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A Novel Use of Temporary ICL During DMEK to Prevent Gas-Induced Opacification of a Scleral-Fixated Carlevale IOL.
No full textPurpose: To report a novel surgical strategy using a temporary implantable collamer lens (ICL) during Descemet membrane endothelial keratoplasty (DMEK) to prevent gas-induced opacification of a scleral-fixated Carlevale intraocular lens (IOL) in a vitrectomized eye.
Observations: A 68-year-old male with a history of blunt trauma, pars plana vitrectomy, and Carlevale IOL implantation developed irreversible corneal edema. DMEK was performed with the intraoperative placement of an inverted ICL in the anterior chamber, serving as a protective barrier between the gas tamponade and the IOL. The ICL was explanted two weeks later, without complications. The endothelial graft remained well attached throughout the follow-up period, with no intraoperative or postoperative adverse events. The optical clarity of the Carlevale IOL was preserved, and no ICL-related complications were observed. Best-corrected visual acuity (BCVA) improved from logMAR 1.00 preoperatively to logMAR 0.22 by 3 months, with stability maintained through the 6-month follow-up period.
Conclusions and importance: Temporary ICL implantation during DMEK may be an effective strategy to prevent gas-induced opacification in eyes with hydrophilic IOLs. Unlike IOL exchange, which adds surgical trauma, or gas-minimizing strategies, which risk detachment, this approach preserves full tamponade while safeguarding IOL clarity
Familial Hypercholesterolaemia and the Risk of Cardiovascular Events.
No full textFamilial hypercholesterolaemia (FH) is an autosomal dominant genetic disorder, characterised by markedly elevated levels of low-density lipoprotein cholesterol (LDL-C) from birth, which confers a substantially increased risk of premature atherosclerotic cardiovascular disease (ASCVD). Pathogenic variants primarily occur in the genes encoding the low-density lipoprotein receptor (LDLR), apolipoprotein B (ApoB), low-density lipoprotein receptor adaptor protein 1 (LDLRAP1), or proprotein convertase subtilisin/kexin type 9 (PCSK9). Early diagnosis, based on clinical criteria, family history, and genetic testing, is imperative to promptly initiate aggressive therapeutic strategies. Standard treatment involves lifestyle modifications and high-intensity pharmacotherapy, primarily with statins, often in combination with ezetimibe. For patients who do not achieve their therapeutic goals or are intolerant, PCSK9 inhibitors represent a significant evolution in the treatment paradigm. In this article, we present a case of homozygous familial hypercholesterolaemia
A Portuguese Expert Panel Position Paper on the Management of Heart Failure with Preserved Ejection Fraction - Part II: Unmet Needs and Organization of Care in Portugal.
No full textIn Portugal, a 15.2% prevalence of heart failure with preserved ejection fraction (HFpEF) was recently identified among those aged ≥50 years. HFpEF represents 90% of Portuguese heart failure patients. HFpEF management in Portugal is challenging due to patient heterogeneity, diagnostic and therapeutic complexity, and organizational constraints on the healthcare system. Considering the above, a panel of Portuguese experts convened to address HFpEF management within the national context. This was done in a two-paper set. This, the second paper, identifies unmet needs and suggests a set of measures to improve the current organization of HFpEF management in Portugal. Our purpose is to create a multidisciplinary integrated care system, ensuring a seamless connection between hospitals and primary care. Additionally, we propose a practical approach to the management of HFpEF, including a roadmap for screening, diagnosis, referral and treatment. The aim is to help clinicians improve HFpEF management throughout the disease trajectory
Anterolateral Corner of Knee: Current Concepts.
No full textThe anatomy of the antero-lateral corner (ALC) has been the topic of recent interest, as evidenced by the increasing number of publications. Knowledge needs to be improved amongst clinicians regarding the anatomy and biomechanical function of this vital structure and its implications on the rotational stability of the knee. There has yet to be a consensus on the role of surgical procedures and their indications for addressing the instability associated with the injury to these structures. Through this article, the authors have tried to outline the existing literature regarding Anterolateral knee instability, the associated structures, and the management of its injuries, emphasising the role of the anterolateral capsule and reconstructive procedures in combined ligamentous knee injuries
Case Report: a Role for Hemoadsorption in Hemophagocytic Lymphohistiocytosis.
No full textHemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening hyperinflammatory syndrome. HLH can occur as a primary (familial) or secondary (acquired) disorder. Secondary HLH (sHLH) manifests in response to infection, malignancy, autoimmune disorders or drugs. Presentation is usually non-specific, with fever, cytopenias, elevated inflammatory markers and hepatosplenomegaly. A high level of suspicion coupled with the use of diagnostic scores (HScore and HLH-2004) is required for timely diagnosis. Specific studies such as bone marrow biopsy or soluble interleukin-2 (IL-2) receptor (CD25) levels are necessary for distinguishing HLH from other conditions, but should not delay treatment. Corticosteroids, in addition to other immunossupressants, should be initiated promptly in order to reduce morbidity and mortality. In secondary cases, treatment of underlying causes is necessary for complete remission. Long-term immunossupression may be required beyond resolution of the HLH trigger to avoid relapses. We report a case of severe acute HLH in a patient with distributive and cardiogenic shock and multiorgan dysfunction. The patient was successfully treated with CytoSorb hemoadsorption therapy. This case highlights diagnostic challenges, therapeutic interventions, and the potential role of hemoadsorption therapy as a complementary treatment option for HLH
Multiple Sclerosis Relapse Incomplete Recovery and Associated Factors - a Systematic Review and Meta-Analysis.
No full textObjectives: We conducted a meta-analysis to assess the frequency of incomplete recovery from multiple sclerosis (MS) relapses and a systematic review to evaluate the influence of six factors on incomplete recovery: relapse severity, age, sex, disease duration, disease-modifying treatment use, and the presence of contrast-enhancing lesions at relapse.
Methods: We searched Scientific databases to identify suitable publications. Our outcome was MS relapse incomplete recovery, defined as a post-relapse EDSS measured at least 6 months after the event higher than the pre-relapse EDSS. We synthesized the rate of incomplete recovery using meta-analysis (random effect model). and summarized the effect estimates (or HR) for demographic and clinical factors.
Results: We included 13 studies (with a total of 19,920 patients and 27672 relapses having at least six month of follow up) . The pooled rate of incomplete recovery was 0.42 (95 % confidence interval 0.31 to 0.54). The subgroup systematic review identified that relapse severity was the most consistent and strongest predictor of incomplete recovery, with odds ratios ranging from 2.4 to 17.2. Other factors were less consistently associated with relapse recovery.
Conclusion: This systematic review indicates that relapse recovery is often incomplete, with relapse severity being the strongest and most consistent predictor of incomplete recovery
Practices of High-Flow Nasal Therapy in Acute and Chronic Respiratory Failure: the Hi-Flow Survey
No full textBackground: High-flow nasal therapy (HFNT) is a widely used non-invasive respiratory support technique, but data on its clinical application remain limited. This study aimed to assess clinicians' self-reported practices, perceptions and barriers regarding HFNT use in acute and chronic respiratory failure.
Methods: A cross-sectional web-based survey was disseminated among members of the European Respiratory Society's respiratory intensive care, rehabilitation and chronic care, and allied respiratory professionals assemblies from September to November 2023. Descriptive analysis was performed, with results presented as frequencies and percentages.
Results: A total of 1176 clinicians from 104 countries participated, primarily pulmonologists (78.3%) and respiratory therapists (9.7%). HFNT was most commonly used for de novo acute respiratory failure (56.2%) and interstitial lung disease exacerbations (56.3%), with lower utilisation for chronic obstructive pulmonary disease with hypercapnia (47.4%) and trauma/atelectasis (41.5%). Despite guideline recommendations, 67% of respondents initiated HFNT only after conventional oxygen therapy failure. HFNT was also frequently used for symptom relief in palliative care, despite limited supporting evidence. Respiratory distress was the primary clinical trigger for HFNT initiation, while the ROX (Respiratory Rate-Oxygenation) index was rarely used to guide escalation of care (32%). Barriers to HFNT adoption included equipment costs (23%), lack of funding (22%) and limited clinician knowledge (18%). HFNT use increased during the COVID-19 pandemic (84%), but long-term application for chronic respiratory failure remained rare (16%).
Conclusions: This survey highlights significant variability in HFNT practices and a disconnect between guidelines and real-world implementation. Addressing financial and educational barriers may improve adherence to evidence-based recommendations
