Pedro Melo

The Portuguese Foundation for Science and Technology supported the doctoral fellowship of A.M.L. (SFRH/BD/78738/2011) and the postdoctoral fellowship of J.A. (SFRH/ BPD/73512/2010). The Portuguese Foundation for Science and Technology Projects PTDC/CVT/108490/2008 and FCT-ANR/ BIA-BIC/0043/2012 supported this work.

The Lagovirus rabbit hemorrhagic disease virus (RHDV), a member of the family Caliciviridae, severely affects European rabbit (Oryctolagus cuniculus) populations by causing rabbit hemorrhagic disease (RHD). RHDV is subdivided in six genogroups but, more recently, a new RHDV variant with a unique genetic and antigenic profile emerged. We performed a study in rabbits found dead in the field during 2013 and 2014 in Portugal to determine the prevalence of this new variant versus the classical RHDV. Fifty-seven liver samples were screened for the presence of RHDV and positive samples were genotyped. All cases of RHDV infection were caused by the new variant. The only former genogroup circulating in Portugal, G1, was not detected. We hence conclude that the new RHDV variant is replacing G1 in Portugal, probably due to a selective advantage. This sudden and rapid replacement emphasizes the necessity of continued monitoring of wild rabbit populations.

BACKGROUND: The efficacy of coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) among patients with stable chest pain has been studied in several trials with conflicting results. METHODS: We performed a systematic review and meta-analysis comparing CCTA first versus direct ICA among patients with stable chest pain, who were initially referred to ICA. PubMed, EMBASE, and Cochrane Central were searched for randomized controlled trials comparing the 2 strategies. Risk ratios (RRs) and mean differences with 95% CIs were computed for binary and continuous outcomes, respectively. RESULTS: Five randomized controlled trials with a total of 5727 patients were included, of whom 51.1% were referred to CCTA and 22.5% of patients had evidence of ischemia on a prior functional test. In the follow-up ranging from 1 to 3.5 years, 660 of the 2928 patients randomized to CCTA first underwent ICA (23%). Patients who underwent CCTA had lower rates of coronary revascularization (RR, 0.74 [95% CI, 0.66–0.84]; P <0.001) and stroke (RR, 0.50 [95% CI, 0.26–0.98]; P =0.043). Cardiovascular mortality (RR, 0.55 [95% CI, 0.24–1.23]; P =0.146), major adverse cardiovascular events (RR, 0.84 [95% CI, 0.64–1.10]; P =0.198), nonfatal myocardial infarction (RR, 1.09 [95% CI, 0.63–1.88]; P =0.768), and cardiovascular hospitalizations (RR, 0.91 [95% CI, 0.59–1.39]; P =0.669) did not differ significantly between groups. CONCLUSIONS: In patients with stable chest pain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA. CCTA was associated with a reduction in the rates of coronary revascularization and stroke compared with direct ICA. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/ ; Unique identifier: CRD42023383143.