Porto Moniz, Portugal
Porto Moniz, Portugal

Time filter

Source Type

Zhang W.,University of Nottingham | Doherty M.,University of Nottingham | Pascual E.,Hospital General Universitario Of Alicante | Barskova V.,State Institute of Rheumatology | And 11 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objectives: To develop evidence-based recommendations for management of calcium pyrophosphate deposition (CPPD). Methods: A multidisciplinary guideline development group of 15 experts, representing 10 European countries, generated key propositions for management of CPPD using a Delphi consensus approach. For each recommendation research evidence was searched systematically. Whenever possible, the effect size and number needed to treat for efficacy and RR or OR for side effects were calculated for individual treatment modalities. Strength of recommendation was assessed by the European League Against Rheumatism visual analogue scale. Results: Nine key recommendations were generated, including topics for general management, treatment of acute attacks, prophylaxis against recurrent acute attacks and management of chronic symptoms. It was recommended that optimal treatment requires both non-pharmacological and pharmacological treatments. For acute CPP crystal arthritis, cool packs, temporary rest and joint aspiration combined with steroid injection are often sufficient. For prophylaxis or chronic inflammatory arthritis with CPPD, oral non-steroidal anti-inflammatory drugs with gastroprotective treatment and/or low-dose colchicine 0.5-1.0 mg daily may be used. Other recommendations included parenteral or oral corticosteroid for acute CPP arthritis in those unresponsive or unsuited to other measures, and lowdose corticosteroid, methotrexate or hydroxychloroquine for chronic inflammatory arthritis with CPPD. Asymptomatic CPPD requires no treatment. Strength of recommendations varies from 79% to 95%. Conclusion: Nine key recommendations for management of CPP crystal associated arthritis were developed using both research evidence and expert consensus. Strength of recommendations was provided to assist the application of these recommendations.


Zhang W.,University of Nottingham | Doherty M.,University of Nottingham | Bardin T.,University Paris Diderot | Barskova V.,State Institute of Rheumatology | And 11 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objectives: To agree terminology and to develop recommendations for the diagnosis of calcium pyrophosphate deposition (CPPD). Methods: The European League Against Rheumatism (EULAR) CPPD Task Force, comprising 15 experts from 10 countries, agreed the terms and recommendations for diagnosis of CPPD using a Delphi consensus approach. Evidence was systematically reviewed and presented in terms of sensitivity, specificity and positive likelihood ratio (LR) to support diagnosis; ORs were used for association. Strength of recommendation (SOR) was assessed by the EULAR visual analogue scale. Results: It was agreed that 'CPPD' should be the umbrella term that includes acute calcium pyrophosphate (CPP) crystal arthritis, osteoarthritis (OA) with CPPD and chronic CPP crystal inflammatory arthritis. Chondrocalcinosis (CC) defines cartilage calcification, most commonly due to CPPD and detected by imaging or histological examination. A total of 11 key recommendations were generated on the topics of clinical features, synovial fluid (SF) examination, imaging, comorbidities and risk factors. Definitive diagnosis of CPPD relies on identification of SF CPP crystals. Rapid onset inflammatory symptoms and signs are suggestive but not definitive for acute CPP crystal arthritis. Radiographic CC is not highly sensitive or specific, whereas ultrasonography appears more useful (LR=24.2, 95% CI 3.51 to 168.01 ) for peripheral joints. Recognised risk factors for CPPD include ageing, OA and metabolic conditions such as primary hyperparathyroidism, haemochromatosis and hypomagnesaemia; familial forms are rare. SORs varied from 53 to 99 (maximum 100). Conclusion: New terms for CPPD were agreed and 11 key recommendations for diagnosis of CPPD were developed using research evidence and expert consensus.


Soares I.,Egas Moniz Hospital | Soares I.,New University of Lisbon | Abecasis P.,New University of Lisbon | Ferro J.M.,University of Lisbon
Archives of Gerontology and Geriatrics | Year: 2011

Our purpose was to evaluate the outcome of patients aged 70 years or older with a first-ever acute ischemic stroke and to identify the factors which determine poor outcome. Data from 115 patients, non-disabled prior to stroke, consecutively admitted to a medical department of a teaching hospital over a 30-month period, were prospectively collected at stroke onset and 6-month follow-up. Clinical and brain imaging findings and functional status were recorded. Predictors of unfavorable outcome at 6 months, defined as a modified Rankin Scale score >2, were analyzed by multiple logistic regression. The mean age of this cohort was 78.6 years (SD, 5.7) and 66.1% were women, 73.9% had hypertension, 25.2% diabetes, 36.0% atrial fibrillation (AF), 33.9% heart failure (HF), 15.8% previous transient ischemic attack (TIA), 47.8% a Charlson comorbidity index (CCI) score >1 and 52.2% a baseline National Institute of Health stroke scale (NIHSS) score ≥6. At 6 months, 54 patients (47%) had unfavorable outcome and the independent predictors of poor outcome were the initial systolic blood pressure and the NIHSS score on admission. In conclusion, near 50% of these old patients were dependent or dead 6 months after stroke onset and the main predictor of poor outcome was the neurological severity of stroke. © 2010 Elsevier Ireland Ltd.


Marques E.F.,Lusiadas Education and Research Center | Ferreira T.B.,Hospital da Luz | Simoes P.,Egas Moniz Hospital
Journal of Refractive Surgery | Year: 2016

PURPOSE: To evaluate the visual results, refractive predictability, rotational stability, and spectacle independence of patients who had cataract surgery with implantation of a diffractive multifocal toric intraocular lens (IOL) (Tecnis Multifocal Toric ZMT 150-400; Abbott Medical Optics, Santa Ana, CA). METHODS: This prospective study included 60 eyes of 30 patients with cataract and regular corneal astigmatism who had phacoemulsification with bilateral implantation of a Tecnis Multifocal Toric IOL. Over a 6-month follow-up period, the main outcome measures were un-corrected and corrected monocular and binocular distance (UDVA and DCVA), intermediate at 80 cm (UIVA and DCIVA), and near at 40 cm (UNVA and DCNVA) visual acuities, spherical equivalent (SE) refraction, residual astigmatism, rotational stability, defocus curves, contrast sensitivity, presence of photic phenomena, and use of spectacles. RESULTS: Results at 6 months showed mean UDVA of 0.07 ± 0.1 logMAR (range: 0.3 to 0.0 logMAR), mean UIVA of 0.18 ± 0.09 logMAR (range: 0.3 to -0.1 log-MAR, and mean UNVA of 0.03 ± 0.09 logMAR (range: 0.2 to -0.1 logMAR). Refractive predictability was excellent with a mean SE of 0.05 ± 0.47 diopters (D) (range: -0.75 to +1.00 D) and a mean refractive cylinder of -0.44 ± 0.49 D (range: -1.25 to 0.00). Mean rotation was 3.18° ± 3.28°. Photic phenomena were moderate or severe in 30% of patients. All patients were spectacle independent at the 6-month follow-up visit at all distances in this case series. CONCLUSIONS: The implantation of the Tecnis multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distance and near visual acuities with good intermediate visual acuity. Predictability of refractive results, rotational stability, and optical performance were excellent, allowing all patients in this series to achieve spectacle independence. Copyright © SLACK Incorporated.


Magalhaes-Costa P.,Egas Moniz Hospital
Journal of Clinical Gastroenterology | Year: 2015

GOALS:: We aimed to evaluate the small-bowel cleansing quality, the diagnostic yield (DY), the transit time, and the patients’ tolerability, by comparing the 2 different polyethylene glycol (PEG) administration schedules. BACKGROUND:: The use of bowel purgatives before small-bowel capsule endoscopy (SBCE) is recommended by the ESGE guidelines. Whether this regimen can be further refined by changing the timing of administration is unknown. STUDY:: Fifty-seven patients were prospectively enrolled and randomized into 2 groups: group 1 (G1, n=29) received 2 L of PEG in the day before SBCE (time between PEG and SBCE=10 h); and group 2 (G2, n=28) received 1 L of PEG in the day before SBCE and 1 L of PEG in the morning before SBCE (time between PEG and SBCE=4 h). The primary outcome measure was small-bowel cleansing quality. Small-bowel cleansing quality was evaluated according to a previously validated grading scale. RESULTS:: The entire and distal half small-bowel cleansing scores were significantly higher among G2 (median score: 8 vs. 10 points, P=0.012; median score: 6 vs. 8 points, P=0.05, respectively). The DY did not differ significantly between groups. There were no significant differences in transit times between the 2 PEG regimens. Both schedules were well tolerated, showing no differences regarding symptoms while ingesting the preparation or after SBCE ingestion. CONCLUSIONS:: Split-dose PEG regimen for SBCE preparation improved the small-bowel cleanliness, did not interfere with transit times and was equally well tolerated by the patients. No differences were observed regarding DY. ClinicalTrial.gov registration: NCT02396017. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Ferreira T.B.,Egas Moniz Hospital | Portelinha J.,Egas Moniz Hospital
Clinical Ophthalmology | Year: 2014

Purpose: To evaluate the distance between the endothelial surface of the cornea to the anterior edge of an Artiflex® phakic intraocular lens (IOL) implant to improve the safety profile of this implant. Methods: This is a retrospective clinical case series of 45 patients who had Artiflex phakic IOL implantation (Artiflex p-IOL) with a follow-up period of 3 years. A Pentacam HR imaging system was used to measure the distance from various points of the anterior edge of the Artiflex IOL to the endothelial surface of the cornea, which we called endothelial-IOL (E-IOL) distance, in 45 eyes. The E-IOL distances were assessed at 1, 3, 6, 12, 24, and 36 months. Corresponding correlations of central endothelial distance to temporal and nasal edges and center of the IOL anterior surface were tabulated. Results: Mean follow-up was 21.39±11.28 months. A statistically significant reduction of the E-IOL distance was observed over the follow-up period (P<0.05), with the mean annual reduction being 24.70 μm. A strong positive correlation between the E-IOL distance of the edges of the IOL and the central distance was observed (correlation coefficients nasal/central: month 1, 0.905; month 36, 0.806; temporal/central: month 1, 0.906; month 36, 0.806; P<0.001). Moderate negative correlations were found between the spherical equivalent power of the implanted IOL and the E-IOL distance (correlation coefficients -0.271 to -0.412, P>0.05). For an E-IOL distance of the IOL edge >1,500 μm, the distance from the endothelium to the central point of the p-IOL optic should be a minimum of 1,700 μm to improve the safety profile for Artiflex p-IOL implantation and reduce the potential complication of accelerated endothelial cell loss. Conclusion: After Artiflex IOL implantation, the mean annual reduction of the E-IOL distance was 25 μm. A negative correlation existed between the spherical equivalent power of the implanted IOL and the postoperative E-IOL distance. The minimum E-IOL distance from the center of the IOL to minimize the risk of endothelial cell loss was 1.7 mm. This distance, as is the 1.5 mm initially proposed by Baikoff, is a postoperative value. We cannot make that assumption for the preoperative evaluation, as the morphometry of the anterior chamber changes with the implant. © 2014 Ferreira and Portelinha.


Furtado J.,Egas Moniz Hospital | Isenberg D.A.,University College London
Clinical Immunology | Year: 2013

Systemic lupus erythematosus (SLE) is an autoimmune disorder with a worldwide distribution, potentially life-threatening with considerable morbidity. The elimination of pathogenic B cells has emerged as a rational therapeutic option. Many open label studies have reported encouraging results in which clinical and serological remission have invariably been described, often enabling the reduction of steroid and immunosuppressive treatment. However, the results from randomized controlled studies have been disappointing and several questions remain to be answered. In this review we will focus on results of B cell direct depletion in the treatment of patients with systemic lupus erythematosus. © 2013.


Ferreira T.B.,Egas Moniz Hospital | Pinheiro J.,Clinica Privada de Oftalmologia
European Journal of Ophthalmology | Year: 2015

Purpose: To evaluate the visual outcomes of pseudophakic patients who underwent supplementary toric intraocular lens (IOL) implantation to correct astigmatic refractive errors. Methods: Pseudophakic patients referred for the implantation of a supplementary toric IOL (Sulcoflex Toric 653T) were evaluated. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), spherical equivalent (SE) refraction, rotational stability, higher order aberrations (HOA), and photopic glare and no-glare contrast sensitivity (CSV-1000, VectorVision) were evaluated. Results: A total of 10 eyes of 10 patients were included. The mean age was 56.42 ± 5.9 years (range 45-65 years). Mean follow-up was 6.99 ± 5.1 months (6-18 months). Postoperatively, UDVA improved to 0.10 ± 0.12 (0.3 to −0.1) (p = 0.004) and CDVA to 0.07 ± 0.12 (0.3 to −0.1) (p = 0.021). Mean SE was -0.30 ± 0.56 D (−1.00 to +0.75) (p = 0.001). Mean toric IOL axis rotation at 6-month follow-up was 3.0° ± 2.45° (0-6). Ocular aberrometry values decreased after surgery (for average HOA root mean square, p = 0.008). Photopic contrast sensitivity (for all spatial frequencies) showed a trend for improvement after surgery; however, this was not borne out from the analysis (p>0.05). Conclusions: The implantation of the Sulcoflex Toric IOL to correct astigmatism in pseudophakic patients provided excellent visual outcomes, predictability of refractive results, rotational stability, and optical performance. The implantation of this IOL is a safe and effective technique to correct pseudophakic cylindrical refractive errors and reduce spectacle dependence in these patients. © 2015 Wichtig Publishing.


Furtado J.,Egas Moniz Hospital | Isenberg D.A.,University College London
Clinical Immunology | Year: 2013

Systemic lupus erythematosus (SLE) is an autoimmune disorder with a worldwide distribution, potentially life-threatening with considerable morbidity. The elimination of pathogenic B cells has emerged as a rational therapeutic option. Many open label studies have reported encouraging results in which clinical and serological remission have invariably been described, often enabling the reduction of steroid and immunosuppressive treatment. However, the results from randomized controlled studies have been disappointing and several questions remain to be answered. In this review we will focus on results of B cell direct depletion in the treatment of patients with systemic lupus erythematosus. © 2012 Elsevier Inc.


Marques E.F.,Cruz Vermelha Hospital | Ferreira T.B.,Egas Moniz Hospital
Journal of Cataract and Refractive Surgery | Year: 2015

Purpose To compare the visual outcomes after cataract surgery with bilateral implantation of 1 of 2 diffractive trifocal intraocular lenses (IOLs). Setting Two clinical centers, Lisbon, Portugal. Design Prospective comparative case series. Methods Phacoemulsification with bilateral implantation of a Finevision Micro F IOL (Group 1) or an AT Lisa tri 839 MP IOL (Group 2) was performed. Over a 3-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), corrected monocular and binocular distance visual acuity, uncorrected intermediate visual acuity at 80 cm, distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity at 40 cm, distance-corrected near visual acuity (DCNVA), spherical equivalent (SE) refraction, defocus curves, contrast sensitivity, presence of dysphotopsia, and use of spectacles. Results Each group comprised 30 eyes (15 patients). The mean values at 3 months were UDVA, 0.03 logMAR ± 0.08 (SD) (Group 1) and 0.08 ± 0.12 (Group 2) (P =.765); DCIVA, 0.04 ± 0.07 logMAR and 0.18 ± 0.18 logMAR, respectively (P =.048); DCNVA, 0.03 ± 0.06 logMAR and 0.11 ± 0.08 logMAR, respectively (P =.032); SE, -0.25 ± 0.30 diopter (D) and -0.02 ± 0.39 D, respectively (P =.087). There was no significant difference in contrast sensitivity or dysphotopic phenomena between groups. Conclusions Both trifocal IOL models provided excellent distance, intermediate, and near visual outcomes. Monocular DCIVA and DCNVA appeared slightly better in Group 1. Predictability of the refractive results and optical performance were excellent, and all patients achieved spectacle independence. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned. © 2015 ASCRS and ESCRS.

Loading Egas Moniz Hospital collaborators
Loading Egas Moniz Hospital collaborators