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Browsing by Author "Santos, Ana Rita"

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  • Acta Pediátrica Portuguesa
    Publication . Alexandrino, Ana Silva; Santos, Ana Rita; Melo, Cristina; Costa, Daniel; Tomé, David; Mesquita Montes, António
    As infeções respiratórias agudas são a principal causa de mortalidade e morbilidade em crianças até aos 3 anos, em parte devido às características anatómicas e fisiológicas próprias desta faixa etária mas também muito por conta dos factores de risco a que são expostas A promoção de saúde assume assim vital importância no que concerne a capacitação e empowerment dos cuidadores face a este contexto O objectivo deste estudo foi analisar a influência de uma sessão de educação acerca da prevenção de infeções respiratórias, ministrada a cuidadores de crianças até aos 3 anos, na condição de saúde da criança (nº de infeções respiratórias das vias aéreas superiores (IVAS) e inferiores (IVAI), uso de antibióticos, recurso a serviços de saúde, absentismo das crianças ao infantário e absentismo laboral) metodologia: Estudo quasi-experimental com uma amostra de 57 cuidadores de crianças até aos 3 anos, aprovado pela Comissão de ética da Reitoria da Universidade do Porto Os cuidadores do grupo experimental (GE=35) assistiram a uma sessão de educação acerca da prevenção das infeções respiratórias, desenhada de acordo com as necessidades sentidas dos mesmos Os cuidadores do Grupo de Controlo (GC=22) não assistiram a esta sessão Foi realizado um follow- -up durante 2 meses de Inverno, ao longo do qual os cuidadores de ambos os grupos responderam a um Diário de Registos Online, com uma periodicidade de 15 dias, acerca da condição de saúde das crianças. Resultados: 15 dias após a sessão de educação o GE teve menos IVAS (GE=31% vs GC=64%; p=0,038), menos recurso a serviços de saúde (GE=20% vs GC= 50%; p=0,036) e menos dias totais de absentismo das crianças ao infantário (GE=4 dias vs GC=20 dias; p=0,032), comparativamente com o GC. Após os 2 meses de follow-up ainda se continuaram a verificar diferenças significativas entre os grupos para o recurso a serviços de saúde (GE=25% vs GC= 33%; p=0,039) e verificou-se ausência de IVAI no GE comparativamente ao GC que teve uma incidência de 5% (p=0,035). A sessão de educação acerca da prevenção de infeções respiratórias teve uma influência positiva na diminuição do nº de IVAS e IVAI, no recurso a serviços de saúde e no absentismo das crianças ao infantário.
    2013-10Other Open access Show more
  • Association between neurodegeneration and macular perfusion in the progression of diabetic retinopathy: a 3-year longitudinal study
    Publication . Marques, Inês P.; Ferreira, Sónia; Santos, Torcato; Madeira, Maria H.; Santos, Ana Rita; Mendes, Luís; Lobo, Conceição; Cunha-Vaz, José
    The aim of this study was to explore the relation between retinal neurodegenerative changes and vessel closure (VC) in individuals with nonproliferative diabetic retinopathy (NPDR) in a follow-up period of 3 years. This is a 3-year prospective longitudinal study with four annual visits. This study involved 74 individuals with type 2 diabetes, NPDR, and Early Treatment Diabetic Retinopathy Study grades from 10 to 47, one eye/person. An age-matched healthy control population of 84 eyes was used as control group. Participants were annually examined by color fundus photography, spectral domain-optical coherence tomography (SD-OCT) and OCT-angiography (OCTA). VC was assessed by OCTA vessel density maps. SD-OCT segmentations were performed to access central retinal thickness (CRT) and retinal neurodegeneration considered as thinning of the ganglion cell plus inner plexiform layer (GCL + IPL). Results: Type 2 diabetic individuals presented significantly higher CRT (p = 0.001), GCL + IPL thinning (p = 0.042), and decreased vessel density at the superficial capillary plexus (p < 0.001) and full retina (FR) (p = 0.001). When looking at changes occurring over the 3-year period of follow-up (Table 2), there were statistically significant decreases in GCL + IPL thickness (−0.438 μm/year; p = 0.038), foveal avascular zone circularity (−0.009; p = 0.047), and vessel density in superficial capillary plexus (−0.172 mm−1/year; p < 0.001), deep capillary plexus (DCP) (−0.350 mm−1/year; p < 0.001), and FR (−0.182 mm−1/year; p < 0.001). A statistically significant association was identified between GCL + IPL thinning and decrease in DCP vessel density (β = 0.196 [95% confidence interval: 0.037, 0.355], z = 2.410, p = 0.016), after controlling for age, gender, diabetes duration, hemoglobin A1c level, and CRT. Retinal neurodegenerative changes show a steady progression during a 3-year period of follow-up in eyes with NPDR and appear to be directly associated with progression in decreased vessel density including vascular closure through preferential involvement of the DCP. Our findings provide evidence that retinal neuropathy is linked with microvascular changes occurring in diabetic patients.
    2022-08Journal article Restricted access Show more
  • Baseline Characterization of Retinal Vascular Disease in Eyes with Mild to Moderate Non Proliferative Diabetic Retinopathy (NPDR) in Diabetes Type 2, Using Novel Non-Invasive Imaging Methods, in a Longitudinal, Prospective and Interventional 2-Year Clinical Study (Cordis)
    Publication . Ribeiro, M.; Marques, I.P.; Santos, Ana Rita; Coimbra, R.; Santos, T.; Figueira, J.; Cunha-Vaz, J.G.
    Characterization of retinal microvascular changes occurring in eyes with mild to moderate non proliferative diabetic retinopathy (NPDR), during a period of 2 years using lower than optical normal reflectivity (LOR) ratios obtained with OCT-Leakage. Capillary closure in the superficial and deep retinal vascular layers using OCTAngiography (OCTA) will be also analyzed in eyes that are at risk for developing sight threatening diabetic retinopathy (central involved macular edema (CIME) or proliferative diabetic retinopathy (PDR).
    2020-10-29Conference object Open access Show more
  • Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuity
    Publication . Busch, Catharina; Okada, Mali; Zur, Dinah; Fraser-Bell, Samantha; Rodríguez-Valdés, Patricio; Cebeci, Zafer; Lupidi, Marco; Fung, Adrian T.; Gabrielle, Pierre-Henry; Giancipoli, Ermete; Chaikitmongkol, Voraporn; Laíns, Inês; Santos, Ana Rita; Kunavisarut, Paradee; Sala-Puigdollers, Anna; Chhablani, Jay; Ozimek, Malgorzata; Hilely, Assaf; Degenhardt, Valentin; Loewenstein, Anat; Iglicki, Matias; Rehak, Matus
    Patients with DMO and good baseline VA, managed by observation, are of increased risk for VA loss if DRIL, HRF and EZ disruption are present at baseline. Earlier treatment with anti‐VEGF in these patients may potentially decrease the risk of VA loss at 12 months.
    2020-11Journal article Restricted access Show more
  • Central and peripheral involvement of the retina in the initial stages of diabetic retinophaty
    Publication . Santos, Ana Rita; Almeida, Ana Catarina; Rocha, Ana Cláudia; Reste-Ferreira, Débora; Marques, Inês Pereira; Martinho, António Cunha-Vaz; Mendes, Luís; Santos, Torcato; Lewis, Warren; Cunha-Vaz, José; Santos, Ana Rita
    To determine the degree of central microvascular closure using optical coherence tomography angiography in eyes of patients with type 2 diabetes with visible lesions only in the central retina or only in the periphery. Cross-sectional study. All 127 eyes underwent ultra-widefield fundus photography 200° examinations with OPTOS California (Optos, Dunfermline, United Kingdom) and Cirrus Angioplex optical coherence tomography angiography 3 × 3 mm acquisitions (ZEISS, Dublin, CA). Twenty-five eyes showed visible lesions only in the central retina, 57 only in the peripheral retina, and 45 presented visible lesions in entire retina. The group with visible lesions only in the periphery showed definite closure in the superficial capillary plexus in 49% of the eyes, whereas the group with visible lesions only in the central seven-early treatment diabetic retinopathy study fields area showed a definite closure in 64%. Central capillary closure is already present in the initial stages of diabetic retinopathy even when lesions are only visible in the peripheral retina. Capillary closure in the superficial capillary plexus is three times more frequent than in the deep capillary plexus, demonstrating earlier closure of the superficial capillary plexus. Eyes with visible lesions only in the periphery show a milder form of retinopathy.
    2024-04Research article Open access Show more
  • Characterisation of progression of macular oedema in the initial stages of diabetic retinopathy: a 3-year longitudinal study
    Publication . Lobo, Conceição; Santos, Torcato; Marques, Inês P.; Madeira, Maria H.; Santos, Ana Rita; Figueira, João; Cunha-Vaz, José
    To characterise the prevalence and three-year progression of centre-involving diabetic macular oedema (CI-DMO) in minimal to moderate non-proliferative diabetic retinopathy, using optical coherence tomography (OCT) and measurements of retinal fluid using tissue optical reflectivity ratios (OCT-Leakage). Seventy-four eyes from 74 patients were followed in a 3-year prospective longitudinal observational cohort of type 2 diabetes (T2D) patients using spectral-domain optical coherence tomography (SD-OCT), OCT-Angiography (OCT-A) and OCT-Leakage (OCT-L). Eyes were examined four times with 1-year intervals. Sixteen eyes (17.8%) were excluded from the analysis due to quality control standards. Retinal oedema was measured by central retinal thickness and retinal fluid by using optical reflectivity ratios obtained with the OCT-L algorithm. Vessel density was measured by OCT-A. Thinning of the ganglion cell and inner plexiform layers (GCL + IPL) was examined to identify retinal neurodegenerative changes. Diabetic retinopathy ETDRS classification was performed using the seven-field ETDRS protocol. CI-DMO was identified in the first visit in 9% of eyes in ETDRS groups 10–20, 10% of eyes in ETDRS group 35 and 15% of eyes in ETDRS groups 43–47. The eyes with CI-DMO and subclinical CI-DMO showed a progressive increase in retinal extracellular fluid during the 3-year period of follow-up. The eyes with CI-DMO and increased retinal extracellular fluid accumulation were associated with vision loss. The prevalence of subclinical CI-DMO and CI-DMO in the initial stages of NPDR occurs independently of severity grading of the retinopathy, showing progressive increase in retinal extracellular fluid and this increase is associated with vision loss (82% 9 out of 11 cases).
    2023-02Journal article Open access Show more
  • Characterization of 2-year progression of different phenotypes of nonproliferative diabetic retinopathy
    Publication . Ribeiro, Luísa; Marques, Inês P.; Santos, Torcato; Carvalho, Sara; Santos, Ana Rita; Mendes, Luís; Lobo, Conceição; Cunha-Vaz, José
    The aim of the study was to characterize the 2-year progression of risk phenotypes of nonproliferative diabetic retinopathy (NPDR) in type 2 diabetes (T2D) phenotype C, or ischemic phenotype, identified by decreased skeletonized retinal vessel density (VD), ≥2 SD over normal values, and phenotype B, or edema phenotype, identified by increased retinal thickness, i.e., subclinical macular edema, and no significant decrease in VD. A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with 4 visits (baseline, 6 months, 1 year, and 2 years). Ophthalmological examinations included best-corrected visual acuity, color fundus photography (CFP), and optical coherence tomography (OCT) and OCT angiography. Early Treatment Diabetic Retinopathy Study grading was performed at the baseline and last visits based on 7-field CFP. Results: One hundred and twenty-two eyes from T2D individuals with NPDR fitted in the categories of phenotypes B and C and completed the 2-year follow-up. Sixty-five (53%) of the eyes were classified as phenotype B and 57 (47%) eyes as phenotype C. Neurodegeneration represented by thinning of the ganglion cell layer and inner plexiform layer was present in both phenotypes and showed significant progression over the 2-year period (p < 0.001). In phenotype C, significant progression in the 2-year period was identified in decreased skeletonized VD (p = 0.01), whereas in phenotype B microvascular changes involved preferentially decrease in perfusion density (PD, p = 0.012). Phenotype B with changes in VD and PD (flow) and preferential involvement of the deep capillary plexus (p < 0.001) is associated with development of center-involved macular edema. In the 2-year period of follow-up, both phenotypes B and C showed progression in retinal neurodegeneration, with changes at the microvascular level characterized by decreases in PD in phenotype B and decreases in VD in phenotype C.
    2023Journal article Open access Show more
  • Characterization of disease progression in the initial stages of retinopathy in type 2 diabetes: A 2-year longitudinal study
    Publication . Marques, Inês P.; Alves, Dalila; Santos, Torcato; Mendes, Luís; Lobo, Conceição; Santos, Ana Rita; Durbin, Mary; Cunha-Vaz, José
    To characterize 2-year changes occurring in neurodegeneration, edema, and capillary dropout in nonproliferative diabetic retinopathy. Two-year prospective longitudinal observational cohort of eyes/patients with type 2 diabetes using spectral domain optical coherence tomography (SD-OCT) and opti cal coherence tomography angiography (OCTA). Eyes were examined three times with intervals of 1 year. Thickness of the full retina and layer-by-layer measurements were used to identify edema or neurodegeneration. OCTA vessel density maps of the retina were used to identify capillary dropout. Early Treatment Diabetic Retinopathy Study (ETDRS) classification was performed using the seven-field ETDRS protocol. A total of 62 eyes from 62 patients with diabetes were followed for 2 years. After verification for image quality, a total of 44 eyes from 44 patients (30% women) aged 52 to 80 years were retained for data analysis. There were 18 eyes with ETDRS grades 10 to 20, 17 eyes with ETDRS grade 35, and 9 eyes with ETDRS grades 43 to 47. During the 2-year follow-up period, there was a progressive increase in capillary dropout, whereas edema and neurodegeneration remained stable. In multivariate analysis, consid ering a model adjusted for age, sex, hemoglobin A1C, visual acuity, and diabetes duration, vessel density remained significantly different between Diabetic Retinopathy Severity Scale groups (Wilks’ λ = 0.707; P = 0.015) showing association with disease progression. Capillary dropout increased in a period of 2 years in eyes with minimal, mild, and moderate diabetic retinopathy, whereas the presence of edema and neurodegeneration remained stable
    2020-08Journal article Open access Show more
  • Characterization of initial stages of diabetic macular edema
    Publication . Santos, Ana Rita; Santos, Torcato; Alves, Dalila; Marques, Inês P.; Lobo, Conceição; Cunha-Vaz, José
    This study is aimed at characterizing the type of retinal edema in the initial stages of retinopathy in type 2 diabetes. In this retrospective cross-sectional study, spectral domain optical coherence tomography (OCT) layer by layer analysis of the retina in association with OCT-Leakage, an algorithm to detect sites of low optical reflectivity, were used to examine eyes with minimal, mild, and moderate diabetic retinopathy (DR). A total of 142 eyes from 142 patients (28% women) aged 52–88 years were imaged. Macular edema, either subclinical (SCME) or central-involved macular edema (CIME), was present in 43% of eyes in group 10–20, 41% of eyes in group 35, and 38% of eyes in group 43–47. The inner nuclear layer (INL) was the layer showing higher and most frequent increases in retinal thickness (79%). The edema was predominantly intracellular in group 10–20 (65%) and extracellular in groups 35 (77%) and 43–47 (69%). Eyes from diabetic patients in the initial stages of DR with different Early Treatment Diabetic Retinopathy Study gradings show similar prevalence of SCME and CIME, independent of the severity of the retinopathy. Retinal edema is located mainly in the INL and appears to be mostly extracellular except in the earliest stages of diabetic retinal disease where intracellular edema predominates.
    2019-11Journal article Open access Show more
  • Characterization of one-year progression of risk phenotypes of diabetic retinopathy 
    Publication . Ribeiro, Luísa; Marques, Inês P.; Coimbra, Rita; Santos, Torcato; Madeira, Maria H.; Santos, Ana Rita; Barreto, Patrícia; Lobo, Conceição; Cunha-Vaz, José
    We characterized the progression of different diabetic retinopathy (DR) phenotypes in type 2 diabetes (T2D). A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with three visits (baseline, 6 months, and 1 year). Demographic and systemic data included age, sex, diabetes duration, lipid profile, and hemoglobin A1c (HbA1c). Ophthalmological examinations included best-corrected visual acuity (BCVA), color fundus photography (CFP), and optical coherence tomography (OCT and OCTA). Phenotype classification was performed at the 6-month visit based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Only risk phenotypes B (MAT < 6 and increased CRT) and C (MAT ≥ 6 with or without increased CRT) were included. ETDRS grading was performed at the baseline visit based on seven-field CFP.A total of 133 T2D individuals were included in the study; 81 (60%) eyes were classified as phenotype B and 52 (40%) eyes as phenotype C. Of these, 128 completed the 1-year follow-up. At baseline, eyes with phenotype C showed greater capillary closure (superior capillary plexus, deep capillary plexus, and full retina, p < 0.001) and increased foveal avascular zone (FAZ) area (p < 0.001), indicating more advanced microvascular disease. Neurodegeneration represented by thinning of the ganglion cell layer + inner plexiform layer (GCL + IPL) was present in both phenotypes. When analyzing the 1-year progression of each phenotype, only phenotype C revealed a significant decrease in BCVA (p = 0.02) and enlargement of the FAZ (p = 0.03). A significant progressive decrease in the vessel density of the deep capillary layer and in MAT occurred in both phenotypes, but these changes were particularly relevant in phenotype C and ETDRS grades 43–47. During the 1-year period, both phenotypes B and C showed progression in GCL + IPL thinning (p < 0.001). In the 1-year period of follow-up, both phenotypes B and C showed progression in retinal neurodegeneration, whereas phenotype C showed more marked disease progression at the microvascular level.
    2022Journal article Open access Show more