Browsing by Author "Paiva, Ana"
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- Acute kidney injury after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a Portuguese populationPublication . Carias, Eduarda; Ferreira, Hugo; Chuva, Teresa; Paiva, Ana; Maximino, JoseBackground: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemothera-py (CRS/HIPEC) is associated with a higher rate of major complica-tions, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further pro-gression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods: This retrospective study collected demographic, tumor -related, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Re-nal impairment was defined according to Kidney Disease Improv-ing Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results: Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ra-tio (OR) 6.48, confidence interval (CI) 1.601 -26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26 -109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07 -5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94 -0.98, P = 0.037) and AKI development. Conclusion: Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institu-tion of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.
- FAtiMA toolkit: toward an accessible tool for the development of socio-emotional agentsPublication . Mascarenhas, Samuel; Guimarães, Manuel; Prada, Rui; Santos, Pedro A.; Dias, João; Paiva, AnaMore than a decade has passed since the development of FearNot!, an application designed to help children deal with bullying through role-playing with virtual characters. It was also the application that led to the creation of FAtiMA, an affective agent architecture for creating autonomous characters that can evoke empathic responses. In this article, we describe the FAtiMA Toolkit, a collection of open-source tools that is designed to help researchers, game developers, and roboticists incorporate a computational model of emotion and decision-making in their work. The toolkit was developed with the goal of making FAtiMA more accessible, easier to incorporate into different projects, and more flexible in its capabilities for human-agent interaction, based upon the experience gathered over the years across different virtual environments and human-robot interaction scenarios. As a result, this work makes several different contributions to the field of Agent-Based Architectures. More precisely, the FAtiMA Toolkit’s library-based design allows developers to easily integrate it with other frameworks, its meta-cognitive model affords different internal reasoners and affective components, and its explicit dialogue structure gives control to the author even within highly complex scenarios. To demonstrate the use of the FAtiMA Toolkit, several different use cases where the toolkit was successfully applied are described and discussed.
- Severe acute kidney injury in hospitalized cancer patients: epidemiology and predictive model of renal replacement therapy and In-Hospital MortalityPublication . Marques, Roberto Calças; Reis, Marina; Pimenta, Gonçalo; Sala, Inês; Chuva, Teresa; Coelho, Inês; Ferreira, Hugo; Paiva, Ana; Costa, José MaximinoBackground: Acute kidney injury (AKI) is a common complication among cancer patients, often leading to longer hospital stays, discontinuation of cancer treatment, and a poor prognosis. This study aims to provide insight into the incidence of severe AKI in this population and identify the risk factors associated with renal replacement therapy (RRT) and in-hospital mortality. Methods: This retrospective cohort study included 3201 patients with cancer and severe AKI admitted to a Comprehensive Cancer Center between January 1995 and July 2023. Severe AKI was defined according to the KDIGO guidelines as grade ≥ 2 AKI with nephrological in-hospital follow-up. Data were analyzed in two timelines: Period A (1995–2010) and Period B (2011–2023). Results: A total of 3201 patients (1% of all hospitalized cases) were included, with a mean age of 62.5 ± 17.2 years. Solid tumors represented 75% of all neoplasms, showing an increasing tendency, while hematological cancer decreased. Obstructive AKI declined, whereas the incidence of sepsis-associated, prerenal, and drug-induced AKI increased. Overall, 20% of patients required RRT, and 26.4% died during hospitalization. A predictive model for RRT (AUC 0.833 [95% CI 0.817–0.848]) identified sepsis and hematological cancer as risk factors and prerenal and obstructive AKI as protective factors. A similar model for overall in-hospital mortality (AUC 0.731 [95% CI 0.71–0.752]) revealed invasive mechanical ventilation (IMV), sepsis, and RRT as risk factors and obstructive AKI as a protective factor. The model for hemato-oncological patients’ mortality (AUC 0.832 [95% CI 0.803–0.861]) included IMV, sepsis, hematopoietic stem cell transplantation, and drug-induced AKI. Mortality risk point score models were derived from these analyses. Conclusions: This study addresses the demographic and clinical features of cancer patients with severe AKI. The development of predictive models for RRT and in-hospital mortality, along with risk point scores, may play a role in the management of this population.