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Browsing by Author "Branco, J"

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  • Acute Haematogenous Osteomyelitis in Lisbon: An Unexpectedly High Association with Myositis and Arthritis
    Publication . Gouveia, C; Branco, J; Norte, S; Arcangelo, J; Alves, P; Pinto, M; Tavares, D
    Introduction: Despite the current trend toward less aggressive therapeutic approaches, acute haematogenous osteomyelitis (AHO) continues to be a challenge and is associated with significant morbidity worldwide. Our aim was to assess whether compliance with the current protocol was achieved in 80% of cases, to identify complications and the associated risk factors, and to analyse trends in the aetiology and management of AHO in the paediatric population. Methods: We conducted a longitudinal, observational, single-centre study in patients with AHO aged less than 18 years admitted to a paediatric hospital between 2008 and 2018 divided in 2 cohorts (before and after 2014). We analysed data concerning demographic and clinical characteristics and outcomes. Results: The study included 71 children with AHO, 56% male, with a median age of 3 years (interquartile range, 1-11). We found a 1.8-fold increase of cases in the last 5 years. The causative agent was identified in 37% of cases: MSSA (54%), MRSA (4%), S. pyogenes (19%), K. kingae (12%), S. pneumoniae (8%), and N. meningitidis (4%). Complications were identified in 45% of patients and sequelae in 3.6%. In recent years, there was an increase in myositis (30% vs 7%; P=.02), septic arthritis (68 vs 37.2%; p=0.012) and in the proportion of patients treated for less than 4 weeks (37 vs 3.5%; p=0.012), with a similar sequelae rates. The risk factors associated with complications were age 3 or more years, C-reactive protein levels of 20mg/L or higher, time elapsed between onset and admission of 5 or more days and positive culture, although the only factor that continued to be significantly associated in the multivariate analysis was positive culture. The presence of complications was a risk factor for sequelae at 6 months. Conclusions: Our study confirms that AHO can be aggressive. The identification of risk factors for complications is essential for management.
    2022Journal article Open access Show more
  • Association Between Memory B-Cells and Clinical and Immunological Features of Primary Sjögren’s Syndrome and Sicca Patients
    Publication . Barcelos, F; Martins, C; Papoila, A; Geraldes, C; Cardigos, J; Nunes, G; Lopes, T; Alves, N; Vaz-Patto, J; Branco, J; Borrego, LM
    B-cells play a pivotal role in primary Sjögren's syndrome (pSS) pathogenesis. We aim to (1) evaluate the distribution of B-lymphocyte subpopulations in pSS and Sicca patients, (2) establish cut-off points that discriminate pSS from controls, (3) evaluate the association between memory B-cells and phenotypic features in pSS. We included 57 pSS patients, 68 Sicca and 24 healthy controls. Circulating B-cells were characterized by flow cytometry as naïve and memory subsets and classified from Bm1 to Bm5. Compared to controls, pSS patients had lower percentages (29.5 vs 44.4%) and absolute numbers (47 vs 106 cells/µl) of memory B-cells. Through ROC curves, a cut-off of ≤ 58 total memory B-cells/µl yielded a specificity of 0.88 and a sensitivity of 0.60 for pSS, and was met by 59.6% of pSS patients, 38.8% of Sicca and 12.5% of controls. A cut-off of < 23.5 Switched-memory B-cells/µl yielded a specificity of 0.88 and a sensitivity of 0.54 and was met by 54.4% of pSS patients, 37.3% of Sicca and 12.5% of controls. In pSS, lower total memory B-cells count was associated with longer disease duration (14.3 vs 8.1 years, p = 0.006) and more active disease profile, as evaluated by the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) (3.1 vs 1.4, p = 0.043). Decreased numbers of memory B-cells clearly discriminated pSS from controls and can also have prognostic value. It remains to be clarified whether Sicca patients with decreased memory B-cells represent pSS and if B-cell profiling could help in the diagnosis of pSS.
    2018-06Journal article Open access Show more
  • Asthma App Use and Interest Among Patients With Asthma: A Multicenter Study
    Publication . Jácome, C; Almeida, R; Pereira, AM; Araújo, L; Correia, MA; Pereira, M; Couto, M; Lopes, C; Chaves Loureiro, C; Catarata, MJ; Santos, LM; Ramos, B; Mendes, A; Pedro, E; Cidrais Rodrigues, JC; Oliveira, G; Aguiar, AP; Arrobas, AM; Costa, J; Dias, J; Todo Bom, A; Azevedo, J; Ribeiro, C; Alves, M; Pinto, PL; Neuparth, N; Palhinha, A; Marques, JG; Martins, P; Trincão, D; Neves, A; Todo Bom, F; Santos, M A; Branco, J; Loyoza, C; Costa, A; Silva Neto, A; Silva, D; Vasconcelos, MJ; Teixeira, MF; Ferreira-Magalhães, M; Taborda Barata, L; Carvalhal, C; Santos, N; Sofia Pinto, C; Rodrigues Alves, R; Moreira, AS; Morais Silva, P; Fernandes, R; Ferreira, R; Alves, C; Câmara, R; Ferraz de Oliveira, J; Bordalo, D; Calix, MJ; Marques, A; Nunes, C; Menezes, F; Gomes, R; Almeida Fonseca, J
    2020-04Journal article Open access Show more
  • Clinical Courses, Impact and Prognostic Indicators for a Persistent Course of Low Back Pain: Results from a Population-Based Cohort Study
    Publication . Antunes Gomes, L; Rodrigues, AM; Branco, J; Canhão, H; Brazete Cruz, E
    Background: Low back pain (LBP) is a long-term health condition with distinct clinical courses. Its characterization together with the identification of prognostic factors for a persistent LBP course may trigger the development of personalized interventions. This study aimed to investigate the courses of chronic LBP (CLBP), its cumulative impact, and the indicators for the persistence of pain. Material and methods: Patients with active CLBP from the EpiDoC, a population-based cohort study of a randomly recruited sample of 10.661 adults with prolonged follow-up, were considered. Pain, disability, and health-related quality of life (HRQoL) were assessed at three time-points over five years. According to their pain symptoms over time, participants were classified as having a persistent (pain at the baseline and at all the subsequent time-points) or a relapsing pain course (pain at the baseline and no pain at least in one of the subsequent time-points). A mixed ANOVA was used to compare mean differences within and between patients of distinct courses. Prognostic indicators for the persistent LBP course were modulated through logistic regression. Results: Among the 1.201 adults with active CLBP at baseline, 634 (52.8%) completed the three time-points of data collection: 400 (63.1%) had a persistent and 234 (36.9%) a relapsing course. Statistically significant interactions were found between the group and time on disability (F (2,1258) = 23.779, p<0.001) and HRQoL (F (2,1252) = 82.779, p<0.001). In the adjusted model, the persistent course was associated with the disability level (OR 1.86, CI95% 1.40-2.40, p<0.001), depressive symptoms (OR 1.96, CI95% 1.21-3.18, p = 0.007), female gender (OR 1.90, CI95% 1.26-2.87, p = 0.002) and having a manual job (OR 1.46, CI95% 1.02-2.10, p = 0.040). Conclusion: In the long-term, patients with CLBP may follow a persistent or relapsing course of pain. Being female, presenting depressive symptoms, having a manual job and higher disability at baseline predicts a persistent course of LBP.
    2023Journal article Open access Show more
  • Escleroterapia do Varicocelo da Veia Ovárica: Resultados a Curto e Longo Prazo
    Publication . Pisco, JM; Duarte, M; Bilhim, T; Mota Capitão, L; Menezes, JD; Albino, JP; Branco, J
    Purpose: To evaluate the safety and efficiency of sclerotherapy in ovarian vein varicocele. Study population: During 6 years, 36 women with the clinical diagnosis of ovarian vein varicocele were evaluated. Methods: The diagnosis was confirmed by flebography of the ovarian vein in 35 of the patients. In these patients sclerotherapy of the ovarian vein was performed with success by selective retrograde catheterization of the ovarian vein by femoral approach in 31 patients and by brachial approach in 4 patients. Four to eight ml of polidocanol l3% was used in each vein. Results: There was clinical improvement with complete resolution of all symptoms in 29 patients(82.9%) and partial symptomatic relief in 6 (17.1%). Long term results, evaluated between 1 and 6 years (mean 37.3 months), showed complete resolution of symptoms in 27 (77.1%) and recurrence in 8 (22.9%). Four patients with recurrence, improved following repeated sclerotherapy. Thus, there was long term improvement in 31 patients (88.6%). Conclusion: Sclerotherapy of ovarian vein appears to be a safe and efficient treatment of ovarian vein varicocele.
    2008Journal article Open access Show more
  • Estudo Comparativo entre Dois Tipos de Eco-Contrastes: Echovist® e Levovist®, Avaliação da Permeabilidade Tubária em Infertilidade Feminina
    Publication . Vaz-Oliani, DCM; Fonseca, MCCR; Branco, J; Oliani, AH
    Na propedêutica inicial do casal infértil, a realização da Sonossalpingografia (SoSG) contrastada através de dois tipos de ecocontrastes, Echovist® e Levovist®, durante a realização da ultra-sonografia ginecológica convencional pode, em casos seleccionados, substituir como exame de “screening” da permeabilidade tubária a Histerossalpingografia (HSG) e a Laparoscopia com cromotubação (LPC). Objectivos: Comparar os resultados da permeabilidade tubária através da SoSG contrastada com Echovist® ou com Levovist® e a HSG e determinar a sua acuidade em relação a LPC considerada “gold-standard”. Pacientes e métodos: Foram avaliadas prospectivamente 90 pacientes inférteis submetidas a SoSG em que se utilizou o contraste ecogénico Echovist® e 28 pacientes em que se utilizou o eco-realçador Levovist®. Para a HSG utilizou-se, em todas as pacientes, contraste iodado e hidrossolúvel Telebrix®. A observação da permeabilidade tubária teve sua avaliação final e sistemática pela LPC. Resultados: No estudo das trompas pelo Echovist® observamos permeabilidade em 67 pacientes (74,4%) e obstruções bilaterais em 23 das pacientes (25,6%) e pelo Levovist®, respectivamente, 22 (78,6%) e 6 pacientes (21,4%). Na comparação da avaliação da permeabilidade tubária entre a SoSG com Echovist® e LPC encontramos: especificidade € 91,3%, sensibilidade (S) 100%, falsos positivos (FP) 8,7%, falsos negativos (FN) 0%, valor preditivo positivo (VPP) 97,1%, valor preditivo negativo (VPN) 100% e Kappa de 96,5%, e entre a HSG e LPC, neste grupo Echovist® foram: E 100%, S 91,04%, FP 0%, FN 8,96%, VPP 100%, VPN 79,31% e Kappa de 88,6%. Na comparação da avaliação da permeabilidade tubária entre a SoSG com Levovist® e LPC encontramos: E 100%, S 100%, FP 0%, FN 0%, VPP 100%, VPN 100% e Kappa de 100%, e entre a HSG e LPC, no grupo Levovist® foram: E 100%, S 86,36%, FP 0%, FN 13,64%, VPP 100%, VPN 66,67% e Kappa de 82,2%. Conclusões: As Sonossalpingografias (SoSG) contrastadas utilizando-se como eco-realçadores o Echovist® ou o Levovist® podem ser consideradas exames complementares equivalentes na rotina da avaliação inicial do factor tubário por apresentarem, além do mesmo composto químico activo, alta sensibilidade, especificidade e concordância, ambos com acuidade superior à HSG quando comparados com a LPC.
    2005Journal article Open access Show more
  • Factor V Leiden and Prothrombin G20210A in Portuguese Women with Recurrent Miscarriage: Is it Worthwhile to Investigate?
    Publication . Serrano, F; Lima, ML; Lopes, C; Almeida, JP; Branco, J
    OBJECTIVE: To compare the prevalence of factor V Leiden (FVL) and prothrombin (PT) G20210A mutations in Portuguese women with unexplained recurrent miscarriage (RM) and a control group of parous women. MATERIALS AND METHODS: FVL and PT G20210A analysis were carried out in 100 women with three or more consecutive miscarriages and 100 controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal losses). RESULTS: Overall, the prevalence of FVL and PT G20210A was similar in women with RM (5 and 3%) compared with controls (5 and 1%) OR 1.36 (CI 95% 0.45-4.08). In RM embryonic subgroup, PT G20210A was observed in 1.3% of women and FVL prevalence (2.6%) was inclusively lesser than that of controls. Both polymorphisms were more prevalent in women with fetal losses than in controls, although statistical significance was not reached due to the small size of the >10 weeks' subgroup. CONCLUSION: These data indicate that neither FVL nor PT G20210A is associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with embryonic RM and negative personal thromboembolic history.
    2011Journal article Open access Show more
  • Full-Thickness Macular Hole After Lamellar Macular Hole Surgery: a Case Report
    Publication . Dutra Medeiros, M; Alkabes, M; Nucci, P; Branco, J
    PURPOSE: To describe a case of full-thickness macular hole (FTMH) after vitrectomy for lamellar hole (LH). METHODS: Case report. RESULTS: The authors report a patient with progressive visual loss secondary to LH who developed FTMH following a vitrectomy repair. The postoperative findings as well as the clinical course after the second surgical approach are described. CONCLUSIONS: Surgeons should be aware of this complication following LH surgical approach.
    2015Journal article Open access Show more
  • Intraocular Lens Power Calculation Formulas Accuracy in Combined Phacovitrectomy: an 8-Formulas Comparison Study
    Publication . Hipólito-Fernandes, D; Luís, ME; Maleita, D; Gil, P; Maduro, V; Costa, L; Marques, N; Branco, J; Alves, N
    Background: Our study aimed to assess and compare the accuracy of 8 intraocular lens (IOL) power calculation formulas (Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane and PEARL-DGS) in patients submitted to combined phacovitrectomy for vitreomacular (VM) interface disorders. Methods: Retrospective chart review study including axial-length matched patients submitted to phacoemulsification alone (Group 1) and combined phacovitrectomy (Group 2). Using optimized constants in both groups, refraction prediction error of each formula was calculated for each eye. The optimised constants from Group 1 were also applied to patients of Group 2 - Group 3. Outcome measures included the mean prediction error (ME) and its standard deviation (SD), mean (MAE) and median (MedAE) absolute errors, in diopters (D), and the percentage of eyes within ± 0.25D, ± 0.50D and ± 1.00D. Results: A total of 220 eyes were included (Group 1: 100; Group 2: 120). In Group 1, the difference in formulas absolute error was significative (p = 0.005). The Kane Formula had the lowest MAE (0.306) and MedAE (0.264). In Group 2, Kane had the overall best performance, followed by PEARL-DGS, EVO 2.0 and Barrett Universal II. The ME of all formulas in both Groups 1 and 2 were 0.000 (p = 0.934; p = 0.971, respectively). In Group 3, a statistically significant myopic shift was observed for each formula (p < 0.001). Conclusion: Surgeons must be careful regarding IOL power selection in phacovitrectomy considering the systematic myopic shift evidenced-constant optimization may help eliminating such error. Moreover, newly introduced formulas and calculation methods may help us achieving increasingly better refractive outcomes both in cataract surgery alone and phacovitrectomy.
    2021Journal article Open access Show more
  • Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections
    Publication . Lemos, V; Cabugueira, A; Noronha, M; Abegão Pinto, L; Reina, M; Branco, J; Gomes, T
    PURPOSE: The aim of the this study was to determine the effect of intravitreal antivascular endothelial growth factor injections on intraocular pressure (IOP) and identify possible risk factors for the development of increased IOP. MATERIALS AND METHODS: This prospective study included a total of 106 eyes receiving intravitreal injection of bevacizumab as treatment for macular edema or active choroidal neovascularization. IOP was measured by Goldmann applanation tonometry immediately before the intravitreal injection and 5 min, 1 h and 15 days after the procedure. The records of the study patients were reviewed for age, gender, history of glaucoma, diabetes mellitus, phakic status, systemic and topical medication and number of previous injections. Subconjunctival reflux was registered. IOP elevation was defined as IOP ≥21 mm Hg and/or a change from baseline of ≥5 mm Hg recorded at least on two or more measurements on the same visit. RESULTS: Mean preoperative IOP was 15.31 ± 3.90 mm Hg and postoperative IOP values were 27.27 ± 11.87 mm Hg (after 5 min), 17.59 ± 6.24 mm Hg (after 1 h) and 16.86 ± 3.62 mm Hg (after 15 days). The IOP variation was statistically significant between pre- and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). CONCLUSIONS: More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections. © 2015 S. Karger AG, Basel.
    2015Journal article Open access Show more