Browsing by Author "Santos, MJ"
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- Alterações da refracção e motilidade na população de prematuros do HFF rastreada para ROPPublication . Rodrigues, J; Vaz, F; Santos, MJ; Ribeiro, F; Teixeira, SA criança prematura apresenta maior risco de morbilidade ofltalmológica e de alterações do desenvolvimento neurológico, nomeadamente de estrabismo, erros refractivos (miopia), diminuição da acuidade visual, defeitos da visão cromática e dos campos visuais. Os autores realizaram uma análise retrospectiva sobre a distribuição de casos de estrabismo, nistagmo e erros refractivos (miopia eq. esférico >= -0.25 D; alta miopia eq. esférico >= -5.00 D; astigmatismo >= 1.00D) na população de prematuros rastreada para ROP e nascidos no HFF entre Outubro de 1997 e Outubro de 2001. Foram considerados como critérios de inclusão: idade gestacional <= 32 semanas ou muito baixo peso ao nascer <= 1500g; 12 meses de idade corrigida até 31 de Outubro de 2002; e seguimento clínico após os 6 meses de idade. São apresentados os resultados e as conclusões da análise de 191 processos clínicos consultados
- AmbliopiaPublication . Coutinho, I; Santos, C; Pinto, S; Santos, MJPretende-se rever a definição, causas e tratamento da ambliopia.
- Bilateral acute angle closure glaucoma caused by fluoxetine: a case reportPublication . Pina, S; Silva, F; Alves, S; Azevedo, A; Santos, MJ; Vaz, F; Kaku, P; Esperancinha, FBackground: Acute angle closure glaucoma (ACG) occurs in patients with narrow iridocorneal angle, being more prevalent in elderly, hyperopic and asian. Mydriasis, induced by factors such as darkness, stress or drugs, may be a triggering factor of this disease. Methods: Case report of a 55 years old patient, female, black, with history of depressive mood that one month after initiation of oral fluoxetine therapy, appears in the emergency department with bilateral condition of intense eye pain, tearing, photophobia, decreased vision, nausea and vomiting. Ophthalmological exam showed corneal edema, conjunctival injection, mid mydriasis, narrow anterior chamber (AC) and IOP of 58 mmHg OD and 47 mmHg in OS. After systemic therapy with intravenous mannitol, oral acetazolamide and topical pilocarpine, the transparency of the cornea improved, allowing us to perform bilateral iridotomy. Later, the patient underwent Pentacam exam, OCT RNFL and Computerized Perimetry Results: After therapy, there was complete recovery of the symptoms, with stabilization of IOP at 10-12 mmHg OU. Gonioscopy revealed a narrow iridocorneal angle, grade II in Shaffer’s classification, corroborated by the Pentacam exam. The OCT showed a pathological decrease of the nerve fiber layer in the upper OD and suspicion in the upper OS. Perimetry also revealed changes in threshold sensitivity, especially in the right eye. Conclusions: We concluded this to be a case of bilateral AACG, probably induced by fluoxetine, a selective serotonin reuptake inhibitor (SSRI). Some studies refer that there are serotonergic receptors in the iris-ciliary body complex which, once stimulated, could lead to pupil sphincter muscle relaxation. Thus, the increased serotonin levels associated with the anticholinergic effects inherent to these agents, appears to be an important factor in inducing mydriasis, triggering AACG in patients with predisposing ocular anatomy. The growing number of AACG cases associated with fluoxetine, paroxetine and venlafaxine reported in the literature in recent years, shows that may be important an ophthalmologycal exam before initiating treatment with SSRIs, to exclude a narrow angle AC in these patients.
- Body composition phenotypes in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of caucasian female patients.Publication . Santos, MJ; Vinagre, F; Silva, J; Gil, V; Fonseca, JOBJECTIVES: The amount and distribution of fat and lean mass have important implications for health and systemic inflammation may represent a risk for altered body composition. The aim of this study was to analyse whether changes in body composition are similarly associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), two inflammatory conditions of different pathogenesis. METHODS: Body mass index (BMI), waist circumference, fat mass (FM) and fat-free mass (FFM) were measured in 92 women with SLE, 89 with RA and 107 controls. Results were compared among the 3 groups and correlations of FM percentage were explored within SLE and RA. RESULTS: Abnormal body composition was more frequent in women with SLE and RA than in non-inflammatory controls, despite having a similar BMI. RA diagnosis was significantly associated with overfat (OR=2.782, 95%CI 1.470-5.264; p=0.002) and central obesity (OR=2.998, 95%CI 1.016-8.841; p=0.04), while sarcopenia was more common among SLE (OR=3.003; 95%CI 1.178-7.676; p=0.01). Sarcopenic obesity, i.e. the coexistence of overfat with sarcopenia, was present in 6.5% of SLE and 5.6% of RA women, but no controls. Independent correlations of FM percentage in women with SLE included smoking, disease activity and CRP. In RA, education, disease activity and cumulative corticosteroid dose were identified as independent predictors of FM percentage. CONCLUSIONS: Women with SLE or RA diagnosis are more likely to have abnormal body composition phenotype, with some differences existing between these two conditions. Changes in body composition are partly explained by the inflammatory burden of disease and its treatment.
- Cardiovascular risk profile in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of female patientsPublication . Santos, MJ; Vinagre, F; Silva, J; Gil, V; Fonseca, JOBJECTIVE: Premature atherosclerosis is well-documented both in Systemic Lupus Erythematosus (SLE) and in Rheumatoid Arthritis (RA) patients, but cardiovascular (CV) risk is particularly high in lupus women. Although conventional CV risk factors do not fully explain the excessive risk in inflammatory diseases, they remain major contributors to atherosclerosis. The aim of the present study was to investigate whether CV risk factors are differentially associated with SLE and RA. METHODS: One hundred women with SLE, 98 with RA and 102 controls matched on age and without overt CV or renal disease were assessed for the presence of Framingham (hypertension, hypercholesterolemia, low HDL, diabetes, smoking) and other CV risks (atherogenic index of plasma (AIP), insulin resistance, obesity, central obesity, metabolic syndrome, uric acid, sedentarism, hypothyroidism and family history of premature CV disease). RESULTS: Modifiable CV risk factors are highly prevalent and occur more frequently in SLE and RA than in age-matched controls. Some differences in Framingham risk factors were found between SLE and RA, with hypertension being more common in young lupus women, hypercholesterolemia more frequent in RA and low HDL-C more frequent in SLE. However, the estimated 10-year Framingham CHD risk or the Reynolds Risk Score was comparable in both diseases. Although hypercholesterolemia was more frequent in RA, lupus women display a more atherogenic lipid profile, with significantly lower HDL-C levels (56.5±16 mg/dl versus 63.7±18; p=0.005), and more cases above the high risk cutpoints for cholesterol/HDL-C (14% versus 4.1%; p=0.01) and for AIP (15% versus 6.1%; p=0.03). Also, uric acid levels are higher in SLE women (4.8±1.5 mg/dl) than in RA (4.1±1.1 mg/dl), p=0.001. On the other hand, insulin resistance is significantly higher in women with RA as compared with SLE (median HOMA-IR 3.5 [6.4]) versus 0.72 [2.5]; p<0.0001) and the difference remained significant after adjustment for BMI and corticosteroids. CONCLUSIONS: Cardiovascular risk profile is distinct in SLE and RA women and the contribution of traditional CV risk factors to atherogenesis may be different in these two diseases. Prospective studies are necessary to understand how the control of modifiable risks can improve CV outcome in different inflammatory settings.
- Comparison of macular thickness and volume in amblyopic children using time domain optical coherence tomographyPublication . Silva, F; Alves, S; Pina, S; Azevedo, A; Pêgo, P; Santos, MJ; João, RPurpose: Cortical and lateral geniculate changes are well documented in amblyopia but retinal involvement is controversial. Our aim was to compare macular volume and thickness between the sound and the amblyopic eye, in children with unilateral amblyopia due to anisometropia or strabismus, using optical coherence tomography. Materials and Methods: Amblyopic children up to the age of 18 were examined with Stratus OCT3, assessing macular volume and thickness. Statistical analysis was done using the Wilcoxon signed rank test and a level of significance of 5% was chosen. Results: 19 amblyopic patients were studied, 15 with strabismus and 4 with anisometropia. The foveal minimum thickness was significantly greater in the amblyopic eye; by contrast, significantly reduced thickness was found in the inner nasal, inner inferior and outer inferior macular areas of the amblyopic eye. Macular volume and retinal thickness in the other macular areas were reduced in amblyopic eyes but this was not significant. Conclusions: There seems to be a difference in macular thickness between both eyes in patients with unilateral amblyopia due to strabismus or anisometropia, at least in some areas. Our results are according to some studies performed so far, although others contradict these results, reflecting the different experimental settings used.
- Coriorretinopatia central serosa: uma revisãoPublication . Pina, S; Santos, C; Pedrosa, C; Ramalho, M; Coutinho, I; Santos, MJ; Pires, G; Silva, F; Teixeira, S
- Doença de Coats: diferentes apresentaçõesPublication . Santos, C; Pina, S; Ramalho, M; Pedrosa, C; Pinto, S; Santos, MJ; Teixeira, SIntrodução: A Doença de Coats caracteriza-se pelo desenvolvimento anormal dos vasos retinianos (telangiectasia), com deposição progressiva de exsudados intra e subretinianos e consequente descolamento de retina exsudativo. É uma patologia rara, esporádica, idiopática e unilateral (95%), que afecta maioritariamente indivíduos do sexo masculino (75%). A idade média de diagnóstico é aos 10 anos de idade. Na maioria dos doentes manifesta-se por diminuição da acuidade visual, estrabismo e/ou leucocória. O diagnóstico é clínico baseando-se nos achados fundoscópicos característicos. Vários exames complementares como a angiografia fluoresceínica, podem auxiliar a caracterizar a patologia. A classificação da Doença de Coats é útil para a escolha da opção terapêutica e prognóstico. Material e métodos: Os autores descrevem 4 casos clínicos de Doença de Coats, quanto à sua clínica, abordagem diagnóstica, opções terapêuticas e seguimento em consulta. Resultados: Os doentes foram submetidos a fotocoagulação laser indirecta e a crioterapia quando indicada. Após tratamento demonstraram melhoria clínica e funcional. Conclusão: A laserterapia e a crioterapia são opções terapêuticas nos estádios iniciais da patologia, permitindo a estabilização da doença. O diagnóstico precoce e a abordagem terapêutica atempada são essenciais para prevenir a diminuição progressiva da função visual. O tempo médio de recorrência da doença é de dez anos, sendo um seguimento regular e a longo prazo essenciais. Bibliografia: 1. Shields J, Shields C. Coats disease: The 2001 LuEsther T. Mertz Lecture. Retina. 2002; 22(1): 80-91. 2. Shields J, Shields C, Honavar S, Demirci H. Clinical variations and complications of Coats disease in 150 cases: The 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001 May; 131(5): 561-71. 3. Shields J, Shields C, Honavar S, Demirci H, Cater J. Classification and management of Coats disease: The 2000 Proctor Lecture. Am J Ophthalmol. 2001 May; 131(5): 572-83. 4. Hu Z, Gao R, Jin C, Liang X, Zhang S. Photocoagulation and scleral cryotherapy for Coats disease. Yan Ke Xue Bao. 1996 Dec; 12(4): 199-201. 5. Mosin I, Moshetova L. Tactics of treating children with Coats disease. Vestn Oftalmol. 2002 Mar-Apr; 118(2): 11-5.
- Early vascular alterations in SLE and RA patients--a step towards understanding the associated cardiovascular riskPublication . Santos, MJ; Carmona-Fernandes, D; Canhão, H; Silva, J; Fonseca, J; Gil, VAccelerated atherosclerosis represents a major problem in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients, and endothelial damage is a key feature of atherogenesis. We aimed to assess early endothelial changes in SLE and RA female patients (127 SLE and 107 RA) without previous CV events. Biomarkers of endothelial cell activation (intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), thrombomodulin (TM), and tissue factor (TF)) were measured and endothelial function was assessed using peripheral artery tonometry. Reactive hyperemia index (RHI), an indicator of microvascular reactivity, and augmentation index (AIx), a measure of arterial stiffness, were obtained. In addition, traditional CV risk factors, disease activity and medication were determined. Women with SLE displayed higher sICAM-1 and TM and lower TF levels than women with RA (p = 0.001, p<0.001 and p<0.001, respectively). These differences remained significant after controlling for CV risk factors and medication. Serum levels of vascular biomarkers were increased in active disease and a moderate correlation was observed between sVCAM-1 levels and lupus disease activity (rho = 0.246) and between TF levels and RA disease activity (rho = 0.301). Although RHI was similar across the groups, AIx was higher in lupus as compared to RA (p = 0.04). Also in active SLE, a trend towards poorer vasodilation was observed (p = 0.06). In conclusion, women with SLE and RA present with distinct patterns of endothelial cell activation biomarkers not explained by differences in traditional CV risk factors. Early vascular alterations are more pronounced in SLE which is in line with the higher CV risk of these patients.
- Horizontal Gaze Palsy With Progressive Scoliosis and Severe Keratoconus With a Compound Heterozygous Mutation in ROBO3.Publication . Pina, S; Pedrosa, C; Feijóo, B; Machado, S; Prieto, I; Costa, C; Santos, MJThe authors report the case of a child with horizontal gaze palsy with progressive scoliosis and keratoconus. ROBO3 analysis identified compound heterozygous mutations. Keratoconus surgical approach resulted in visual acuity improvement in both eyes. The previously unreported occurrence of keratoconus with horizontal gaze palsy with progressive scoliosis suggests that ophthalmologic assessment should search for signs of this ectasia in these patients.
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