Catarina O'Neill - Academia.edu (original) (raw)

Papers by Catarina O'Neill

Revista española de cardiología, Oct 1, 2020

Please cite this article in press as: Barbosa AR, et al. Impaired myocardial deformation assessed... more Please cite this article in press as: Barbosa AR, et al. Impaired myocardial deformation assessed by cardiac magnetic resonance is associated with increased arrhythmic risk in hypertrophic cardiomyopathy. Rev Esp Cardiol. 2020.

GE Portuguese Journal of Gastroenterology, Mar 8, 2023

Background: Dysphagia is a prevalent condition which may severely impact the patient's quality of... more Background: Dysphagia is a prevalent condition which may severely impact the patient's quality of life. However, there are still lacking standardized therapeutic options for esophageal motility disorders. Summary: Dysphagia is defined as a subjective sensation of difficulty swallowing which can result from oropharyngeal or esophageal etiologies. Regarding esophageal dysphagia, after excluding structural causes and esophageal mucosal lesions, high-resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM has not only improved the sensitivity for detecting achalasia but has also expanded our understanding of spastic and hypomotility disorders of the esophageal body. The Chicago Classification v4.0 uses a hierarchical approach and provides a standardized diagnosis of esophageal motility disorders, allowing a tailored therapeutic approach. Dysphagia is often a long-term health problem that broadly impacts health and well-being and leads to physical and psychosocial disability, namely, malnutrition and aspiration pneumonia, as well as social isolation, depression, and anxiety. Apart from achalasia, most esophageal motility disorders tend to have a benign long-term course with symptoms of dysphagia and noncardiac chest pain that can improve significantly over time. Patient-reported outcomes (PROs) are self-assessment tools that capture the patients' illness experience and help providers better understand symptoms from the patients' perspective. Therefore, PROs have a critical role in providing patient-centered care. Key Messages: Motility disorders should be ruled out in the presence of nonobstructive esophageal dysphagia, and treatment options should be considered according to the severity of symptoms reported by the patient.

GE Portuguese Journal of Gastroenterology, May 16, 2022

Introduction: The European Society of Gastrointestinal Endoscopy (ESGE) identified the need to be... more Introduction: The European Society of Gastrointestinal Endoscopy (ESGE) identified the need to benchmark the quality of small bowel capsule endoscopy (SBCE) and produced a set of performance measures (PM). The aim of this study is to critically evaluate the accordance of the PM for SBCE in two Portuguese centers with different SBCE platforms. Methods: The authors conducted a cross-sectional analysis of consecutive SBCE performed in an 18-month period in 2 Portuguese centers that used two different SBCE platforms Mirocam ® (IntroMedic, Seoul, South Korea) and PillCam ® (Medtronic, Yokneam, Israel). A total of 10 PM (6 key, 4 minor) were evaluated and compared between the 2 centers. Results: A total of 493 SBCE were included. The minimum standard established by ESGE was reached in 3/6 key PM (com-plete visualization, lesion detection rate, and capsule retention rate), and none of the 4 minor PM. PM compliance significantly differed between the 2 centers: complete small bowel visualization 95.9 and 90% (p = 0.01), diagnostic yield 50.6 and 63% (p = 0.005), adequate small bowel cleansing level according to Brotz scale 69.54 and 84.6% (p ≤ 0.001), patients with high risk of capsule retention offered a patency capsule 4.2 and 73% (p ≤ 0.001), respectively. Conclusion: This study highlights and critically discusses technical and organizational issues that should be considered in defining more realistic PM thresholds, aiming to improve SBCE quality.

United European gastroenterology journal, Apr 22, 2021

To the Editor We read with great interest the review by Degré et al. 1 and the debate over cortic... more To the Editor We read with great interest the review by Degré et al. 1 and the debate over corticosteroids use in severe alcoholic hepatitis (sAH). Patients with sAH have poor short-term outcomes, with an estimated mortality of 20%-30% within 1 month of presentation. 2 Unfortunately, corticosteroids have been the only medical therapy associated with a short-term benefit in selected patients with sAH, since STOPAH trial revealed a reduction in the 28-day mortality. 2 Careful monitoring for infection is essential during corticosteroid use, since it plays a major role in the outcomes of sAH. 2 A 57-yearold Nepalese man was recently admitted to our gastroenterology ward due to esophageal variceal bleeding secondary to alcoholic cirrhosis. Laboratory work-up was remarkable for eosinophilia (absolute eosinophil count of 1556 cells/µl). He referred intermittent The authors declare that there are no conflict of interests.

European Heart Journal, Oct 1, 2019

Background Strain techniques, such as feature tracking cardiac magnetic resonance (FT-CMR), have ... more Background Strain techniques, such as feature tracking cardiac magnetic resonance (FT-CMR), have emerged as a promise for more accurate evaluation of cardiac function compared to ejection fraction. In hypertrophic cardiomyopathy (HCM) patients, impaired myocardial deformation measured by FT-CMR has been associated with severity of hypertrophy and presence of late gadolinium enhancement (LGE) but associations with clinical severity and prognosis are scarce. Purpose To analyse the association between left ventricular strain measured by FT-CMR, morphologic features and prognostic markers in patients with HCM. Methods Retrospective analysis of clinical, echocardiography, Holter and CMR data of HCM patients aged ≥16 years followed at two referral centres. Ventricular arrhythmias (VA) were defined as non-sustained or sustained ventricular tachycardia or sudden cardiac arrest. Sudden cardiac death (SCD) risk was evaluated using the score proposed by the European Society of Cardiology. LGE extension was evaluated using the American Heart Association 17-segment model. FT-CMR was used to evaluate global peak systolic longitudinal (GLS), radial (GRS) and circumferential (GCS) strains - GLS was averaged from three standard longitudinal views while GRS and GCS were averaged from the basal, mid and apical LV short-axis planes. Results A total of 109 HCM patients (59.2±16.2 years old; 60.6% males) were included; mean follow-up was 39±25 months. Mean LV mass was 170.6±70.3g, LVEF was 63.7±10.0% and the number of segments with LGE was 3.14±3.32. Mean GLS, GRS and GCS were −14.8±4.0%, 34.4±13.3% and −17.5±4.8%, respectively. Impaired strain was associated with higher LV mass (GLS: r=0.46, GRS: r=−0.46, GCS: r=0.47, p&lt;0.001 for all), reduced LVEF (GLS: r=−0,33, GRS: r=0,44, GCS: r=−0.41, p&lt;0.003 for all) and LGE extension (GLS: r=0.26, GRS: r=−0.38, GCS: r=0.38, p&lt;0.01 for all). SCD risk score was 3.12%±2.98 (8 patients scored as high risk) and VA were documented in 26 patients (26%). Patients with VA had worse strain values than those without (GLS −13.2±4.12 vs −15.5±3.71, p=0.011; GCS −15,8±5.22 vs −18.3±4.24, p=0.017). Patients with high estimated risk of SCD also had worse strain values than those at low/intermediate risk (GLS −12.2±3.57 vs −15.1±3.83, p=0.048; GCS −14.5±4.26 vs −17.9±4.54, p=0.047). A correlation between SCD risk and GLS and GCS was observed (r=0.32, p=0.004; r=0.23, p=0.03, respectively). Conclusions In our population, worse strain measurements were associated with a more severe HCM phenotype, presence of VA and a higher estimated risk of SCD. Strain assessed by FT-CMR may improve risk stratification in HCM patients.

Endoscopy, Apr 26, 2023

Endoscopic submucosal dissection of rectal lesion recurrence at the anastomosis site: when the st... more Endoscopic submucosal dissection of rectal lesion recurrence at the anastomosis site: when the staples lead the way ▶ Fig. 1 Lateral spreading tumor of the granular type at the anastomosis site 4 years after anterior rectum resection due to an early neoplastic lesion: a direct view; b inverted view.

GE Portuguese Journal of Gastroenterology, Apr 20, 2021

$Research paper thumbnail of Circumferential Endoscopic Submucosal Dissection for Refractory Dysplastic Barrett’s Esophagus After Mucosal Resections and Radiofrequency Ablation – a Salvage and Definitive Treatment Approach?$

Endoscopy, Apr 1, 2022

Esophageal SCC, although the incidence is declining compared with adenocarcinoma in North America... more Esophageal SCC, although the incidence is declining compared with adenocarcinoma in North America and Europe, is the number one cause of esophageal cancer in the world. The 5-year survival rate for patients with esophageal cancer, although generally poor, has been improving over the past years. This is mainly due to early identification and better therapeutic options. Although more advanced esophageal cancers may require chemotherapy or esophagectomy, patients with lesions limited to the mucosa and submucosa without lymph node involvement, along with poor or reluctant surgical candidates, may undergo endoscopic treatment. A relatively new technique, ESD, uses an en bloc resection of the tissue by direct visualization that allows for a better detailed analysis of the resected margins and depth of invasion, and it is ideal for lesions larger than 2 cm. Patients with decompensated cirrhosis with concomitant esophageal varices and esophageal cancer represent a challenging population because of the high risk of periprocedural and postprocedural bleeding secondary to thrombocytopenia, coagulopathy, and portal hypertension. With increased experience with ESD, centers around the world have begun to use it for the treatment of early esophageal cancer. Studies have compared ESD with EMR, and although ESD is technically more difficult, it has been associated with a similar rate of adverse events and, in some cases, better local recurrence outcomes. Ideally, esophageal varices are eradicated with band ligation before tissue resection. Endoscopic injection sclerotherapy is typically avoided because it is associated with submucosal fibrosis, which can complicate the planned resection. ESD is a potential option for early cancers found in decompensated cirrhotic patients with esophageal varices if performed in properly selected patients at centers of excellence. Further studies are needed to define the risks and long-term outcomes before it can be implemented as a standard practice before liver transplantation. However, this case highlights a potential alternative to other high-risk options for a high-risk population.

Cureus, Feb 1, 2023

Substernal goiter represents a common and challenging clinical scenario in medical practice. Symp... more Substernal goiter represents a common and challenging clinical scenario in medical practice. Symptoms often include dysphagia, dyspnea, and hoarseness, deeming the vascular compressive symptoms an unusual finding. In extraordinarily rare cases, its slow and gradual growth determines the emergence of severe superior vena cava syndrome, with consequent development of upper esophageal downhill varices. In contrast with distal esophageal varices, downhill variceal hemorrhage is extremely rare. The authors report a patient admitted to the emergency room due to upper gastrointestinal hemorrhage, caused by downhill upper esophageal varices' rupture, secondary to compressive substernal goiter. In this case, irregular follow-up resulted in massive thyroid growth, progressive vascular and airway compression, and the development of venous collateral pathways. Despite the severity of those compressive symptoms, the patient was not a surgical candidate considering her multiple cardiovascular and respiratory comorbidities. Newly developed thyroid ablative techniques may emerge as a possible life-saving treatment when the surgical approach cannot be considered.

Revista Espanola De Cardiologia, Oct 1, 2020

Endoscopy

Journal of Crohn's and Colitis

Background Sarcopenia (loss of skeletal muscle mass and/or strength) is a predictor of postoperat... more Background Sarcopenia (loss of skeletal muscle mass and/or strength) is a predictor of postoperative morbidity in various surgical populations. We evaluated the impact of sarcopenia in postoperative outcomes after intestinal surgery in patients with Crohn’s disease (CD) at a tertiary referral centre. Methods This is a retrospective analysis of all patients with CD undergoing intestinal surgery at our centre, between January 2013 and September 2019 with available abdominal computed tomography images within 90 days before surgery. The images were assessed for sarcopenia according EWGSOP2 criteria (Skeletal Muscle Index <39 cm2/m2 for female and <55 cm2/m2 for male) and visceral and subcutaneous fat areas. All patients were coded for postoperative complications using the Clavien–Dindo classification system. Results A total of 114 patients with Crohn’s disease were included (table 1 and 2). The prevalence of sarcopenia was 67.5%. Common intestinal procedures were ileocecal resecti...

Cureus

Acta Médica Portuguesa, 2022

Introdução: A pandemia de COVID-19 impôs uma reorganização dos serviços de saúde e a teleconsulta... more Introdução: A pandemia de COVID-19 impôs uma reorganização dos serviços de saúde e a teleconsulta surgiu como solução para manter o acompanhamento dos utentes. Este estudo caracterizou, pela perspetiva dos médicos, a consulta não presencial (CNP) realizada no Serviço Nacional de Saúde (SNS) durante a primeira fase da pandemia e identificou fatores que influenciam a experiência da consulta.Material e Métodos: Estudo transversal analítico com base num questionário online dirigido aos médicos do SNS entre julho e setembro de 2020. Recolheram-se dados demográficos e informação sobre a prática, atitudes e perceções relativas à CNP. Foram calculadas razões de prevalência através de regressões Poisson, ajustadas para identificar fatores associados a maior satisfação, utilização de videochamada e maior motivação para realizar teleconsultas no futuro.Resultados: Obtiveram-se 2225 respostas válidas. A CNP foi realizada por 93,8% dos inquiridos neste período, dos quais 99,0% utilizou o telefon...