação correta. A presente revisão confirma resultados das anteriores revisões citadas, mas acrescenta aspetos importantes relacionados com as barreiras colocadas aos migrantes, nomeadamente nos sistemas de saúde. Conclusões: É reconhecido que a migração gera uma situação de maior vulnerabilidade ao contágio de IST, juntamente com atitudes relacionadas com crenças e comportamentos de risco.