Publications by authors named "Cachanado M"
Background: Vertigo is a priority for training and decision support in emergency departments (ED). Benign paroxysmal positional vertigo (BPPV), though manageable at bedside, remains frequently underdiagnosed and undertreated. This study assessed the effectiveness of a two-tiered educational intervention on posterior and horizontal BPPV management in the ED setting.
View Article and Find Full Text PDFBackground: We previously reported the safety and immunogenicity data from a randomized trial comparing the booster responses of vaccinees who received monovalent (MV) recombinant protein Beta-variant (MVB.1.351) and MV ancestral protein (MVD614) vaccines with AS03 adjuvant (Sanofi/GSK) to booster response of vaccinees who received mRNA MV ancestral strain BNT162b2 vaccine (Pfizer-BioNTech).
View Article and Find Full Text PDFBackground: Dyspnoea is often found months and years later in the "long-covid" syndrome, impairing quality of life and further perpetuating anxiety and post-traumatic stress disorders. Physiotherapy was recommended as a treatment in long-covid, but there is still insufficient evidence on its effectiveness.
Methods: We conducted a systematic literature search on MEDLINE, PEDro, WOS, Scopus, VHL and the Cochrane Library until July 2023 (PROSPERO registration number: CRD42023427464).
Objectives: Prone positioning (PP) has benefits in patients with acute respiratory distress syndrome. The objective of this study was to compare the effects and complications of PP in obese versus non-obese patients with moderate-to-severe acute respiratory distress syndrome after cardiothoracic surgery.
Methods: We retrospectively analysed a database established in 2014-2021 in an intensive care unit.
Background: Red blood cell transfusion can cause fluid overload. We evaluated the interaction between heart failure (HF) at baseline and transfusion strategy on outcomes in acute myocardial infarction (AMI).
Methods: We used data from the randomized REALITY trial.
Background: The aim of this trial-based economic evaluation was to assess the incremental costs and cost-effectiveness of the modified diagnostic strategy combining the YEARS rule and age-adjusted D-dimer threshold compared with the control (which used the age-adjusted D-dimer threshold only) for the diagnosis of pulmonary embolism (PE) in the Emergency Department (ED).
Methods: Economic evaluation from a healthcare system perspective alongside a non-inferiority, crossover, and cluster-randomized trial conducted in 16 EDs in France and two in Spain with three months of follow-up. The primary endpoint was the additional cost of a patient without failure of the diagnostic strategy, defined as venous thromboembolism (VTE) diagnosis at 3months after exclusion of PE during the initial ED visit.
Article Synopsis
- - Tracheal intubation is typically advised for coma patients, but its effectiveness in those with acute poisoning remains unclear; a study aimed to evaluate whether withholding intubation would affect outcomes for these patients.
- - The multicenter randomized trial took place across 20 emergency departments and 1 ICU in France and involved 225 comatose patients with severe poisoning, comparing a conservative approach to standard intubation practices.
- - Results indicated that patients in the conservative treatment group had better clinical outcomes, lower intubation rates, fewer adverse events, and a reduced incidence of pneumonia compared to those receiving routine intubation.
Article Synopsis
- Older patients (≥75 years) waiting overnight in emergency departments (ED) for hospital admission may face higher in-hospital mortality risks and adverse health events compared to those admitted before midnight.
- A study involving 1598 older patients in France found that those who spent the night in the ED had a mortality rate of 15.7% compared to 11.1% for those admitted earlier.
- Patients in the ED group also experienced more adverse events and had a longer median hospital stay (9 days compared to 8 days for the ward group).
Impact of transfusion strategy on platelet aggregation and biomarkers in myocardial infarction patients with anemia.
Eur Heart J Cardiovasc Pharmacother
November 2023
Background: Higher rates of thrombotic events have been reported in myocardial infarction (MI) patients requiring blood transfusion. The impact of blood transfusion strategy on thrombosis and inflammation is still unknown.
Objective: To compare the impact of a liberal vs.
Article Synopsis
- - Validated clinical decision rules aimed at reducing unnecessary use of computed tomographic pulmonary angiography (CTPA) in emergency departments (EDs) for suspected pulmonary embolism (PE) were analyzed to observe changes in CTPA usage over time.
- - A retrospective study across 26 European EDs examined nearly 9,000 CTPAs performed between January 2015 and December 2019, revealing significant increases in CTPA usage and diagnosed PEs, particularly among low-risk patients.
- - The findings indicated a trend toward more frequent CTPA use and a higher diagnosis rate of PEs despite efforts to limit unnecessary imaging, highlighting the need for ongoing assessment of clinical decision rules in practice.
Background: We pooled data from 2 cohorts of immune checkpoint inhibitors-treated microsatellite instability-high/mismatch repair-deficient (MSI/dMMR) metastatic colorectal cancer patients to evaluate the prognostic value of RAS/BRAFV600E mutations and Lynch syndrome (LS).
Patients And Methods: Patients were defined as LS-linked if germline mutation was detected and as sporadic if loss of MLH1/PMS2 expression with BRAFV600E mutation and/or MLH1 promoter hypermethylation, or biallelic somatic MMR genes mutations were found. Progression-free survival (PFS) and overall survival (OS) were adjusted on prognostic modifiers selected on unadjusted analysis (P < .
Background: Severe hypoxemia in patients with COVID-19 pneumonia might result from hypoxic pulmonary vasoconstriction, contributing to ventilation/perfusion (V/Q) mismatch. Because almitrine improves V/Q, it might reduce the risk for mechanical ventilation (MV) in such patients. Our primary objective was to determine the effect of almitrine on the need for MV at day 7.
View Article and Find Full Text PDFArticle Synopsis
- Biliary complications (BC) after liver transplantation are common and lead to serious health issues, with no surgical method proven to reduce their risk.
- A multicentric randomised controlled trial tested the effectiveness of using an intraductal removable stent (IRS) during liver transplant surgery to see if it could minimize BC occurrences.
- The study found that while IRS was used in 117 patients, it did not significantly decrease the incidence of BC compared to 118 patients who received standard care, and removal of the stent posed additional challenges.
Article Synopsis
- The study analyzes the effectiveness and safety of different strategies for diagnosing pulmonary embolism (PE) in the emergency department using elevated D-dimer thresholds without extensive imaging.* -
- A total of 3330 adult patients were evaluated, with findings showing a low failure rate (less than 1.85%) across various diagnostic approaches, indicating that these methods are reliable.* -
- Although there was no significant difference in failure rates among the tested rules, the 4-level pulmonary embolism probability score (4PEPS) led to a notably lower use of chest imaging compared to the other strategies.*
Economic evaluation of restrictive vs. liberal transfusion strategy following acute myocardial infarction (REALITY): trial-based cost-effectiveness and cost-utility analyses.
Eur Heart J Qual Care Clin Outcomes
February 2023
Aims: To estimate the cost-effectiveness and cost-utility ratios of a restrictive vs. liberal transfusion strategy in acute myocardial infarction (AMI) patients with anaemia.
Methods And Results: Patients (n = 666) with AMI and haemoglobin between 7-8 and 10 g/dL recruited in 35 hospitals in France and Spain were randomly assigned to a restrictive (n = 342) or a liberal (n = 324) transfusion strategy with 1-year prospective collection of resource utilization and quality of life using the EQ5D3L questionnaire.
Article Synopsis
- - The study aimed to compare the immune responses of two mRNA COVID-19 vaccines (BNT162b2 and mRNA-1273) to see if mixing them for the second dose produces a similar immune effect as receiving the same vaccine for both doses.
- - Nearly 400 adults participated, receiving either the same vaccine for both doses or a mix; the results showed that mixing the vaccines resulted in different antibody levels.
- - Overall, the research suggests that using either vaccine interchangeably is safe and effective, but those who received mRNA-1273 as a second dose reported more side effects compared to those who got BNT162b2.
Article Synopsis
- The study aimed to validate the safety of a combined diagnostic strategy for ruling out pulmonary embolism (PE) that incorporates the YEARS rule and age-adjusted D-dimer thresholds in emergency departments across France and Spain.
- It involved a total of 1414 patients who were either at low risk for PE or had an intermediate risk, examining the outcomes of using different intervention strategies regarding chest imaging and D-dimer levels.
- The results showed that the intervention group had a very low rate of venous thromboembolism at 3 months (0.15%), suggesting that this combined strategy is a safe alternative for excluding PE without unnecessary imaging.
Article Synopsis
- The study investigates the effectiveness and safety of cyclophosphamide for treating patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF) when used alongside high-dose methylprednisolone.
- Conducted as a double-blind, placebo-controlled trial across 35 departments in France, 120 patients were randomly assigned to receive either cyclophosphamide or a placebo, with all participants monitored for 3-month all-cause mortality.
- Results showed that 3-month mortality was 45% in the cyclophosphamide group compared to 31% in the placebo group, indicating no significant advantage for cyclophosphamide (p=0.10), and the trial is registered as NCT024605
Acute myocardial infarction is a common condition responsible for heart failure and sudden death. Here, we show that following acute myocardial infarction in mice, CD8 T lymphocytes are recruited and activated in the ischemic heart tissue and release Granzyme B, leading to cardiomyocyte apoptosis, adverse ventricular remodeling and deterioration of myocardial function. Depletion of CD8 T lymphocytes decreases apoptosis within the ischemic myocardium, hampers inflammatory response, limits myocardial injury and improves heart function.
View Article and Find Full Text PDFImportance: The optimal transfusion strategy in patients with acute myocardial infarction and anemia is unclear.
Objective: To determine whether a restrictive transfusion strategy would be clinically noninferior to a liberal strategy.
Design, Setting, And Participants: Open-label, noninferiority, randomized trial conducted in 35 hospitals in France and Spain including 668 patients with myocardial infarction and hemoglobin level between 7 and 10 g/dL.