Assessing medication use patterns by clinical outcomes severity among inpatients with COVID-19: A retrospective drug utilization study.

PURPOSE: This study assessed medication patterns for inpatients at a central hospital in Portugal and explored their relationships with clinical outcomes in COVID-19 cases. METHODS: A retrospective study analyzed inpatient medication data, coded using the Anatomical Therapeutic Chemical classification system, from electronic patient records. It investigated the association between medications and clinical severity outcomes such as ICU admissions, respiratory/circulatory support needs, and hospital discharge status, including mortality (identified by ICD-10-CM/PCS codes). Multivariate analyses incorporating demographic data and comorbidities were used to adjust for potential confounders and understand the impact of medication patterns on disease progression and outcomes. RESULTS: The analysis of 2688 hospitalized COVID-19 patients (55.3% male, average age 62.8 years) revealed a significant correlation between medication types and intensity and disease severity. Cases requiring ICU admission or ECMO support often involved blood and blood-forming organ drugs. Increased use of nervous system and genitourinary hormones was observed in nonsurvivors. Corticosteroids, like dexamethasone, were common in critically ill patients, while tocilizumab was used in ECMO cases. Medications for the alimentary tract, metabolism, and cardiovascular system, although widely prescribed, were linked to more severe cases. Invasive mechanical ventilation correlated with higher usage of systemic anti-infectives and musculoskeletal medications. Trends in co-prescribing blood-forming drugs with those for acid-related disorders, analgesics, and antibacterials were associated with intensive interventions and worse outcomes. CONCLUSIONS: The study highlights complex medication regimens in managing severe COVID-19, underscoring specific drug patterns associated with critical health outcomes. Further research is needed to explore these patterns.

Effects of a high-fat meal on inflammatory and endothelial injury biomarkers in accordance with adiposity status: a cross-sectional study.

BACKGROUND: It is known that consuming a high-fat meal (HFM) induces microvascular dysfunction (MD) in eutrophic women and aggravates it in those with obesity. Our purpose was to investigate if the MD observed after a single HFM intake is caused by endothelial damage or increased inflammatory state, both determined by blood biomarkers. METHODS: Nineteen women with obesity (BMI 30-34.9 kg/m2) and 18 eutrophic ones (BMI 20.0-24.9 kg/m2) were enrolled into two groups: Obese (OBG) and Control (CG), respectively. Blood samples were collected at five-time points: before (fasting state) and 30, 60, 120, and 180 min after HFM intake to determine levels of adipokines (adiponectin, leptin), non-esterified fatty acid (NEFA), inflammatory [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)] and endothelium damage [soluble E-selectin, soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), plasminogen activator inhibitor-1 (PAI-1)] biomarkers. RESULTS: Levels of soluble E-selectin, leptin, and PAI-1 were higher in OBG at all-time points (P < 0.05) compared to CG. In the fasting state, OBG had higher levels of NEFA compared to CG (P < 0.05). In intra-group analysis, no significant change in the levels of circulating inflammatory and endothelial injury biomarkers was observed after HFM intake, independently of the group. CONCLUSION: Our findings suggest that women with obesity have an increased pro-inflammatory state and more significant endothelial injury compared to eutrophic ones. However, the consumption of a HFM was not sufficient to change circulating levels of inflammatory and endothelial injury biomarkers in either group. REGISTRATION NUMBER FOR CLINICAL TRIALS: NCT01692327.

Exercise with blood flow restriction improves muscle strength and mass while preserving the vascular and microvascular function and structure of older adults.

BACKGROUND: Changes in muscle mass, strength, vascular function, oxidative stress, and inflammatory biomarkers were compared in older adults after resistance training (RT) performed with low-intensity without blood flow restriction (RT-CON); low-intensity with BFR (RT-BFR); and high-intensity without BFR (RT-HI). METHODS: Thirty-two untrained individuals (72±7 y) performed a 12-week RT after being randomized into three groups: RT-CON -30% of 1 repetition maximum (RM); RT-BFR -30% of 1RM and mild BFR (50% of arterial occlusion pressure); RT-HI -70% of 1 RM. RESULTS: Improvements in handgrip strength were similar in RT-BFR (17%) and RT-HI (16%) vs. RT-CON (-0.1%), but increases in muscle mass (6% vs. 2% and -1%) and IGF-1 (2% vs. -0.1% and -1.5%) were greater (p < 0.05) in RT-BFR vs. RT-HI and RT-CON. Changes in vascular function, morphology, inflammation, and oxidative stress were similar between groups, except for time to reach maximum red blood cell velocity which showed a greater reduction (p < 0.05) in RT-BFR (-55%) vs. RT-HI (-11%) and RT-CON (-4%). CONCLUSION: RT with low intensity and mild BFR improved muscle strength and mass in older individuals while preserving vascular function. This modality should be considered an adjuvant strategy to improve muscle function in older individuals with poor tolerance to high loads.

Seroprevalence of SARS-CoV-2 and assessment of epidemiologic determinants in Portuguese municipal workers.

OBJECTIVES: To assess the seroprevalence of SARS-CoV-2 antibodies in municipal employees of Northern Portugal during the first pandemic wave (May-June 2020) and its association with potentially related risk factors for infection. MATERIAL AND METHODS: The authors assessed municipal employees of 2 cities in Northern Portugal, in whom serological tests to SARS-CoV-2 and an epidemiological survey were applied. The authors assessed the proportion of individuals presenting IgM and/or IgG antibodies to SARS-CoV-2, and evaluated the association between having positive serological test results, epidemiologic variables and clinical presentations. Reported symptoms were evaluated on their sensitivity, specificity, and predictive values. RESULTS: The authors assessed 1696 employees, of whom 22.0% were firefighters, 10.4% were police officers, 10.3% were maintenance workers, and 8.1% were administrative assistants. The seroprevalence of SARS-CoV-2 infection was 2.9% (95% CI: 2.1-3.7%). Administrative assistants comprised the professional group with highest seroprevalence of SARS-CoV-2 (OR = 1.9 in the comparison with other occupational groups, 95% CI: 0.8-4.3, p = 0.126). The seroprevalence of SARS-CoV-2 infection among those who were in direct contact with COVID-19 patients in their professional activity was 3.9%, compared to 2.7% among those who were not in direct contact with such patients (OR = 1.5, 95% CI: 0.8-2.8, p = 0.222). The highest risk of infection was associated with the presence of a confirmed SARS-CoV-2 infection in the household (OR = 17.4, 95% CI: 8.3-36.8, p < 0.001). Living with a healthcare professional was not associated with a higher risk of infection (OR = 1.0, 95% CI: 0.4-2.5, p = 0.934). Anosmia/ dysgeusia was the symptom with the highest positive predictive value (52.2%, 95% CI: 31.8-72.6, p < 0.001) and specificity (99.3%, 95% CI: 98.9-99.7, p < 0.001), while cough was the most prevalent symptom among SARS-CoV-2 seropositive participants (36%). CONCLUSIONS: The authors observed a SARS-CoV-2 seroprevalence of 2.9% among assessed municipal employees. Anosmia/dysgeusia was the COVID-19 symptom which displayed the highest positive predictive value and specificity. Int J Occup Med Environ Health. 2022;35(3):297-307.

Changes in appetite, taste, smell, and food aversion in post-bariatric patients and their relations with surgery time, weight loss and regain.

PURPOSE: We aimed to study the occurrence of long-term changes in appetite, taste, smell perceptions, and food aversion in patients following bariatric surgery. Additionally, we compared two surgery types, excess weight loss, rate of weight regain, and time since surgery. METHODS: This cross-sectional study included 146 post-bariatric patients who were without regular medical follow-up (126 post-Roux-en-Y gastric bypass [RYGB] and 20 post-sleeve gastrectomy [SG]), aged 42 ± 8 years, BMI of 32.6 ± 6.3 kg/m2, with excess weight loss of 87.5 ± 20.2%, rate of weight regain (RWR) of 15.4 [3.9-30.9]% and time since surgery of 5.0 ± 4.0 years. They answered a questionnaire about sensory and food perceptions at their first medical appointment at our unit. RESULTS: Changes in appetite (76%), taste (48.6%), and an increased sensation for sweet taste (60.2%) frequently occurred in our sample. Sensory and food aversion perceptions, taste changes to specific foods, and loss level of taste and smell were similar between RYGB and SG. No differences between patients with or without changes in appetite, taste, smell, and food aversion perceptions concerning excess weight loss were observed. The RWR in post-RYGB was lower in those with changes in taste and smell (P = 0.05). Sensory changes were noted in those with shorter time since surgery for both surgeries (P ≤ 0.05). CONCLUSION: Changes in appetite and taste occurred frequently in our patients even in the long term. Post-RYGB patients with lower RWR had more changes in taste and smell while a shorter time since surgery showed more frequent changes in appetite, taste, and smell. LEVEL OF EVIDENCE: Level V, cross-sectional study. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04193384).

Sarcopenia in the elderly versus microcirculation, inflammation status, and oxidative stress: A cross-sectional study.

BACKGROUND: Age-related mechanisms of sarcopenia associated with vascular function have been recently suggested. This study compared and tested associations between muscle mass and strength, microcirculation, inflammatory biomarkers, and oxidative stress in older adults classified as sarcopenic and non-sarcopenic. METHODS: Thirty-three physically inactive individuals (72±7 yrs) were assigned to age-matched sarcopenic (SG) and non-sarcopenic (NSG) groups. Between-group comparisons were performed for appendicular skeletal mass (ASM), handgrip and isokinetic strength, microvascular function and morphology, C-reactive protein, insulin-like growth factor-1, tumor necrosis factor-alpha, interleukin-6 (IL-6), soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, endothelin-1, and oxidized low-density lipoprotein. RESULTS: ASM and knee isokinetic strength were lower in SG than NSG (P < 0.05). No difference between groups was found for outcomes of microvascular function and morphology, but log-transformed IL-6 concentration was twice greater in SG vs. NSG (P = 0.02). Correlations between ASM index, handgrip and knee isokinetic strength vs. markers of microcirculatory function, capillary diameters, vascular reactivity, and endothelial injury were found only in SG. CONCLUSION: Decreased ASM index and strength have been associated with microcirculatory profile, indicating that microcirculation impairment may be involved somehow in Sarcopenia development. The inflammation status, particularly elevated IL-6, seems to play an important role in this process.

Peripheral microvascular dysfunction is also present in patients with ischemia and no obstructive coronary artery disease (INOCA).

BACKGROUND: In patients with ischemia and no obstructive coronary artery disease (INOCA), coronary microvascular dysfunction is associated with higher rate of major adverse cardiovascular events. OBJECTIVE: To demonstrate if microvascular dysfunction present in coronary microcirculation of patients with INOCA may be detected noninvasively in their peripheral circulation. METHODS: 25 patients with INOCA and 25 apparently healthy individuals (controls) were subjected to nailfold videocapillaroscopy (NVC) and venous occlusion plethysmography (VOP) to evaluate peripheral microvascular function and blood collection for biomarkers analysis, including soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelin-1 (ET-1) and C-reactive protein (CRP). RESULTS: Red blood cell velocity (RBCV) before and after ischemia (RBCVmax) were significantly lower in patients with INOCA (p = 0.0001). Time to reach maximal red blood cell velocity (TRBCVmax) was significantly longer in INOCA group (p = 0.0004). Concerning VOP, maximal blood flow (p = 0.004) and its relative increment were significantly lower in patients with INOCA (p = 0.0004). RBCVmax showed significant correlations with sVCAM-1 (r = -0.38, p < 0.05), ET-1 (r = -0.73, p < 0.05) and CRP (r = -0.33, p < 0.05). Relative increment of maximal post-ischemic blood flow was significantly correlated with sVCAM-1 (r = -0.42, p < 0.05) and ET-1 (r = -0.48, p < 0.05). CONCLUSIONS: The impairment of microvascular function present in coronary microcirculation of patients with INOCA can be also detected in peripheral microcirculation.

Does Resistance Training with Blood Flow Restriction Affect Blood Pressure and Cardiac Autonomic Modulation in Older Adults?

Resistance training (RT) with blood flow restriction (BFR) appears to accelerate muscle hypertrophy and strength gains in older populations. However, the training-related effects of RT with BFR upon blood pressure (BP) and cardiac autonomic modulation in the elderly remains unclear. The objective of this study is to compare the chronic effects of low-intensity RT performed with soft BFR (BFR) vs. high-intensity (HI) and low-intensity RT (CON) without BFR on BP and heart rate variability (HRV) indices in older adults. Thirty-two physically inactive participants (72 ± 7 yrs) performed RT for upper and lower limbs (50-min sessions, 3 times/week) for 12 weeks, being assigned into three groups: a) BFR; 30% of 1 repetition maximum (RM) with BFR corresponding to 50% of arterial occlusion pressure; b) HI; 70% of 1RM without BFR; c) CON; 30% of 1 RM without BFR. Resting BP and HRV were assessed at rest in the supine position, before and after exercise interventions. Systolic BP (Δ = -7.9 ± 8.0 mmHg; p = 0.002; effect size = 0.62), diastolic BP (Δ = trace length by the duration of the test 5.0 ± 6.0 mmHg; p = 0.007; effect size = 0.67) and mean arterial pressure (Δ = -6.3 ± 6.5 mmHg; p = 0.003/effect size = 0.77) reduced after BFR, remaining unaltered in HI and CON. HRV indices of sympathetic and vagal modulation did not change in all groups (p ≥ 0.07 for all comparisons). 12-wk RT with low intensity and relatively soft BFR substantially reduced BP at rest in older adults vs. traditional RT performed with either low or high intensity. Those reductions were not parallel to changes in autonomic modulation.

Acute Effects of Metformin and Vildagliptin after a Lipid-Rich Meal on Postprandial Microvascular Reactivity in Patients with Type 2 Diabetes and Obesity: A Randomized Trial.

BACKGROUND: Type 2 diabetes mellitus and obesity are both related to endothelial dysfunction. Postprandial lipemia is a cardiovascular risk. Notably, it is known that a high-fat diet may elicit microvascular dysfunction, even in healthy subjects. Since anti-diabetic drugs have different mechanisms of action and also distinct vascular benefits, we aimed to compare the results of two anti-diabetic drugs after the intake of a lipid-rich meal on microcirculation in patients with type 2 diabetes and obesity. In parallel, we also investigated the metabolic profile, oxidative stress, inflammation, plasma viscosity, and some gastrointestinal peptides. SUBJECTS/METHODS: We included 38 drug-naïve patients, all women aged between 19 and 50 years, with BMI ≥ 30 kg/m2. We performed endothelial measurements and collected samples before (fasting) and after the intake of a lipid-rich meal at 30, 60, 120, and 180 min. Patients were randomized to metformin or vildagliptin, given orally just before the meal. Endothelial function was assessed by videocapillaroscopy and laser-Doppler flowmetry to investigate microvascular reactivity. Besides, we also investigated plasma viscosity, inflammatory and oxidative stress biomarkers, gastrointestinal peptides, and metabolic profile in all time points. RESULTS: No differences at baseline were noted between groups. Vildagliptin increased glucagon-like peptide-1 compared to metformin. Paired comparisons showed that, during the postprandial period, vildagliptin significantly changed levels of insulin and glucagon-like peptide-1, and also the dipeptidyl peptidase-4 activity, while metformin had effects on plasma glucose solely. Metformin use during the test meal promoted an increase in functional capillary density, while vildagliptin kept non-nutritive microvascular blood flow and vasomotion unchanged. CONCLUSIONS: After the intake of a lipid-rich meal, the use of vildagliptin preserved postprandial non-nutritive microflow and vasomotion, while metformin increased capillary recruitment, suggesting protective and different mechanisms of action on microcirculation.

Identifying common baseline clinical features of COVID-19: a scoping review.

OBJECTIVES: Our research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19. DESIGN: We conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020. SETTING: Studies conducted in any setting and any country were included. PARTICIPANTS: Studies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2. RESULTS: In total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants' age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%-99%), cough (4%-92%), dyspnoea/shortness of breath (1%-90%), fatigue (4%-89%), myalgia (3%-65%) and pharyngalgia (2%-61%), while regarding comorbidities, we found cardiovascular disease (1%-40%), hypertension (0%-40%) and cerebrovascular disease (1%-40%). Such heterogeneity impaired the conduction of meta-analysis. CONCLUSIONS: The infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.

Nutrition Information in Oncology - Extending the Electronic Patient-Record Data Set.

Electronic health records (EHRs) present extensive patient information and may be used as a tool to improve health care. However, the oncology context presents a complex content that increases the difficulties of EHR application. This study aimed at developing openEHR-archetypes representing clinical concepts in cancer nutrition-care, as well as to develop an openEHR-template including the aforementioned archetypes. The study involved the following stages: 1) a thorough literature review, followed by an expert's (nutrition guideline authors) survey, aiming to identify the main statements of published clinical guidelines on nutrition in cancer patients that were not included on the Clinical Knowledge Manager (CKM) repository; 2) modelling of the archetypes using the Ocean Archetype Software and submission to the CKM repository; 3) creating an example template with Template Designer; and 4) automatic conversion of the openEHR-template into a readily usable EHR using VCIntegrator. The clinical concepts (among 17 clinical concepts not yet available in the CKM repository) chosen for further development were: body composition, diet plan, dietary nutrients, dietary supplements, dietary intake assessment, and Malnutrition Screening Tool (MST). So far, four archetypes were accepted for review in the CKM repository and a template was created and converted into an EHR. This study designed new openEHR-archetypes for nutrition management in cancer patients. These archetypes can be included in EHR. Future studies are needed to assess their applicability in other areas and their practical impact on data quality, system interoperability and, ultimately, on clinical practice and research.

Obesity blunts cephalic-phase microvascular responses to food.

Neurally mediated anticipatory responses, also named cephalic-phase responses, and microcirculatory regulation are two important mechanisms to maintain metabolic homeostasis. Altered cephalic-phase responses in obesity and its metabolic consequences have been proposed. There is, however, a lack of studies focusing on in vivo assessment of the microcirculation during this phase in patients with obesity. In this randomized controlled trial, we selected patients with obesity and healthy subjects after clinical and laboratory assessments. Those with obesity were randomized into two groups: experimental (cephalic-phase microvascular response stimulation - CP group, n = 13) and controls (n = 14). Healthy subjects (n = 17) were also included to form a CP control group. Skin microvascular assessment was used as a model of systemic microcirculation. Resting functional capillary density (FCD) and peak FCD during post-occlusive reactive hyperemia (PORH) were measured by dorsal finger videocapillaroscopy and expressed mainly capillary recruitment capacity. Resting red blood cell velocity (RBCV), peak RBCV during PORH (RBCVmax), and time taken to reach RBCVmax (TRBCVmax) were assessed by dynamic nailfold videocapillaroscopy and expressed the microhemodynamics. Patients with obesity (with or without stimulus) failed to show an increase on FCD during PORH post-stimulus (p = 0.221 and p = 0.307, respectively) depicting lack of capillary recruitment. In contrast, healthy subjects presented an increase in this microvascular outcome (p = 0.004). Changes in all variables of microhemodynamics occurred in both CP groups (healthy and those with obesity). During CP, we originally demonstrated an absence of capillary recruitment in subjects with obesity. These findings might contribute to the literature of microvascular impairment and metabolic conditions.

Identifying Indicators to Assess and Monitor Data Integration Engines Systems.

We aimed to identify relevant indicators for end-users in integration engines for healthcare systems. METHODS: The study was performed in two steps, including interviews and the identification of additional indicators from the literature. RESULTS: 10 interviews were performed and 90 indicators identified. DISCUSSION: Several of the indicators are difficult to calculate, nevertheless, they have the potential to improve data quality and processes in healthcare institutions and should be further explored in future studies.

Evaluation of Heart Rate Variability and Endothelial Function 3 Months After Bariatric Surgery.

We investigated endothelial and autonomic nervous functions after bariatric surgery. For this, we prospectively recruited 40 patients for bariatric surgery or medical treatment (20 in each group). Heart rate variability (HRV) and endothelial function were evaluated before and 3 months after treatments. Glucagon-like peptide 1 (GLP-1), insulin, and glucose at fasting and 30 and 60 min after a standard 300-kcal meal were also analyzed. Surgery but not medical care increased HRV in all time-domain variables, while frequency-domain variables, vascular elasticity, and endothelial reactivity did not change. Changes in GLP-1 and insulin resistance markers did not correlate with HRV. After 3 months, bariatric surgery improved the parasympathetic activity of cardiac autonomic function. Trial registration: NCT03911479.

Strength training with blood flow restriction - a novel therapeutic approach for older adults with sarcopenia? A case report.

INTRODUCTION: A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia - appendicular skeletal muscle mass index (ASM) of 7.10 kg/m2. PURPOSE: To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. METHODS: In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). RESULTS: LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. CONCLUSION: LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.

30-days effects of vildagliptin on vascular function, plasma viscosity, inflammation, oxidative stress, and intestinal peptides on drug-naïve women with diabetes and obesity: a randomized head-to-head metformin-controlled study.

BACKGROUND: Obesity is the main risk factor for diabetes and excessive visceral fat triggers low-grade inflammatory process, mediated by activation and release of cytokines and high flow of free fatty acids that contribute to insulin resistance, increased oxidative stress, and impaired endothelial function. Metformin and vildagliptin have known vasculoprotective actions, but the value of these drugs on drug-naïve diabetic patients during 30 days use warrants investigation. Our purpose was to observe their effects on endothelial function, oxidative stress, inflammatory biomarkers, and plasma viscosity. METHODS: 38 women with obesity and type 2 diabetes drug-naïve, aged between 19 and 50 years, BMI ≥ 30 kg/m2, were recruited and subjected to measurements of endothelial function, nutritive skin microvascular reactivity, plasma viscosity, inflammatory and oxidative stress biomarkers at baseline and randomized 1:1 to ingest metformin (850 mg twice/day) or vildagliptin (50 mg twice/day) during 30 days, and then, re-evaluated. RESULTS: No differences between groups were noticed at baseline. After treatment, vildagliptin promoted an improvement on endothelial-dependent and -independent vasodilatations, at arteriole level, while metformin resulted in improved nutritive microvascular reactivity, at the capillary level. Intragroup analysis showed that vildagliptin reduced insulin, C-peptide and oxidized LDL, and increased adiponectin and glucagon-like peptide-1 while metformin reduced weight, plasma glucose, total cholesterol, HDL-c, LDL-c, and dipeptidyl peptidase-4 activity, with an unexpected increase on tumor necrosis factor-α. No significant difference in plasma viscosity was noted. CONCLUSIONS: In the vascular beds investigated, both drugs used for only 30 days improved endothelial function, through distinct, and possibly, complementary mechanisms on drug-naïve diabetic women.Trial Registration ClinicalTrials.gov: NCT01827280.

Can openEHR Represent the Clinical Concepts of an Obstetric-Specific EHR - ObsCare Software?

ObsCare is an obstetric-specific Electronic Health Record in use in nine Portuguese obstetric departments. Like other EHRs, it faces major challenges related to semantic interoperability and data quality. openEHR is proposed to address those needs. This study aimed to describe a summary representation of Obscare workflow and to validate whether archetypes in the openEHR Clinical Knowledge Manager repository can represent ObsCare clinical concepts. The study included the phases: a) ObsCare form selection; b) Description of the workflow care process; c) Detailed data extraction; and d) CKM models analysis. 379 variables were analyzed: 219 were fully represented in CKM repository; 99 were partially represented and needed archetype modification; and 61 were not represented and need new archetypes. To conclude, our study showed that the openEHR CKM repository requires further enhancements to be able to fully answer to the needs of an obstetric-specific EHR, the ObsCare software.

The Impact of Electronic Obstetric Records Using the ObsCare Software on Scientific Production.

AIMS: To compare the characteristics of scientific publications performed in hospitals that used with those that didn't use an obstetric electronic health record (EHR). METHODS: This study included two reviews (A and B). Review A was an exploratory analysis of all 100 abstracts presented at the Scientific Meeting of the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, in November 2017. Review B was a systematic review of studies in obstetrics, performed in Portugal and published between 2016-18 and indexed in PubMed. In both reviews, the included papers/abstracts were divided into two groups: from hospitals that used ObsCare® (ObsCare group) and from hospitals without a specific obstetric EHR or that didn't use ObsCare (sObsCare group). RESULTS: In both reviews, the sample size was significantly higher in hospitals from the ObsCare group. In review B, the length of the study period was also significantly longer in ObsCare group; no significant difference was found in review A. CONCLUSION: Publications from hospitals that used an obstetric specific EHR (ObsCare), included a higher number of patients and longer study periods.

From ObsCare Software to an OpenEHR Platform: Modelling Obstetric Archetypes.

INTRODUCTION AND AIMS: Electronic health records (EHRs) are important tools to facilitate communication between care providers and to improve clinical research. In obstetrics they became essential. The ObsCare software was created to answer to the need for an EHR with specific obstetric features. The present study aimed to develop openEHR-archetypes capable of representing an ObsCare® EHR form and to create an openEHR-template using the developed archetypes. METHODS: The study was performed in four phases: 1) selection and description of the ObsCare form; 2) Clinical Knowledge Manager (CKM) analysis; 3) modelling of the archetypes; 4) creation and testing of the template. RESULTS: One openEHR-archetype - Newborn summary - was modelled to assemble the following three clinical concepts that were not represented in CKM: hours of life, "Examination of newborn movements" and "Examination of reflexes". Finally, an openEHR-template was built and automatically converted into an EHR by VCIntegrator. CONCLUSIONS: Considering the potential to improve clinical research, we believe that more obstetric-gynecologic clinical statements should be modelled into openEHR.

Organ dysfunction in cirrhosis: a mechanism involving the microcirculation.

INTRODUCTION: Microcirculation is essential for adequate tissue perfusion and organ function. Microcirculatory changes may occur in cirrhosis, inducing loss of multiorgan function. The aim was to evaluate preliver transplantation and postliver transplantation aspects of multiorgan function, microcirculation, inflammatory, and endothelial biomarkers and survival in a controlled study including cirrhotic outpatients. PATIENTS AND METHODS: We accessed functional capillary density (FCD) and red blood cell acceleration (RBCA) by nailfold videocapillaroscopy. Inflammatory and endothelial biomarkers [interleukin-6 (IL-6), soluble intercellular adhesion molecule-1, endothelin-1, and tumor necrosis factor-α] were analyzed. Cerebral and renal functions were assessed to represent organ dysfunction and regression analyses were carried out. Receiver operating characteristic curves were constructed and survival Kaplan-Meier analysis was carried out. RESULTS: Fifty-four patients and 18 controls were included. Inflammatory and endothelial markers increased in advanced disease. FCD was reduced and RBCA was progressively lower according to disease severity. RBCA correlated inversely with inflammatory and endothelial biomarkers, and directly with renal function. The presence of hepatic encephalopathy correlated inversely with RBCA and directly with IL-6 and endothelin-1. In multivariate analysis, RBCA was an independent factor for organ dysfunction. The area under the receiver operating chartacteristic curve for IL-6 for survival was 0.74 (0.59-0.89), P=0.05. Transplant-free survival was 97.5% for values under 5.78 ng/ml (IL-6 best cutoff) and 83.9% above 5.78 ng/ml, log-rank=0.018. Eleven patients underwent transplantation, with an overall improvement in microcirculatory function. CONCLUSION: Our results suggest a mechanism of organ damage in cirrhosis, where microcirculatory dysfunction could be correlated to inflammatory and endothelial biomarkers, and loss of multiorgan function. IL-6 seems to be an important survival marker of inflammation. Liver transplantation improved microcirculatory dysfunction, corroborating this hypothesis.